What doctor should husband see next?

[gcvmom]

I'm trying to figure out who husband should see next about his chronic fatigue. Not every day is bad, but there are weeks where it's all he can do to get through the day without a nap.

Here's what we know:

He's using a cpap/bipap thingy and to my knowledge is not snoring anymore. He's thinking he needs to go back for another sleep study because he doesn't wake up feeling refreshed. Oh, and he's also taking melatonin to see if that helps him sleep better. Apparently it's not doing much. He also takes a multivitamin and extra B vitamins.

He's gained about 60 pounds in the past three years, which I'm sure contributes to the problem. He takes a statin and a cholesterol medication -- not sure if those contribute to fatigue.

He takes seizure medications and Paxil, which we know can cause sedation, and although his docs have had him change the dosing schedule to see if that will lessen the sleepiness, it hasn't helped as much as he'd hoped.

psychiatrist added a low dose of Nuvigil, and that has helped him with better alertness in the mornings for work. But there are still some days when he feels like he's crashing.

He drives 100 miles a day to and from work in heavy traffic, so that's a contributing factor.

He's under a lot of stress at work, even though he loves his job, and I'm sure that takes it's toll.

And he eats a lot of fast food, which, with all that fat content is not the best thing for feeling alert -- I've advised him to try eating a lower fat, lower carb, higher protein diet, but does he? Nope. He also drinks a LOT of caffeinated diet soda.

He's going back in for bloodwork on the lipid medications and to check his glucose next week, and he has a psychiatrist and neuro appointment the week after that. Any ideas on what we should be pushing for? Maybe a CBC... a new sleep study... ???

 

[HaoZi]

A nutritionist? A way to get his cholesterol levels down through foods will help a lot of problems.
Have his testosterone levels been checked?

 

[Mattsmom277]

I would think maybe an endocronologist? I do believe with sleep apnea that even if the snoring is eliminated etc it can be a struggle and cause fatigue issues. Yet there are so many causes of chronic fatigue. Since he's carrying extra weight as well, a good regiment to start the morning can help so much come bed time. I'd say perhaps some level of physical activity soon after waking each morning can help boost endorphins etc to kick start his day. And so many people overlook a solid night time pre-sleep routine of relaxation and slowing down of stimulation to allow for a easy transition to sleep. Melatonin is also a natural and helpful sleep aid. Would he take supplements like that? B12 can cause fatigue if it is depleted as can vitamin D etc. A good multi vitamin, daily sunshine and some exercise and a good transition to sleep time in evenings might make a big difference for him while he looks for ideas of the cause of this. So sorry he's coping with fatigue issues. I think fatigue can be more debilitating in my life at times than chronic pain, spasms, vision problems, bladder problems etc combined. It's a vicious life stealer it is. I wish him the best of luck!

 

[nvts]

Hey! I would think that there are so many contributing factors that studies aren't going to make much of a difference. I think they're going to have to pick a regimin and work with it. He needs to get off the caffeine and the fast food - once he does that, he may be able to get off the statin drugs.

Has he had his thyroid checked? They're finding that if he's very low on the scale BEFORE you hit the "medication number" it can be wise to start a medication protocol anyway (which could be quite possible with the tireds and the weight gain).

Otherwise, I'd look into an endocrinologist too!

Chronic fatigue is miserable - I can testify - I've been tired for 13 years!

Beth

 

[gcvmom]

LOL -- Haozi, I wish he'd see one. He's the kind of person who is impatient and wants a quick fix, who eats emotionally and who does not do well if he feels "deprived." I went out and bought some "healthy" frozen dinners for him to try for nights like tonight when he's getting home late (it's 7:30pm and he just called to say he's about a half hour away still). Plus I got some ready-made low calorie, high protein salads for him to take for lunch. We'll see if this is even something he'll consider for the next few days. It's like he wants someone to tell him what to do and set everything up for him, but he doesn't want to give up a lot of the things that are contributing to his problems.

Mattsmom, he IS taking melatonin, a multivitamin AND extra B vitamins. I've tried to get him to go walking with me (we live on a hill, so just a trip to the end of our street and back up would be a great start), but he's not motivated yet. I sure hope it doesn't take a heart attack or a stroke to get it through his head that he needs to do something...

Beth, I'm not sure if his thyroid's been checked, much less his testosterone. When he goes in next week I'll remind him to ask about that.

