Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder...

61
Fatigue Don Thomas, Jr., MD, FACP, FACR Author of “The Lupus Encyclopedia: A Comprehensive Guide for Patients and Families Arthritis and Pain Associates PG County, Greenbelt, MD www.arthritispainpg.com : 301-345-5600 Associate Professor of Medicine Uniformed Services University of the Health Sciences Bethesda, MD

Transcript of Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder...

Page 1: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

FatigueDon Thomas, Jr., MD, FACP, FACR

Author of “The Lupus Encyclopedia: A Comprehensive Guide for Patients and Families

Arthritis and Pain Associates PG County, Greenbelt, MD

www.arthritispainpg.com : 301-345-5600

Associate Professor of Medicine

Uniformed Services University of the Health Sciences

Bethesda, MD

Page 2: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.
Page 3: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Exhausted

Page 4: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Exhausted

“Can’t do the thingsI enjoy and want to do!

Help!”

Page 5: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Exhausted

Stopped enjoyable things

Low concentration

Page 6: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Exhausted

Stopped enjoyable things

Low concentration

Can’t sleep

Page 7: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Exhausted

Stopped enjoyable things

Low concentration

Can’t sleep

20 pounds weight gain

Page 8: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Requests:

Sleeping pill

Weight loss pill

Energy vitamins

Page 9: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.
Page 10: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.
Page 11: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.
Page 12: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.
Page 13: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.
Page 14: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.
Page 15: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Inflammation LabsSed rate (ESR)C-reactive protein (CRP) GammaglobulinsAnti-dsDNA

Page 16: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Inflammation LabsSed rate (ESR)C-reactive protein (CRP) GammaglobulinsAnti-dsDNA

Low complement levels (C3, C4)

Page 17: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Organ Inflammation LabsLiver Function Tests (LFTs)Muscle enzymesIncreased protein in urineAnemia of inflammationLow white blood cell countLow platelet count

Page 18: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Other Sjogren’s organ problems

Interstitial lung diseasePrimary biliary cholangitis (previously cirrhosis)

Page 19: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Health News Florida

Page 20: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Biologics HQ

Page 21: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Pharmaceutical Quotes

Page 22: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

The Today Show

Page 23: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Sjogrens.org

Page 24: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

DysautonomiaAutonomic dysfunction

Page 25: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

DysautonomiaAutonomic dysfunction

POTS

Page 26: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

POTSPostural orthostatic tachycardia syndrome

Page 27: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

POTS

FatigueWeakDizzyLightheadedHeart palpitations

Page 28: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

https://blog.daveasprey.com/at-home-tests/

10 minutes: If HR increases ≥30 bpm but no decrease in BP

POTS?

Page 29: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

POTS Treatments

Exercise

Drink lots of fluids

Avoid inactivityWinker R, et al. Endurance exercise training in orthostatic intolerance: a randomized,

controlled trial. Hypertension. 2005 Mar;45(3):391-8. Epub 2005 Feb 7.

Page 30: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

POTS TreatmentsExerciseDrink lots of fluidsAvoid inactivity

Medicines

Winker R, et al. Endurance exercise training in orthostatic intolerance: a randomized, controlled trial. Hypertension. 2005

Mar;45(3):391-8. Epub 2005 Feb 7.

Page 31: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.
Page 32: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Exercise as important for Living

as Eating& Sleeping

Page 33: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

How do you motivate yourself to exercise?

Share in the Chat Box

Page 34: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

www.dysautonomiainternational.org

Page 35: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Treatable

Blood countsThyroid

Vitamin B12

Vitamin D

Celiac disease

Hepatitis C

Page 36: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Treatable

Blood counts

ThyroidVitamin B12

Vitamin D

Celiac disease

Hepatitis C

Page 37: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Treatable

Blood counts

Thyroid

Vitamin B12Vitamin D

Celiac disease

Hepatitis C

Page 38: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Treatable

Blood counts

Thyroid

Vitamin B12

Vitamin DCeliac disease

Hepatitis C

Page 39: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Treatable

Blood counts

Thyroid

Vitamin B12

Vitamin D

Celiac diseaseHepatitis C

Page 40: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Treatable

Blood counts

Thyroid

Vitamin B12

Vitamin D

Celiac disease

Hepatitis C

Page 41: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Healthy Debate healthydebate.ca

Page 42: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Drugs that cause fatigue

AlcoholPain medicinesAntidepressantsBlood pressure medicines (beta-blockers, diuretics)Proton pump inhibitors (such as pantoprazole)Anti-anxiety pillsSleeping pillsMuscle relaxantsAntihistaminesStatinsAntibiotics Anti-psychotics

Page 43: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Fatigue: most common causes

Insomnia with poor sleep hygieneObstructive Sleep ApneaDepressionAnxiety DisorderFibromyalgia

Page 44: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Fatigue: most common causes

Insomnia with poor sleep hygiene

Depression

Page 45: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Rx

ExerciseSleep hygieneHealthy DietWeight loss

Page 46: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Rx

ExerciseSleep hygieneHealthy DietWeight loss

Meds?: Paxil

Page 47: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

NBC News at nbcnews.com

Page 48: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.
Page 49: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

CRESTAFatigueClinic

Page 50: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

CRESTA Fatigue Clinic Method

Pain managementExercisePilatesSleep hygieneEnergy managementStress reduction

Page 51: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

CRESTA Fatigue Clinic Method

Pain management

ExercisePilatesSleep hygieneEnergy managementStress reduction

Page 52: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

CRESTA Fatigue Clinic Method

Pain managementExercise

PilatesSleep hygieneEnergy managementStress reduction

Page 53: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

CRESTA Fatigue Clinic Method

Pain managementExercisePilates

Sleep hygieneEnergy managementStress reduction

Page 54: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

CRESTA Fatigue Clinic Method

Pain managementExercisePilatesSleep hygiene

Energy managementStress reduction

Page 55: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

CRESTA Fatigue Clinic Method

Pain managementExercisePilatesSleep hygieneEnergy management

Stress reduction

Page 56: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Join their Facebook

CRESTA Fatigue Clinic Health Champions

Page 57: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.
Page 58: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

150minutes/week

Moderate aerobic exercise

Page 59: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

Exercise as important for Living

as Eating& Sleeping

Page 60: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.

NBC News at nbcnews.com

Page 61: Fatigue - f.hubspotusercontent30.net · Obstructive Sleep Apnea Depression Anxiety Disorder Fibromyalgia. Fatigue: most common causes Insomnia with poor sleep hygiene Depression.