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My Dr. tends to pull out all the stops when I complain about something. I know that sounds good, but I'm struggling to pay off debt and even though I have good insurance, the co-pays throw my budget out of whack.

I have been feeling fatigued for some time. I mean I go home from work and want to lie down for a nap before supper. And one day last week I just could not keep my head up so I went home and slept all day and all night. The next day I was refreshed.

I have also been having some return of depressed feelings. Nothing too serious, but enough to make me wonder if I need my ADs adjusted - been on the same one and the same dosage for 15 years now.

Well my Dr. has ordered a battery of tests - he thinks he may feel a goiter in my neck - I can't tell what the hell he is talking about - it looks and feels fine to me. He ordered a sonogram of my thyroid. He also wants me to do a sleep test with some sort of device that I take home that monitors my oxygen levels while I sleep. Then he set me up with a new IC because the one I used during my D has retired. Oh, and of course the usual blood tests.

I would think he would do the blood work first and then proceed if something seems off. All I can see is all the bills coming in for these procedures. And I'm not at all happy about talking to a NEW IC. The person he's referring me to is a Psychologist so he can't prescribe meds anyway. What is the point of that?

I wish I hadn't said anything at all. Naps are a good thing, right?

NL

Naps are a good thing. However if your tired all the time or you are now tired after doing the usual activities. Then something has changed. It's time to find out what has changed.

But why the blitz? Wouldn't you start with blood work and go from there? It just feels like so much testing on a lot of different fronts.

NL

The kinda fatigue you are describing is not just needing a nap.

I was going to mention that you may need your thyroid tested because it could be under active (hypothyroidism).

I was also gonna mention sleep apnea and getting a sleep study. They will have you sleep overnight in a clinic setting with wires all over your head and body to monitor your oxygen levels and also count how much you snore and stop breathing in the night. Maybe not the most comfortable sleep you'll ever have but it's not really painful. They will watch you thru close circuit cameras and audio too.

If your thyroid is under active you'll probably only have to take medicine for that.

If it's sleep apnea they may recommend cpap therapy which is a machine w/ a hose and mask that will continuously pump air into you to keep your airways open and keep you breathing thru the night.

I have under active thyroid and used to have sleep apnea which I overcame by losing weight (100 lbs).

Good luck. PM me if you have any questions.

And one day last week I just could not keep my head up so I went home and slept all day and all night. The next day I was refreshed.

This was me for months...I have hypothyroidism. Now that i am on meds i can function and get through my day much better.

You as the patient can slow things down. Do not be afraid to tell the doctor "look, I don't have a lot of money to throw at this thing, can we just take it one test at a time?" (to which I would suggest the Thyroid test first)

He may not even realize you are having a hard time with the bills at this point and is just trying to treat you as well as he can.

Dr's that do this annoy me. They throw everything at the issue and see what sticks. It's an easy way to figure out what's wrong without spending time asking more in depth questions, and assessing the situation.

Having trouble sleeping? Oh well lets do a sleep study. Feeling tired? Yup I thinki I feel a goiter, better get and ultrasound of that.

Ok so if your sleep is of poor quality or not enough you are going to be consistently tired.

Did he run through these questions

Do you snore?

When you wake do you feel rested?

Do you have jumpiness when you sleep?

Do you ever wake up gasping?

Do you wake up frequently during the night?

How many hours a night do you sleep?

Do you nap every day?

This assessment gives me an idea of what's going on, and then I can decide based on this, and other things like weight gain/loss, body habitus, family history if it truly is a sleep study time, or if you just need to clean up your sleep hygiene.

Thyroid levels should be checked, and again look at weight gain/loss, increase/decrease in body hair. Hot or Cold all the time? These all indicate if there is thyroid issue. The Ultrasound may or may not be expensive depending on what your insurance plan is. Some cover them well others not so much.

I would start with the lab work and see what the results are. I would also look into the ultrasound, if you do have a goiter, then it should be taken care of before you have serious problems. Thyroid cancers are common in women in their 30-40's. They are also cureable, so don't panic.

Tell your Dr frankly about your concerns of costs. Some of them just don't get it, until you say wait a second. This is going to cost me money I don't have.

If you think you need meds with psych then obviously go to the appropriate person, many do not do both anymore though, therapy and meds. If your PCP is adept and knowing meds, and comfortable ordering them maybe a therapist is all you need. I do agree that the same AD and same AD dose for 15 years is probably not effectively treating your depression. Does your PCP do a yearly depression screening?

PM me if you want some other ideas.

All of the testing seems reasonable to me, but agree that if you can't fit the co-pays in your budget right now, then do the thyroid blood tests first. If he is feeling a goiter, it may not be a bad idea to get the ultrasound regardless of the thyroid test results.

So then it's the sleep study and the psychologist. If you are feeling more depressed and your PCP is comfortable adjusting your ADs in the context of being seen by a psychologist, then other than your co-pay issues, this seems reasonable to me.

The sleep questions tushnurse asks are good ones, but sometimes people still don't realize whether they snore, etc.

