Monday, December 22, 2014
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

Chronic fatigue syndrome: Fact or fiction?

By
From page B10 | April 14, 2012 |

Doctors and patients alike sometimes struggle to affix a meaningful diagnosis to nonspecific symptoms. When a patient develops a number of symptoms that seem to go together, we sometimes call this a syndrome.

Syndromes often are described when neither doctor nor patient really understands what is going on.

Perhaps a quintessential example of such a situation is what we encounter in the so-called chronic fatigue syndrome.

Let us consider how best to struggle with symptoms of fatigue.

As an internist, I prefer to always consider the possibility that what a patient calls “fatigue” may be something else altogether.

One fatigue mimicker is actual muscular weakness. This can occur in a variety of conditions including muscular dystrophy, muscle inflammation conditions, deconditioning following hospitalization or stroke, depression, nutritional deficiencies or glandular disorders.

I typically test muscle strength by examination procedures (such as squeezing a device called a Jamar Dynonometer). If the muscles are really weak, various tests can sort out a specific diagnosis.

In addition to blood work, studies of neurological function of muscles or even muscle biopsies may on occasion prove necessary.

If a patient is strong physically, but describes a pervasive lack of energy, we may need to consider fatigue as a distinct entity and there is yet another “laundry list” of possible explanations.

For example, does the patient have iron-deficiency anemia? So-called “iron-poor blood,” as it was once referred to in vitamin advertisements, can result from conditions ranging from menstruation to colon cancer, and an appropriate evaluation is necessary before simply prescribing an iron supplement.

Does the patient have an under-active thyroid gland, and if so what is the cause?

Is the patient clinically depressed, or suffering from a sleep disorder, or side effects of prescribed medications?

All of these conditions can be specifically diagnosed and treated.

For example, thyroid hormone can be supplemented with pills, sleep disorders can be treated and medication side effects can be addressed by prescribing better-tolerated alternative medications.

Sometimes fatigue responds to an exercise program and lifestyle changes, if no specific cause emerges.

In general, I like to tailor the treatment to the specific diagnosis, however.

In some cases, no cause of fatigue is specifically identifiable. In recent decades, these patients on occasion have been diagnosed with “chronic fatigue syndrome.” Patient support groups have emerged to advocate for sufferers of this malady and a variety of practitioners purport to treat chronic fatigue syndrome.

The underlying cause is felt to be unknown, but chronic fatigue syndrome criteria for diagnosis often are described as including fatigue, swollen lymph nodes and blood tests revealing antibodies to common viruses. A specific offending virus that is often cited as causative is Epstein-Barr virus.

Treatments undertaken for chronic fatigue syndrome include pain killers, antidepressants, psychotherapy, and nutritional support, but symptoms tend to be chronic.

The axiom Primum Non Nocere, or “first do no harm,” should guide physician and patient toward relatively benign therapies, if at all possible.

The Epstein-Barr that is purported to cause chronic fatigue syndrome is also widely described in nonfatigued hosts. Moreover, I rarely find objective physical examination findings in chronic fatigue syndrome patients to suggest an ongoing infection of any sort.

We also know that the history of medicine is replete with diagnoses that were once popular and now are discredited. Neurasthenia, for example, was a 19th century condition that bore similarity to chronic fatigue syndrome, albeit in a different historical and cultural context.

I recognize, however, that medical research is always advancing and forcing us to reconsider our entrenched opinions.

Perhaps further research on viruses and physiology will shed light on the chronic fatigue syndrome. In medicine, the only thing that stays the same is change.

Scott Anderson, M.D., Ph.D. (stamdphd@comcast.net) is Clinical Professor of Rheumatology, Allergy, and Clinical Immunology at UC Davis. This article is informational, and does not constitute medical advice.

