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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Severe Fatigue And Sleepiness In An Elderly Person

My Mom is 93, and up until a few months ago was an amazingly energetic and cognitively alert woman. In the past 6 months, she had a non-bloodborne MRSA cellulitis infection, a fall that caused a rib contusion, and a very mild MI ... all of which she has recovered from. It has been at least 2 months since the last issue, and her LVEF post-MI is still 51%. She is able to tolerate a fair amount of exercise for someone her age (she is able to tolerate machines at cardiac rehab for 15 mins at a time). The problem is over the past few months she has developed severe fatigue, daytime sleepiness, lack of energy and depression that she says affects her ability to function. Sure, it could be her age, but 6 months ago this was not anywhere near as much of a problem. Hemoglobin is normal, Thyroid is normal (she is on Synthroid), cardiologist says it s not likely to be cardiac related, Serum Glucose is 78 (normal), Serum Electrolytes (Sodium, Potassium, Chloride) all normal. Kidney and Liver Enzymes all normal. My question is this. Her last endocrinological blood workup in May indicated an Intact PTH of 82 pg/ml with a Serum Calcium of 9.3 mg/dl. The PTH is elevated. When I read the symptoms of Hyperparathyroidism, I see many of her complaints. Given the elevated PTH, but a normal Serum Calcium ... could the elevated PTH be the cause of her recent complaints of fatigue, depression and lack of energy?
Thu, 1 Aug 2019
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General Surgeon 's  Response
Hi,

There are many causes of excessive sleepiness. Pathologic sleepiness can be caused by external factors, primary psychiatric or sleep disorders.

The extrinsic factors include poor sleep hygiene, chronic alcohol or drug use, and the consumption of caffeinated beverages. Intrinsic causes include psychiatric conditions, such as major depressive disorder, and primary sleep disorders, such as narcolepsy, obstructive sleep apnea, idiopathic hypersomnia, restless legs syndrome/periodic limb movement disorder, and circadian rhythm disturbances.

Excessive sleepiness also may be caused by the use of prescription or over-the-counter medications. See if you have any of the above.

The celiac disease leads to malabsorption and can cause fatigue.
Iron deficiency can contribute. Get your hemoglobin and iron studies done. It will help to identify iron deficiency if any.

Modafinil and regular exercise are probably the best options for you. The celiac disease only will not cause such severe symptoms.

I don't see any reason for you to avoid any more foodstuff. In fact, it can lead to nutritional deficiency and cause more harm.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Ivan R. Rommstein, General Surgeon
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Suggest Treatment For Severe Fatigue And Sleepiness In An Elderly Person

Hi, There are many causes of excessive sleepiness. Pathologic sleepiness can be caused by external factors, primary psychiatric or sleep disorders. The extrinsic factors include poor sleep hygiene, chronic alcohol or drug use, and the consumption of caffeinated beverages. Intrinsic causes include psychiatric conditions, such as major depressive disorder, and primary sleep disorders, such as narcolepsy, obstructive sleep apnea, idiopathic hypersomnia, restless legs syndrome/periodic limb movement disorder, and circadian rhythm disturbances. Excessive sleepiness also may be caused by the use of prescription or over-the-counter medications. See if you have any of the above. The celiac disease leads to malabsorption and can cause fatigue. Iron deficiency can contribute. Get your hemoglobin and iron studies done. It will help to identify iron deficiency if any. Modafinil and regular exercise are probably the best options for you. The celiac disease only will not cause such severe symptoms. I don t see any reason for you to avoid any more foodstuff. In fact, it can lead to nutritional deficiency and cause more harm. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Ivan R. Rommstein, General Surgeon