Extreme intermittent/ongoing fatigue, lethargy, fainting

Hi,

I am a while 20yr/s female from NZ,.

It's been about a year since the symptoms started, and for about a year no one can figure out what's wrong with me. I'm starting to lose hope that I'll ever feel normal again, so this is my last resort. I'm hoping someone can give me some suggestions of where to look and what to ask Doctors to look for, because I'm out of ideas.

For the best part of a year, I've been incredibly fatigued, lethargic, and tired to the point where it's an effort to have a shower, to get out of bed, to stand up at work for more than 15mins. I feel like I'm in the body of an old woman, where in reality I am only twenty. I can't stand up at work for more than 15-30mins before I feel like I'm going to faint or fall over. Everything feels heavy and I feel slow physically and mentally. Sitting down, eating or drinking barely helps. I've tried caffeine, it works for about 15mins and then I drop again.

There are some days, not everyday but some days, where getting out of bed is an effort in itself. My heart will race just from sitting up and getting out of bed, like I've run a mile. Often, I have trouble bending down or kneeling down to pick things up etc, because it is just so difficult to stand back up. I have days where I feel just on the lower side of normal, but there are other days where I am so fatigued I can barely function cognitively. I've had days at work where I've been so exhausted I can't comprehend what I'm doing, can't work out basic math, can barely stay upright.

At the beginning of the year, I was experiencing a number of sleeping difficulties. At first, I had ongoing insomnia for months on end, and then it switched around and I ended up falling asleep in college, unable to stay awake in the day, sleeping 14 hours and waking up tired or with migraines. I began taking caffeine pills 1 or 2 day for a week or 2, but that barely dented my fatigue and tiredness.

I have also been experiencing hives on and off irregularly for that year, with no apparent allergic catalyst. Each time the hives flare up, there is nothing in common with the circumstances.

I've had my blood tested, the only abnormality was a slightly low B12 count, which I took B12 for, for about 6 months. That helped with the sleeping, but not with the fatigue, lethargy and fainting. I have been tested for Epstein-Barr, which was negative. My blood count is fine, so are my nutrient levels. My ANA came back slightly elevated, but not enough to cause symptoms. My thyroid was normal. My BP is normal for my age.

I've had a very stressful 2 years, however I am taking escitalopram 20mg for anxiety. I have been taking it for about a year or more, long before symptoms began. Even now, after the year has ended and the stress is gone, I am still without relief. I can't exercise because I simply do not have the energy.

I am not a vegan or vegetarian, I have a diet full of meats, proteins, vegetables, fruits and whatever else you can think of. I have not been exposed to any areas that are home to exotic parasites, viruses or bacteria. I am not depressed.

Any ideas? Much appreciated.

[LowCortisol]

You say you had blood tests. Have you checked your cortisol? If this is very low it can explain difficulty getting out of bed and severe exhaustion.

While you're having that checked you should check your Vitamin D (25-hydroxy measure).

I had/have low cortisol and take supplements which while not removing all the lathargy, I would say removed 80% of it. And my Vit D was very low, with supplements of 2,000IU/day I feel far far better.

Have these two things checked. They may be the answer.

[LowCortisol]

I forgot to ask....are your headaches mainly when you wake up? Do they in fact wake you up? Do you need tablets to alleviate the pain?

[Sorenn]

Usually, yes. But they can also be triggered by sensitivity to light and sound. I can't tolerate loud noises. They often wake me up, yes. I don't get them every day but when I do they generally last all day, without change to the severity of the pain (which usually makes me want to cleave the top of my head off). Tablets do not help with the pain at all. I can't take prescription analgesics because of my current medication.

[Dr. Kokil Mathur]

Hi
Welcome to the MedHelp forum!
I suggest you get the whole situation reassessed. Extreme fatigue could be due to hormonal imbalance, anemia, diabetes, hypothyroidism, or due to kidney or liver problems. Another possibility is sleep disturbances (like sleep apnea, imbalance of rapid eye and non rapid eye movement sleep etc.). You may sleep your customary 7-8 hours and yet feel fatigued. You need sleep studies to rule this out. Other possibilities are chronic fatigue syndrome, depression, low Vit b12 (reassess this), low iron, low calcium, sodium and potassium. Hyperthyroidism too causes increased sweating and tiredness.   Postviral fatigue syndrome is another possibility. Persisting EBV infection or mono can also be the cause. A comprehensive investigation is required keeping all the points in mind. Do discuss this with your doctor and get yourself examined. Take care!