Fatigue – WHY am I so tired?
Just thinking about fatigue can make me tired! There are so many aspects to this issue. People can mean so many different things when they use the word. Are they talking about muscle fatigue that happens when they have exercised beyond the limits of their muscle(s)? Do they mean brain fog and difficulty processing information at certain times or nearly all the time? Do they mean a lack of a sense of meaning or joy from activities that used to be meaningful to them?
Definitions of Fatigue
The American Heritage Dictionary of the English Language lists three definitions of fatigue (the noun), which are:
1) physical or mental weariness resulting from effort or activity,
2) something, such as tiring effort or activity, that causes tiredness or weariness, and
3) the decreased capacity or complete inability of an organism, organ, or part to function normally because of excessive stimulation or prolonged exertion.
Taber’s Cyclopedic Medical Dictionary defines fatigue as:
1) A feeling of tiredness or weariness resulting from continued activity or as a side effect of some psychotropic drug. This overwhelming sustained sense of exhaustion results in decreased capacity for physical and mental work.
2) The condition of an organ or tissue in which its response to stimulation is reduced or lost as a result of overactivity.
3) To bring about fatigue (when the word is a verb)
The medical definition from Taber is closer to what I think polio survivors mean when they talk about exhaustion.
Causes of Fatigue
There can also be so-o-o many causes for a feeling of fatigue - separate from, or in addition, to one’s prior history of polio and whatever damage the polio might have caused. The website for the Mayo Clinic (www.mayoclinic.org) lists 27 conditions that (can) be the basis for your feeling this way! These other conditions, if present, can be the sole reason that one is fatigued or there can be more than one thing causing this feeling of exhaustion. When these conditions are added together, it can be truly tiresome.
It makes sense that if one is not getting restorative sleep, they will be tired the next day. Causes of non-restorative sleep can include untreated sleep apneas, restless legs, the need for frequent trips to the bathroom during the night, depression, and difficulty getting to sleep or maintaining sleep.
Unrelated to poor sleep is an even longer list of conditions that can be responsible for fatigue including severe liver, kidney, heart or lung diseases, various causes of anemia, many cancers or the effects of chemotherapy or radiation used to treat them, auto-immune diseases such as rheumatoid arthritis or inflammatory bowel conditions, an underactive or overactive thyroid gland, uncontrolled blood sugar, a number of medications (pain meds especially opioids, some heart and blood pressure drugs, antihistamines, and meds for anxiety, depression, and other mental health issues), and miscellaneous conditions as diverse as chronic fatigue syndrome, long COVID, fibromyalgia, post-concussion syndrome, multiple sclerosis, and grief.
Treatment Options for Fatigue
It is important to rule out and/or treat conditions that could be causing or contributing to a person’s feeling of being overtired. Depending upon the cause of your fatigue, the treatments can vary and will be different than the treatment recommended for fatigue due to post-polio syndrome (PPS).
Note: Your physician can treat these causes simultaneously while the individual is enacting the measures recommended for post-polio fatigue.
Several medications to treat PPS fatigue have been researched. Several had significant side effects and, to date, none have been found to be any more effective than lifestyle changes. It would be wonderful if there were medications that decreased or eliminated post-polio fatigue but two years later, as I update my original 2022 article, that is still NOT the case.
The measures that have been found to be helpful are pacing activities, taking rest breaks, and a careful assessment of one’s activities and using that information to modify one’s activities. Once again, I have attached an activity diary (fatigue log) with this article that was developed by the International Centre for Polio Education for use in their clinic.
To cover the kind of detail that is needed to get a “full picture”, this diary/log will be a multi-page exercise. (I understand that this is a tedious undertaking, but one that is, without question, worthwhile). During the period that the data is being recorded, recordings of activity should be made at least once an hour. It is easy to “forget” or negate some activities that you may just take for granted if you wait until the end of the day to write them down.
After completion of a carefully done, brutally honest activity diary, some polio survivors will be able to self-identify areas where they need to make changes. I imagine that the majority will benefit from going over the results with someone who can be much more objective. That person might be a trusted friend, a spouse, or a professional such as a physical or occupational therapist.
Intermittent Fatigue
What if you don’t have daily fatigue or maybe even not what you’d call “exhaustion”? Polio-related fatigue may still affect you and can lead to falls and injuries if you don’t pay attention and alter your behavior.
Many of us have soldiered on and pushed through for much of our lives. We have ignored the messages coming from our bodies sometimes to the point of totally blocking those messages. Similar to telling a child or pet “just a minute”, we have told our bodies “just a minute”. But how often was that really only a minute (60 seconds) instead of 10-15 minutes or even more? Sometimes we could persevere without any apparent ill effects other than temporary “tiredness”, but that might no longer be true.
Have you become aware that after a certain amount of activity you are much more clumsy than usual and/or are more likely to fall? Often family members or friends recognize when we are “overdoing” long before we do. Does your spouse tell you to stop and rest when you are doing some tasks, or they step in and take over? They have recognized the signs that you are getting fatigued. Pay attention to the same clues that those who care about you notice. If you can’t identify those cues yourself, ask your loved ones what they see that leads them to “catch” you and then start watching for those signs yourself.
When you feel those signals, it is time to stop and make a mental note of what those signals are for you. You may not even be aware that you feel anything, but you may hear your loved one’s voice in your head saying, “Don’t you think you’ve done enough for now?” The goal is to internalize these signals and wrap things up quickly or stop and come back later. With practice you’ll learn what your limits are or how to recognize that your body is telling you, “Enough”. If you are “tone-deaf” to your body, you can set a timer when starting any activity and stop when the timer goes off. It may be hard to believe but you actually can get more done by pausing to rest and then getting back to work than if you push through when fatigue has set in!
In his article A Message About Winter Wellness and Energy Conservation, Dr. DeMayo used the holidays as an example perhaps because it intensely highlights the choices we can make about activities that may be adding up to make us tired, fatigued, weary to the bone. Discovering what your triggers are will not be easy, nor quick. There may be a few “aha” moments along the way, but mostly it will be a series of small insights and steps that add up to decreasing your fatigue while still allowing you to get enjoyment out of your life.
The act of conscientiously filling out the activity diary/ fatigue log will be challenging. Simply sitting down once every hour to list the activities that you did in the last hour and how hard it was to do those activities may lessen your exhaustion by forcing you to take a physical rest break every hour.
Countless polio survivors who have completed the activity diary worksheets and then modified their lives continue having enjoyable and meaningful lives. Polio survivors are creative beings who learned to walk when doctors said they would never walk or discovered they could breathe on their own by using a technique such as “frog breathing” that even the medical community did not know about. You can do this too!
Maybe you will even develop some tips and techniques that you can share with others to help them make their lives better too.
If you made these adjustments, were doing reasonably well and now the exhaustion has returned:
It is time to have a medical re-evaluation especially checking your blood chemistries and thyroid, because you may have developed new medical problems since the last time you were checked.
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