Depression in teenagers can be devastating, and it's more common than you think. Recommended options for treatment include Cognitive Behavioral Therapy, other forms of counseling, and anti-depressant medications. Some teens are quite reluctant to see a therapist, however, and medication isn't always enough.
A study was recently published in the British Medical Journal which evaluates the effectiveness of a video game ("Sparx") that teaches skills usually learned during cognitive behavioral therapy. These results are very interesting, as they demonstrate the video game was even more effective than therapy in alleviating symptoms of depression.
This is new, and not yet available to the general public. But it's exciting to think that we may soon have more options available to help depressed teenagers!
http://www.sparx.org.nz/
Showing posts with label common teenage illnesses. Show all posts
Showing posts with label common teenage illnesses. Show all posts
Thursday, May 31, 2012
Saturday, November 13, 2010
Hypoglycemia is a myth?
Parents worry their child might have hypoglycemia (or low blood sugar). They notice that when their child has not eaten for a while they get really mean and cranky. Or their teenager (who skips breakfast and lunch) becomes low on energy, possibly even feeling dizzy in the afternoon. Parents worry that this could mean their child has diabetes. It looks the same as when the child's diabetic grandparent seems "out of it" when their blood sugar level drops. Then they have to get the grandparent to drink orange juice to bring the level back up.
This concern brings itself to my office with a parent asking that their child's sugar be checked, or asking for a diabetes check, or simply with questions about hypoglycemia. Many believe this is a very common condition, and some think that it is a sign of diabetes.
My goal in this blog post is to dispel the myths--the myth that hypoglycemia is a sign of diabetes (it definitely is NOT), and the myth that hypoglycemia is a common and likely explanation for children being mean, cranky, low on energy, or dizzy.
First lets talk about diabetes. The main problem in diabetes is either lack of insulin, or decreased ability to respond to insulin. Insulin is a chemical that is made in the body by the pancreas. Its purpose is to make glucose (sugar) available and usable as a source of energy. Without the important, life-sustaining effects of insulin the result is HIGH blood sugar, or HYPERglycemia. In that case there is lots of sugar circulating in the blood, but it is useless to the body as energy. If a blood test is done, the blood sugar level will be very high.
Diabetes comes in two forms. Type I is insulin dependent--meaning that insulin must be injected into the body--and usually starts at a young age. Type II is not usually insulin dependent, is often controlled with diet or pills, and is traditionally thought to start in adulthood. The SIDE EFFECT of insulin or pills used in diabetes can be HYPOglycemia. If a diabetic person has low blood sugar it is usually an undesirable, and sometimes unavoidable, side effect of the medication they are using to treat their diabetes.
Is that point clear? Having diabetes means you will have HIGH blood sugar levels. Treatment of diabetes could have the occasional side effect of low blood sugar (hypoglycemia), but this is a result of the treatment, not the diabetes itself.
But, now that you know that hypoglycemia (or low blood sugar) does not suggest your child has diabetes, I must go on to dispel the myth that hypoglycemia is a common symptom.
Blood sugar levels are very tightly regulated by your body. Think of this as an algorithm: Levels get high and more insulin is released so the sugar can be processed as energy. Levels start to drop and natural body chemicals stimulate your body to release glucose from various places where it is stored (the liver is a big storage center for glucose). If blood sugar levels are starting to drop there might be a feeling of hunger or thirst as your body is stimulating you to replace your energy stores.
We could not live without this tight regulation of blood sugar levels. If our blood sugar levels were constantly getting low we would be passing out, having seizures, becoming brain damaged, and having terrible things happen to us. Our bodies are so sensitive and so good at preventing low blood sugar that we can often feel the effects of just a slight drop in an otherwise normal blood sugar level. This might be a feeling of hunger, crankiness, headache, or jitteriness. If we tested our blood sugar at that time it would likely be in a "normal" range! Yet the slight drop stimulated the symptoms we are having.
