Tiredness and Dangerous Disease

QUESTION: I have never been athletic, but of late, even the slightest
exercise leaves me weary and tired. Lately my boss has commented how droopy
and tired looking I look, for there are times I can scarcely open my eyes. My
girl friend thinks I am suffering from a weird, but dangerous disease. I
don't want to go to my doctor with a silly complaint like just being tired.
What do you think?
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ANSWER: Though the complaint of fatigue is a frequent one in daily practice
with so many possible causes and explanations, there are a few clues in your
letter that make me side with your girl friend. Fatigue that follows brief
exercise and droopy eyelids (called ptosis) are the signs of a disorder known
as myasthenia gravis, a rare disease that is first seen in women between the
ages of 20 to 40 years of age. The symptoms may come and go over a brief
period, and are sometimes hard to nail down, but can become progressive and
life threatening when the muscles that are responsible for breathing become
affected. It is believed that the condition is the result of an autoimmune
attack on the receptor in the connection between nerves and muscles that
responds to the chemical acetylcholine, and permits the transmission of the
stimulus that makes the muscles contract. When this mechanism fails, muscles
do not contract and the patient experiences the weakness. When it affects the
muscles that control the eyes, double vision may result. The physician may
test for this disease by injecting a substance, edrophonium, into a vein. A
sufferer of myasthenia will experience a sudden, though short lasting,
improvement in muscle function. Other tests may be used to confirm the
diagnoses, and the good news is that a class of medication called
cholinesterase inhibitors are useful oral medications that can successfully
treat the disease. The medications must be carefully dosed and controlled,
and require ongoing evaluation and modification. Take the advice of both your
girl friend and me, get to your physician now, and take this along as an
expression of my opinion.