Jen Rulon

Feeling Fatigued? When To Call A Doctor?

 So, you’ve changed your diet, gotten more rest, and exercised more, but you’re still unbearably exhausted. As we have seen, long work days, continuous physical labor, irregular sleep, or lack of sleep. All of these can cause a feeling of tiredness. Usually, you can remedy this fatigue by night or so of proper sleep. However, sometimes this does not fix the situation, and an underlying organic disorder must be considered.

The first step is to visit a doctor, but how do you tell when you can wait for an appointment and when you need immediate attention?

There are cases when fatigue requires emergency care. For example, when symptoms like chest pain accompany it, shortness of breath, and feeling faint, all indicative of life-threatening heart issues or unexplained and severe abdominal, pelvic, or back pain, will necessitate calling 911 or visiting a hospital’s emergency department.

Whether one visits an emergency room or has a regular appointment with a physician, a complete physical exam will likely be performed, including a full blood workup. Once armed with this information, an individual can partner with their doctor to form a treatment plan.

There is quite a list of issues that can cause fatigue, from minor to dangerous, from blood disorders to heart disorders to depression. However, these should all be manageable with a well-chosen health care team.


Fatigue is often one of the symptoms of anemia. We most often think of anemia as an iron deficiency, but there are many types of anemia in reality. This blood disorder can be caused by various vitamin or mineral deficiencies other than iron or bone marrow disease, and it can be the result of chronic liver problems. In addition, some medications, such as anti-inflammatory medications, can affect the production of red blood cells. Then, hereditary disorders such as sickle cell anemia, a type of hemolytic anemia that can contribute significantly to excessive fatigue.

Why would this result in fatigue? As stated previously, red blood cells carry oxygen throughout the body, oxygen necessary for the cells to produce energy. Poorly circulating blood causes oxygen levels to go down, and as a consequence, so do energy levels. If the organs are receiving less oxygen, they won’t function as well.

Heart Issues

As one might expect, if blood and the circulatory system come into play, so does the heart. The heart moves the blood throughout the body. Think of a fuel pump in a car moving gasoline through the vehicle. If the movement of the fuel is impeded, it affects the evolution of the vehicle. According to naturopathic doctor Dr. Gabrielle Francis, compromising the heart will compromise circulation efficiency, leading to fatigue.

Chronic Fatigue Syndrome

 Chronic Fatigue Syndrome is a poorly understood condition that consists of extreme exhaustion that cannot be explained by any other medical disorder and is not improved by rest or sleep. There are no definitive tests to diagnose CFS, sometimes called Systemic Exertion Intolerance Disease or Myalgic Encephalomyelitis, and the cause is unknown. However, many experts believe it to be due to factors. Therefore, treatment instead focuses on symptom alleviation without a reason to zero in. Besides exhaustion, symptoms include a severe reduction in concentration, memory loss, pain in the throat, joints, or muscles, poor quality sleep, and excessive crippling fatigue following exertion.


Often confused with Chronic Fatigue Syndrome and often co-existing with CFS, fibromyalgia is another poorly understood disorder of unknown cause. Fibromyalgia’s most well-known symptom is widespread pain, including extreme fatigue, memory, and sleep issues. As with CFS, treatment is focused on symptom alleviation.


It has long been known that depression has a physical effect on the body. As a result, people who suffer from the major depressive disorder are often less active, and it has already been seen that lack of activity can lead to fatigue. As it turns out, fatigue is one of the most prevalent presenting symptoms of major depressive disorder.

Three categories have been identified with depression: physical, cognitive, and emotional. The physical symptoms are as previously discussed. There is a significant decrease in physical activity and physical endurance, lower energy, feeling slow and sluggish, and having issues sleeping (either not sleeping well or sleeping too much.) As far as cognitive fatigue, one could expect to see symptoms such as decreased concentration, attention, mental endurance, and slowed mental processing and thinking. Emotional exhaustion would be characterized by apathy, reduced interest in activities once enjoyed, and feeling emotionally low. All of this combines to create a self-perpetuating cycle. A person who suffers from major depressive disorder withdraws from activity. The lack of movement and emotional stress brings on fatigue, and with fatigue comes a further drop in mood. One state fuels the other.

The question then becomes, how do you differentiate between fatigue associated with major depressive disorder and that which might be a side effect of medications used to treat depression? According to Dr. Fava, you must consider many things. First, fatigue can undoubtedly present without MDD. Sometimes exams will reveal a patient with some depressive symptoms that co-exist with but are not severe enough to qualify for a diagnosis of MDD. Therefore, it becomes essential to identify the source of these symptoms as accurately as possible. There exists a battery of tests that doctors use to help differentiate. Dr. Fava specifically mentions the Fatigue Questionnaire and the Fatigue Associated with Depression (FasD) scale. These are self-scored by the patient and are done periodically during treatment to monitor progress and symptoms.

 Why is this important to differentiate between MDD-related depression and medication-induced side effects? Again, according to Dr. Fava, patients suffering from major depressive disorder who have residual fatigue are more likely to have recurrent episodes of depression. Being aware of this likelihood of relapse would be vital to the formation of treatment and ensure the success of that treatment. As the well-known adage of the Roman general, Vegetius says, if you want peace, prepare for war. If a treatment plan is in place, you have a battle plan in place for possible relapses to be dealt with, but you can also manage the fatigue.

Outlook on Fatigue

Fatigue, upon investigation, is much more complicated than it would seem. The causes of fatigue are myriad, and the prognosis for relief will be just as varied. Treatment could be as simple as a change in diet or exercise or could require an entire battery of tests. Assistance could be immediate or could require constant monitoring and adjustments.

In cases involving a chronic illness, treatment often requires an individual to accept a new normal. This is not to say that someone should be resigned to a life of unbearable exhaustion. With careful self-monitoring, the new normal could mean learning to manage symptoms with conventional therapies, home remedies, and alternative therapies. Alternative treatments could include yoga practice, acupressure, massage, and homeopathic remedies. The important thing is to remember that what works for one person may not work for another. However, the biggest takeaway from this is that the human mind and body are intricately linked, and one can have a profound effect on the other.


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AUTHOR: Jen Rulon

I have been coaching triathletes, runners, and cyclists for over 21+ years; I received my Master's Degree in Kinesiology with an emphasis in Exercise Science. And as you may have learned, there is more to life than swimming, biking, and running. It is a lifestyle, and I am here to help you cross that finish line with a smile, whether it is an Ironman Triathlon or the Ironman of Life. You can find my knowledge shared in Triathlete Magazine, Runners World, on the TEDx Stage, the Health and Wellness Expo in San Antonio, TX, Southwest Research Institute Human Performance Summit, Training Peaks Workshops, "Self Motivation Strategies for Women" on Amazon, Men's Journal Online, and the New York Times. I also practice what I preach—she's a 15x Ironman Triathlete who participated in the Ironman World Championship in Kona, Hawaii, on October 14, 2017.

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