Similarly we might respond to rapid metabolism of simple sugars by feeling a quick boost in energy, followed an hour later by the "crash" as the sugars are absorbed from the blood stream. However, if we test the blood sugar level during the "sugar high" and the "crash", it will most likely fall into a medically normal range. We feel the tiny changes as the sugar is used and then leaves the blood stream, but these changes do not show up on a blood test. And, these adjustments are a NORMAL part of the process of using the energy we put into our bodies. Your body makes you hungry and cranky so you will EAT, and replace the energy you are using.
Is your child feeling jittery, hungry, cranky, low on energy, and mean? Obviously these are unpleasant symptoms. Possibly they are related to the body's metabolism of sugar, but they almost never translate into hypoglycemia that we can identify on a blood test. Other explanations for these symptoms could be fatigue, poor sleep, sensory overload, need to exercise or play, thirst, hunger, illness, or need for some quiet alone time.
It is definitely possible to smooth out the feelings we have as our body makes slight adjustments in our blood sugar levels. Protein, especially, helps even out the ups and downs of otherwise normal blood sugars. The body will first use the simple sugars in the blood, as they are the easiest to digest, then move on to other sources, such as protein, to help maintain smooth blood glucose levels. Some protein at breakfast, lunch, and snack can go a long way toward helping your child feel better throughout the day. An all carbohydrate diet (such as a breakfast pastry in the morning, followed by graham crackers for snack, and then a granola bar at lunch) sets your child up to feel bad, noticing all those little ups and downs as the body tries to maintain normal blood glucose levels.
You don't believe me? You were diagnosed with hypoglycemia, you say? I'm not saying it's impossible to have hypoglycemia--I'm just saying it's much more likely that your child is feeling the effects of normal body metabolism, and that if we check the blood sugar levels they will look normal!
As a physician, I have had patients and parents who did not believe me, who needed proof their child was not hypoglycemic. I have sent blood glucose monitoring units home with families, to check blood sugars throughout the day and record symptoms. Years ago one teenager did a beautiful job with this. He monitored his levels throughout the day, recorded his cranky, weak, and hungry symptoms, checked levels before and after eating, upon getting up in the morning, after exercise, etc. Despite having many symptoms he thought were attributable to hypoglycemia, ALL of the blood sugar levels recorded were in the medically normal range!
So, when you think about it, were you really diagnosed with hypoglycemia? Or did someone offer that diagnosis to you as an explanation for the symptoms I have described, without explaining in detail how the body works to maintain normal sugar levels? It would be easy for a health care provider to offer hypoglycemia as an explanation for such symptoms (it's hard to explain, after all), and then put the focus on improving the diet to help minimize those unpleasant symptoms.
Now that I have hopefully dispelled the common myths around hypoglycemia, I do have to mention some true examples of hypoglycemia! Newborn babies are at risk for hypoglycemia. Through the pregnancy the fetus makes its own insulin to respond to its mother's blood sugar levels. So the newborn baby sometimes comes out of the womb making much more insulin than it will end up needing, and there will be low blood sugars for a period of time. These levels can be very low, and sometimes need to be treated for a few days after birth.
There is also a condition that can affect young, usually tiny, toddlers and preschoolers. They might have true hypoglycemia after a long fast (often over night). Their symptoms are pretty dramatic--a seizure or loss of consciousness, inability to wake up--not just cranky. There are some rare conditions that can affect older kids, as well. Again, the symptoms will be dramatic--loss of consciousness, seizures, inability to wake up. Usually these symptoms are on a level that an ambulance must be called to take the patient directly to the hospital.
And, by the way, symptoms of Type I, childhood, insulin dependent, diabetes (which is HIGH blood sugar, remember?) are excessive thirst, excessive urination, excessive appetite, and weight loss.
Please keep in mind that the comments in my blog are meant to provide you with useful information and things to think about, but not to diagnose or rule out any particular medical condition in your child. My blog is not meant to be a comprehensive analysis of any particular condition. For that you need the personal attention of your child's own doctor.
