Detective work, part II

When last we spoke, I was working with medical professionals to determine the cause of my ongoing fatigue. The neurologist tried many different medications; some worked to a degree, but all had side effects that seemed worse than the fatigue itself. The naturopath had many suggestions for healthier eating, but she was mostly concerned that my thyroid medication was not at an adequate level.

My primary care doctor decided to explore this possibility by checking not just TSH (thyroid stimulating hormone, the usual test used by Kaiser) but also T3 and T4, the separate thyroid hormones. She also grilled me on how I was taking the medication: Was I taking it first thing in the morning?  Yes. On an empty stomach with plenty of water?  Yes. With any other medications?  Why, yes… all of my morning meds were being taken together. Wait… you are taking thyroid medication with iron? That’s not good. Iron inhibits thyroid absorption. Take it at a different time of day. Why are you taking iron supplements, anyway?  I’ve done it for years, because I have always been anemic.

Fast forward one day. My primary care doctor frantically calls me to tell me to stop taking iron supplements immediately. Besides checking my hemoglobin level (which shows how much iron is in your blood; under 12.0 gm/dL, you are considered anemic, and mine came in at 12.9), she also ran a serum ferritin test, which shows how much iron is actually stored in your body. Normal serum ferritin levels for adult women, depending on whom you consult, are between 10 to 200 ng/mL. In the past, I’d had results ranging from 10 to 33.  This time, mine was 896.

This is bad. Iron is a heavy metal, and iron overload can basically damage all your major organs, and your body has NO mechanism to rid itself of extra iron, except blood loss. (This is exactly how I had poisoned myself with iron, by continuing to take a daily iron supplement for eight years after having a hysterectomy.)

And what, you may ask, are the most common early symptoms of iron overload? Fatigue and apathy.

I started giving blood the next day, and over the past three months, I’ve gotten my ferritin level down to about 600. At this rate, it will be months before I am back to normal. Will it be a cure for my apathy and lack of energy? It’s hard to say, but at least it will be one possible cause eliminated!

Public service announcement: Even with all this iron in my body, I am still borderline anemic. So if you are taking iron supplements because of anemia, make sure you get regular serum ferritin tests. Just because you don’t have iron in your blood does not mean you don’t have iron elsewhere in your body!

iron by Harald Link / CC BY

Detective work, part I

Fatigue. Apathy. They have been my constant companions for almost a decade. The question has been, what is the cause?

A glance at a WebMD slideshow gives some possible causes, and I had eight of the first ten:

  • Not enough sleep (as any reader of this blog knows) ✔
  • Sleep apnea ✔
  • Unhealthy diet (historically, although I’ve gotten much better recently) ✔
  • Anemia (since I was a kid) ✔
  • Depression ✔
  • Hypothyroidism (for almost 30 years) ✔
  • Caffeine overload
  • Hidden UTI (an issue I often have due to MS) ✔
  • Diabetes
  • Dehydration (I know I don’t drink nearly enough water) ✔

The others were heart disease, shift work, food allergies, Chronic Fatigue Syndrome and Fibromyalgia, none of which I have to deal with, thankfully.

And then, of course, there is the elephant in the room: MS. Fatigue is one of the major symptoms of Multiple Sclerosis, affecting 80% of people with MS.

Here’s a tidbit from the National MS Society:

Researchers are beginning to outline the characteristics of this so-called “MS fatigue” that make it different from fatigue experienced by persons without MS.

  • Generally occurs on a daily basis
  • May occur early in the morning, even after a restful night’s sleep
  • Tends to worsen as the day progresses
  • Tends to be aggravated by heat and humidity
  • Comes on easily and suddenly
  • Is generally more severe than normal fatigue
  • Is more likely to interfere with daily responsibilities

MS-related fatigue does not appear to be directly correlated with either depression or the degree of physical impairment.

I’ve been working with my doctors (neurologist, naturopath, and primary care doctor) to figure out which of the many possible causes is actually the source of all this fatigue. Suddenly, a new possibility came into play, something that no one had thought of.

Tune in tomorrow for part II!

tired by fltmech98 / CC BY

Sleeping? Pills?

I am exhausted. I need to sleep.

I am tempted to stay awake because I still have one more dose of medication due in about two hours.

I feel absolutely wiped out. I’ve been fighting a cold all week. I’m beginning to feel sad for no reason. These are all things that would be helped by getting more sleep.

My leg has been bothering me because I have that cold. (Anything that kicks my immune system into play causes my MS symptoms to act up.) When I miss a dose of meds, there is the distinct potential for lost time the next day due to my body giving me grief. So I should take the drugs, right?

I think I have decided to choose the sleep. Even if I feel bad physically tomorrow, at least I’ll be well-rested! If I choose to stay up to take the drugs (or to have David wake me when it is time to take them), I will be even more tired and there is no guarantee that I will feel well, even so.

Hasta mañana. Stay tuned for my report on this experiment.

Edited the next morning to add: I chickened out. I stayed up until 11 pm, took the medicine, and then took some melatonin so I’d be sure to sleep — and got 8.5 hours! I’m still exhausted, but every little bit helps.

sleeping pills by madamepsychosis / CC BY