 

[HaoZi]

Ummm... maybe a local pathologist will let him watch an autopsy so he can get a really good look at what's happening when he eats like that?

 

[susiestar]

His reg doctor can do the thyroid check but be sure they do the test that shows if your body is attacking the thyroid, not just the thyroid levels. Has his testosterone been checked? Even slightly low levels can cause a lot of fatigue AND symptoms of depression. Again his reg doctor can check this. It is easy to boost testosterone because the medication is a gel sold in premeasured packets or a pump that gives a certain amount with each pump. MUCH easier on the stomach than estrogen and/or progesterone were on me! The testosterone does have to be rewritten every so many months (I think every time a refill is needed) because it is often abused by those who want to bulk up or boost sports performance.

An endocrinologist would be a very good doctor to see. Does he have any symptoms of diabetes and has the A1C test been done (tells you your likelihood of getting diabetes I think)? The kids I know at school who have diabetes all struggle with fatigue.

A nutritionist would also be very helpful. If you want to help him boost alertness, fitness, mental acuity, etc.... have him try the Zone Diet by Dr. Sears. It is not specifically a diet, more a way of life where you work to balance protein, carb and fat in each meal/snack. It does amazing things and I know a LOT of people that it helped. My mother has a liver condition that all the docs and research say can NOT improve once damage has started. Hers showed signs of major healing after 18 mos following the ideas behind the Zone diet and lowering her stress. You aim for 30% fat, 30% protein and 40 % carbs. The various Zone books have recipes and even tell you things to order when you go out to eat. Egg McMuffins are high on fat but otherwise work very well. I know my mom buys protein powder and mixes it with either coffee or juice in the morning and it makes a HUGE difference - she isn't NEARLY as witchy as she was before she started. But if she misses a morning it really shows.

They have some strange recipes, but many are real world things. LIke go ahead and have the candy you crave - pair half a snickers with 2 oz lean deli meat for a snack. They also have bars that they sell that are actually good tasting. The balance bars also fit this. A group of us at a bank I worked in all did this at once and our boss (who didn't join us) was astonished - the quality and amount of work we did went up significantly and the errors we made went down even more. We also didn't gritch as much about anything AND we lost weight! It is quite do-able and maybe if you help your husband see some choices that would fit a plan like this, and help him work out meals he would like and could pack for lunch at work, then he would try it.

 

[gcvmom]

I am worried about diabetes in him since his dad developed it in his 60s and his older sister developed it in her 40s. Both his grandmothers had it, too. So he's pretty much guaranteed to end up that way if he doesn't make some changes soon. I think his last glucose was borderline. I'll be interested to see how it is when he goes in next week for the fasting test.

 

[DammitJanet]

Well you know I have fibro and the fatigue that goes with it not to mention the absolute boatload of medications Im on that just have "may cause sedation" on every single label, so I really do feel his pain. Its a struggle for me to be awake during the day but at night when I should be sleeping considering thats when I take most of my medications (including sleeping pills and XanaxER) Im wide awake and alert...go figure!

After reading your thread though several things jumped out at me...what medications is he on? Is the MS sedating? Can he be switched to one that is not? Lamictal does not sedate me and neither does topamax. Some folks say that topamax causes problems but not for me.

I take lovastatin. If its causing any issues, I dont know about them and I take it in the morning. I found out that my cholesterol and my thyroid were bad sometime last fall. I am like 95% sure the cholesterol went through the roof due to seroquel because prior to starting it, I had my levels done regularly and while it wasnt wonderful at 210, this last time it was 375. You dont stay steady for years at right around 200 and then suddenly jump a 175 points without a reason.

They also found out that my thyroid was slightly low. I was exhausted, hair falling out, dry skin, gaining weight like crazy, moodier, etc. They gave me synthroid and my hair started growing in again. My skin is still a bit dry but I have lost 10 pounds without trying.

Now my diet stinks and I drink diet coke by the gallon. The only exercise I get is chasing Keyana. I did start saphris the other day and I have noticed that I am now getting up a tiny bit earlier. I think it is actually more activating than what they say it is.

 

[gcvmom]

Janet, he's on Trileptal. He tried Lamictal, and while it did okay for seizure control and mood stabilization, he got a rash so the neuro made him stop taking it. He still gets seizures, even on Trileptal, but these aren't the typical convulsive type. Only he knows he's having one.

He also takes Simvastatin, Trilipix. His cholesterol numbers are much better since he's been on this combo.

