Question: Hi Doctor,
I have felt fatigued for many years and it is especially strong when I am under pressure and stress. I had to cut down my work to 50% over more than 6 months to even cope. It is like my body does not have enough energy to act. I still have muscular strength, but my endurance is weaker. I do have stiffness in my joints often, and particularly in neck and lower back. I have tested a lot of tests recently to try to find out what could be the cause.

I have tested the usual blood test like full blood count etc and they are all within normal range. Perhaps at the lower end when it comes to White blood cells (WBC 4.2, normal range: 3.8-10.6). The only tests that have come back outside the normal range is a stool test, where they indicated that there is fat - and the primary diagnosis was Malabsorption of fat in the digestion system. The other test related to digestion and enzymes are:
Albumin - 4.3 g/dl
Globulin - 2.2
Total protein - 6.5
Ureum - 33.3 mg/dl
Creatinin - 0.86
Lipase - 31 U/l
Amylase pancreas - 34
CEA - 1.9 ng/ml
Yeast 1+ (normal should be negative to 1+ it says in the report)

Now, this is my only lead at the moment. Subsequently I tested several liver vales such as SGOT and SGPT and they were right in the middle of normal range. I have also tested GGT and FA for liver and bile duct status and GGT was 11 and FA 42, that is, close to the minimum of the normal range.

I also tested for Hepatitis:
Anti HBs - Positive 507,
Anti HCV Total - Negative,
HBsAg - Non reactive

I don't understand what these means, and I have taken vaccine for Hepatitis A+B. However, I think I travelled in Asia before I got vaccinated. This was probably in 1998, and the vaccine I must of taken 1999.

With this background, my question is... what do I do about the fat found in my stool analysis. The doctor here in Indonesia (I live here temporary) said the fat is nothing to worry about. I still asked to have the above tests completed to be on the safe side.

I need guidance to dig deeper into my digestive system and find out what is bothering my digestion. I have had loose to medium stool for as long as I remember and a lot of problems related to digestion. Also I have mainly eaten a vegetarian diet the last 12 years, but have added beef to the diet the last 3 months to secure that I have enough protein. I have also tested to eat Full range digestive enzymes and I think that it gave me more energy... but it is still to be repeated and confirmed.

Thankful for your recommendations, or if you wish to refer me to a colleague specialize in digestion/internal medicine.

BR
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