Fatigue and Accommodation
An Excerpt From: The Guide to Living With HIV Infection
The Causes of Fatigue
Fatigue for people with HIV infection comes from anything from the stresses of everyday life, to the drugs against the virus, to the virus itself.
Fatigue often accompanies depression: people dealing with depression lose not only a sense of hope but also their physical energy. They are tired, sometimes exhausted, sometimes apathetic. Fatigue can also have physical causes, which can be sorted out by a medical evaluation (see chapter 6, under "Causes of Constitutional Symptoms").
Fatigue is a subjective symptom; it cannot be objectively verified or quantified like a blood count. Fatigue is also common to everyone; up to 25 percent of all people without HIV infection complain of being chronically fatigued. For people with HIV infection, a medical evaluation needs to review factors that cause fatigue but that are treatable: depression, anemia, medicines, and infections. Most people just learn to live with and around fatigue.
The Effects of Fatigue
Although the causes of fatigue may be physical, the effects are psychological. In fact, depression not only causes fatigue but is also caused by it. Dean said he has good days and bad days. On the good days, he has more energy. After a rough night and diarrhea, he will be tired the next day: he said, "Those are the crying days."
Another psychological effect of fatigue is irritation. Lisa Pratt's husband "had always been a go-getter," she said, and resented his fatigue. "My husband," Lisa said, "had to give up little things he liked because he had no stamina. For years, he had been an actor in our local community theater. He couldn't keep up with the rehearsal schedule and thought he was going to have to quit. It hurt to not go. And it made him mad to give in." Dean said that until he learned to pace himself, he regularly worked fourteen hours a day running a small newspaper, came home angry, then "got the blues."
Accommodating to Fatigue
Whether its cause is psychological or physical, fatigue cannot be ignored. First, talk to your doctor so that what's treatable can be treated. After that, the best way to deal with fatigue may be to accept it and go on from there. Decide what you want to do most, be sure it is possible, plan it out, and pace yourself. Lisa's husband stayed in the community theater but tried out only for small roles. Dean kept his job but cut back his hours and tried to have meetings in his office rather than in offices across town.
In general, try to find ways to accomplish what you want with less energy. Lisa's husband's fatigue also affected their social life: "Socially, we didn't go out as much. But then we redefined 'socially.' Instead of going out drinking and dancing, we entertained at home. Our social life didn't disappear." People who find driving tiring can often take public transportation. When they want to buy clothes or household supplies or presents, they order from catalogs or the Internet. To buy groceries, they find a store that delivers, or ask their friends. They get their medication from pharmacies that deliver.
Do what you can; don't give up before you need to. Steven says, "I keep pushing myself. I do wake up tired and don't like that. I make myself get up. I get out of that bed." If you know you've done your best, then relax and rest. Try not to let fatigue affect your good opinion of yourself. You've done what you could. Just take care of yourself.
This article was provided by Johns Hopkins University Press. It is a part of the publication The Guide to Living With HIV Infection.