Scott Anderson

LEAVE A COMMENT

Discussion | 5 comments

The Daily Republic does not necessarily condone the comments here, nor does it review every post. Read our full policy

  • Huh?April 14, 2012 - 1:30 pm

    An article, by a medical professional, that suggests that Chronic Fatigue Syndrome might be fiction...and doesn't even mention Myalgic Encephalomyelitis. That in itself is indefensible--that is, if one has an interest in knowing the subject they're writing about--but unfortunately not even all that uncommon. An article that mentions Neurasthenia, and not ME...that takes some doing. I don't suppose it would hurt to take a look at this. http://www.virology.ws/2011/11/23/chronic-fatigue-syndrome-and-the-cdc-a-long-tangled-tale/

    Reply | Report abusive comment
  • KALApril 14, 2012 - 3:23 pm

    Dr. Anderson writes a thoughtful article. However he fails to mention that the "fatigue" in myalgic encephalomyelitis (ME), sometimes called chronic fatigue syndrome, is a rather rare and specific form. According to the latest clinical diagnostic definition published in 2011 (Carruthers B et al) post exertional malaise lasting 24-hours or more, unrelieved by rest and upon minimal exertion such as doing the dishes is considered mandatory as is part of a specific pattern of symptoms and signs. Researchers at the University of the Pacific, Stanford University, the University of Utah, Harvard University, Mt Sinai and others are all adding to the nearly 5,000 biomedical research papers on ME and CFS demonstrating the pathological changes in the different physiological systems in such patients. Harvard professor and ME and CFS researcher, Dr. Anthony Komaroff states that these include changes in the autonomic nervous system, the immune system, energy metabolism and mitochondria, as well as the active process of “gene expression” in the illness and, as Dr Anderson notes, links to an infectious process. Because multiple definitions selecting very different cohorts are used the literature is very mixed. Researching apples and calling them peaches doesn't work from a scientific standpoint. Currently, Dr. Ian Lipkin direction of the Columbia University Center for Infection and Immunity is coordinating a large study of 200 very narrowly defined patients using cutting edge deep sequencing methods to look for pathogens as well as biomarkers in such patients.

    Reply | Report abusive comment
  • Barba BrightApril 17, 2012 - 2:30 pm

    At least the comments are worth reading.

    Reply | Report abusive comment
  • Phoebe SnowdenApril 17, 2012 - 2:57 pm

    While I do appreciate much of Dr. Anderson's article, I believe that he is misinformed about true CFS, also called myalgic encephalomyelitis. I hope that he will investigate Dr. Jose Montoya's work at Stanford (Stanford Chronic Fatigue Initiative) so that he gets a better idea of what constitutes a CFS patient. CFS is now often used as a "garbage can diagnosis" by physicians who don't know any better, and the CDC has not helped the situation with their increasingly vague & inaccurate definitions. True CFS patients have chronic, quantifiable infections, including EBV, CMV, HHV-6, Parvovirus, Coxsackie B, and mycoplasma & chlamydia pneumoniae along with other very specific biomarkers. Until the CDC definitions are changed (or myalgic encephalomyelitis is once again recognized as a disease in the US) and physicians are better educated, people will continue to be incorrectly diagnosed with CFS and true CFS patients will continue to pay the price for medical ignorance.

    Reply | Report abusive comment
  • MystyApril 18, 2012 - 4:42 am

    Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). Sjögren's syndrome, also known as "Mikulicz disease" and "Sicca syndrome", is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva. Down syndrome or Down's syndrome, also known as trisomy 21, is a chromosomal condition caused by the presence of all or part of an extra 21st chromosom CFS is a collection of people. ME is a World organisation recongised neurolgical disease that has been recorded as such since 1969. Many people have died from ME. About 3 cases have already been reported by the press this year. Chronic fatigue syndrome is a fiction without any science applied. ME is a fact with a wealth of scientific evience behind it including brains scans. When GPs can be bother to read the literature may be they will be qualified to write articles.

    Reply | Report abusive comment
.

