Hello,
Thank you for choosing DoctorSpring.
I identify four possible areas where there could be derangements which can result in tiredness.
1. Diabetes
2. Hypothyroidism
3. Nutritional (from the gastric bypass)
4. Medication side effects.
I would like to know some additional information from you so that I can provide my best and learned opinion.
1. How is your blood pressure now ? May I know the latest readings
2. Is you Hb (Haemoglobin), S.Electrolytes normal ?
3. How is your HbA1C ? What are your typical fasting and post postprandial levels ?
4. You even had any fever (during the 6 months or prior to onset of this tiredness ?
5. Was Cymbalta or Topiramate started recently ? In this 6 months ?
6. Are you stressed right now ? Do you constantly worry about things at home / workplace ?
You can reply as a followup
Thank you
Patient replied :
First let me say my roux-n-y was not gastric bypass. My common bile duct was cut so therefore my intestines are connected directly to my liver with no bile ducts. Okay now on to the answers you needed. 1. Bps range from 119/62 to highest 130/72 2. Haemoglobin is 13.6 k+=3.6 Na=142 3. HbA1C=5.2, fasting 92-110, postprandial=156-178 4. No fever during this period 5. Cymbalta I have taken for approx 12 years and Topiramate approx 1 year. 5. I do concern myself with my residents I care for after work hours and occasionally it is a stressful job, but I don't think I am overly stressed about it. I am concerned about the fatigue because I can sleep anytime of day for 8-16 hours and still wake up exhausted. While I am working I m fine, but as soon as I get home and settled down I am out. I do wake frequently for urination. But can go back to sleep with ease.
Hello,
Thank you for the additional details.
Well, that rules out all most all the obvious possibilities. Since you have been well evaluated I am assuming your other blood tests are also normal (the liver and renal function tests especially ) and you do not have any other major signs or symptoms.
The last think you want to do is now to think in lines of Chronic fatigue syndrome. As you might know some viral infections can cause prolonged fatigue (even without obvious primary infection). This is highly possible. Meanwhile I would recommend a set of investigations if not done already
1. LFT, RFT
2. HIV
3. ESR, CRP
4. Cardiac Evaluation (Echo)
5. ANA
6. Peripheral Smear
7. Creatine Kinase
8. Anti Endomysial antibodies
A few viral/infectious diesase antibody tests are also recommend pending the above mentioned tests - EBV, CMV, Lymes.
I understand this can be frustrating, but hopefully this is just a passing phase of viral infection as I mentioned earlier.
Hope this helps
Feel free to ask followups questions
Thank you