This concern brings itself to my office with a parent asking that their child's sugar be checked, or asking for a diabetes check, or simply with questions about hypoglycemia. Many believe this is a very common condition, and some think that it is a sign of diabetes.
My goal in this blog post is to dispel the myths--the myth that hypoglycemia is a sign of diabetes (it definitely is NOT), and the myth that hypoglycemia is a common and likely explanation for children being mean, cranky, low on energy, or dizzy.
First lets talk about diabetes. The main problem in diabetes is either lack of insulin, or decreased ability to respond to insulin. Insulin is a chemical that is made in the body by the pancreas. Its purpose is to make glucose (sugar) available and usable as a source of energy. Without the important, life-sustaining effects of insulin the result is HIGH blood sugar, or HYPERglycemia. In that case there is lots of sugar circulating in the blood, but it is useless to the body as energy. If a blood test is done, the blood sugar level will be very high.
Diabetes comes in two forms. Type I is insulin dependent--meaning that insulin must be injected into the body--and usually starts at a young age. Type II is not usually insulin dependent, is often controlled with diet or pills, and is traditionally thought to start in adulthood. The SIDE EFFECT of insulin or pills used in diabetes can be HYPOglycemia. If a diabetic person has low blood sugar it is usually an undesirable, and sometimes unavoidable, side effect of the medication they are using to treat their diabetes.
Is that point clear? Having diabetes means you will have HIGH blood sugar levels. Treatment of diabetes could have the occasional side effect of low blood sugar (hypoglycemia), but this is a result of the treatment, not the diabetes itself.
But, now that you know that hypoglycemia (or low blood sugar) does not suggest your child has diabetes, I must go on to dispel the myth that hypoglycemia is a common symptom.
Blood sugar levels are very tightly regulated by your body. Think of this as an algorithm: Levels get high and more insulin is released so the sugar can be processed as energy. Levels start to drop and natural body chemicals stimulate your body to release glucose from various places where it is stored (the liver is a big storage center for glucose). If blood sugar levels are starting to drop there might be a feeling of hunger or thirst as your body is stimulating you to replace your energy stores.
We could not live without this tight regulation of blood sugar levels. If our blood sugar levels were constantly getting low we would be passing out, having seizures, becoming brain damaged, and having terrible things happen to us. Our bodies are so sensitive and so good at preventing low blood sugar that we can often feel the effects of just a slight drop in an otherwise normal blood sugar level. This might be a feeling of hunger, crankiness, headache, or jitteriness. If we tested our blood sugar at that time it would likely be in a "normal" range! Yet the slight drop stimulated the symptoms we are having.
Similarly we might respond to rapid metabolism of simple sugars by feeling a quick boost in energy, followed an hour later by the "crash" as the sugars are absorbed from the blood stream. However, if we test the blood sugar level during the "sugar high" and the "crash", it will most likely fall into a medically normal range. We feel the tiny changes as the sugar is used and then leaves the blood stream, but these changes do not show up on a blood test. And, these adjustments are a NORMAL part of the process of using the energy we put into our bodies. Your body makes you hungry and cranky so you will EAT, and replace the energy you are using.
Is your child feeling jittery, hungry, cranky, low on energy, and mean? Obviously these are unpleasant symptoms. Possibly they are related to the body's metabolism of sugar, but they almost never translate into hypoglycemia that we can identify on a blood test. Other explanations for these symptoms could be fatigue, poor sleep, sensory overload, need to exercise or play, thirst, hunger, illness, or need for some quiet alone time.
It is definitely possible to smooth out the feelings we have as our body makes slight adjustments in our blood sugar levels. Protein, especially, helps even out the ups and downs of otherwise normal blood sugars. The body will first use the simple sugars in the blood, as they are the easiest to digest, then move on to other sources, such as protein, to help maintain smooth blood glucose levels. Some protein at breakfast, lunch, and snack can go a long way toward helping your child feel better throughout the day. An all carbohydrate diet (such as a breakfast pastry in the morning, followed by graham crackers for snack, and then a granola bar at lunch) sets your child up to feel bad, noticing all those little ups and downs as the body tries to maintain normal blood glucose levels.