Solano News

Christmas comes early to San Marco Street park

By Ryan McCarthy | From Page: A1, 2 Comments | Gallery

 
Travis squadron delivers Christmas gifts to East Tabor

By Ryan McCarthy | From Page: A1 | Gallery

 
 
 
 
Multiple car accident blocks I-80 in Vacaville

By Glen Faison | From Page: A3, 2 Comments | Gallery

 
Famous Creations’ toy drive and cupcake sale

By Daily Republic staff | From Page: A4 | Gallery

Last-minute shopping at Vacaville Premium Outlets

By Daily Republic staff | From Page: A4, 1 Comment | Gallery

 
Kitchen fire dislocates family for Christmas

By Susan Hiland | From Page: A4, 3 Comments | Gallery

Suisun City police log: Dec. 20, 2014

By Susan Hiland | From Page: A9

 
Fairfield police log: Dec. 20, 2014

By Susan Hiland | From Page: A9

Weather for Dec. 22, 2014

By Daily Republic | From Page: B10

 
.

US / World

A look at the 2 NYC officers killed in ambush

By The Associated Press | From Page: A1

 
Killer of 2 NYC officers had long criminal history

By The Associated Press | From Page: A1, 3 Comments

 
Killings of 2 New York officers trigger backlash

By The Associated Press | From Page: A1, 6 Comments

California puzzles over safety of driverless cars

By The Associated Press | From Page: A1, 4 Comments

 
Timeline of events before and after NY cop deaths

By The Associated Press | From Page: A1

Pakistan makes arrests in Taliban school carnage

By The Associated Press | From Page: A5

 
Tent city sprouts in shadow of downtown Detroit

By The Associated Press | From Page: A5

 
US mulls putting NKorea on terrorism sponsor list

By The Associated Press | From Page: A5

Satanic Temple puts up display at Michigan Capitol

By The Associated Press | From Page: A5, 3 Comments

 
Australian woman charged with murder of 8 children

By The Associated Press | From Page: A5

Exit poll: Ex-regime official is Tunisia’s new president

By The Associated Press | From Page: A5

 
.

Opinion

Faust and the 2015 federal budget

By Mike Kirchubel | From Page: A8, 15 Comments

 
Obama, surgeon general still losing to NRA

By Francis Wilkinson | From Page: A8, 5 Comments

Let the music begin

By Colleen Britton | From Page: A8, 3 Comments

 
Editorial Cartoon: Dec. 22, 2014

By Daily Republic Syndicated Content | From Page: A8

 
.

Living

Today in History: Dec. 22, 2014

By The Associated Press | From Page: A2

 
Community Calendar: Dec. 22, 2014

By Susan Hiland | From Page: A2, 1 Comment

Horoscopes: Dec. 23, 2014

By Holiday Mathis | From Page: B5

 
 
Horoscopes: Dec. 22, 2014

By Holiday Mathis | From Page: A7

.

Entertainment

TVGrid Dec 22

By Daily Republic Syndicated Content | From Page: B6

 
TVGrid Dec 23

By Daily Republic Syndicated Content | From Page: B7

‘Hobbit’ goes out on top with $90.6 million 5-day debut

By The Associated Press | From Page: B7

 
Good news from Tom Brokaw: His cancer is in remission

By The Associated Press | From Page: B7

Review: ‘The Interview’ deserves to be seen

By Jake Coyle | From Page: B7

 
Happy day: Elton John, David Furnish marry in England

By The Associated Press | From Page: B7

.

Sports

The Week Ahead: Not much of a break for Christmas

By Paul Farmer | From Page: B1

 
Steelers, Packers win, move into playoffs

By The Associated Press | From Page: B1 | Gallery

Raiders knock Bills out of playoffs with 26-24 win

By The Associated Press | From Page: B1 | Gallery

 
Kings snap 5-game losing skid, beat Lakers 108-101

By The Associated Press | From Page: B1 | Gallery

Burns gives Sharks late-night win over Blues in OT

By The Associated Press | From Page: B1

 
NFL Roundup: Cowboys end 4-year drought, make playoffs

By The Associated Press | From Page: B2 | Gallery

7 hurt when lightning strikes near Tampa Bay game

By The Associated Press | From Page: B2

 
India’s Arjun Atwal wins Dubai Open

By The Associated Press | From Page: B2

Documents: FSU QB Winston cleared in conduct hearing

By The Associated Press | From Page: B2

 
Super-G crash makes Vonn wait in bid for record

By The Associated Press | From Page: B2

.

