Aside from the obvious first-visit history and screening to rule out anemia, hypothyroidism, depression and Lyme disease, what is the most appropriate method for working up a diagnosis of fatigue?— Amy Lee Heimink, ANP, Marlboro, N.Y.

Over the years, I have come to rely heavily on sleep pattern. Does the patient sleep enough, and of what quality is that sleep? The Epworth Sleepiness Scale is very useful in that determination. Following that assessment, workups to explore lupus, fibromyalgia and diabetes should be conducted. — Sherril Sego, FNP-C, DNP (176-1)

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These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a question, submit it here.