Basically- thyroid dysfunction, sleep apnea and depression are three big reasons why people feel fatigued. I think all the tests your doc ordered are appropriate, but just talk to him about how to move forward given your tight budget.

I would make your doc aware of your financial concerns and try to request that your doctor perform a test for TSH first. Some doctors like to run a T3 and T4 at the same time to get a complete picture.

I SO feel your pain. I'm going through a sort of similar situation right now. I was diagnosed with hypothyroidism several years ago and my doc was very thoroughly monitoring other things as well. The thyroid needs to be rechecked every 6 months. But he insisted on an annual physical which would end up costing me well over $100 in copays after labs/office visit, etc. Then I'd turn around and about spend that at my 6 mo checkup, which was just supposed to be for thyroid recheck. That on top of 12 $10 synthroid prescription copays... it adds up.

If your doctor suspects a thyroid issue, please don't put it off. I've been off my meds for over a month (been trying to switch docs to cut costs) and ran out of meds. Have an appt next Tues with an endocrinologist. My levels are suuuupperrrrr high. It's got my hormones all out of whack, anxiety out the wazoo. Issues with insomnia. Fatigue. Heart palpitations. A little depression. Weight gain. Foggy head feeling. Blech. No nodules or goiter on the thyroid though, thank goodness.

(((Newlease)))

Thanks for all the responses and suggestions. I usually get about 8 hours of sleep a night. I never wake up energized, but usually can tell how I'm going to be about an hour after rising. Most days I feel good, but a lot of days I spend in a fog.

I usually have a big slump of feeling extremely tired mid-afternoon and that lasts until I go to bed. I don't snore a lot. Some nights I make a lot of bathroom visits, sometimes I wake up having not moved. I dream a lot and most times remember my dreams.

My feet and hands are cold all the time, even in the summer. I can't wear sandals to work because my feet freeze in the air conditioning.

I have lost about 17 lbs recently due to better eating and some exercise. However it is more and more difficult for me to exercise because I'm so damn tired all the time. And when I do force myself to exercise, it doesn't energize me like it used to.

I went yesterday for blood work, urine test, and a sonogram on my thyroid. I haven't scheduled the sleep test yet and I have an appt. with the psychologist at the end of this month. I think my PCP doesn't want to mess with my ADs until I talk with someone who might make recommendations.

I'm going to resist the sleep test until the thyroid issues are resolved one way or the other.

THANKS again! You guys are the best and help me feel like I'm not TOTALLY crazy. Just the regular amount.

NL

Just got a call from the Dr. office - blood work fine - ultrasound good. No thyroid problems. Guess I'll move on to the sleep study, but I really think it will be fine also. Crap. Now I feel like I should just "Snap out of it!"

NL

The kinda fatigue you're describing doesn't get "snapped" out of

From what you describe about waking often to use bathroom and remembering dreams and waking not feeling rested, I'm gonna bet that they find sleep apnea. Sounds very similar to my situation when I was diagnosed.

I would venture to guess that this is probably not a sleep issue, and has more to do with menopause, and hormone levels, and a need for switching up the AD's.

Personally I would ask your PCP if you can try a different AD. Most of them are willing to make adjustments and try different ones at the request of the patient. It is not uncommon, and should be expected of them to have some knowledge and ability to treat depression and anxiety. (If not get a new Dr).

You described the same kind of fatigue I was experiencing a couple of years ago. It drove me crazy to be an otherwise healthy person who felt excessively tired every day. The fatigue was interfering with my life, so I realized I needed to figure it out.

Do you have any other symptoms or issues? Even ones that don't seem related?

Mine was caused by a few different factors and took some time to figure out. I have some chronic back issues and the pain caused me to toss and turn all night. As a result, I never got into deep, restorative sleep. I improved some of it (better pillows, mattress, etc), but was still exhausted.

I was also experiencing some relatively minor stomach issues. I chalked them up to a sensitive stomach and food allergies. I've always had a sensitive stomach so it wasn't anything new. It turned out (from blood work) that I was suspected as having h. pylori (results were inconclusive). The Dr. tested for it after I mentioned having minor stomach upset in passing during a physical.

Thank goodness she tested and treated it, because I was likely fighting an infection and not absorbing all of the nutrients from my food. That was probably the real cause of my fatigue and I had completely dismissed the symptoms.

My energy levels went back to normal a few weeks after finishing treatment. It was really surprising, but made a world of difference for me. Good luck.

I wish I had a Dr that would listen to me... I say one thing, she hears something else...

I'm glad you got good news on the thyroid blood work but I know the not having concrete answers right now sucks. I hope you find a cause soon, that that cause is nothing major, and start to feel better!

(((Newlease)))

You could have my mom's Dr who acts like every test comes out of his personal pocket. We never get to the bottom of anything.

Last year I went for a sleep study and have sleep apnea. I sleep with a CPAP machine and feel SO MUCH better and rested. I've been falling asleep the past 2 weeks without it, and I can feel a difference. I hope they can figure it out for you.