I'm wondering now if he's in the early stages of diabetes. He complained tonight that his eyes have been bugging him lately, that things are harder to see close up suddenly. He just had his vision checked last month (that's how we found out he has glaucoma) and his accuity was fine. He drinks a lot of diet soda all day long, so I don't know if it's because he's thirsty or just craving the caffeine. And because he drinks a lot, he has to pee a lot, so who knows if that's got anything to do with the diabetic urinary problems they talk about.

He gets virtually no aerobic exercise at all these days. He sits in the car for 3 to 4 hours a day, and sits at his desk the other 8 to 10 hours. On the weekends, all he wants to do now is sleep in until 10am or later! At night, he unwinds by playing spider solitaire for hours and watches TV. All in all, a recipe for pretty crummy health.

He needs to get a job closer to home so he has time to take better care of himself!

 

[Hound dog]

Ok I'm going to be really unpopular. It's most likely his diet and the fact that he is overweight. The paxil is playing a secondary role by making it worse as is stress and the fact he is on the road so much.

Fast food is not only full of fats and carbs, it's chuck full of salt, which causes you to retain fluids even if it's not necessarily noticeable. Due to his work hrs ect I doubt he's getting much exercise. Physical exercise actually gives a person energy. I used to doubt that until I found it out for myself. lol And drinking in all that caffiene plays havoc with blood sugar, believe it or not.

If he could at the very least cut his fast food consumption down to half and increase his physical exercise he would probably begin to feel better......and maybe that would cause a spiral effect where he would cut down on the junk food and increase the exercise more.

I know it's not so easy to do. Always easier said than done. But often it's not something mysterious causing fatigue.......it's just something simple that needs to be changed. You've done cpap, vitamins, and adjusted medications........I'd say work on diet/exercise before paying another doctor bill.

Hugs

 

[gcvmom]

HD, what you're suggesting is pure common sense And yes, that's not something he usually wants to hear. Maybe if the doctor tells him to do X, then he'll listen. Because of course, anything I suggest is just me trying to nag or control him, right?

Normally, I don't say much at all about his health problems or choices unless he brings it up and starts complaining and asking me what I think. It is very tempting to interject my opinion when we're dining out and I'm looking at what he orders or how much he eats. But he and I approach food differently. For example, when we go out to eat, he picks an item based on whether or not he likes how it tastes. He doesn't look at price or nutritional values at all. If we got to a buffet, he loads up his plate, goes back for seconds, thirds, fourths, dessert, more dessert, etc. Then there's me: I look first at the price, then at the relative healthiness, and FINALLY whether or not I'll like the taste! At buffets, I'm usually finished after one, maybe two sensible trips and get to sit there while he chides me "Is that all you're eating?" A lot of it has to do with how he grew up with food. His family is very much a bunch of emotional eaters, and whenever comfort foods are handy at family gatherings, they load up their plates like they're getting ready to hibernate for the winter. I have emotional eating, too, but it tends to be more in the form of snacking when I'm anxious.

I guess we'll know more after the bloodwork next week -- maybe the doctor will finally call it like it is and tell him specifically what he needs to do.

 

[Hound dog]

Oh I so get the "nagging and controlling" thing with husband too. lol

All I hear anymore is how awful he feels. And yeah, I don't doubt he's not feeling great. He comes down in the mornings, lights a cigarette, opens a can of coke, parks his fanny on the loveseat in front of the computer and tv and does not move except to get up and fix himself 4 sandwiches at noonish.........in between having more cokes and snaking on 10 slices of american cheese at once. All the while chain smoking. At dinner.......he eats enough for 2 people, this has decreased from eating enough for 4 people when I threw a major hissy fit. lol More cheese to snack on after dinner.......and maybe more sandwiches if he can sneak it in.

He's horribly overweight and continues to pack on the pounds. He chain smokes at least 4 packs a day. His b/p is through the roof and he's not medicated due to no insurance.........and no doctor because he refused to go to mine. He does not MOVE except when I force him to take the dogs out, going out to occasionally pay a bill, or run to the store........because I won't go so he HAS to move. ugh

Well, gee.......... I wonder why you feel like crud?? omg lol He has all the symptoms of congestive heart failure. When he complains I tell him point blank why he feels the way he does. And yeah I'm nagging ect ugh Don't care. I tell him he needs to stop pretending to be a 90 yr old man stuffed in a 62 yr old's body. lol I can't control his behavior, but I won't give him sympathy and find it even hard to drum up empathy.

