Lab tests--what to cover for one last go?

[AHI15]

Hi:

Of course, having been tired/fatigued for 19 years, I've been tested for a whole slew of stuff. So the question is, if I was going to prompt my Dr. to draw blood one more time to see if anything shows up, what should be tested?

And sometimes, there are details about the way the tests are specified that may make a difference in the value of the results. So if you respond with your excellent medical wisdom, please be sure to clarify the detailed specs of lab tests that should be taken.

Things which I've been tested for in the past (all negative unless noted):

1. Thyroid
2. Blood glucose (normal fasting; I had a glucose tolerance test once, positive for hypoglycemia at the time, but I think medicine is more uncertain now than ever about the significance of this .)
3. Viruses/pathogens: CMV, EBV (positive), HIV, Lyme
4. Heavy metals: As (almost at upper bound, not sure why, but still within range), Pb, Ag, Hg.
5. Allergens: I'm allergic to dust mites, mold, animal danders. (see note 1 below)

What hasn't been looked at or what I'd like to double-check:

1. Thyroid
2. Vitamin levels: D, other?
3. EBV -- more detailed review?
4. what else?

NOTES:

1. I have no furry pets right now. I had developed the theory b4 the last sleep study that cytokines produced as a result of allergies could account for chronic fatigue, and the almost sickly feeling of it. I do take antihistamine regularly--though it is 3rd gen. so doesn't cause drowsiness. I don't really believe that allergies are the root cause of my problem. Though I am interested in pursuing allergy immuno-therapy in the near future to see if it helps.

[Xney]

That list looks pretty good. You might toss some more things in there, but you might need other, additional symptoms to prompt them.

[brucifer]

I'm totally with you on fighting the fatigue thing. That has been my major fight all along. OSA was only my latest battle. Fatigue can be a real bear to tackle and can take years to pin down.

An EKG and a heart stress test are worthing doing. Also, double-check any medications that you currently are taking, and see if fatigue is a potential side effect. My cardiologist didn't like it, but I stopped taking my beta-blocker and statin, and I felt MUCH better. I told him that my quality of life was more important to me than a 7% improved mortality rate based on a couple of clinical studies, so it was a conscious choice I made with my cardiologist.

One doctor also Rx Ambien to help me sleep. but I didn't take it because I felt my condition was chronic, and Ambien is really best for just an occasional difficult time sleeping. Hope you find the source of your fatigue issue. Best of luck.

[AHI15]

I'm totally with you on fighting the fatigue thing. That has been my major fight all along. OSA was only my latest battle. Fatigue can be a real bear to tackle and can take years to pin down.

An EKG and a heart stress test are worthing doing. Also, double-check any medications that you currently are taking, and see if fatigue is a potential side effect.

I've had EKG a few times, because I was having mild palpitations due to very infrequent severe work stress. The EKGs were always Ok, my BP is normal, but I haven't specifically had a heart stress test.

I spend a significant proportion of days on no meds. at all. So I'm pretty sure I'm not adversely affected by them.

My cardiologist didn't like it, but I stopped taking my beta-blocker and statin, and I felt MUCH better. I told him that my quality of life was more important to me than a 7% improved mortality rate based on a couple of clinical studies, so it was a conscious choice I made with my cardiologist.
One doctor also Rx Ambien to help me sleep. but I didn't take it because I felt my condition was chronic, and Ambien is really best for just an occasional difficult time sleeping. Hope you find the source of your fatigue issue. Best of luck.

Thanks for the input!

[kaiasgram]

Cortisol and adrenal gland function?

[policebox]

I'd add free and total testosterone to the list, ferritin, the B vitamins such as B12 and folate. Deficiencies in any of those can cause fatigue.

[jweeks]

Of course, having been tired/fatigued for 19 years, I've been tested for a whole slew of stuff. So the question is, if I was going to prompt my Dr. to draw blood one more time to see if anything shows up, what should be tested?

Hi,

Two things that I have heard friends mention recently where they have had unexpected issues -- vitamin D level and blood CBC (hemoglobin level). Low levels of D can throw you off, and just slightly low hemoglobin can leave you fatigued.

