A Question of Health: What's causing my husband's fatigue? And must I stop driving due to my diabetes?

TIRED ALL THE TIME

TIRED ALL THE TIME

A few years ago my husband, who is now 58, was diagnosed with atrial fibrillation. With medication, and after taking early retirement from a stressful job, he was able to lead a normal life. Eighteen months ago he had a minor stroke. He has recovered completely, although his geographical memory seems to have been affected. However, he complains of tiredness and spends part of each day asleep in a chair. He sees no point in going to the doctor, regarding himself as an old man. He lacks interest in anything other than routine activities. Could his tiredness be due to the stroke, his heart condition, his medication, psychological problems, or even our low-fat diet?

Your husband's tiredness is definitely not caused by your low-fat diet. All of your other suggestions are possible, but the most likely cause of his tiredness is depression. Atrial fibrillation is an irregularity of the heartbeat. Usually it can be controlled with medication, and once it is under control it causes few if any symptoms. Some medications can cause tiredness, so it is possible that he is taking some medication that is affecting his energy levels. The long-term effects of stroke are difficult to predict, but it sounds as though your husband has recovered from his stroke with relatively minor disability.

This brings us back to psychological and psychiatric problems, such as depression. A man in his fifties who has had major health problems leading to retirement from a stressful job is a prime candidate for a depressive illness. He has some of the classic symptoms of depression: tiredness, lack of interest and lack of motivation. He seems to have given up the struggle to get better. At the age of 58, he is definitely not an old man, and you should strenuously encourage him to get medical help. Depression is a treatable illness, and the results of treatment are excellent.

DRIVING TEST

I have had mild diabetes for a few years. At first I was able to control it with dieting. After about four years I was put on tablets twice a day. Recently things seem to have got worse, and it is likely that I am now going to have to take insulin injections for the rest of my life. I have heard that I may have to stop driving, which would make it impossible for me to continue working. Am I obliged to inform the driving authorities about my diabetes?

If you have diabetes that requires regular insulin injections, you are required to inform the Driver and Vehicle Licensing Agency (DVLA). This is also true of any other medical condition that may affect your fitness to drive. People who have diabetes that is controlled by either tablets or diet do not need to inform the DVLA, unless their eyesight is affected by their diabetes. With diabetes, you will be allowed to continue driving as long as you are able to recognize the symptoms of low blood sugar. If you have a licence to drive a large goods vehicle (LGV) or a Passenger Carrying Vehicle (PCV), the medical rules are stricter, and you may not be allowed to continue driving if you have to take insulin.

Firstly contact the DVLA, either by phone (0870 600 0301) or through their website (www.dvla.gov.uk). You will be asked to complete a questionnaire, and the DVLA may want to contact your doctors for further information. Car insurers also want to know about medical conditions, and I advise you to read the small print on your policy and let your insurance company know about your diabetes. Failure to do so may make your insurance invalid.

FATHER TIME

How accurate are DNA paternity tests? Are they available over the internet?

DNA paternity tests are extremely accurate if they are done in a competent laboratory. The tests are complicated and expensive. In order to establish who is the biological father of a child, DNA samples are required from both the child and the presumed father. If a sample from the mother is provided, the test is easier to interpret. If the DNA of the child matches that of the father, paternity is established. If there is no match, the presumed father is not the biological father. The tests can be done on blood samples or swabs taken from the inside of the cheek. There are some companies that offer this service over the internet, but I would advise you to discuss testing with a doctor or genetic counsellor before going ahead with it.

HAVE YOUR SAY - READERS WRITE

MM from Salisbury has suggested one further way of helping people who suffer from migraine:

Many people with migraine have found help and advice from the Migraine Action Group, who produce a regular magazine and many leaflets on the subject. There are also some local self-help groups around the country. See www.migraine.org.uk, phone 01536 461333, or write to Migraine Action Association, Unit 6, Oakley Hay Lodge Business Park, Great Folds Road, Great Oakley, Northants, NN18 9AS. There is also a small fee for membership for those who wish to join the association.

Please send your questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020 7005 2182; or e-mail health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions