Buyer Beware

As chronic and autoimmune patients, we live lives of heightened control. Different conditions can be controlled by varying degrees. Some, like diabetes (my main one) allow for a lot of control because we know what causes it and therefore, what to do to regulate it. Some, like fibromyalgia are less well known, and therefore, it is harder to regulate. Either way, we focus on whatever details we can. We plan, we plot, we obsess over every possible way to exercise as much power as we can over our recalcitrant bodies. We think that if we can control all of these little details, our lives will be as close to normal as we can get.

The control we seek can involve several elements: nutrition, exercise, physical therapy, psychotherapy, medication, and medical devices. As research and treatments evolve, new or enhanced ways to address those elements become available. They may or may not be right for your condition, but we tend to jump on them anyway. If it’s new, it must be better, right? The next thing is the best thing.

Not so fast. The risks involved with new treatments can be scary, especially if the old one is working.

I have a thing when it comes to my condition. Everyone has a thing. We do it when we feel anxious or out-of-control, or sometimes when we feel anxious and out-of-control. Mine is research. If I learn of something that could help me exercise more control over my condition, I will research it to death. I read academic articles, reviews, technical specs if it’s a device, and talk to the people who run it.

While some of that information might be useful, not all of it is necessary. Here are a couple of things you can do to make an informed decision about a new treatment:

• Check with the FDA: Their processes for approval are lengthy and burdensome, but (annoying as they are) they are there for a reason. Run any new drug treatments, devices, and sometimes even diet supplements through their database and see what they have to say about the risks.
• Check with your trusted providers: You know your disease, but they will often know a lot about these “next best things”. Discussions with them are better than whatever you can come up with on the internet because you can’t tailor someone else’s reviews to how your body works. They will tell you whether the next development is just bells and whistles and not worth the money, or whether the latest diet trend is worth a try or a total fad. They will listen and make suggestions if you want to try new avenues of treatment.
• Listen to the voice inside your head: The truth is, we know. With a basic understanding of how the next best thing works, we know whether it will work for us. Instinct tells us. It’s hard to hear if we are feeling insecure or out-of-control, though. In those moments, we are prone to bury our inner voice under whatever we need to justify a new tool to address an old problem. Every time I have asked for a crutch to help me lose weight, the answer – from multiple doctors at different times – has always been no. Even using something as basic as an appetite suppressant could have a negative effect if used over a prolonged period of time. Each time I knew what they would say before I asked. I also knew they were right.

There’s a large industry built around all of these treatments, both legitimate and not. That industry spends a lot of money on advertising. They wouldn’t do that if it didn’t work. So, evaluate, but don’t get stuck in what the business world calls analysis paralysis. If whatever you choose doesn’t work, you can always go back to the way it was.

The March of Progress

Technology is not my friend. I can walk by a computer and it breaks. When IT comes, the issue magically doesn’t exist anymore.

Because of that, we don’t talk much about healthcare tech in this space. But there are some pretty interesting things going on in that field. I was reminded by that when I started seeing emails for two upcoming conferences in my inbox: HIMSS18 and Health Datapalooza. Those savvier than I am -- tech companies, government, and nonprofits -- are all working to develop the next big advance. One of the most foundational, that might have a huge impact on our everyday lives, is medical interoperability.

Medical interoperability is when medical data systems talk to each other. Right now everything is siloed, partly because many doctors, hospitals, and pharmacies are using outdated systems and partly because of laws in this country that protect patients’ privacy. It was a long hard fight to get that second one, which manifests itself in the Health Insurance Portability and Accountability Act (HIPAA) and protects an individual’s health information as a measure to prevent discrimination against people with medical conditions. You don’t want to be the topic of general conversation in a hospital break room or for your family to be used as a worst-case scenario by your insurance company as mine was in the 1980s (and that was before I had diabetes). The only reason we even knew about it was because there was a family friend in the room.

Interoperability could revolutionize the healthcare industry if they can figure out how to keep privacy rules intact. If all your providers, insurance companies, and even you can see your entire medical record, your providers would have a more detailed and holistic view of you as a patient. Trends would be less likely to be missed and one provider might catch a warning sign in their specialty that another doesn’t consider important. If you were in the hospital, vital sign monitoring equipment could talk to IV equipment. Your doctor could monitor you from your Apple Watch or Fitbit. Research institutions could take information that had been scrubbed of your identity to help develop new treatments for your condition. Real-time information would take the place of catching up after months.

Technologically inept as I am sometimes, I would welcome advances in medical technology. Not just the ones that blow your mind like gene therapy, but those that address the back of the house. Let’s face it. Our biggest nuisance headaches come from the administrative side of the medical equation. If they can figure out how to save time by getting everyone’s computers to talk to each other, that’s something I can support.

If you want to know more, check out the conferences mentioned above. They’re coming up soon, and I for one will be curious to see what the new year might bring in medical technology. What new advances would you like to see?

The Things They Don’t Talk About at Parties

It’s bad enough to be diagnosed with a chronic or autoimmune condition. After the initial rush of fear, anger, and anxiety about what it means, there’s a period of adjustment during which you learn your disease. You get your prescriptions, your devices, the plan your doctors recommend, and then you have to ratchet it into your life. There’s a lot of trial and error. And if it doesn’t work, you start playing with what you’ve got.

For me, that manifested itself in something called diabulimia, an eating disorder where you don’t take enough insulin to cover your food intake and basically end up starving yourself because your body doesn’t have the tools to absorb what you are eating. One article I read years ago compared the damage done to your kidneys to putting an entire turkey – not a chicken – down your garbage disposal every day. Like any eating disorder, your body will start to shut down if it doesn’t get what it needs, but the damage is accelerated because of the already-impaired immune system.

Into the woods

I was diagnosed with Type 1 diabetes when I was 14, a very vulnerable age for girls and boys. I had never been thin (it’s just not my genetic build), but before my diagnosis I weighed about 90 pounds. It was just when women’s clothes were vanity sized into size 0, and even that was a little loose. Everyone – teachers, friends -- told me how good I looked. Funny how my parents never did. They must have been worried to see me eating about 5000 calories a day and still be that thin.

When we finally figured out it was diabetes, doctors put me on a 2500 calorie diet and wouldn’t take me off. I gained 60 pounds in six months, started associating insulin with weight gain, and hello, eating disorder. It lasted six years and almost cost me my vision (retinopathy) and my mobility (neuropathy), and did cost me at least 40% of my kidney function.

Out of the woods

I was lucky. We had a family friend whose wife was diabetic. When I started getting retinopathy, he arranged to send me to the Joslin Clinic, which is the gold standard for diabetes research and treatment. They helped pull me out of it.  I was 20 by then. If I had continued, I would have killed myself eventually.

Apparently, diabulimia is a fairly well-known phenomenon, although it is not recognized as a complication of diabetes either in the United States or the United Kingdom. I never heard a medical provider mention it until long after I’d been scared straight. Granted, my first endocrinologist was an egotistical jerk, but even as I pulled myself out of that very bad place, no one ever named it and told me that I wasn’t the only one.

There’s a danger in this lack of discussion. I suspect that teenagers aren’t the only diabetics vulnerable to diabulimia, and I suspect that other chronic and autoimmune conditions have equally dangerous potential when we stray from medical advice – I’m looking at you, opioid addiction.

Don’t get me wrong. Being able to understand your body and manipulate your treatment can be vital to living your best life, but there are many paths you can take and not all of them are healthy. If your mind isn’t healthy and you are suddenly handed a tool you can use to get you what you think you want, like an “ideal” body weight, it’s just so easy to take the unhealthy path.

A good provider and a good therapist may have been able to keep me from that path, or at least shorten the duration. If we had known the danger, if we had been able to put a name to it to understand it, we would have been able to see the path out of the woods. It’s a lot harder to remain in a dark place when you can see a path toward the light.

Do The Right Thing

Last week, I introduced Reasonable Accommodation and outlined a little about how I was affected when how my former employer – let’s call them Stumble, Bumble, and Fall Consulting, or SBF -- failed to follow the law. Now I will go into more detail about what happened and what SBF could have done to be a responsible, accommodating employer.

First, let me give you the details of the situation. I am a contractor for the Federal government. For the first time in a decade with SBF, I went more than a week or so without doing client work. It’s a difficult situation, but a company as big as SBF has reserves to handle situations like mine. Finally, a project came along where SBF was a subcontractor to a smaller contracting company. I had no experience in the kind of work they needed, but it was client work and I wasn’t given a choice on whether to accept it.

