Tuesday, September 30, 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

Solano focuses on rail safety

By Barry Eberling | From Page: A3

 
Police search for missing man

By Glen Faison | From Page: A5 | Gallery

 
 
Measure A committee plans weekend precinct walk

By Susan Winlow | From Page: A5

Voters who have moved urged to check registration

By Barry Eberling | From Page: A6

 
Caltrans cancels nighttime Highway 37 closures

By Barry Eberling | From Page: A5

 
Fairfield police log: Sept. 27, 2014

By Glen Faison | From Page: A12, 1 Comment

Suisun City police log: Sept. 28, 2014

By Glen Faison | From Page: A12

 
Suisun City police log: Sept. 27, 2014

By Glen Faison | From Page: A12

Fairfield police log: Sept. 28, 2014

By Glen Faison | From Page: A12, 1 Comment

 
.

US / World

5 more bodies found at Japan volcano; toll now 36

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

 
Group: Wildlife populations down drastically

By The Associated Press | From Page: , 1 Comment

45 dogs dead, 48 alive after North Las Vegas fire

By The Associated Press | From Page:

 
Police link 2nd case to missing Va. student arrest

By The Associated Press | From Page:

Netanyahu: Hamas, Islamic State group share creed

By The Associated Press | From Page: | Gallery

 
Cancer doctor given 10 years for poisoning lover

By The Associated Press | From Page: | Gallery

Afghan president sworn in, paving way for US pact

By The Associated Press | From Page:

 
Police ease tactics in Hong Kong protest standoff

By The Associated Press | From Page:

Study: Recessions can postpone motherhood forever

By The Associated Press | From Page: | Gallery

 
White House intruder got far past front door

By The Associated Press | From Page: , 1 Comment

Obama efforts to oust Assad pushed to back burner

By The Associated Press | From Page:

 
Islamic State closes in on Kurdish area of Syria

By The Associated Press | From Page:

Sacramento police seek suspect in dog’s drowning

By The Associated Press | From Page:

 
Shooing birds from Bay Bridge could cost millions

By The Associated Press | From Page:

Governor signs bills to help those in foster care

By The Associated Press | From Page:

 
Mountain View police ID gas victims as father, son

By The Associated Press | From Page:

.

Opinion

Editorial cartoons for Sept. 30, 2014

By Daily Republic Syndicated Content | From Page:

 
 
.

Living

Today in History: Sept. 30, 2014

By The Associated Press | From Page:

 
I’m unhappy with Phil and playing ‘happy family.’ What should I do?

By Kathy Mitchell and Marcy Sugar | From Page:

Community Calendar: Sept. 30, 2014

By Susan Hiland | From Page:

 
Horoscopes: Sept. 30, 2014

By Holiday Mathis | From Page: B7

.

Entertainment

Amanda Bynes arrested for DUI in Los Angeles

By The Associated Press | From Page: , 2 Comments | Gallery

 
They did. They do. Clooney/Alamuddin wedding No. 2

By The Associated Press | From Page: | Gallery

Football commands highest TV ad prices

By The Associated Press | From Page: | Gallery

 
TVGrid Sept 30

By Daily Republic Syndicated Content | From Page: B8

 
.

Sports

Developer asks for more time for LA football plan

By The Associated Press | From Page:

 
Monday’s sports transactions

By The Associated Press | From Page:

 
Raiders fire coach Dennis Allen

By The Associated Press | From Page:

Prep boys soccer: VCS still looking for 1st win of season

By Daily Republic staff | From Page:

 
Charles sends Chiefs to 41-14 rout of Patriots

By The Associated Press | From Page:

Clippers return focus to team post-Sterling

By The Associated Press | From Page:

 
Giants have ample experience facing elimination

By The Associated Press | From Page:

Dover installs catch fence for 2015 NASCAR season

By The Associated Press | From Page:

 
Warriors happy to have core back, build on success

By The Associated Press | From Page: | Gallery

All-women sports show debuts with perfect timing

By The Associated Press | From Page:

 
Autopsy shows Chiefs LB Belcher had CTE damage

By The Associated Press | From Page:

AJ Hinch hired to manage Astros

By The Associated Press | From Page: | Gallery

 
Phil Mickelson saves best shot for his captain

By The Associated Press | From Page:

MLB batting average lowest since 1972 – before DH

By The Associated Press | From Page:

 
Wild, wild SEC West set for historic day

By The Associated Press | From Page:

Kershaw 1st to lead majors in ERA 4 straight years

By The Associated Press | From Page:

 
AP source: 7 umpires rotate at World Series

By The Associated Press | From Page:

Pagenaud joins Penske for 2015 IndyCar season

By The Associated Press | From Page:

