Increasing fatigue and tiredness after work outs

Patient

Q: For the last 5 years, I've been in a bad work out cycle. If you look at me you can tell I work out, I have an athletic build, low BMI and by all appearences, don't look like I'm in bad shape. However for the last 5 years, I'll start my work out routine for the 1st week, things will go pretty well. Shakey, as it is always is starting out, but feeling good. By week 2, I'll have 60% less energy, and by week 3, I'll have almost none- barely able to get off the couch, out of bed in the morning. And for the next 1.5-2 months I won't work out. This has gone on for at least 5 years. I drink at least a liter of water a day, eat fairly regularly, and healthy. I feel like I'm going nuts but the bouts of sheer exhaustion is getting worse as I get older. Help!!

Doctor

A:   According to your description of the progressive tiredness and fatigue, a possible inflammatory Myopathy must be ruled out. General symptoms of inflammatory myopathy include slow but progressive muscle weakness that starts in the proximal muscles, those muscles closest to the trunk of the body.  Inflammation damages the muscle fibers, causing weakness, and may affect the arteries and blood vessels that run through the muscle.  Other symptoms include fatigue after walking or standing, tripping or falling, and difficulty swallowing or breathing.  Some individuals may have slight muscle pain or muscles that are tender to touch. These rare disorders may affect both adults and children, although dermatomyositis is the most common chronic form in children.  Polymyositis and dermatomyositis are more common in women than in men. Diagnosis is based on the  medical history, results of a physical exam and tests of muscle strength, and blood samples that show elevated levels of various muscle enzymes and autoantibodies.  Diagnostic tools include electromyography to record the electrical activity that controls muscles during contraction and at rest, ultrasound to look for muscle inflammation, and MRI to reveal abnormal muscle and evaluate muscle disease.  A muscle biopsy can be examined by microscopy for signs of chronic inflammation, muscle fiber death, vascular deformities, or the changes specific to the diagnosis. The chronic inflammatory myopathies cannot be cured in most adults but many of the symptoms can be treated.  Options include medication, physical therapy, exercise, heat therapy (including microwave and ultrasound), orthotics and assistive devices, and rest.  Most cases of dermatomyositis respond to therapy.  The disease is usually more severe and resistant to therapy in individuals with cardiac or pulmonary problems.

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