I knew right away that it was going to be a bad situation. First, it was in one of the worst neighborhoods in Washington. There was no safe place to park, and in the four months I was on the project, there were four shootings in and around the premises where I parked, including the shooting of a pregnant teenager the weekend before I started. It was high stress even getting to the office, and that kind of stress affects blood sugar.

Additionally, I was commuting for a minimum of three hours/day with no flextime and no telework, which meant I no longer had time to exercise and plan meals as required for optimum care of diabetes.

Last, and worst, SBF was aware that the project I was walking into – as a task lead! – was a longstanding hostile work environment. The prime contractor had let people go for being pregnant and for being male, both illegal. The only people on that contract from SBF were there because, like me, they hadn’t had a project for a while. SBF knew they should have broken the contract long before I got there, but they didn’t. In the end, the prime contractor bullied me, and I was told I had to sit there and take it, without defending myself my team, or expressing concerns about how I could effectively do my job with the restrictions the prime contractor placed on us. This added to my stress level and contributed to the loss of control of my condition I am still struggling with.

From bad to worse

Most of us as chronic and autoimmune patients are protected by the Americans with Disabilities Act. As such, we are entitled to certain accommodations for our conditions. If our conditions get in the way of us performing our duties or, in my case, if our duties negatively impact our conditions, our employers must take measures (within reason) to adjust the situation so we can do our jobs and effectively look after our conditions. See below for a description of actions I took, actions SBF took, and actions SBF should have taken under the law.

I told my bosses at SBF before I started that the project was unsustainable, and that the HR department should look for another project as if I still didn’t have one.

• What SBF did: Nothing.
• What SBF should have done: Not made me take the project.

I repeatedly called and emailed my SBF bosses to keep them appraised of the situation and letting them know how the project was affecting my conditions. I begged them to take me off that project.

• What SBF did: Nothing, including not keeping me on HR’s radar for a new project.
• What SBF should have done: Arranged flextime or telework options, taken me off the project, or found me other work.

After three weeks, I found a promising new project that solved stress, commuting, and lack of experience issues.

• What SBF did: Barred me from taking the project because it was short-term (with the potential of becoming permanent), even though I clearly accepted the risk of being laid off if the project didn’t become permanent.
• What SBF should have done: Allowed me to take the project or found me another one.

In the end, the project and prime contractor wreaked such havoc with my diabetes regimen, my doctor had to write a note setting an end date to my participation on the project. SBF asked me multiple times to stay on since they couldn’t find anyone to fill such an awful position, but that letter at least protected me when the team I had worked with for a decade wouldn’t. Two weeks after I left the bad project, I started at the project I had found for myself, as it had turned into a permanent position.

This situation was so bad, I consulted an employment attorney, who, after an initial evaluation, thought I might have a legal case against SBF. I thought about pursuing it, but honestly, I don’t have the time, energy, or money to fund a lawsuit, at least right now. But I also haven’t completely abandoned the possibility, although I don’t know what the statute of limitations is.

Since then, I did really well on the project I found, and managed to stay with them when I left SBF. But I continue to struggle medically and haven’t really started to recover from the immense toll that unfortunate project took on my health. Next week, I will detail the medical fallout and why it is so dangerous for us when employers ignore their legal obligations to us.

Are You Seeing The Forest or The Tree?

I’ve wanted to talk about reasonable accommodation for a long time, but I had to leave my former employer before I felt comfortable doing that. It turns out not every employer takes the definition of “reasonable accommodation” to heart.

Reasonable accommodation says that, under the Americans with Disabilities Act of 1990, employers can’t discriminate against you because of a qualified medical condition. The definition of disability is opaque. Suffice it to say most, if not all of us in the chronic and autoimmune community are covered.

But what does being covered by reasonable accommodation actually mean?

The ADA says that if our conditions get in the way of us performing our duties, employers must make “reasonable accommodations” for us. This can include special office furniture, flexible schedules/telework, or even altering duties. For over a decade I had informal accommodation, mostly in the form of telework to make up for doctors’ appointments that would have eaten through all my vacation time. I am a contractor, so I made arrangements with my client and company staff on the project. No one seemed to care as long as I got my work done, which I did.

That changed in the summer of 2016. The details of the situation are for the next posts, but this situation turned out to be so detrimental to my health that my doctor wrote a note saying I could no longer be on that project. Nineteen months later, I still haven’t recovered.

My former employer’s failure to comply with reasonable accommodation laws caused more damage than I thought, and not just physically. One of the people responsible for the decision to keep me in the bad situation was someone I’d worked with closely for nearly a decade. I trusted him, which is not something I do easily or often.

When this colleague blocked my escape from the situation, it felt like betrayal, and man did that hurt. But instead of allowing myself to be sad and hurt, I did what they told me to and let righteous indignation sweep in to fill the vacuum where the hurt and sadness should have been. I built a bubble to protect myself from feeling what I didn’t want to. I was afraid that if I felt that, I would fall down a rabbit hole and not be able to climb out.

So, I built my bubble, and in doing so, I kept out all the good stuff, too: the excitement of a new job and good, impactful work; the satisfaction of maintaining this blog and connecting with some amazing people; and the support and plain old happiness I get from simply spending time in the company of people I love and trust. The mental effort it takes to maintain a protective bubble like that is massive. That’s the vicious circle I should have been looking at.

I have maintained my bubble since I started that awful project, and when my colleague, who was also my boss, couldn’t even be bothered to say, “Sorry to hear you’re leaving. Good luck in your new job,” a couple of months ago, it made it worse. After a decade there was not even an attempt at common decency, so I withdrew even more. Without the good to balance the bad, I felt more and more exhausted, making me less and less inclined to attend to my own health needs.

Now that I know what to look for, it will be easier to let go of my bubble, especially now that I don’t work for that company anymore. But that doesn’t mean it will be easy. I will have to allow myself to feel things I don’t want to feel and just be ok with it – my version of “leaning in.” That might take a while.

While I am not in a good place right now, I am not in a state of mind meriting a formal diagnosis, but obviously, my mental health has had a major effect on me physically, and it has derailed me for now. I believe it was actually dangerous for a while, with my diabetes out of control, and the resulting weight gain, which makes everything worse physically and metabolically. The one thing I did right, even during the worst of it, was go back to my therapist. I had been doing so well before that, I hadn’t needed treatment. But I needed it then. It felt like a lifeline.

Everyone has issues, sometimes more serious than other times. This is why it’s so important to have someone who can help -- a good therapist, access to a hotline (link to hotline listing), or someone who is trained to help you out of the more serious issues. I may have gone years trying to hold up my bubble, fighting with myself over what got my limited energy. Now it’s time to make improving my mental health a priority, and with it will come the energy I need to put myself back together physically. Or at least it will be a big step in the right direction.

Meeting Another One in (Almost) a Million

In the 35 years since my first terrifying medical incident, a rare and often deadly disease, I have never met someone else who survived what I had. That’s unsurprising since it only affects only one or two children in every 100,000, and there is a 10-20% mortality rate. In fact, of the three children with bacterial streptococcal meningitis that year, I was the only one who survived.

But a couple of weeks ago, I was in the elevator of my apartment building (yes, I am the kind of person who starts conversations in elevators), and I found one! Oddly, we were talking about the switch from hard copy bulletin board to digital bulletin board in our garage elevator lobbies. Someone mentioned that it really helped the elderly residents who had vision problems, and I piped up that I appreciated it because of my steroid-induced cataracts. The other meningitis survivor asked why I was on steroids, and *boom* there we were, two meningitis survivors on one elevator.

I suspect she was about 10-15 years older than I, and she was 16 when she got sick which is a little more dangerous than six, but it also means that we had it within a couple of years of each other. Weird, right?

We got off the elevator and had some time to compare notes. We were both in a coma. Hers was longer, but my fever was higher. We had similar experiences coming out of our comas (too personal to share here), and we both had major, lasting side effects. She lost 10 years of memory, going from new driver to first grader in the space of her coma. She had to relearn everything she’d lost in those 10 years. I didn’t have 10 years to lose, but I lost some motor skills and the use of the left side of my body (temporarily) through paralysis.