You don't believe me? You were diagnosed with hypoglycemia, you say? I'm not saying it's impossible to have hypoglycemia--I'm just saying it's much more likely that your child is feeling the effects of normal body metabolism, and that if we check the blood sugar levels they will look normal!
As a physician, I have had patients and parents who did not believe me, who needed proof their child was not hypoglycemic. I have sent blood glucose monitoring units home with families, to check blood sugars throughout the day and record symptoms. Years ago one teenager did a beautiful job with this. He monitored his levels throughout the day, recorded his cranky, weak, and hungry symptoms, checked levels before and after eating, upon getting up in the morning, after exercise, etc. Despite having many symptoms he thought were attributable to hypoglycemia, ALL of the blood sugar levels recorded were in the medically normal range!
So, when you think about it, were you really diagnosed with hypoglycemia? Or did someone offer that diagnosis to you as an explanation for the symptoms I have described, without explaining in detail how the body works to maintain normal sugar levels? It would be easy for a health care provider to offer hypoglycemia as an explanation for such symptoms (it's hard to explain, after all), and then put the focus on improving the diet to help minimize those unpleasant symptoms.
Now that I have hopefully dispelled the common myths around hypoglycemia, I do have to mention some true examples of hypoglycemia! Newborn babies are at risk for hypoglycemia. Through the pregnancy the fetus makes its own insulin to respond to its mother's blood sugar levels. So the newborn baby sometimes comes out of the womb making much more insulin than it will end up needing, and there will be low blood sugars for a period of time. These levels can be very low, and sometimes need to be treated for a few days after birth.
There is also a condition that can affect young, usually tiny, toddlers and preschoolers. They might have true hypoglycemia after a long fast (often over night). Their symptoms are pretty dramatic--a seizure or loss of consciousness, inability to wake up--not just cranky. There are some rare conditions that can affect older kids, as well. Again, the symptoms will be dramatic--loss of consciousness, seizures, inability to wake up. Usually these symptoms are on a level that an ambulance must be called to take the patient directly to the hospital.
And, by the way, symptoms of Type I, childhood, insulin dependent, diabetes (which is HIGH blood sugar, remember?) are excessive thirst, excessive urination, excessive appetite, and weight loss.
Please keep in mind that the comments in my blog are meant to provide you with useful information and things to think about, but not to diagnose or rule out any particular medical condition in your child. My blog is not meant to be a comprehensive analysis of any particular condition. For that you need the personal attention of your child's own doctor.
Friday, November 12, 2010
Fatigue, Teens, and Tweens
I see many tired teenagers in the office every day. They take naps after school, can hardly get out of bed in the morning, sometimes sleep half the day on weekends, and generally are low on energy. They always seem low on energy when it is time to get up to go to school, do homework, or do chores. They often revive in an amazing way when it is time for sports practice or competitions, or time to engage in some way with peers.
Their sleep habits are often poor--bedtime of 10:30 or later, then up at 6:30 on school days (teenagers should be getting about 10 hours of sleep at night, averaged over the week, without counting naps). Their phones, computers, TVs are in their rooms to distract them as they try to fall asleep. They often skip breakfast, or have a high sugar treat on the way out the door. Lunch is fast food, or the equivalent in high fat and low nutritional content. Or they don't eat lunch. Fluids can be minimal throughout the day. Some teens barely exercise. Most spend lots of time in front of a screen (TV, computer, games, phones).
Then there is the stress of being a teenager--six or seven teachers making demands, tests, homework, sports, clubs, applying to college (fatigue is VERY common for seniors in high school!), lack of spending money, or the added pressure of a job, relationships with family and friends, a boyfriend or girlfriend, fitting in socially...Actually listing this makes ME feel a little tired and stressed. Wouldn't YOU want a nap after school, too?
