Dear Dr. Garner,
I have been totally exhausted the past few months, and despite going to several doctors, have not found anyone who could help me. I have no specific complaints, but feel drained of energy. I would really appreciate any suggestions you might have as to what is going on.
Drained in Ditmas Park

Dear Drained,

There are several conditions that could be causing your problem. Underlying diseases, such as depression, diabetes, thyroid disease, and hormonal issues must be carefully evaluated. If all of these are ruled out, then something to be considered is Chronic Fatigue Syndrome. In this disease, which affects mostly young women in their prime (men are also affected), there is severe fatigue, which lasts for at least six months.

It used to be thought that people with this disease were either malingerers, or crazy. The Centers for Disease Control has embarked on a multi-million dollar publicity campaign to help bring to the attention of the public as well as doctors, that it is a real disease.

It is estimated that over one million people have Chronic Fatigue Syndrome (CFS). It affects all races and economic groups.

The disease causes one to become so fatigued that normal tasks cannot be performed.

The Symptoms

People with CFS, experience fatigue that lasts at least six months, as well as some of the following symptoms:

• Headaches,
• Sore throat,
• Tender or painful areas in the neck or armpits (lymph nodes),
• Unexplained muscle soreness,
• Pain that moves from joint to joint,
• Loss of memory or concentration,
• Trouble sleeping,
• Extreme tiredness after exercising that lasts more than 24 hours,
• Jaw pain,
• Weight loss or gain.

Chronic Fatigue Syndrome is non-contagious and non-fatal.

There are triggers that set off the disease, such as a virus, severe stress, depression, or even an allergic reaction.

No one is certain what causes CFS. Some scientists believe it is due to a virus, while others point to genetic defects. Some feel it is related to a defective immune system, in which the body is infected by multiple organisms.

In treating this disorder, the first step is to determine if there is any other explainable cause. This would include a complete physical exam, lab tests and X-rays.

Last month, a research study from Stanford University reported that patients improved dramatically with an anti-viral medication. There was sustained and dramatic improvement. This is very exciting, and may be the route to a cure.

Sleep Therapy, Massage

Other treatments are geared to specific symptoms. For example, sleep therapy for sleeplessness, massage and pain medicine for muscle aches, improved nutrition, and avoidance of tobacco and alcohol (these are known to worsen the disease), and memory aids to help deal with memory loss.

Patients are told to keep a diary to identify times when they have the most energy. Activities can then be planned for these times. The disease requires support from family and friends, and as it becomes better known, it can be expected that these patients will receive more support and sympathy. Feelings of sadness, anger, frustration, as well as grieving are common. Patients should ask for support from family and friends. There are support groups in the community, which are helpful.

Developing an exercise program is imperative. It can be started slowly and gradually increased. It may be for only a few minutes a day, but it is important for flexibility and strength. Simple stretching exercises are good starting points, and should be done with adequate periods of rest following.

Medications can also be very effective when geared to relief of specific symptoms. For example, sleeping pills, whether prescription or over the counter, are very useful.

Nutritional and Herbal Supplements such as vitamins are frequently used in the treatment.

Alternative therapies such as acupuncture, massage, yoga, biofeedback and tai chi have all been found to be helpful.

Cognitive therapy, which helps patients manage activity levels, stress and symptoms, has been shown to improve the well-being of patients.

Not a ‘Yuppie Flu’

What was once known as the “Yuppie flu” when it was first discovered in the 1980s is actually a very real and serious disease.

With increased publicity from the CDC, more funding and research trials will be available.

At least for now, it is known that this is a real illness, and that the patients are not “nuts” or “phonies.”

Living with CFS can be difficult. It can have a major impact on daily life, requiring patients to make significant lifestyle changes.

The severity of CFS varies from patient to patient, with some people able to maintain fairly active lives. CFS can be as disabling as multiple sclerosis, lupus, heart disease, kidney failure and chronic obstructive pulmonary disease (emphysema and bronchitis).

Some patients experience partial or complete improvement of symptoms, but unfortunately, they often reoccur. Patients who are in remission may be tempted to overdo activities when they are feeling better, which can exacerbate symptoms and fatigue and cause a relapse.

Early Detection

There is evidence that the sooner symptom management begins, the better the chance of a good result. Early detection and treatment are therefore critical, as delays may complicate and prolong the course of the illness.

I hope you discuss your situation carefully with your doctor, and should the fatigue persist for more than six months, and you experience some of the other symptoms mentioned above, that further work-up be undertaken as soon as possible to see if you have Chronic Fatigue Syndrome.

Thank you for your question and I hope you feel better soon.

Next week we hear from a patient who wants to know about hay fever, what’s new in treatment, and if there might be any relation to her menstrual cycle. Until then, have a great week and be well.

Dr. Steven Garner, MD, is affiliated with New York Methodist Hospital, Park Slope, and is a Fidelis Care provider. He is the host of the popular call-in cable TV show “Ask the Doctor” seen locally on The Prayer Channel.