That meant that both of us had to relearn how to go to the bathroom, how to write, how to feed ourselves. She recovered faster than I did, but it left is both with some . . . things. She still has muscle spasms and I have back issues from muscle atrophy and occasional shooting pains from the base of my skull into my left shoulder, occasional reminders that will never go away completely.

As we stood there in the lobby, it was weird to have so much in common. Have you ever had the feeling of being happy to see someone you had never met before? And that you very likely will never see again? I live in a building with over three thousand other people. In over 10 years, I had never seen this woman. I gave her my card, but if she hasn’t reached out in the last month, she probably won’t.

And that’s ok. When you have a rare condition, sometimes it’s enough to know there’s someone else out there just like there. However, instead of waiting to find support in random elevator conversations, you might want to find an actual support group, either online or in person. There’s nothing quite like finding the people who know your condition as well as you do. For all the ups and downs you weather every day, you will never have to explain it to them.

2017 -- En Fin (The End)

The holiday season is approaching its end. In a few days, hundreds of millions of people will stay up too late with a bunch of strangers celebrating . . . what? That they survived the year? The beginning of a new one, where we may or may not stick to idealized, nearly impossible resolutions? Why do we need to wait for a whole new year to set goals for ourselves?

I’m sure you can tell that I am not much of a celebrant. (Although, to be fair, perhaps surviving THIS year is celebration-worthy.) However, that has not kept me from developing a New Year’s tradition.

Lame Year’s Eve

It’s exactly what it sounds like. Three of us who grew up together 500 miles away from here plus one husband gather at Moose and Squirrel’s house. (They’re the only ones who have a house.) We catch up while playing cards or watching movies until we fall asleep on the couch. Then we wake up just in time to watch the ball drop in Times Square and go home. Lately, we have even taken to adopting a country with an earlier midnight and celebrating around 9:00 p.m. our time. We’ll make that country’s food and try to track down some shots of their midnight. This year, it’s Brazil, specifically Rio de Janeiro. Who wouldn’t want to celebrate New Year’s with Rio? (Notice I did not say “in.”) I am making risotto cakes with tomato coconut sauce this year. A good time is had by all and we don’t lose New Year’s Day to the recovery.

The funniest thing about it is how many people seem to prefer something like that to their bigger, more formal plans. The best thing about it is that I get to spend some no-pressure, quality time with part of my support system. These are the people who knew me before autoimmune conditions. I mean, how many friends do you have that you’re ok falling asleep in front of?

This year was hard, and I am glad to see the back of it. I hesitate to say that 2018 can’t possibly be as bad, since Murphy has a way of proving me wrong. So, whatever happened this year, and whatever’s coming this year, I’m glad I’ll be spending the end and the beginning with Moose and Squirrel.

If I Must

If I must make a New Year’s Resolution, I resolve to laugh more. Sometimes we get so bogged down in our chronic lives, we don’t realize what we are missing. But there is a reason “Laughter is the best medicine.” has survived a generation or two, and now the saying is borne out by science.

I’m sure you can feel the stress drain from your body with a good belly laugh. Or you’ve suddenly started laughing in the middle of a fight about something that seemed serious at the time. But did you know there are biochemical benefits as well? It strengthens your immune system, releases endorphins, which relieve pain, and it increases blood flow, which is good for your heart.

Robert Frost said, “If we couldn’t laugh, we would all go insane.” So, in the interest of collective sanity, I invite you to share my resolution to laugh more in 2018.

What are your traditions and resolutions for this year?

Not ok

Do you remember Successories, those posters (and so many other products) that had “motivational” sayings on them? Fifteen or twenty years ago, they were everywhere – offices, dorm rooms, and gyms across the country. [Full disclosure: I had a desk calendar. Our office manager chose it.] I suppose the idea was that if you were struggling with Gratitude, Collaboration, Excellence, Integrity, Perseverance, (all those things you’re already bringing to the table), you could just look at one of those posters and muster the strength to be all you could be, to borrow an Army slogan from roughly the same timeframe.

I have seen a lot of articles mimicking that sentiment directed toward patients struggling with difficult conditions. The main theme is, “Everything is going to be ok. You’re going to be ok.” That’s good some of the time. Not all of the time. The fact is, these conditions are scary. Sometimes you’re not going to be ok. And that’s ok.

