Monday, Aug. 23, 1999

Sick and Tired?

By Christine Gorman

You know you're exhausted when you put the newspaper in the refrigerator and pour orange juice in your cereal, as I did once after a series of trying late-night deadlines. But sometimes being tired means there's something wrong with your body, not just your schedule. Three months after a friend of mine noticed she could no longer keep up with her husband on their morning walk, she was diagnosed with colon cancer. "I was lucky," she says. Her doctors removed the tumor, and 12 years later she is still free of cancer. "I realize now that the fatigue was the first sign that something was wrong," she says.

It's not only cancer that can be at the root of fatigue. The sense that you're run down all the time can signal a host of undetected ailments, from gum disease and sinus infection to anemia and multiple sclerosis. Not every ailment can be cured, but many can be treated.

The problem is, most of us don't take fatigue seriously enough to do anything more than complain about it to each other. Or we worry, sometimes with reason, that if the source of our malaise isn't obvious after a few blood tests, our physicians will consider us hypochondriacs and malingerers. One survey found that 25% of patients in doctors' offices were so tired that their condition interfered with their normal activities but that only half of them actually talked to their physician about it.

In an effort to alert people to the risk of ignoring unexplained fatigue, the American College of Physicians-American Society of Internal Medicine is launching an educational campaign this week that will highlight three of the more common medical causes: thyroid disorders, depression and sleep apnea (a condition often characterized by snoring). "Baby boomers especially want to blame everything on their environment--their jobs, their kids, the stress of living in the '90s," says Dr. Sandra Adamson Fryhofer, who has just been elected president of the organization. But, she adds, you have to be alert to other possibilities as well, particularly after age 40.

Although your situation may differ, here are some general signs that you're not just tired but sick too:

--Your exhaustion comes on suddenly and persists over a few weeks or months.

--You're worn out for no apparent reason for two or more weeks and have trouble keeping up your usual routine.

--Commonsense remedies, such as getting more sleep, going on vacation or cutting back on alcohol and caffeine, don't make you feel any better.

Most important, you need to find a medical professional who has the time and inclination to get to the bottom of your problem. "Fatigue is so common, many doctors treat it like background noise," says Dr. Benjamin Natelson, a neurosciences expert at the University of Medicine and Dentistry-New Jersey Medical School, in Newark, N.J., and the author of Facing and Fighting Fatigue (Yale University Press, $15.95). But even if your physician can't pinpoint a specific reason for your fatigue, there are ways to manage it. For instance, Natelson has found, somewhat to his surprise, that gentle conditioning exercises such as tai chi help some of his patients with chronic-fatigue syndrome. Similar results have been reported for folks being treated for cancer and long-term hepatitis infections. So don't assume fatigue is normal. You might be giving up your best chance for finding relief.

For more Web resources on fatigue and illness, visit time.com/personal You can e-mail Christine at gorman@time.com