Too-Tired Mom

Kelly Anne Spratt, D.O., Director of Women's Cardiovascular Health at the University of Pennsylvania Presbyterian Medical Center, answers your questions.

Q. I'm 32 and have four children, ranging in ages 2 to 12. For about the past year, I've been tired all the time. I have a headache every day that often affects my vision. It starts at the base of my neck and works its way up. I also have a pain in the middle of my chest, above my stomach right below my ribs in the middle, that seems to have started after the birth of my fourth child. Some days my chest feels swollen and sore.

My doctor says all of my symptoms are caused by the stress of having four children, and he put me on anti-depressant medication. I know you don't know me, but I am not a depressive person. I took the drug for three weeks and it did nothing but make me sick and didn't relieve any of my symptoms. Help!

A. First of all, I hope before your doctor put you on anti-depressants that he did some lab tests to make sure you do not have anemia, thyroid, or kidney disease. These are all commonly associated with fatigue. The area you describe as painful may be related to the stomach or duodenum. You could have either inflammation of this area (example, gastritis) or even an ulcer, both of which can cause exactly the type of discomfort in exactly the area you describe. Over a period of time this could lead to fatigue from a variety of causes. Other gastrointestinal causes include gall bladder disease, another common disease in women.

Also, although it is unusual in a young woman, the leading cause of death in all women is heart disease and if you have certain risk factors such as high cholesterol, smoking, or a family history of heart disease, this should be considered as a possiblity. At minimum, you should have an electrocardiogram (EKG) since the area of your discomfort borders on the area where your heart is located. One very common cause of both headache and fatigue is hypertension. You should monitor your blood pressure at home (buy one of the cuffs in a drug store), especially noting if it goes up at the same time as the onset of the headaches. Hypertension can also give you the sensation of fullness in your heart area; this may be what you are feeling in your chest.

All of these possible causes need to be investigated, but keep in mind that stress can in fact bring on these other physical diseases. If there is any way to decrease the amount of stress in your life and you take steps to eat a healthy diet, exercise on a regular basis, and get plenty of sleep, whatever is causing the other symptoms will be improved.