When I was diagnosed with kidney disease, I had a very kind doctor who let me sit in her office and cry for an hour while I called my dad and my boyfriend. I was really scared then. It didn’t feel like I was going to be ok. And that was fine. It was a normal, if overwhelming, reaction to a serious condition. It didn’t help that most people diagnosed with that condition were decades older than my 29 years old. It made me feel that I was that much closer to the possible death that came with it. (The most common causes of death in diabetics are heart disease and kidney failure.)

At that time, I probably would have punched someone who told me everything was going to be ok. I needed time to process, to adjust, and to prove to myself that maybe that was true. I’m not saying that we should allow ourselves to develop a victim’s mentality, but there are more dimensions to the psychological impact of chronic and autoimmune conditions than can be addressed by, “It’s going to be ok” or any other simple motivational saying (I’m looking at you, Nike’s Just Do It).

I wonder how those of you with chronic pain feel about that? Or multiple sclerosis? Or cancer? Or any of the other conditions that challenge you every day or come with the possibility of a long, slow degeneration? I imagine that, like me, you’re ok in waves – up for a while, then down, then up. Hopefully the ups last longer than the downs, but sometimes they don’t.

So, yes, it will probably be ok, but it’s perfectly acceptable to feel like it might not, as long as you don’t let that feeling interfere with getting there. And if you do start to feel like not ok is taking over, make a call.

Does your Chrismukkah suitcase sound like you’re carrying a pharmacy?

Love ‘em or hate ‘em, the holidays are here. When I travel home, we don’t have any more tension than the average dysfunctional family. There’s no yelling or alienating political discussion (we all know what to expect from the others). There are small celebrations to suit a small family. Sometimes I even forget to light Hanukkah candles. Because I forget it’s Hanukkah for all eight days. But, I do enjoy the time with my family, usually at Thanksgiving.

It’s complicated, though. My monster is best behaved when I follow a routine. The holidays are anything but. My brother has four kids and my dad is in his 70s, so that means I’m travelling to make it easiest for everyone. I have to leave my comfort zone, the place where I know who to call and where to go in case of emergency. Even my immune system seems less challenged in my own place, even if all six of my brother’s family pile into my one-bedroom condo.

If your body works anything like mine, the only way to get through holiday visits is to plan as if you were going to another planet.

1. Plan for prevention. Bring bottles of medication instead of separating out what you need for the time you will be gone. If you use consumable medical equipment, make sure you have several of whatever you need and check at least twice. Maybe once more before you leave. The last thing you want is to be held up on the way home by weather, traffic, or overbooking and be short.

Start taking vitamin C a few days before you leave (There are tons of immune system boosters that work to varying degrees, but I prefer the classic.). If you don’t get sick, you can stop taking it a couple of days after you get home. If there is anyone in the household you are visiting who is already sick, take as much as you can. You will know when you’ve taken too much vitamin C if you start feeling nauseated.

2. Plan for every possible sickness. I have a whole separate bag to transport my traveling pharmacy. It consists of every over-the-counter and as-needed prescription I have. With suppressed immune systems, fevers, colds, sore throats, and coughs are all significant possibilities from a quick trip home for the holidays.  

3. Know what your challenges are likely to be and have a strategy to deal with them. Whether it’s suspending your ‘rules” for the time you’re away, looking for the closest gym to your in-laws’ house to maintain your workout routine, or asking your host for detailed menu plans to help you, make sure you have a plan for every challenge you can think of.

4. Only you know what you can handle, but often doing something that makes you stand out from the rest of the family is difficult, and can seem silly for just a few days. But falling out of your routine for those few days can knock you off track for longer (I’m speaking from experience, like when I let playing with kids replace exercise and not picking it up again even though there aren’t kids to play with in my apartment), so enlist help. Find someone you trust for backup or announce your plan to the whole group. You don’t have to give a reason, just state your desire to accomplish your goal for the time you are there. Sometimes just talking to that person(s) is enough to keep you on track.

I instituted these plans for myself after my first couple of visits with multiple kids. For whatever reason, if a kid has a light cold, I get it 10 times worse. More than a few times I’ve driven home thinking I was fine only to realize I had a fever of 102+ when I got up to my apartment. At this point, I always expect to get sick, and it’s a family joke/congratulations if I don’t (I didn’t this year – yay!). Even if I do get sick now, it’s not nearly as bad as it was. I’ll take that.