Business

US companies eager to embrace Cuba face hurdles

By The Associated Press | From Page: B6

 
Survey: US gas prices fall 25 cents per gallon

By The Associated Press | From Page: B6

.

Obituaries

Marian Kay Zutz

By Nancy Green | From Page: A4

 
Bart Ferro

By Nancy Green | From Page: A4

.

Comics

Beetle Bailey Dec 23

By Daily Republic Syndicated Content | From Page: B4

 
Peanuts Dec 23

By Daily Republic Syndicated Content | From Page: B4

Garfield Dec 23

By Daily Republic Syndicated Content | From Page: B4

 
For Better or Worse Dec 23

By Daily Republic Syndicated Content | From Page: B4

Baldo Dec 23

By Daily Republic Syndicated Content | From Page: B4

 
Blondie Dec 23

By Daily Republic Syndicated Content | From Page: B4

Dilbert Dec 23

By Daily Republic Syndicated Content | From Page: B4

 
Frank and Ernest Dec 23

By Daily Republic Syndicated Content | From Page: B4

Sally Forth Dec 23

By Daily Republic Syndicated Content | From Page: B4

 
B.C. Dec 23

By Daily Republic Syndicated Content | From Page: B4

Wizard of Id Dec 23

By Daily Republic Syndicated Content | From Page: B4

 
Baby Blues Dec 23

By Daily Republic Syndicated Content | From Page: B4

Zits Dec 23

By Daily Republic Syndicated Content | From Page: B4

 
Get Fuzzy Dec 23

By Daily Republic Syndicated Content | From Page: B4

Pickles Dec 23

By Daily Republic Syndicated Content | From Page: B4

 
Rose is Rose Dec 23

By Daily Republic Syndicated Content | From Page: B4

Sudoku Dec 23

By Daily Republic Syndicated Content | From Page: B5

 
Bridge Dec 23

By Daily Republic Syndicated Content | From Page: B5

Word Sleuth Dec 23

By Daily Republic Syndicated Content | From Page: B5

 
Crossword Dec 23

By Daily Republic Syndicated Content | From Page: B5

Cryptoquote Dec 23

By Daily Republic Syndicated Content | From Page: B5

 
Get Fuzzy Dec 22

By Daily Republic Syndicated Content | From Page: A6

Baby Blues Dec 22

By Daily Republic Syndicated Content | From Page: A6

 
Baldo Dec 22

By Daily Republic Syndicated Content | From Page: A6

Zits Dec 22

By Daily Republic Syndicated Content | From Page: A6

 
Peanuts Dec 22

By Daily Republic Syndicated Content | From Page: A6

Dilbert Dec 22

By Daily Republic Syndicated Content | From Page: A6

 
Sally Forth Dec 22

By Daily Republic Syndicated Content | From Page: A6

Pickles Dec 22

By Daily Republic Syndicated Content | From Page: A6

 
Rose is Rose Dec 22

By Daily Republic Syndicated Content | From Page: A6

Frank and Ernest Dec 22

By Daily Republic Syndicated Content | From Page: A6

 
Blondie Dec 22

By Daily Republic Syndicated Content | From Page: A6

Beetle Bailey Dec 22

By Daily Republic Syndicated Content | From Page: A6

 
Garfield Dec 22

By Daily Republic Syndicated Content | From Page: A6

B.C. Dec 22

By Daily Republic Syndicated Content | From Page: A6

 
Wizard of Id Dec 22

By Daily Republic Syndicated Content | From Page: A6

For Better or Worse Dec 22

By Daily Republic Syndicated Content | From Page: A6

 
Sudoku Dec 22

By Daily Republic Syndicated Content | From Page: A7

Cryptoquote Dec 22

By Daily Republic Syndicated Content | From Page: A7

 
Bridge Dec 22

By Daily Republic Syndicated Content | From Page: A7

Word Sleuth Dec 22

By Daily Republic Syndicated Content | From Page: A7

 
Crossword Dec 22

By Daily Republic Syndicated Content | From Page: A7