Over the course of a year, I’ll see 5,000 or more patients who come to me for treatment. Of all the symptoms my patients tell me they have, malaise, or a general sense that they’re not feeling as well as they could, is one of the most common complaints I hear. Unfortunately, whenever a patient tells me she is feeling weak and unwell, it opens the door to the possibility of every single medical problem on earth. This can be frustrating and overwhelming to the physician as well as to the patient, so if she simply says she doesn’t feel quite right, I ask her to be as specific with her complaints as she can. It’s important to keep in mind that age and activity levels have a lot to do with how people define malaise. For instance, the malaise of a 20-year-old athlete who cannot run 10 miles every day because of an injury is much different from the 50-year-old executive who can’t seem to find the energy to go to work or the 65-year-old grandmother who just feels too tired to do chores around the house.

If you have been feeling weak and out of sorts lately, answering the following questions will help your physician zero in on the possible causes:

1. How long have I been feeling unwell? A week, a month, or longer?

2. Has there been a change in my appetite or thirst? In my urination or bowel habits?

3. Have I gained or lost a significant amount of weight in the last few weeks or months?

4. For women, if I am still menstruating, has my cycle or flow, or both, changed recently?

5. Have I recently had a fever, night sweats, or a physical intolerance to hot or cold temperatures?

6. Have I recently traveled abroad or to a different region of the country?

7. Do I have a symptom such as a rash, arthritic pain, or swollen glands?

8. Do I think I might have been bitten by a tick recently?

9. Have I been undergoing problems in my personal life lately?

10. Do I have a past history of a serious illness that was cured or went into remission? Have I begun to take a new form of medication recently?

11. Has my urine darkened in color recently?

12. Do I have a history of blood transfusion, sharing a hypodermic needle, drug abuse, or even one unsafe sexual encounter?

13. Do I feel a general ache in my bones?

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A complete medical history and physical exam as well as a series of specific diagnostic tests will help your doctor determine the necessary treatment for your unexplained weight gain.

As with any medical treatment, the risks must be weighed against the benefits when you and your doctor decide about your specific treatment. If your doctor has prescribed steroids to treat another medical condition, you should realize that the short-term use of steroids for a week or even up to a month has not been found to cause any permanent weight or health problems. You’ll lose the extra pounds once you stop taking the steroids.

Water pills, or diuretics, can help reduce a weight gain of a few pounds that comes before menstruation and is caused by water retention—if they’re used judiciously. However, they do not help reduce the body’s stores of fat and are dangerous to use on a reduced-calorie diet since they can cause potassium depletion and dehydration.

Since most cases of weight gain are caused by eating too much and/or moving too little, what I’m going to say next is going to sound boring, but I’m going to say it anyway. If your weight gain is the direct result of too many calories and not enough exercise, you’re going to have to change your lifestyle if you want to lose weight. A sensible weight-reduction plan should include a low-fat, low-calorie diet and regular physical exercise. Your doctor is the best person to advise you about the best course of action for you.

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In an elderly person, weight loss can have certain causes a doctor would never consider to be a problem in a younger person. For one, your elderly aunt may not be able to obtain nutritious food because she’s unable to make it out of the house to go shopping and there’s no one else around to do it for her. Poorly fitting dentures can make it uncomfortable for her to eat, or she may be experiencing increasing senility due to Alzheimer’s disease, cancer, or an underlying infection and has lost her appetite.

As with younger people, I consider weight loss in an elderly person to be serious if she loses more than 10% of her body weight over the course of a month or two. If this happens, I’ll order a blood test to determine if there is evidence of malnutrition. Lower serum protein levels, albumin levels, and lymphocyte counts ate all signs that the immune system is beginning to deteriorate, making an elderly person more prone to infections, bedsores, falls, and other health problems. These can depress the appetite even mote.

The treatment for your elderly relative will depend on the cause. Using Meals on Wheels, taking food supplements, and getting new dentures, as well as possibly going into a nursing home are some of the steps that might be considered by the doctor and the patient’s family.

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High-risk groups. Skin protection from ultraviolet light for persons with frequent exposure to sunlight.

Discussion of aspirin therapy for men who have risk factors for myocardial infarction (e.g., high blood cholesterol, smoking, diabetes mellitus, family history of early-onset coronary artery disease) and who lack a family history of gastrointestinal or other bleeding problems or other risk factors for bleeding or cerebral hemorrhage.

Discussion of estrogen replacement therapy for perimenopausal women who have an increased risk for osteoporosis (e.g., Caucasian, low bone mineral content:, bilateral ovary removal before menopause, early menopause, slender build) and who are without known contraindications (e.g., history of undiagnosed vaginal bleeding, active liver disease, thromboembolic disorders, hormone-dependent cancer).

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Diet and Exercise

Fat (especially saturated fat), cholesterol, complex carbohydrates, fiber, sodium, calcium. Caloric balance. Selection of exercise program.

Substance Use

Tobacco cessation. Alcohol and other drugs. Limiting alcohol consumption.

Driving/other dangerous activities while under the influence. Treatment for abuse.

Injury Prevention

Prevention of falls. Safety belts. Smoke detectors.

Smoking near bedding or upholstery. Hot-water heater temperature. Safety helmets.

High-risk groups. Prevention of childhood injuries for persons with children in the home or automobile.

Dental Health

Regular dental visits, tooth brushing, flossing. Other Primary Preventive Measures

Glaucoma testing by eye specialist.

High-risk groups. Discussion of estrogen replacement therapy for women who have an increased risk for osteoporosis (e.g., Caucasian, low bone mineral content, bilateral ovary removal before menopause, early menopause, slender build) and who are without known contraindications (e.g., history of undiagnosed vaginal bleeding, active liver disease, thromboembolic disorders, hormone-dependent cancer).

Discussion of aspirin therapy for men who have risk factors for myocardial infarction (e.g., high blood cholesterol, smoking, diabetes mellitus, family history of early-onset coronary artery disease) and who lack a family history of gastrointestinal or other bleeding problems or other risk factors for bleeding or cerebral hemorrhage.

Skin protection from ultraviolet light for persons with frequent exposure to sunlight.

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