We at The Patient Advocate’s Chronicle wish you a happy, healthy, and well-planned holiday!

Still Sleepy?

A couple of weeks ago, I posted about the importance of sleep. It would have been better if I had written about the importance of lack of exhaustion. As I began to catch up on sleep, I still couldn’t shake the feeling of being tired all the time. It was better, but still present enough to be a stumbling block. So I began to consider other possible causes. Sometimes exhaustion has nothing to do with how much sleep you get. Chronic and autoimmune conditions that affect hormones or metabolism can be just as guilty. Turned out adjusting my blood pressure medication did wonders, so let’s start with that one:

Hypertension (high blood pressure): Tiredness is a common symptom of hypertension. It causes the constriction of tiny arteries called arterioles. Your heart has to work harder to pump blood throughout your body, which makes you tired and out of breath. Risk factors for high blood pressure include diabetes, being overweight, lack of exercise, race, gender, smoking, and drinking.

Anemia (iron deficiency): Your red blood cells come equipped with hemoglobin, an iron-rich protein that bonds to oxygen molecules and distributes the oxygen to the rest of your body. When there isn’t enough iron in your red blood cells, your tissues don’t get the oxygen they need (including your brain). Lack of oxygen makes you tired, too. Many things can cause anemia, even something as simple as an iron-deficient diet or a heavy period. Chronic conditions like cancer, HIV/AIDS, rheumatoid arthritis, kidney disease, Crohn's disease, and other chronic inflammatory diseases can also cause anemia. (Please note that there are multiple types of anemia, but here I am talking about simple iron deficiency.)

Hypothyroidism (Thyroid imbalance): Hypothyroidism is when your body doesn’t produce enough T3 and T4, the hormones that regulate your body’s internal temperature, metabolism, and heart rate. It is not uncommon for hypothyroidism to go undiagnosed. As with other types of hormone deficiency, your body has to work harder to function properly, which makes you tired. But with hypothyroidism, exhaustion can come from too many directions to list here. Read this for an explanation of most of them.

Sleep apnea: Sleep apnea is when you don’t breathe properly while you are asleep. Instead of breathing evenly, you briefly stop breathing and/or breathe shallowly. Disrupted sleep causes exhaustion during the day just like hypothyroidism. Symptoms like exhaustion and snoring are commonly accepted as “just life,” so sleep apnea can go undiagnosed for a long time.

Undiagnosed condition. There are a lot of conditions that cause exhaustion even when they are being treated properly. Before they are diagnosed, or if they are misdiagnosed, it can get extreme. For example, before I was diagnosed with diabetes, I was sleeping 14 hours a night and still falling asleep in second period. No one bothered to mention that to my mother, so I continued misdiagnosed for several months. In fact, it was when I told my mother that I was too tired to school, she had me tested. (After responding, “Not in my house, you’re not.”) And if your condition is one that can cause dramatic weight loss, that’s like a double whammy – all you systems slow down and you enter starvation conditions, even if you are eating normally.

Drug interactions: I bring this up because of a particular incident I had at work about 10 years ago. I was a newly diagnosed chronic kidney disease patient, and one of the most common treatments for CKD is a class of blood pressure medication called beta blockers. If you have ever had asthma, even if you have grown out of it, you are not supposed to take beta blockers. Well, I forgot to tell my doctor because I hadn’t had it for years. As we adjusted my meds up to properly treat the hypertension, I began to feel tired and breathless, especially when I walked up the stairs. Basically, the beta blocker was working on both my blood vessels (which it was supposed to do) and on respiratory passages (which it wasn’t supposed to do). After just a couple of months, I went to an ER because I wasn’t getting enough oxygen. We knew because my lips had turned blue.

Exhaustion is common. Maybe you can never get to bed on time, or maybe you have young kids who keep you up at night. Or maybe it’s a common problem with a not so common cause – an autoimmune condition. Take stock. If you suspect your tiredness is due to causes other than everyday circumstances, schedule an appointment with your primary care physician and discuss it with them. If there is something medically wrong, better to treat it earlier than later.

NOTE: This post addresses physical, not psychological causes of exhaustion.