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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35796
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Major fatigue problem every day My doctor is treating a

Resolved Question:

Major fatigue problem every day
My doctor is treating a fatigue problem, which started about 8 months ago.
I become very fatigue during the day, and I cannot keep my eyes open and I need to take a nap. I wake up anywhere from 1-4 hours later. The fatigue comes on mostly late in the afternoon, but I have had several days when it started before 11am.
My doctor is currently stumped on this problem and ran the below blood tests.
I filmed myself once when I was working on my computer, to see if I could keep awake during this fatigue. I was able to keep awake for about an hour after the fatigue started, but 1/2 hour in I could not function with my computer work very well. 15 minutes before end of the period, I yawed at least 15 times, before I had to take a nap.
This fatigue is different from being very tired. I can fight through being tired after lack of sleep, but I cannot fight through this fatigue problem. I have never had the fatigue problem while driving and I don’t always have the fatigue problem on the weekends.
Most of my work is on the computer, so my fatigue usually starts while I am working on my computer, maybe because computer work takes up a large part of my day. I am not sure yet if the fatigue is caused by the computer work or it just happen a lot during computer work, because I am on the computer for several hours a day, so the olds are I will have fatigue during the work on a computer.
My Physiatrist put me on Adderall when the fatigue problem started, but I had to stop the Adderall within a month, because the Adderall was causing a major drop in my blood pressure when I stood up from seating. During the Adderall treatment my fatigue occurred less days of the week. The Adderall also seem like it improved my spelling during typing on the computer. I make several simple spelling errors while typing on the computer. Sometimes I will insert a word a couple of words before I should have typed it; like my hands could not keep up with my thoughts. Sometimes I type a word with the opposite meaning ie she instead of he. These errors improved during my treatment of Adderall.
Below is a list of medicines I take.
Buspirone HCL 5mg 1 tab am 1 tab pm
Wellbutrin XL 150mg 3 tab am
Zoloft 100mg 1 tab bedtime
Zoloft 50mg 1 ½ tab bedtime
Lithium 300mg ¼ tab bedtime
Lipitor 40mg 1 tab bedtime
Aspirin 81mg 1 tab am
Vitamin D 1000 IU 1 tab am
My Vitamin D levels are just 1 point down from the low end of normal.
I have been taking the Buspirone, Welbutrin, Lipitor, Aspirin, Vitamin D for more than a year before the fatigue started.
I think I may have taken the Zoloft within 6 months of the fatigue. I took Zoloft several years ago for a couple of months with no fatigue problems.
I think I started taking the Lithium within a couple of months of the start of the fatigue problem.
I tried stopping taking my Lithium for a week, but this did not help. I not sure if one week was enough time to get the Lithium out of my system.
Blood Tests:
My complete blood count (CBC) is normal.
My electrolytes are normal.
My kidney test are normal.
My liver test are normal.
My fasting glucose (blood sugar) level is borderline high with a value of 100.
My TSH (Thyroid Stimulating Hormone) is normal with a value of 1.24
My vit D is acceptable but my doctor still recommends the 1000IU VITD daily.
Medical History:
Had heart attack 2 years ago.
Had a treadmill ultrasound heart test 6 months ago, which was normal.
My Dad died of diabetes at age 45.
My Mom died of ALS at age 63. No other past family history of ALS.
Being treated for depression
Another problem which started about the same time as the fatigue, is hair lost in a 2” dia area. I lost this patch of hair very quickly and then it grew back to a length of .05” and then stopped growing. The hair length has stayed at this .05” length over 8 months.
Thanks for your help,
Submitted: 5 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 5 years ago.
Hello and welcome Mike,

Were your muscle enzymes done?
Have you consulted any specialist?
Was there any viral illness preceding fatigue?
Do you have weight loss, muscle pain, headache, sleep disturbance, joint swelling, dry mouth?

Dr. Arun
Customer: replied 5 years ago.
My muscle enzymes were not done.
Have not consulted any specialist. What specialist would you recommed?
No viral illness.
No weight loss.
Had muscle pain in my right upper arm for a couple of months during this 8 month period, but have not had the pain for a couple of months now. This right arm muscle pain has come and gone over the years.
No headache
No sleep disturbance. I filmed myself sleeping for 8 hours and did not see any sleep disturbance.
The fatigue problem does not seem to be connected with the amount a sleep from the night before. I can sleep from 6-12 hours with the same fatigue problem the next day.
no Dry month
Expert:  Dr. Arun Phophalia replied 5 years ago.
Thanks Mike for the details.

Specialist recommended to work up the fatigue would be; Rheumatologist.

The muscle enzymes should be done. Lipitor occasionally can be responsible for fatigue without muscle pain. This adverse effect can appear any time during the treatment. The rheumatologist would do following investigations;

1) Muscle enzymes;

2) Anti-nuclear antibodies (ANA)

3) Adrenal function test

4) Anti-dsDNA

5) Anti-Sm

6) Anti-SSA (Ro) or Anti-SSB (La)

7) Coombs test

8) Anti-histone

9) EBV

If all these investigations are normal and medication side effects are ruled out; chronic fatigue syndrome would be the consideration of the diagnosis (though not common in males).

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Dr. Arun
Customer: replied 5 years ago.
I have been taking Lipitor for over 2 years, since my heart attack. The fatigue problem did not start until 8 months ago. My heart doctor thought one time that the Lipitor my be causing my arm pains. Do you still think the Lipitor may be a problem even tho I did not have a problem in the first year?
If the problem is the Lipitor, how long after stopping the Lipitor would you think the problem would stop? How long would I need to stop the Lipitor before I can rule of the Lipitor as the problem.
Would any of the above test find a Lipitor problem, or do I need to just stop taking Lipitor and see what happens.
My doctor ordered a special blood test but my medical insurance would not pay for it, so I did not get it. The cost of the test was around $2,000. I can not remember what this test was. Are any of your recommend test may be this same test my doctor ordered? What do you think this test is?
What do you think the chances are that my Lithium is causing the problem? Would any of the above test you recommend catch a Lithium problem. I have not had a Lithium blood test taken since I started on the Lithium 8 months ago. The amount of the Lithium I am taking is very low, so not likely it is a overdose of Lithium problem. How long would you think I would need to stop Lithium to rule it out as the problem?
Do you think there is any chance that my hair lost is related to my fatigue?
I would not stop any of my meds until I talk to the doctor that put me on the meds.
Expert:  Dr. Arun Phophalia replied 5 years ago.

A raised muscle enzyme may be indicative of problem related to Lipitor. Lipitor may not cause muscle problems and related issues initially. You need to stop the Lipitor atleast for two weeks to see the co-relationship. I agree that before stopping any of the medications; your doctor should be consulted. Your doctor may have ordered IgM/IgG coxsackievirus B titer, which is done for the chronic fatigue syndrome. Lithium may be responsible for the fatigue as medications are frequent culprit. The blood levels of Lithium may not be able to point to the cause and the only way to establish the cause and effect relationship is withdrawing it.

It is privilege assisting you.
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