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Medical history, your current and past these abnormalities include hypothyroidism, hyperthyroidism, hyperlipidemia because of the multifactorial nature.

16.06.2015

Fatigue meaning, causes of pulsatile tinnitus - For You

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Fatigue is sometimes referred to as asthenia, tiredness, lack of energy, weakness, and exhaustion. The causes of fatigue in an individual patient are often multiple, with many interrelated factors. In patients without cancer who present with fatigue, the final diagnosis is psychological (eg, depression, anxiety, and other psychological disorders) in almost 75% of patients.
Low red blood cell count related to advanced cancer or chemotherapy has been associated with fatigue, and its treatment results in improvement of fatigue and quality of life in these patients.
Administration of chemotherapy and radiotherapy for malignancy causes a specific fatigue syndrome.
The fourth category in Table 1 is the most relevant for both clinical management and clinical trials in fatigue. In addition to the assessment of the intensity of fatigue, the clinical assessment of these patients requires clinicians to determine the impact of all factors on the presence of fatigue. To treat fatigue optimally, it is vital to identify and prioritize the different underlying factors in the individual patient. In patients with cancer treatment–related fatigue, it is important to exclude specific causes, such as hypothyroidism, hypogonadism, and anemia, and to consider other potential adverse effects of treatment. Psychosocial interventions, such as CBT, have been found to be effective in improving cancer-related fatigue in cancer patients receiving treatment. Lots of employees feel very bad after a crisis (Economic Battle Fatigue): the morale needs to be improved rapidly. Fatigue is also commonly associated with cancer treatment and occurs in up to 90% of patients undergoing chemotherapy. In terminally ill patients with advanced cancer, treatment of anemia may not resolve fatigue adequately because of the multifactorial nature of its etiology. Autonomic failure has also been documented in patients with severe chronic fatigue syndrome.
The pattern of fatigue reported by patients with cancer who receive myelosuppressive chemotherapy is cyclical. Combined therapy with the two modalities appears to cause worse fatigue than does either modality given alone. In addition, commonly used medications, such as opioids and hypnotics, may cause sedation and fatigue.


There is agreement that self-assessment should be the “gold standard.” Because of the complex nature of the symptoms of fatigue, an effort to identify a set of diagnostic criteria similar to those for depression has been attempted. Visual analog scales, numerical scales, the Brief Fatigue Inventory (BFI), and the Piper Fatigue Self-Report Scale have been validated. There is substantial evidence that corticosteroids can reduce fatigue and other symptoms in cancer patients.
Psychostimulants (eg, methylphenidate, 5 to 10 mg in the morning and at noon or 5 mg as needed) may be useful in treating fatigue in patients with advanced cancer.
Based on a preliminary study that found significant improvement of cancer-related fatigue with a dose of 2,000 mg extract of ground root of American ginseng (Panax quinquefolius), Barton et al recently completed a double-blind trial of 2,000 mg of American ginseng vs placebo for 8 weeks in 364 fatigued cancer survivors. This fatigue can strike us all, but is more common in those who have trouble creating routines and regular habits. A recent randomized controlled trial by Montogomery et al found that the benefits of CBT on cancer-related fatigue lasted long after the CBT was finished. Moreover, different studies of fatigue and asthenia have looked at different outcomes, ranging from physical performance to the purely subjective sensation.
When injected into a rested subject, blood from a fatigued subject has produced manifestations of fatigue.
The metabolic abnormalities involved in the production of cachexia and the loss of muscle mass resulting from progressive cachexia may cause profound weakness and fatigue. Although the association between fatigue and autonomic dysfunction has not been established in cancer patients, it should be suspected in patients with severe postural hypotension or other signs of autonomic failure.
Fatigue has been noted to decrease in the first 2 weeks after localized treatment for breast cancer but then to increase as radiation therapy persists into week 4. This syndromal approach has been useful to assess the presence or absence of the clinical syndrome of fatigue. In most patients, the etiology of fatigue or dyspnea is multifactorial, with many contributing interrelated abnormalities. The host production of cytokines in response to the tumor can also have a direct fatigue-inducing effect. However, many abnormalities described in Figure 1 are capable of causing profound fatigue in the absence of significant weight loss. Patients with an adjustment disorder or a major depressive disorder can have fatigue as their most prevalent symptom.


Fatigue tends to worsen with subsequent cycles of chemotherapy, which suggests a cumulative dose-related toxic effect.
In one study of patients with advanced cancer, fatigue was found to be significantly correlated with the intensity of dyspnea.
Muscular or neuromuscular junction abnormalities are a possible cause of chemotherapy- or radiotherapy-induced fatigue.
Compared with women who have no history of cancer, former patients with breast cancer who had received adjuvant chemotherapy reported more fatigue and worse quality of life due to this symptom. It is impossible to be certain whether one of these identified problems is a major contributor to fatigue or simply a coexisting problem in a given patient. The results of this study showed that there was no significant improvement in fatigue in the methylphenidate group compared with the placebo group.
Therefore, it is of great importance to measure the intensity of fatigue and the patient’s performance before and after treating any contributing factor. In a recent double-blind placebo controlled study of 84 advanced cancer patients with fatigue, oral dexamethasone at a standard dose of 8 mg daily for 2 weeks was associated with significant improvement in cancer-related fatigue.
There was also no significant benefit from methylphenidate plus a nursing telephone intervention on cancer-related fatigue.
Counseling (more specifically, cognitive-behavioral therapy [CBT]) for stress management, depression, and anxiety may reduce distress and fatigue as well as improve mood.
If the level of fatigue does not improve after correction of these abnormalities, it is clear then that further treatment will not result in improvement in the future. A 148-patient study by Moraska et al also found no significant improvement in cancer-related fatigue with long-acting methylphenidate compared with placebo. Similar to the previous studies of Bruera et al and Moraska et al, fatigue improved among patients treated with modafinil but there was no significant difference between the active and placebo treatments.
Based on these results, future studies of psychostimulants should be focused on a specific patient group, such as fatigued patients with depression or drowsiness.



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