What can it be?

[siddharth]

Dear Doctors,
For past about 1.5 years I'm feeling that my life is running at very
low energy level. I no longer get up feeling fresh in morning. The whole body feels stiff and tired. the arms, shoulders and the back are particularly painful. I do no heavy exercises other than walking at brisk pace for half an hour in morning/evening. I want to do some running/jogging but the inertia is so much that most of the
times I dont even start, even when I do I stop very soon. whenever I work-out a little bit extra, I feel a queer kind of dull mindedness the whole day.
As the day progresses, I feel better but in the afternoon I again feel
tired and the mind becomes disoriented. It becomes difficult to focus
on something or bring myself to take initiative for any work. by the
time i reach home, my energy levels are completely bottomed-out and i
just watch TV for a couple of hours or read papers, have dinner, read
some more/chat with my wife and go to sleep. sometimes the body pain
and fatigue is so much that it's difficult to sleep. On some nights, I
sweat a lot, esp. neck and face area, and I feel particularly tired
and stiff the next morning. Can you please help me out?
-Siddharth
Important facts:
-I'm 27 yrs old Male. Height 5' 11", weight 78 kg. I've gained 2-3 kgs in last one year.
-I'm vegetarian, non-drinker.
-My family physician got serum B12 level checked 1 year back, it was
"below 150", she prescribed methyl cobalamine injections, After taking
25 of them I rechecked the levels, it was 'above 1000' but the
symptoms only worsened.
I visited Dr P.P. Ashok at Hinduja hospitol, Bombay(India).
He wrote:
clinically N, In. Fatigue syndrom R/o Mysthenia
and asked for some tests which I got done:
-TSH (Ultrasensitive), serum by CLIA- 3.8 ug/dl
-Cortisol, serum(P.M.)- 2.89 ug/dl
-Got Vitamin D3 (25 hydroxy cholecalciferol) (Oct 2007): 'below 7.0' the family physician prescribed: Tab Calcimax andCalcirol sachet which I took for over a month to see no improvement.
Fasting blood sugar 89 mg/dl, urine sugar nil.

[Abhijeet Deshmukh, MD]

Hello.

I would like to consider two differential diagnoses for your symptoms. And the correct one will depend upon your own judgment.

The first one is "Chronic Fatigue Syndrome". And the second differential diagnosis a Depressive disorder.

The difference between the two is the feeling of sadness of mood. If I ask you to list out ten of your most troubling symptoms, would you say fatigue is higher or sadness of mood (if you feel sad). ? If it is the fatigue, then a diagnosis of CFS is more appropriate.

Do you have any stressful events going on ? Are you well adjusted in your work and family ? Do you feel you may have features of depression ? Some of the symptoms of depression are sadness of mood, loss of interest in activities you would enjoy earlier, easy fatigue, sleep disturbance, appetite disturbance, decreased sexual interest, impaired concentration and activities.

I would also like you to observe if you might be having sleep apnea. Do you snore while you sleep ? Sleep apnea is a condition where your breathing stops for about 10 seconds, frequently through the night. As a result, you don't get a refreshing sleep. Sleep apnea is associated with obesity.

I hope this was of help. Do get back if you have more queries.

Regards