Brief Answer:
Consultation

Detailed Answer:
Hi XXXX, thanks for asking from HCM.


I can understand your concern. Chronic tiredness for 25 years is quite a long time. As chronic fatigue syndrome which was a very close differential diagnosis, has been ruled out, we have to think about other causes of it. You have a tendency to drop things (recently developed). Based on these features and your age, there are few possibilities like

: Myopathy - It can be genetic, metabolic or secondary to other causes like drug intake/alcohol/drug abuse/liver or kidney disease/deficiency disease.

: Gradually progressive neuropathy - It can be due to diabetes, alcohol, medication, drug abuse, pesticides, toxic chemical exposure like lead/paint/some factory nearby etc.

: Depression - It can present with different manifestations like you mentioned above. It can be suspected only after ruling out organic causes.

: Nutritional deficiency like anaemia (low haemoglobin), calcium, vitamin D deficiency, multivitamin deficiency like B12/folic acid, low protein.

You should consult doctor (neurologist). He will examine your nervous and muscular system. After it, he may ask for few investigations like

: Blood investigations like haemoglobin level, blood sugar, vitamin B12, vitamin D3 level, liver and kidney function.

: If suspecting low calcium and vitamin D, bone densiometery may help in detecting osteoporosis.

: If suspecting toxin exposure, blood level of lead/mercury or toxin may be advised.

: Muscle enzyme level i.e. CPK and Troponin to find myopathy. If raised level, electromyography (EMG) and nerve conduction velocity (NCV) will help in differentiating between myopathy and neuropathy.

: Rarely if confusion about diagnosis, muscle biopsy may be advised.

If everything comes negative and history is not suggestive of organic disease, you might be referred to Psychiatrist to rule out depression or other psychological dysfunction.

I hope by this protocol we will be able to reach unto some conclusion. Treatment will depend upon final diagnosis.

Hope it will help yo. Still in doubt, do let me know.

Thanks. Take care.

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