There are many causes of fatigue, both physical and emotional. Of course there are important medical causes of fatigue, and mental illness (such as depression) can lead to fatigue. However, fatigue is a common symptom, and MOST OF THE TIME it reflects common, ongoing, physical and emotional stress in a teen or tween's life.
My medical training leads me to think of the most likely things first. There is a kind of medical school joke about zebras and horses. You need the background information that in the United States of America you would be more likely to see horses than you would zebras. In fact, you would probably have to go to a zoo to see zebras, while you could just drive out to the country to see some horses.
So, in south west Michigan, if an animal looked and smelled like a horse, was the same general size as a horse, walked and sounded like a horse--but you just couldn't see its hide to tell if it was striped or plain--would it be more likely a horse or a zebra? The right answer here, of course, is that a HORSE would be more likely than a zebra. It would not be impossible to see a zebra (I guess a farmer could have one as a pet, or one could have escaped from a zoo), but out in the country in south west Michigan you are probably looking at horses.
That means, that when I am assessing someone for the cause of their fatigue, I keep the possibility of zebras (or less common illnesses) in mind, but I do NOT usually end up seeing stripes. I am going to ask general questions about the patient's life, and these answers will factor in an important way into what I think is causing my patient's fatigue. I might ask any or all of the following questions, or even think of other questions that are centered around lifestyle, home, and school:
1. How is school going? Grades, attendance, completing assignments, behavioral concerns at school...new challenges, perfectionism, getting behind in school?
2. How are you getting along with your family? Who do you get along with best? worst?
3. How are things at home?
4. Anything changed at home? Divorce, separation, illness, pets, job loss, troubled sibling...
5. How are things with friends?
6. Dating? How is that going? How long? Physically involved with this person?
7. Are you in trouble with anyone? Suspended? Grounded? Have a probation officer?
8. Substance use/abuse? Tobacco, alcohol, illegal drugs, prescription drugs...
9. What is your daily schedule like?
10. When do you have free time? What do you do with it?
11. What are your eating patterns like? Do you eat three meals? Drink enough water? Take a vitamin?
12. Are you happy with your weight? Dieting? Losing or gaining weight?
13. When and how much do you exercise?
14. Are most teenagers happier than you?
15. Are most teenagers having more fun than you?
16. Do most teenagers have more friends than you?
17. Are most teenagers more popular than you?
18. Are most teenagers thinner than you?
I think this list could be endless. Hopefully you see my point, that any number of these factors could be important considerations in figuring out why your child is tired all the time.
Of course there are the so-called "red flags" when it comes to fatigue. Here I am thinking about signs of depression, deliberate self-harm ("cutting"), thoughts of suicide, a suicide plan. I am also looking for excessive, paralyzing anxiety or panic.
And finally, last on my list, still important but much less likely, the reason most parents bring their fatigued teen or tween to see me, PHYSICAL ILLNESS as a cause of fatigue. Here is where I see parents worry. They believe their teenager has hypoglycemia, or diabetes, or a thyroid condition, or anemia. Now I am asking about weight loss, blood in stools, diarrhea, urinary frequency, excessive thirst, excessively heavy periods, palpitations, dry skin, constipation, night sweats, absent or fewer periods, joint swelling or pain, and other physical symptoms. I always ask about headaches and stomachaches as well, but many people have these symptoms so it doesn't usually help me narrow things down.
Follow all of the above by a physical exam, and sometimes blood work (often just general screening for anemia, hypothyroidism, and a general metabolic panel that includes a blood sugar level), and I am usually left with a physically normal appearing teenager who has normal blood tests. Parents are relieved. BUT THE TEENAGER IS STILL TIRED!
