Fatigue – Is it the Prelude to Serious Disease?
13 Nov 2009
Who isn’t tired now and then? Ask any doctor and he will tell you not many people, as day after day patients complain of this common problem. But how often is the feeling of being tired associated with bona fide medical disease? A report in the Canadian Medical Association Journal helps to answer this question. So what should you know about the TATT syndrome?
Dr. Henk de Vries and his colleagues in Holland studied 571 patients for two years who complained of fatigue, exhaustion or malaise. They report that 10 percent of patients consulting Dutch physicians complained of fatigue. Of this number 46.9 percent were given more than one diagnosis that could be associated with this complaint.
The diseases were quite diverse, but the main categories were muscle skeletal 19.4%, infections 18.2% and psychological troubles 16.5%. A variety of other problems such as sleep disorders and digestive upsets made up the remainder of the diagnoses. Researchers noted as well that fatigue was also often associated with social problems.
But how often did Dutch physicians find significant disease in patients who complained of fatigue? Fortunately, they discovered, that only a minority of these patients required treatment for cardiovascular, endocrine, blood disease, and cancer.
But in his report Dr. Henk de Vries admitted that for at least half of the patients it was impossible to find a medical diagnosis that explained their fatigue.
The Dutch report is not the first one to study the extent of fatigue. For instance, several years ago English researchers found that one in 12 people visiting their family doctor suffered from fatigue. In the U.S it’s reported that one in six patients complains of this symptom. I’m not aware of any Canadian study dealing with fatigue, but certainly this complaint is a universal problem.
Today, I’m seeing more and more patients who complain of what’s been called, the TATT syndrome. They are Tired All The Time. A sizable amount of this fatigue is related to the poor state of the economy, the uncertainty of knowing that their job may end tomorrow or family stress. But whatever the cause, constant worry takes a huge amount of energy and leaves little for every day activities.
The great problem facing doctors is to know when fatigue requires more than a sympathetic ear. Sometimes the diagnosis is apparent when a blood study shows the patient has diabetes or is suffering from chronic anemia. Or if a partner has suddenly run off with their best friend. Or a loving dog has died.
But a red flag should always be raised if someone who has always been full of life and energy suddenly develops fatigue. This is when doctors make every effort determine if an underlying disease is present.
Today the most difficult problem for physicians is dealing with patients who have had every test in the book. Yet these studies have failed to pinpoint a problem and they continue to complain bitterly of the TATT syndrome.
It’s always a difficult for doctors to say, “I don’t know the diagnosis.” After all, it’s not good for the doctor’s ego, as no doctor wants to be a diagnostic failure. But not having a diagnosis is also not good for patients. A non-diagnosis leaves too much uncertainty, leaving nothing for patients to hand their hat on.
That’s why I recently said to a patient, “Your diagnosis is TATT. You are TATT because of marital and social problems and it’s robbing you of that tiger in the tank. Your fatigue and being TATT won’t improve with any medication. So you have no choice but to live with being TATT until these troubles are past history. And fortunately you do not have to worry about a serious medical disease.”
But I also see patients who fit the description of Frederick Lewis Allen who remarked, “I have often been struck by the fact that the symptoms of laziness and fatigue are practically identical? This may be an unkind remark, but today I see more people who given the choice of bed or work prefer bed.
