Long fatigue is the presentation where getting the order right matters most, because the list of treatable medical causes is long and none of them respond to what I do. So before treatment: your GP, and blood tests. Iron studies with ferritin, full blood count, thyroid function, B12 and folate, coeliac serology, glucose or HbA1c, and vitamin D. If you snore or fall asleep in the afternoon, a sleep study. If you are on medication, a review of it.
That is not me passing you along. It is that a ferritin of 8 explains the whole picture and no amount of acupuncture substitutes for iron. I have seen people spend a year on complementary treatment for fatigue that turned out to be undiagnosed coeliac disease, and that is a year nobody gets back.
Once that is clear, what I assess is the shape of the tiredness: tired on waking despite enough hours, or fine until mid-afternoon, or fine until exertion and then flattened for two days. Those are three different problems. The third is post-exertional malaise and points towards ME/CFS, which changes the whole approach — gentle, spaced, and never graded upwards on a schedule.
What I can then work on is sleep quality, digestion, pain that is interrupting rest, and the pacing conversation, which is mostly about giving people permission to do less for a while. Sessions are in Lane Cove, opposite the library, and there is a review point at four rather than an open-ended course.