In my respectful, and humble opinion, the blood tests have contributed very little to the evaluation of the fatigued teen/tween. The physical/medical disorders that could have led to abnormal blood tests just aren't that common in comparison to the psychological, lifestyle, and mental health issues that can lead to fatigue. And while it may relieve YOU, as the parent, to know the blood tests are normal, it didn't help your teen overcome his fatigue!
I am not advocating skipping the medical work up for a fatigued teenager. What I want is for parents and teens to take a close look at their lifestyle, diet, sleep habits, stress, and mental health, and to consider these issues as a possible important cause of fatigue. MOST OF THE TIME these issues will be THE cause of the fatigue, so I don't think we can ignore them.
I don't want to miss an important physical cause of fatigue any more than you do, but I do want to help your child feel better. That will probably take us looking at the whole picture, not just ordering a blood draw. And it may involve a solution that is not as easy as taking a pill. It could include changes in lifestyle, diet, nutrition, sleep habits, exercise. Or a recommendation may be made for counseling or family therapy.
You might also be able to tell from this blog that an evaluation for fatigue deserves its own appointment in my office. This is not a work up I can easily add on to the end of a visit for a cough, strep throat, or wart, or piggy-back on to a sibling's appointment. We need to give this symptom the time and attention it demands. After reviewing the information above, however, you may have more insight into the problem and have some ideas for helping your teen. It's usually ok to try some things before making the appointment.
As I always say, this blog is intended to provide general information for situations that are not specific to any patient or family. My blog is not meant to be medically comprehensive and cannot take every situation or symptom into consideration. Every one deserves to have their concerns personally addressed by their own doctor, and the information in my blog is not a substitute for that kind of attention.
Their sleep habits are often poor--bedtime of 10:30 or later, then up at 6:30 on school days (teenagers should be getting about 10 hours of sleep at night, averaged over the week, without counting naps). Their phones, computers, TVs are in their rooms to distract them as they try to fall asleep. They often skip breakfast, or have a high sugar treat on the way out the door. Lunch is fast food, or the equivalent in high fat and low nutritional content. Or they don't eat lunch. Fluids can be minimal throughout the day. Some teens barely exercise. Most spend lots of time in front of a screen (TV, computer, games, phones).
Then there is the stress of being a teenager--six or seven teachers making demands, tests, homework, sports, clubs, applying to college (fatigue is VERY common for seniors in high school!), lack of spending money, or the added pressure of a job, relationships with family and friends, a boyfriend or girlfriend, fitting in socially...Actually listing this makes ME feel a little tired and stressed. Wouldn't YOU want a nap after school, too?
There are many causes of fatigue, both physical and emotional. Of course there are important medical causes of fatigue, and mental illness (such as depression) can lead to fatigue. However, fatigue is a common symptom, and MOST OF THE TIME it reflects common, ongoing, physical and emotional stress in a teen or tween's life.
My medical training leads me to think of the most likely things first. There is a kind of medical school joke about zebras and horses. You need the background information that in the United States of America you would be more likely to see horses than you would zebras. In fact, you would probably have to go to a zoo to see zebras, while you could just drive out to the country to see some horses.
So, in south west Michigan, if an animal looked and smelled like a horse, was the same general size as a horse, walked and sounded like a horse--but you just couldn't see its hide to tell if it was striped or plain--would it be more likely a horse or a zebra? The right answer here, of course, is that a HORSE would be more likely than a zebra. It would not be impossible to see a zebra (I guess a farmer could have one as a pet, or one could have escaped from a zoo), but out in the country in south west Michigan you are probably looking at horses.
That means, that when I am assessing someone for the cause of their fatigue, I keep the possibility of zebras (or less common illnesses) in mind, but I do NOT usually end up seeing stripes. I am going to ask general questions about the patient's life, and these answers will factor in an important way into what I think is causing my patient's fatigue. I might ask any or all of the following questions, or even think of other questions that are centered around lifestyle, home, and school:
1. How is school going? Grades, attendance, completing assignments, behavioral concerns at school...new challenges, perfectionism, getting behind in school?
