Can I talk about one of my handful of medical soapboxes for a minute?
Let’s talk fatigue. The other day a nurse asked me if I thought she needed B12 shots. This nurse is a total stranger to me. I have no way of scanning her blood with my eyes and determining if she’s B12 deficient. So I asked her: why do you think you might need B12? Her reply? “I’m tired all the time. I took some B12 pills and they didn’t give me a boost at all but my friend takes shots and I think that might help.”
Since I’m a nice doctor with loads of time on my hands (*snark*!), I sat her down for a chat. I first explained that B12 replacement is only necessary in people who are deficient in it, and even if your B12 is low, you can usually replace it just fine with pills. (For a great recent article on the B12 shot fetish, check here).
Then I asked her: tell me about your sleep. It amazes me that we as a country are constantly paying billions every year for energy pills and drinks and magic herbs, yet we completely ignore the simplest, most accessible, and most cost-efficient energy source we could tap into: SLEEP.
Y’all, I’m not being flippant when I tell you that I LOVE sleep. I get singled out as the weirdo or the party pooper for being adamant that I get adequate sleep every night, but then again, you don’t see me taking a blood pressure pill with a bucket ‘o’ coffee in the mornings, so I guess the joke’s on them. (BTW, it IS possible to make it through medical school and get decent grades, adequate sleep, and not use stimulants. I’ve done it.)
Back to the story. The nurse was staying up until 3AM every night and had to be at work at 8.
She said she couldn’t sleep, so she would sit up and watch tv all night. I explained to her again how our brains need darkness to cue melatonin release, which cues us to go to sleep. I told her to shut off the tv and just deal with laying there for a while and see if she didn’t go to sleep before 3. Of course, I also suggested taking a little melatonin for a week or so to help reset her circadian rhythms and help the process along.
Good sleep hygiene isn’t always the answer to fatigue issues, but it’s a start. If the nurse had been obese or had told me she snored, I may have suggested she see her doctor to be worked up for sleep apnea. She could be depressed for all I know. She could be abusing caffeine or alcohol. She could legitimately be anemic. She could have COPD or heart failure. She could just be out of shape. Who knows.
My point is that there is no magic shot for energy. And doctors who say “oh you’re tired? Let me give you some B12” without properly investigating the patient’s complaint are not only perpetuating this misconception, but are doing their patients a terrible disservice.