Kathryn D. was getting desperate. All her life she had been healthy and active, eating wisely and keeping fit with sports and regular exercise. She went to her health club almost every day for a session of low-impact aerobics followed by a swim. But several months ago she began having trouble keeping up with her usual schedule. At first, she found herself getting tired toward the end of her aerobics class. Her arms, particularly, seemed to get heavy. Then when she entered the pool and started swimming, she found that it was hard to lift her arms over her head; she abandoned the crawl and the backstroke and did the sidestroke and breaststroke instead. She did not have any flulike symptoms, so she told herself that she needed more sleep and perhaps she should eat a little more.

Over the next few weeks, however, things only got worse. Aerobics classes were becoming an ordeal. Her instructor became concerned and suggested that Kathryn see her doctor. She did so, but he could find nothing wrong with her. She was not anemic, showed no signs of an infection, and seemed to be well nourished. He asked how things were going at work.

“Well, lately I’ve been under some pressure,” she said. “The head of my department quit a few weeks ago, and I’ve taken over his job temporarily. I think I have a chance of getting the job permanently, but I feel as if my bosses are watching me to see whether I’m good enough for the job.” Kathryn and her physician agreed that increased stress could be the cause of her problem. “I’d prefer not to give you any medication at this time,” he said, “but if you don’t feel better soon we’ll have a closer look at you.”

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