-john-

[deltadave]

While there are undoubtedly several (dozens?)(hundreds?) of possibilities, given the sudden onset, nebulous history of drug abuse and overwhelming fatigue (as opposed to sleepiness) I think I'll go with cardiomyopathy. Add echocardiogram and/or cardiopulmonary exercise test.

[tooter]

Possibly...... http://health.yahoo.net/adamcontent/hypochondria ??

[deltadave]

Possibly...... http://health.yahoo.net/adamcontent/hypochondria ??

If CPX is normal, I would go with depression next.

[Mundy]

Thyroid can be tricky. Most doctors only test TSH which is a pituitary hormone. Many with thyroid problems ( me included) feel that a free T3 and free T4 which are thyroid hormone tests are more accurate. If I'm getting too little thyroid replacement hormone, I'm dead tired, want to sleep all the time, and feel somewhat depressed all the time.

[AHI15]

Possibly...... http://health.yahoo.net/adamcontent/hypochondria ??

WTF?!?! Perhaps you are unaware that I had a PSG with a diagnosis of OSA? That is a medical condition, not paranoia.

The question is whether there is something else wrong? There are good reasons to believe there are. Like deltadave said, "with a nebulous history of drug abuse" it is entirely possible that there is just plain damage, and now I'm paying the price for it. Who knows?

I've spent more years not going to Drs. than going, while trying to battle this myself through exercise. Does putting up a fight through 3 hrs a day ice figure skating and weight lifting for 5 years to drum up energy sound like hypochondria?

Is a high EBV antibody count a figment of my imagination? Yes, it is indeterminate as to whether it is the cause of my fatigue, but it is a physically real measurable abnormality with the potential to cause fatigue. So is my measured response to glucose.

No doctor has ever told me "you have no illness."

I'll try to stay polite, but it's difficult. Got anything constructive to add?

[AHI15]

Thyroid can be tricky. Most doctors only test TSH which is a pituitary hormone. Many with thyroid problems ( me included) feel that a free T3 and free T4 which are thyroid hormone tests are more accurate. If I'm getting too little thyroid replacement hormone, I'm dead tired, want to sleep all the time, and feel somewhat depressed all the time.

These are the kind of little details that can make the difference btw a waste of time and rigorous investigation. Thanks!

[kaiasgram]

AHI, re the "hypo" post: Try to ignore stuff like that -- I got that same message thrown at me early on by another member who was fond of taking stabs at people who were vulnerable and struggling. You don't need to respond, in fact you can use the "foes" feature to ignore posts by a specific individual. It felt good when I used it to virtually get rid of the insensitive posts of that member. When I saw that unkind post you got I considered adding a second name to my "ignore" list. Still considering...

[AHI15]

Possibly...... http://health.yahoo.net/adamcontent/hypochondria ??

If CPX is normal, I would go with depression next.

What is CPX?

I've had several psychiatric and psychological evals. Result was ADHD, not depression. My mood is good except when I can't sleep. When I have even a little bit of a refreshing sleep, I turn into a very motivated, ambitious, autodidactic person.

Then again, there are psychiatrists who will diagnose everyone with depression, or whatever their favorite nail is to hit with their hammer. Psychiatry is a hazardous thing, mostly for being extremely un-rigorous about eliminating potential medical or psychological resolutions to symptoms before reaching a psychiatric diagnosis. Then if they give you a med., and you have a side effect, they are just as likely to diagnose the side effect as another mental illness vs. backing you off the med.

Then there are the psychotherapists who will listen to 100s of hrs of patient babbling--never to provide a single word of concrete instruction as to WHAT TO DO about it. Yet they don't mind taking your money.

My wife can do better than that, and she even gives free haircuts

I believe in using mental health professionals carefully and to take their guidance with a grain of salt, or rather, supplement with countless hours of your own research and at least a 2nd opinion if you have any doubts. That said, I am NOT one of those people who thinks mental illness has no physical basis. I think it often does, and sometimes doesn't. It's all just very complex and science is still scratching the surface of how the human body works.

Thanks for the input.