2. How are you getting along with your family? Who do you get along with best? worst?
3. How are things at home?
4. Anything changed at home? Divorce, separation, illness, pets, job loss, troubled sibling...
5. How are things with friends?
6. Dating? How is that going? How long? Physically involved with this person?
7. Are you in trouble with anyone? Suspended? Grounded? Have a probation officer?
8. Substance use/abuse? Tobacco, alcohol, illegal drugs, prescription drugs...
9. What is your daily schedule like?
10. When do you have free time? What do you do with it?
11. What are your eating patterns like? Do you eat three meals? Drink enough water? Take a vitamin?
12. Are you happy with your weight? Dieting? Losing or gaining weight?
13. When and how much do you exercise?
14. Are most teenagers happier than you?
15. Are most teenagers having more fun than you?
16. Do most teenagers have more friends than you?
17. Are most teenagers more popular than you?
18. Are most teenagers thinner than you?
I think this list could be endless. Hopefully you see my point, that any number of these factors could be important considerations in figuring out why your child is tired all the time.
Of course there are the so-called "red flags" when it comes to fatigue. Here I am thinking about signs of depression, deliberate self-harm ("cutting"), thoughts of suicide, a suicide plan. I am also looking for excessive, paralyzing anxiety or panic.
And finally, last on my list, still important but much less likely, the reason most parents bring their fatigued teen or tween to see me, PHYSICAL ILLNESS as a cause of fatigue. Here is where I see parents worry. They believe their teenager has hypoglycemia, or diabetes, or a thyroid condition, or anemia. Now I am asking about weight loss, blood in stools, diarrhea, urinary frequency, excessive thirst, excessively heavy periods, palpitations, dry skin, constipation, night sweats, absent or fewer periods, joint swelling or pain, and other physical symptoms. I always ask about headaches and stomachaches as well, but many people have these symptoms so it doesn't usually help me narrow things down.
Follow all of the above by a physical exam, and sometimes blood work (often just general screening for anemia, hypothyroidism, and a general metabolic panel that includes a blood sugar level), and I am usually left with a physically normal appearing teenager who has normal blood tests. Parents are relieved. BUT THE TEENAGER IS STILL TIRED!
In my respectful, and humble opinion, the blood tests have contributed very little to the evaluation of the fatigued teen/tween. The physical/medical disorders that could have led to abnormal blood tests just aren't that common in comparison to the psychological, lifestyle, and mental health issues that can lead to fatigue. And while it may relieve YOU, as the parent, to know the blood tests are normal, it didn't help your teen overcome his fatigue!
I am not advocating skipping the medical work up for a fatigued teenager. What I want is for parents and teens to take a close look at their lifestyle, diet, sleep habits, stress, and mental health, and to consider these issues as a possible important cause of fatigue. MOST OF THE TIME these issues will be THE cause of the fatigue, so I don't think we can ignore them.
I don't want to miss an important physical cause of fatigue any more than you do, but I do want to help your child feel better. That will probably take us looking at the whole picture, not just ordering a blood draw. And it may involve a solution that is not as easy as taking a pill. It could include changes in lifestyle, diet, nutrition, sleep habits, exercise. Or a recommendation may be made for counseling or family therapy.
You might also be able to tell from this blog that an evaluation for fatigue deserves its own appointment in my office. This is not a work up I can easily add on to the end of a visit for a cough, strep throat, or wart, or piggy-back on to a sibling's appointment. We need to give this symptom the time and attention it demands. After reviewing the information above, however, you may have more insight into the problem and have some ideas for helping your teen. It's usually ok to try some things before making the appointment.
As I always say, this blog is intended to provide general information for situations that are not specific to any patient or family. My blog is not meant to be medically comprehensive and cannot take every situation or symptom into consideration. Every one deserves to have their concerns personally addressed by their own doctor, and the information in my blog is not a substitute for that kind of attention.
Subscribe to:
Posts (Atom)