His over eating is why there are rarely any snack foods or sweets in the house. Don't even get me started on when we go out to eat!

 

[HaoZi]

Can you call his doctor and have the doctor suggest he see a nutritionist or something without the doctor telling him you called about it?

 

[susiestar]

I hope the doctor tells him like it is. The zone diet that I suggested takes agreement, but you can learn to follow it and eat out pretty easily. It is one reason I suggested it. The bars actually taste pretty good and I HATE anything that remotely tastes like health food. Always have. My kids will pick a zone or balance bar over a candy bar most of the time if they have a choice - and they are not big into health food either.

Is there any way you could give husband incentives to walk up and down stairs in his office building?My husband lost a bunch of weight when he would do this. He even worked up from 5-6 flights per day to 50 flights. Not all at once, but every couple of hours he would take 20 mins and go do the stairs. It made a BIG difference in his energy levels.

The nagging stinks, but if he isn't going to take care of himself he won't feel good. You can refuse to listen when he whines and complains unless he is taking steps to get healthier. My mom used to do this with my dad when he had leg cramps. If he was wearing cheap shoes or old shoes then she wouldn't rub them when they hurt. Not until he got and wore good shoes because they made such a huge difference for him.

She would walk away, pretend he wasn't talking, change the subject and even ask him to go take out the trash or do another small chore. Eventually he would clue in to why she wasn't listening to him. maybe this would work with your husband.

Maybe some of the techniques from Love and Logic Parenting would help? maybe his health complaints shoudl drain all the energy out of you so you cannot do his laundry or make dinner or whatever. Soemtiems we have to use these on our husband's because it is like someone said on another thread - Some teen boys grow up to be men.... The rest just look like men. It was one of us warrior moms, but I forget which ones.

 

[gcvmom]

HaoZi, if the timing of his appointment were better, I could go with him, and he does ask me to go with him sometimes because he knows he doesn't remember to ask everything, but I have to drive difficult child 2 and our carpooler to school then. I might just give him a list of questions to ask... he's been cooperative that way before.

Susie, yes, there are certain (ahem) incentives he would LOVE me to offer him, but it's beyond my ability right now, lol! And that is truly the only thing I think he would respond to. But what he wants and what I can give are very hard to reconcile on a regular basis. He really has to want to do this for himself. Yes, it's part of him growing up to be a man My BFF once told me that she firmly believed most men don't finish maturing until they hit 50. That's been the trajectory he's on since I've known him! So I guess two more years until he's "perfect"!

 

[DammitJanet]

I used to be able to eat that way at buffets but no longer. I can get a little bit on a plate...eat that...maybe if there is something that I especially like say if we go to a seafood buffet and there are scallops or oysters, then I might go back for seconds of them but at a regular buffet I am doing good to actually get down a normal dinner plate. I will only eat dessert at a buffet if they have bread pudding because I only make it at home maybe once a year. Or once in a blue moon I get a meringue pie and just eat the meringue. Im funny that way. I dont get my moneys worth at a buffet.

Im a snacker. Especially at night. I can go all day not eating a darned thing but let it get 10 or later and I have to snack.

Oh...and I wanted to add this...

About him drinking so much diet soda and having to pee a lot. When Tony drinks a lot of diet coke (and he does), he has to pee a bunch, his urgency is really bad and he can get back pain more often. If he cuts down on the soda, this goes away. Now it doesnt do this to me so dont know. I think if I was Tony I would drink something else...lol. But hey...I dont force him to drink it...lol. He does drink tea when we go out and I have offered to make iced tea here at home but Im not gonna argue the issue.

 

[GoingNorth]

Janet. Aspartame has the same effect on me that it does on Tony: makes me pee a LOT. I still stick to diet (caffeine free) coke for the calorie savings (and like you, the sugared stuff tastes awful), and because caffeine and I do not get along well at all other than maybe a cup or two of tea or coffee in the AM.

 

[Marguerite]

An endocrinologist would be a good specialist over all and would also nag about weight loss. Or a gastroenterologist - that's what helped me lose the weight. But the trigger for me was really bad liver function tests.

I also agree, getting his testosterone checked, plus thyroid plus fasting glucose/fasting insulin would be valuable. But it would take a specialist to nag him about the results.

Marg