Friday, September 19, 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

Shelter uses technology to reunite pets, owners

By Susan Hiland | From Page: A1 | Gallery

 
Weekend full of jazz on tap in Vacaville

By Amy Maginnis-Honey | From Page: B1

 
Royal Tailor plans high-energy, genre-blending show

By Amy Maginnis-Honey | From Page: B1

Missouri Street Theatre set to open ‘Bonnie and Clyde’

By Amy Maginnis-Honey | From Page: B1

 
 
Fairfield police arrest 2 in robberies investigation

By Barry Eberling | From Page: A3, 10 Comments | Gallery

Police make child molestation arrest

By Barry Eberling | From Page: A3, 2 Comments | Gallery

 
Dignitaries celebrate opening of $30M courthouse

By Jess Sullivan | From Page: A3, 2 Comments | Gallery

 
Men, again, are seen as missing in Fairfield

By Ryan McCarthy | From Page: A4, 5 Comments | Gallery

Stolen vehicle investigation leads to 3 arrests

By Barry Eberling | From Page: A4, 2 Comments | Gallery

 
Police seek help to find missing Fairfield man

By Glen Faison | From Page: A4 | Gallery

Fairfield eyes sale of excess government land

By Ryan McCarthy | From Page: A4

 
Suisun City police log: Sept. 17, 2014

By Susan Hiland | From Page: A12

Fairfield police log: Sept. 17, 2014

By Susan Hiland | From Page: A12

 
Weather for Sept. 19, 2014

By Daily Republic | From Page: B12

.

US / World

Strong Senate vote for Obama on Syria rebel aid

By The Associated Press | From Page: A1

 
Scots reject independence in historic vote

By The Associated Press | From Page: A1, 1 Comment | Gallery

Man arrested in fast-growing California wildfire

By The Associated Press | From Page: A1 | Gallery

 
Passenger says JetBlue plane filled with smoke

By The Associated Press | From Page: A4 | Gallery

Law makes earthquake insurance more understandable

By The Associated Press | From Page: A4

 
GOP pushes diverse candidates, but will it matter?

By The Associated Press | From Page: A4, 1 Comment

Boxer indicates big decision to come next year

By The Associated Press | From Page: A5 | Gallery

 
Father arrested in fatal stabbing of 6-year-old

By The Associated Press | From Page: A5

Health exchange addresses dropped policies

By The Associated Press | From Page: A5

 
UC system plan calls for anti-sex abuse effort

By The Associated Press | From Page: A5

Democratic state lawmaker arraigned on DUI charges

By The Associated Press | From Page: A5, 1 Comment

 
PG&E emails may have violated rules, judge says

By The Associated Press | From Page: A5

500 Berkeley students missed sex abuse classes

By The Associated Press | From Page: A5

 
In wake of beheadings, Busch Gardens removes props

By The Associated Press | From Page: A6

Trooper ambush suspect added to most wanted list

By The Associated Press | From Page: A6

 
CDC tells healthy adults not to forget flu vaccine

By The Associated Press | From Page: A6 | Gallery

Border Patrol to test wearing cameras

By The Associated Press | From Page: A6 | Gallery

 
Kansas court: Remove Democrat from Senate ballot

By The Associated Press | From Page: A6

Ukraine’s pleas for lethal aid from US go unmet

By The Associated Press | From Page: A6

 
Sheriff: Fla. man kills 6 grandchildren, daughter

By The Associated Press | From Page: A6

Couple in Craigslist slaying sentenced to life

By The Associated Press | From Page: A6

 
Series of attacks kills at least 36 in Iraq

By The Associated Press | From Page: A10

Sierra Leone to shut down for 3 days to slow Ebola

By The Associated Press | From Page: A10 | Gallery

 
British hostage appears in new video

By The Associated Press | From Page: A10

Witness: 21 killed by Mexico army had surrendered

By The Associated Press | From Page: A10

 
Militant gains illustrate plight of Syrian Kurds

By The Associated Press | From Page: A10

.

Opinion

 
Did the ‘War on Poverty’ fail?

By Ben Boychuk and Joel Mathis | From Page: A11

 
Do you feel more secure?

By Bud Stevenson | From Page: A11, 1 Comment

My support for anyone but Moy

By Letter to the Editor | From Page: A11, 16 Comments

 
.

Living

Today in History: Sept. 19, 2014

By The Associated Press | From Page: A2

 
Community Calendar: Sept. 19, 2014

By Susan Hiland | From Page: A2

Horoscopes: Sept. 19, 2014

By Holiday Mathis | From Page: A9

 
Mother-in-law bothers me at work for kid’s minor infractions

By Kathy Mitchell and Marcy Sugar | From Page: A9

.