 
Texas’ Strong tells Goodell colleges can do better

By The Associated Press | From Page:

Hornets await NBA investigation into Taylor

By The Associated Press | From Page:

 
Trout, Strasburg giving playoffs a fresh look

By The Associated Press | From Page:

 
NC State coach: No. 1 Florida State faked injuries

By The Associated Press | From Page:

A’s Lester, Royals’ Shields in AL wild-card focus

By The Associated Press | From Page:

 
Raiders’ season spinning out of control

By The Associated Press | From Page: | Gallery

Harbaugh dismisses reports of 49ers discord

By The Associated Press | From Page: | Gallery

 
3-way race for NL MVP; Trout takes his turn in AL

By The Associated Press | From Page:

Stewart never considered retiring after Ward death

By The Associated Press | From Page: | Gallery

 
Twins fire manager Ron Gardenhire after 13 seasons

By The Associated Press | From Page:

.

Business

Bank of America paying $7.65M to resolve inquiry

By The Associated Press | From Page:

 
Microsoft to offer early look at next Windows

By The Associated Press | From Page: | Gallery

US stocks head lower, following drops overseas

By The Associated Press | From Page:

 
US consumer spending up 0.5 percent in August

By The Associated Press | From Page: | Gallery

ATM fees keep climbing, survey says

By The Associated Press | From Page:

 
.

Obituaries

.

Comics

Beetle Bailey Sept 30

By Daily Republic Syndicated Content | From Page: B6

 
Garfield Sept 30

By Daily Republic Syndicated Content | From Page: B6

For Better or Worse Sept 30

By Daily Republic Syndicated Content | From Page: B6

 
B.C. Sept 30

By Daily Republic Syndicated Content | From Page: B6

Wizard of Id Sept 30

By Daily Republic Syndicated Content | From Page: B6

 
Sudoku Sept 30

By Daily Republic Syndicated Content | From Page: B7

Dilbert Sept 30

By Daily Republic Syndicated Content | From Page: B6

 
Crossword Sept 30

By Daily Republic Syndicated Content | From Page: B7

Baby Blues Sept 30

By Daily Republic Syndicated Content | From Page: B6

 
Baldo Sept 30

By Daily Republic Syndicated Content | From Page: B6

Peanuts Sept 30

By Daily Republic Syndicated Content | From Page: B6

 
Sally Forth Sept 30

By Daily Republic Syndicated Content | From Page: B6

Cryptoquote Sept 30

By Daily Republic Syndicated Content | From Page: B7

 
Frank and Ernest Sept 30

By Daily Republic Syndicated Content | From Page: B6

Pickles Sept 30

By Daily Republic Syndicated Content | From Page: B6

 
Blondie Sept 30

By Daily Republic Syndicated Content | From Page: B6

Zits Sept 30

By Daily Republic Syndicated Content | From Page: B6

 
Get Fuzzy Sept 30

By Daily Republic Syndicated Content | From Page: B6

Bridge Sept 30

By Daily Republic Syndicated Content | From Page: B7

 
Rose is Rose Sept 30

By Daily Republic Syndicated Content | From Page: B6

Word Sleuth Sept 30

By Daily Republic Syndicated Content | From Page: B7

 
.

Discover Solano Fall/Winter 2014

Discover Solano Fall 2014: Sonoma County

By Jess Sullivan | From Page: DIS2

Discover Solano Fall 2014: Winters

By Barry Eberling | From Page: DIS3

Discover Solano Fall 2014: Historic Downtown Winters

By Susan Hiland | From Page: DIS3

Discover Solano Fall 2014: Napa County

By Barry Eberling | From Page: DIS20

Discover Solano Fall 2014: Western Railway Museum

By Susan Hiland | From Page: DIS23

Discover Solano Fall 2014: Yolo County

By Jess Sullivan | From Page: DIS23

Discover Solano Fall 2014: Benicia

By Barry Eberling | From Page: DIS29

Discover Solano Fall 2014: Downtown Benicia

By Susan Hiland | From Page: DIS31

Discover Solano Fall 2014: Benicia Fire Museum

By Susan Hiland | From Page: DIS31

Discover Solano Fall 2014: Benicia Plein Air Gallery

By Susan Hiland | From Page: DIS31

Discover Solano Fall 2014: Benicia Marina

By Susan Hiland | From Page: DIS32

Discover Solano Fall 2014: Dixon

By Barry Eberling | From Page: DIS33

Discover Solano Fall 2014: Fairfield

By Ryan McCarthy | From Page: DIS35

Discover Solano Fall 2014: Solano Town Center

By Susan Hiland | From Page: DIS36

Discover Solano Fall 2014: Jelly Belly Candy Co.

