Fatigue Evaluation in Southlake, TX

Fatigue is one of the most common reasons adults come in and one of the most poorly handled. The usual pattern is a basic blood count, a normal result, and a suggestion to get more rest. We work through it systematically, because there is usually a findable reason.

The visit

We start with the shape of it. How long, whether it came on suddenly or crept in, whether rest helps at all, whether it is physical exhaustion or mental fog, and what your sleep actually looks like from lights out to alarm.

Post-exertional worsening, where activity leaves you flattened for a day or more afterward, is a specific pattern that points somewhere different and we ask about it directly.

Then medications. Beta blockers, antihistamines, sleep aids, muscle relaxants, gabapentin, several antidepressants and statins in a minority of people all cause fatigue. Going through the list carefully is worth doing before ordering a single test.

What we test

• CBC with ferritin. Ferritin specifically, not just hemoglobin. Iron stores fall long before anemia appears.
• TSH, since thyroid disease is a leading treatable cause. See thyroid disorders.
• Comprehensive metabolic panel for kidney, liver, calcium and electrolytes.
• A1c, because early insulin resistance produces fatigue well before diabetes appears. See prediabetes.
• Vitamin B12 and vitamin D.
• Sleep apnea screening, the most commonly missed cause we encounter by a wide margin. See sleep apnea.
• Depression and anxiety screening with scored tools. See depression.

Based on your history we add celiac testing, inflammatory markers, HIV or hepatitis testing, cortisol, testosterone, or an EKG. In women in their forties and fifties, perimenopause is a frequent and frequently overlooked answer, covered on our women’s health page.

When we move faster

Fatigue with unintentional weight loss, fever, drenching night sweats, swollen lymph nodes, bone pain or breathlessness changes the pace immediately. That combination gets investigated quickly rather than observed for three months.

What we do not do

We do not run broad hormone panels, adrenal fatigue testing, or unvalidated chronic infection panels on people with normal standard workups. They generate abnormal-looking numbers that lead to expensive treatments for conditions that were not there.

If you have had one of those done elsewhere, bring it. We will go through it with you honestly rather than dismissing it.

If everything comes back normal

That happens, and it does not mean nothing is wrong.

We look again at sleep quality, activity level, alcohol, mood and stress load, and we treat what we find. Deconditioning is real and reversible. So is the exhaustion of caring for someone else, which nobody screens for.

Some patients meet criteria for ME/CFS or long COVID. Both are real diagnoses with management strategies, and both deserve better than being told the tests were normal.

You get a follow-up either way

Fatigue that gets one visit and no plan tends to go unsolved for years. You leave with a next step and a date, even if that step is a two-week symptom diary.

Fatigue evaluation usually starts with a full annual physical exam. See our primary care Southlake practice overview.