Entertainment

Week in preview Sept. 19-25, 2014

By Amy Maginnis-Honey | From Page: B1

 
Review: ‘Leave You’ has A-list cast, B-grade result

By The Associated Press | From Page: B2

 
Adam Driver shifts into hyper drive

By Jake Coyle | From Page: B2

Peter Fonda’s ‘Easy Rider’ bike going to auction

By The Associated Press | From Page: B3

 
‘The Voice’ winner goes to Broadway’s ‘Pippin’

By The Associated Press | From Page: B3

TV Guide Network renaming itself POP

By The Associated Press | From Page: B3

 
Entertainment calendar Sept. 19, 2014

By Amy Maginnis-Honey | From Page: B4

Darrell Hammond takes over for Don Pardo on ‘SNL’

By The Associated Press | From Page: B5

 
The Roosevelt trail, from Maine to North Dakota

By The Associated Press | From Page: B6

TVGrid

By Daily Republic Syndicated Content | From Page: B6

 
.

Sports

Nashville new home for Athletics’ Triple-A team

By The Associated Press | From Page: B7

 
 
Vanden volleyball team remains undefeated in SCAC play

By Daily Republic staff | From Page: B7

 
49ers’ Derek Carrier ready to step in at tight end

By The Associated Press | From Page: B7, 1 Comment

Raiders seek ways to get Reece more involved

By The Associated Press | From Page: B7 | Gallery

 
Athletics out of top wild-card spot as Texas sweeps

By The Associated Press | From Page: B7 | Gallery

Falcons romp to 56-14 win over hapless Buccaneers

By The Associated Press | From Page: B8 | Gallery

 
2-time Grand Slam winner Li Na retires from tour

By The Associated Press | From Page: B8

Stacy Lewis, Mi Jung Hur share LPGA lead in Alabama

By The Associated Press | From Page: B8

 
WR Simpson, in more trouble, released by Vikings

By The Associated Press | From Page: B8

Royal & Ancient votes to admit female members

By The Associated Press | From Page: B8

 
MLS says Chivas USA might not play in 2015

By The Associated Press | From Page: B8

Tiger Woods says he might coach himself

By The Associated Press | From Page: B8

 
Police: Cardinals RB Dwyer head-butted wife

By The Associated Press | From Page: B8

Signups for Friday, Sept. 19, 2014

By Paul Farmer | From Page: B10

 
Appeals court reconsidering Barry Bonds conviction

By The Associated Press | From Page: B10

Prep football capsules: Week 3

By Paul Farmer | From Page: B10

 
.

Business

Nissan’s small car excels at affordability

By Ann M. Job | From Page: C1 | Gallery

 
Self-driving cars now need a permit in California

By The Associated Press | From Page: C2 | Gallery

Alibaba prices IPO at $68 per share

By The Associated Press | From Page: B11 | Gallery

 
Home Depot says malware affected 56M payment cards

By The Associated Press | From Page: B11

Applications for US jobless benefits fall sharply

By The Associated Press | From Page: B11, 1 Comment

 
Apple locks itself out of devices with passwords

By The Associated Press | From Page: B11

Alibaba’s plan: Today, China. Tomorrow, the world.

By The Associated Press | From Page: B11

 
Chevron meets new, voluntary shale drilling rules

By The Associated Press | From Page: B11

Ellison gives up Oracle CEO role, becomes chairman

By The Associated Press | From Page: B11

 
California bill increases Hollywood tax credits

By The Associated Press | From Page: B11

Fed keeps rates low, but brace for the inevitable

By The Associated Press | From Page: B11

 
.

Obituaries

Margaret King

By Susan Hiland | From Page: A4

 
Mae Frances Jones

By Nancy Green | From Page: A4

.

Comics

Rose is Rose

By Daily Republic Syndicated Content | From Page: A8

 
Zits

By Daily Republic Syndicated Content | From Page: A8

Baldo

By Daily Republic Syndicated Content | From Page: A8

 
Peanuts

By Daily Republic Syndicated Content | From Page: A8

For Better or Worse

By Daily Republic Syndicated Content | From Page: A8

 
Pickles

By Daily Republic Syndicated Content | From Page: A8

Baby Blues

By Daily Republic Syndicated Content | From Page: A8

 
B.C.

By Daily Republic Syndicated Content | From Page: A8

Get Fuzzy

By Daily Republic Syndicated Content | From Page: A8

 
Dilbert

By Daily Republic Syndicated Content | From Page: A8

Wizard of Id

By Daily Republic Syndicated Content | From Page: A8

 
Beetle Bailey

By Daily Republic Syndicated Content | From Page: A8

Garfield

By Daily Republic Syndicated Content | From Page: A8

 
Blondie

By Daily Republic Syndicated Content | From Page: A8

Sally Forth

By Daily Republic Syndicated Content | From Page: A8

 
Frank and Ernest

By Daily Republic Syndicated Content | From Page: A8

Bridge

By Daily Republic Syndicated Content | From Page: A9

 
Sudoku

By Daily Republic Syndicated Content | From Page: A9

Cryptoquote

By Daily Republic Syndicated Content | From Page: A9

 
Word Sleuth

By Daily Republic Syndicated Content | From Page: A9

Crossword

By Daily Republic Syndicated Content | From Page: A9