There are essentially three types of diseases. One type fumes. They are like monarchs. They announce their arrival, they barge in, they trample. As mere mortals, we either hurl defiance at them or we yield. Another type flaunts. They flutter their wings, tease a wee bit, and depart. But the third type is often the trickiest, the unknown devils. Like a serpent in the grass, they wriggle their way through, stare without blinking, and produce the final smack out of nowhere. These are the ones patients are most unaware of, and these are the ones we physicians are most wary of.
Fatigue typifies this third type. Trashed and dismissed as tiredness and with a “get your backside off your chair” kind of attitude, fatigue is that seemingly innocent bystander who can deliver the decisive hack.
As a clinical entity, fatigue comes in many shades, present in variable degrees in individual patients. A common presentation is an inability to initiate activity (perception of generalised weakness in the absence of objective findings). Closely following this is the reduced capacity to maintain activity, otherwise called easy fatigability. And then the worst. Difficulty with concentration, memory, and emotional stability — what we call mental fatigue. So whether it’s recent, prolonged fatigue or chronic, fatigue is almost always the harbinger of something deeper. Let us address the concerning connections, one by one.
Depression
Depression, with its sense of inexplicability, frequently starts out as fatigue. Long, long before the hair tearing begins, the desire for the rope kicks in. Extreme, relentless fatigue becomes the frontline feature. Ditto with anxiety.
Mental and emotional abuse
While physical abuse grabs more headlines, mental and emotional abuse is more common, and sometimes just as harmful. This includes the effects of a toxic, exhausting culture at the workplace. The medical literature is clear that victims of such kinds of abuse often tuck themselves into a quiet corner, reluctant to release their pent-up feelings. What seeps through is fatigue.
Different types of cancer have one thing in common — fatigue TT archives
Cancer
Any and every cancer hides beneath the cover of fatigue. And while we sprint around, shopping for over-the-counter energy pills, or worse, herbal remedies, it spreads wide and deep. Of all diseases, cancer is the one where the race against time is the most acute. In this race, fatigue usually remains unnoticed and unchallenged.
Under-functioning thyroid
Are you feeling cold? Are you losing your hair? Are you feeling fatigued? If the answers to all three are yes, your thyroid gland is probably under-functioning.
Heart-related diseases
Coronary artery disease doesn’t always assert itself prominently. Especially for women, where the symptoms can be unconventional. Long before the double trouble of chest pain and shortness of breath set in, fatigue from compromised blood makes its weary way, generally going undetected. Not just ischaemia (inadequate blood supply to parts of the body), but heart-related conditions like pulmonary hypertension and cardiomyopathy also have an enduring bond with fatigue.
Hormonal afflictions
In men, thyroid hormone afflictions, which may include a decline in testosterone levels, come with fatigue. For women, heavy menstrual bleeding invariably precipitates fatigue.
The list is long. From multi-system diseases like diabetes to side effects of numerous drugs, fatigue is an everyday enemy that most of us have normalised as benign. However, the truth is that fatigue is a formidable foe, closely cooperating with multiple greater foes, which must be acknowledged and addressed. We must not take being tired for granted.
Dr Shuvendu Sen, born and brought up in Kolkata, is a US-based physician currently serving as the vice-chair, Research, at the Jersey Shore University Medical Center, New Jersey. An award-winning physician and author, his works include The Fight Against Alzheimer’s (Rupa Publications, 2024), Why Buddha Never Had Alzheimer’s (HCI/ Simon & Schuster, 2017) and A Doctor's Diary (Times Group Books, 2014), among others. Dr Sen can be reached at shuvendusen57@gmail.com
