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Medical Edge Newspaper Column from Mayo Clinic

EVEN THOSE IN PEAK HEALTH CAN SUCCUMB TO FATIGUE

DEAR MAYO CLINIC: I’m an active 53-year-old woman. I eat well and run about 40 miles a week. Recently, I began feeling overwhelmingly fatigued and was diagnosed with mononucleosis — for the third time. Why do I keep getting it? Is there anything I can do to speed my recovery and prevent future bouts?

ANSWER: It’s great that you are doing so much to stay healthy — especially running 40 miles a week!

Fatigue can occur even when you are making many healthy choices. In fact, acute fatigue is one of the most common reasons patients come to see primary care providers. Because there are so many possible causes, it can be difficult to pinpoint the reason.

The search should begin with a comprehensive history and exam that covers:

— Other symptoms: Cold dry skin could point to a thyroid disorder, a common cause of fatigue. Night sweats and lymph node swelling along with fatigue can be symptoms of an underlying malignancy such as lymphoma or a systemic infection. Seasonal allergies can also make you feel very tired.

— Other illnesses: Extreme fatigue can be a warning sign of diabetes. It’s associated with many other illnesses, too, such as fibromyalgia, heart disease, lung disease, muscle disease and several others. Sleep apnea is a common cause of fatigue because it interferes with sound sleep.

— Medications: Some cause sleepiness, while others, including stimulants, can interfere with quality sleep.

— Mental health issues: Depression can zap your energy.

— Lifestyle choices: It’s basic, but are you getting enough sleep? Managing stress? Really eating well? If you’re a vegetarian, it’s easy to be low on iron in your diet — another possible cause of fatigue. Too much caffeine or alcohol can leave you feeling tired.

I suggest you work closely with a physician to pinpoint the cause of your fatigue and develop a treatment plan. From what you’ve shared, mononucleosis is probably not the cause.

Once you’ve had the “mono virus,” also called the Epstein-Barr virus, you usually have antibodies to it in your blood for the rest of your life. While recovery from mono can take weeks, you are unlikely to contract it again because your body has created these antibodies. It is probable that only one of your three episodes was due to true Epstein-Barr virus.

— Margaret Houston, M.D., Family Medicine, Mayo Clinic, Rochester, Minn.

Additional Resources:
Figuring Out the Causes of Fatigue
Appointment Information
More Information on Fatigue

READERS: Set a goal to lose weight — 20, 30, 40 pounds — and get busy.

It seems straightforward, but goal setting for weight loss isn’t as simple as it may sound. If you set goals too high, you’ll set yourself up for disappointment. If you don’t identify goals, chances are nothing much will happen.

Here’s a goal-setting approach that supports successful weight management. It’s called SMART — Specific, Measurable, Attainable, Realistic and Trackable.

— Specific: State exactly what you want to achieve, how you’re going to do it and the time frame in which you want to achieve it. It’s helpful to plan a series of small goals that build on each other instead of one large, all-encompassing goal. A small goal might be to have at least one serving of fruit each day.

— Measurable: Be sure you can tell whether you’ve achieved a goal. If your goal is to walk 30 minutes a day, wear a watch while you walk to track the time.

— Attainable: Ask yourself whether the goal is reasonable. Are you allowing sufficient time and resources? Better to succeed at one small change this week than try for too much, fail and quit.

— Realistic: Set goals within your capabilities, and consider your limitations. Is it realistic to plan to exercise two hours every day if you’ve never exercised that much before?

— Trackable: Look for ways to record your progress, such as a food journal or exercise log.

Finally, focus on making performance goals rather than outcome goals. Performance goals —such as increasing your vegetable intake or walking a specific number of miles each week — help you achieve a healthy weight. Success is measured by your mastery of each activity. Outcome goals — such as losing a specific amount of weight each week — can lead to frustration and disappointment.

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.