Chronic Fatigue and Breathing Issues: When to See a Specialist?

Chronic issues

Hello, doctor.
Recently, I have been experiencing long-term fatigue, lack of energy, excessive sleepiness, occasional shortness of breath, chest tightness, and poor memory (most notably over the past seven years).
Rest and sleep can alleviate the fatigue, but the relief does not last long.
My daily life and work are quite normal, with no significant stress and no insomnia, getting about 6 to 7 hours of sleep, and no noticeable weight changes.
I have had blood tests done, and my blood sugar, thyroid function, and liver function are all normal, with no hepatitis B.
I use a ventilator for sleep apnea, which only helps with morning dizziness, but the symptoms persist.
During a health checkup, the doctor mentioned that my creatinine level is 1.0 and I have trace amounts of protein in my urine (20 mg+/-, which has been ongoing for about 20 years), and further kidney function tests are needed.
I wonder if this could be an autoimmune issue, and should I consult an immunologist?

wei, 40~49 year old female. Ask Date: 2015/04/10

Dr. Chen Bozhang reply Family Medicine

Dear Mr.
Wei,
In your letter, you mentioned that you have been experiencing long-term fatigue, lack of energy, excessive sleepiness, occasional shortness of breath, chest tightness, and poor memory.
You also have issues with sleep apnea and have used a ventilator.
I recommend discussing with the physician who evaluated your sleep apnea whether this hypoxic condition is contributing to your chronic fatigue and excessive sleepiness.
If so, more effective treatment options may be considered.
Additionally, your symptoms involve multiple systems and have persisted for a long time.
I suggest consulting with a family medicine or general internal medicine physician to thoroughly discuss potential underlying causes.
Each individual's physical and mental background is different, and the same symptoms may have various contributing factors, making it difficult to generalize.
Lastly, your creatinine level of 1.0 is within the normal range, and the proteinuria is minimal.
Further evaluation of your kidneys may be warranted, and you can directly consult a nephrologist for this.
The minimal proteinuria is theoretically not directly related to your long-term fatigue and excessive sleepiness.
I hope this information is helpful for you.

Reply Date: 2015/04/10

More Info

Based on your symptoms and medical history, it appears that you are experiencing a complex interplay of chronic fatigue, breathing difficulties, and other systemic issues. Given the duration and nature of your symptoms, it is crucial to approach this situation methodically.

Chronic fatigue syndrome (CFS) is a condition characterized by extreme fatigue that doesn't improve with rest and may worsen with physical or mental activity. It can be accompanied by a variety of symptoms, including sleep disturbances, cognitive difficulties, and muscle pain. Your description of fatigue, sleepiness, and memory issues aligns with this condition. However, it is essential to rule out other potential causes of your symptoms, especially since you have a history of breathing issues and have undergone various tests that returned normal results.

The fact that you have normal blood tests for blood sugar, thyroid function, and liver function is reassuring, but the presence of microalbuminuria (20 mg+/−) over the past 20 years suggests that there may be an underlying kidney issue that needs further investigation. Kidney function can significantly impact overall health and energy levels, and it is wise to follow up on this with a nephrologist. They can assess your kidney function more thoroughly and determine if there is any underlying pathology contributing to your symptoms.

Your breathing difficulties, particularly the sensation of not being able to breathe properly, could be related to several factors. Given your history of sleep apnea and the use of a CPAP machine, it is possible that your sleep quality is still compromised, leading to daytime fatigue and cognitive issues. Sleep apnea can cause significant disruptions in sleep architecture, leading to non-restorative sleep and chronic fatigue. It would be beneficial to have a sleep study conducted to evaluate the effectiveness of your current treatment and to rule out any other sleep disorders.

Additionally, your symptoms could be exacerbated by anxiety or stress, even if you feel that your life is relatively normal and without significant pressure. Anxiety can manifest physically, leading to symptoms such as chest tightness, difficulty breathing, and fatigue. It may be worthwhile to explore this aspect with a mental health professional, particularly if you find that your symptoms worsen in stressful situations.

As for the autoimmune aspect, while your symptoms could suggest an autoimmune disorder, the presence of microalbuminuria alone does not confirm this. If you have concerns about autoimmune conditions, it would be prudent to consult with a rheumatologist or an immunologist. They can perform specific tests to evaluate for autoimmune markers and help determine if there is an underlying autoimmune process contributing to your fatigue and other symptoms.

In summary, I recommend the following steps:
1. Consult a Nephrologist: Given your long-standing microalbuminuria, it is essential to evaluate your kidney function and assess for any underlying kidney disease.

2. Follow Up on Sleep Issues: Consider a sleep study to evaluate the effectiveness of your CPAP therapy and to rule out other sleep disorders.

3. Explore Mental Health Support: If anxiety or stress is a concern, speaking with a mental health professional may provide strategies to manage these feelings and their physical manifestations.

4. Consider Autoimmune Evaluation: If you suspect an autoimmune issue, a consultation with a rheumatologist or immunologist may be warranted to explore this further.

By taking these steps, you can work towards a clearer understanding of your health and develop a comprehensive treatment plan that addresses your chronic fatigue and breathing difficulties. Remember, it is essential to communicate openly with your healthcare providers about all your symptoms and concerns to ensure a thorough evaluation and appropriate management.

Similar Q&A

Which Specialist to Consult for Suspected Chronic Fatigue Syndrome?

Hello Doctor: My symptoms are as follows: I experience intermittent fatigue, lethargy, and weakness several times a day, along with occasional brief episodes of dizziness and nausea. These symptoms occur sporadically throughout the day and are short-lived, resolving quickly. I do...

Dr. Chen Taicheng reply Family Medicine
Chronic Fatigue Syndrome is a diagnosis of exclusion; however, your own hyperlipidemia and long-term nasal congestion, post-nasal drip, allergic rhinitis, and gastroesophageal reflux could contribute to symptoms of chronic fatigue. Additionally, if there is a possibility of sleep...

Which Medical Specialty Should I Consult for Breathing and Fatigue Issues?

1. I often feel fatigued when breathing in my chest, and sometimes I experience chest tightness and difficulty breathing (a bit of shortness of breath). 2. When I engage in light exercise or physical work, my heart rate increases, and I feel uncomfortable and need to stop. 3. My ...

Dr. Lai Hexian reply Family Medicine
Hello, please visit a neurologist for an evaluation to determine if it is a midlife complication of poliomyelitis.

Understanding Chronic Fatigue: When to Seek Specialized Medical Help

Hello, Doctor. I am deeply troubled by fatigue. I have to spend a lot of time sleeping every day, and I feel very tired and want to sleep again right after waking up. This has severely affected my academic performance. However, after examinations, including liver function and thy...

Dr. Xu Ruihong reply Gastroenterology and Hepatology
There are many causes of fatigue, including both physiological and psychological issues. If a thorough examination by a physician reveals no physiological problems, it may be beneficial to consult a psychiatrist to explore any potential psychological issues. Engaging in regular e...

Understanding Breathing Difficulties: When to See a Specialist

Hello: For the past six months, I have been experiencing almost daily nasal congestion (which requires the use of sprays or medications for relief), occasional stiffness in my shoulders and neck, occasional dizziness, and a light-headed feeling. I have to breathe very deeply, and...

Dr. Ye Qianyu reply Family Medicine
Hello! It is recommended that you see an otolaryngologist.