RA, Fatigue, BP & Me
I've been suffering from severe fatigue lately, for months, and my providers are having difficulty figuring out what's causing it for sure. RA itself causes fatigue, of course. And so does anemia, which I have. Although I've been taking prescription iron supplements to try to get that under control. The other culprit for my everyday exhaustion? I suspect my blood pressure medication might be to blame. But who knows! Everything is a guessing game when you live with RA and other comorbidities.
Chronic RA fatigue
According to an article from Everyday Health, fatigue is "one of the most common and frustrating RA symptoms" that patients have.1 The article points out that it's also not very well understood by rheumatologists.
Yousaf Ali, MD, chief of the division of rheumatology at Mount Sinai West Hospital in New York City, says, "It is a systemic type of exhaustion, meaning it affects your whole system instead of just a certain body part."
The article goes on to explain that "people battling the chronic fatigue of RA often describe it as a deep tiredness or slowing down, akin to the feeling someone else might have while recovering from the flu."
I definitely agree with this last statement. It does feel like a "deep tiredness," as though my body is exhausted from battling against some major illness. Or like I'm weighted down with an unbearably heavy load on my back or I'm wading through thick molasses. Lately, all I've been wanting to do most of the time is just lie down in bed. I feel like I don't have enough energy to even be upright. What's going on?! In most of my 21 years of living with RA, my fatigue was never this bad. Sometimes not even when flaring.
I've struggled with anemia for the majority of the time I've had RA, I think, and I'm pretty much always anemic unless I'm taking iron supplements or getting I.V. infusions (the infusions work the best). The last time I saw my integrative doctor she looked at all of my iron-related labs and was appalled at how bad/low they were. Those results were from before I started taking prescription strength iron supplements again, however. Hopefully, they're somewhat improved since I've been choking down those pills each morning a few months ago. I need to get new labs done to see if anything's changed for the better.
So is the anemia causing my severe fatigue? I'm sure it's not helping, but even when my hemoglobin has been at its lowest, I didn't feel this exhausted all the time. My gut tells me that something else is going on.
Blood pressure medication
In December 2017 I was put on blood pressure medication for the first time in my life. Unhappy at having another health condition to deal with, and extra pills to remember each day, this was not a good development. But, my blood pressure had been reading way too high every time I had it checked at a medical appointment. And I go to the doctor all the time, so it was getting checked a lot.
My primary care physician started me out on this new treatment by first prescribing hydrochlorothiazide, which is a diuretic (water pill), taken once a day. After a couple months not showing much improvement, she added carvedilol, which is a beta blocker medication that's taken twice daily. Did this do the trick? Yes, thankfully. My blood pressure is now much lower and always in a normal range. Yet around the time I began taking the beta blocker, I noticed I kept having dizzy spells. Every time I would get up from sitting or lying down, a wave of severe dizziness would hit me and I would have to hold onto something so I wouldn't black out and fall down. This was not good, obviously.
Also during this time, possibly affecting my blood pressure and dizziness, is that I lost quite a bit of weight--over 15 lbs. Weight loss can help a lot with lowering blood pressure, so maybe losing those pounds caused it to be too low along with the medications. This was a theory three of my providers had: my primary doctor, integrative doctor, and clinic pharmacist. After some coordinated discussions, the carvedilol dosage was decreased and my dizzy spells went away. WHEW! What a relief. But the extreme fatigue was still hanging around, upsetting my life and driving me crazy. Was I still too medicated? The jury is out on this until further medical appointments, I suppose.
Of course, I'm hoping that the cause of my fatigue is the blood pressure medication and that by adjusting the dose/treatment again, my constant exhaustion will get better. I have things I need to do! I can't just give up and live in my bed, no matter how much my body wants me to right now.
When was your last flare?