Question: White male, age 88, type two diabetes(insulin dependent), hypopituitarism, steroid deficiency(take 30 mg hydrocortisone daily) hypothyroidism(150 mg synthroid daily) BP is 125/76. CLL is in the 14,000 lymphocytic range. Chief Complaint: For the past few weeks I have awakened in the morning extremely fatigued, a condition that persists throughout the day. Eyes become puffy. ( aside: Ankles have been edematous for several years so I sleep with pillow under to elevate). Lack of energy keeps me from commiting efficiently to daily routine activities. I walk .5 miles daily on treadmill and intersperse various additional exertions during the day such as climbing steps, lifting weights and walking one mile to and from post office. Since retiring 20 years ago, I take one hour naps daily around 3 PM. Sleep 7 -8 hours/night. Recent stress tests ruled out any cardiac problems. MRI, and CATSCAN performed at local hospital last week were negative (I had an unusual ataxic episode and we wished to rule out a stroke) .
Any suggestions on how to get me re-energized?

May I first compliment you on your helpful guidance. I will relay your suggestions to my Endocrinologist(Dr. Mansour Saberi) and primary care physician(Dr.Rajshekar Narasamaiah) here in Delaware in the USA. Several of the tests you suggest have been performed but there are others that have not been.

Incidentally, though not germane to the subject but perhaps of possible interest to you, Dr. Narasamaiah has been straddling his stateside practice with prolonged visits to his hometown in XXXXXXX to sponsor, and supervise construction of a hospital in Bangalador in honor of his deceased father. Fortunately, the project is near completion and we patients will be glad to have him return full time.

Again, thanks for your input.
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