By Susan Hiland | From Page: DIS36

Discover Solano Fall 2014: Fairfield Aquatics Complex

By Susan Hiland | From Page: DIS37

Discover Solano Fall 2014: Anheuser-Busch Brewery Tours

By Susan Hiland | From Page: DIS37

Discover Solano Fall 2014: Suisun Valley

By Barry Eberling | From Page: DIS39

Discover Solano Fall 2014: Glashoff’s Studio

By Susan Hiland | From Page: DIS40

Discover Solano Fall 2014: Wine Tasting

By Susan Hiland | From Page: DIS41

Discover Solano Fall 2014: Manka’s Corner

By Susan Hiland | From Page: DIS41

Discover Solano Fall 2014: Rio Vista

By Susan Winlow | From Page: DIS42

Discover Solano Fall 2014: Foster’s Bighorn Bar

By Susan Hiland | From Page: DIS43

Discover Solano Fall 2014: Suisun City

By Amy Maginnis-Honey | From Page: DIS45

Discover Solano Fall 2014: Rush Ranch

By Susan Hiland | From Page: DIS46

Discover Solano Fall 2014: The Suisun Wildlife Center

By Susan Hiland | From Page: DIS46

Discover Solano Fall 2014: Grizzly Island

By Susan Hiland | From Page: DIS46

Discover Solano Fall 2014: Vacaville Museum

By Susan Hiland | From Page: DIS47

Discover Solano Fall 2014: Downtown Vacaville

By Susan Hiland | From Page: DIS47

Discover Solano Fall 2014: Vacaville Premium Outlets

By Susan Hiland | From Page: DIS48

Discover Solano Fall 2014: Vacaville

By Susan Winlow | From Page: DIS49

Discover Solano Fall 2014: Nut Tree Plaza

By Susan Hiland | From Page: DIS50

Discover Solano Fall 2014: Vallejo

By Barry Eberling | From Page: DIS52

Discover Solano Fall 2014: Vallejo Symphony

By Susan Hiland | From Page: DIS53

Discover Solano Fall 2014: Mare Island Museum

By Susan Hiland | From Page: DIS53

Discover Solano Fall 2014: Children’s Wonderland

By Susan Hiland | From Page: DIS53

Discover Solano Fall 2014: Vallejo Baylink Ferry

By Susan Hiland | From Page: DIS54

Discover Solano Fall 2014: Empress Theatre

By Susan Hiland | From Page: DIS54

Discover Solano Fall 2014: Six Flags Discovery Kingdom

By Susan Hiland | From Page: DIS54

Discover Solano Fall 2014: Flyway Festival

By Susan Hiland | From Page: DIS54

Discover Solano Fall 2014: Bay Area Ridge Trail

By Susan Hiland | From Page: DIS54

Discover Solano Fall 2014: Solano County

By Barry Eberling | From Page: DIS55

Discover Solano Fall 2014: Solano County Golf Courses

By Susan Hiland | From Page: DIS56

Discover Solano Fall-Winter 2014 Calendar

By Glen Faison | From Page: DIS57

Discover Solano Fall 2014: Sterling Winery

By Susan Hiland | From Page: DIS59

Discover Solano Fall 2014: Safari West

By Susan Hiland | From Page: DIS59

Discover Solano Fall 2014: UC Davis Mondavi Center

By Susan Hiland | From Page: DIS59

Discover Solano Fall 2014: Calistoga Hot Springs

By Susan Hiland | From Page: DIS59

Discover Solano Fall 2014: Bale Grist Mill

By Susan Hiland | From Page: DIS59

Discover Solano Fall 2014: The Petrified Forest

By Susan Hiland | From Page: DIS59

Discover Solano Fall 2014: Winters Opera House

By Susan Hiland | From Page: DIS59

Discover Solano Fall 2014: Robert Louis Stevenson Park

By Susan Hiland | From Page: DIS60

Discover Solano Fall 2014: Sonoma Train Town

By Susan Hiland | From Page: DIS60

Discover Solano Fall 2014: Vintage Aircraft Company

By Susan Hiland | From Page: DIS60

Discover Solano Fall 2014: Casinos

By Susan Hiland | From Page: DIS60

Discover Solano Fall 2014: Scientopia Discovery Center

By Susan Hiland | From Page: DIS60

Discover Solano Fall 2014: Old Faithful Geyser

By Susan Hiland | From Page: DIS60

Discover Solano Fall 2014: The Sonoma Raceway

By Susan Hiland | From Page: DIS60

Discover Solano Fall 2014: Hot Air Ballooning

By Susan Hiland | From Page: DIS60