CHRONIC FATIGUE

Chronic fatigue is a term that means fatigue which lasts for a long period of time.

Chronic fatigue syndrome (CFS) is a diagnosis used for some patients with a particularly severe form of chronic fatigue. CFS is also known as myalgic encephalomyelitis (ME).

Many definitions have been proposed for CFS/ME. The simplest definition is that CFS/ME is a condition characterised by severe fatigue lasting for more than six months, where common medical causes of fatigue have been excluded.

CFS/ME has been a controversial disorder and, although some doctors remain sceptical, it is now widely accepted that CFS/ME is a real physical illness.

Many patients with CFS/ME have been mistakenly diagnosed with depression. Whilst depression can be a symptom of CFS/ME, this is not primarily a depressive illness.

A large number of medical causes of fatigue should be tested for and ruled out before the diagnosis of CFS/ME is made. These include anaemia (low iron levels), hypothyroidism (underactive thyroid), Addison’s disease, heavy metal toxicity, cancer, auto-immune disease, HIV, sleep apnoea, tick-borne diseases, diabetes, hepatitis, major depression and chronic inflammatory response syndrome (CIRS).

Patients with chronic fatigue syndrome generally have many other symptoms in addition to the fatigue. These other symptoms can include headache, muscle and joint pain, muscular weakness, poor memory and concentration (sometimes known as “brain fog”), sleep disturbance, bowel problems, low blood pressure, dizziness, palpitations, recurrent sore throats, swollen glands and flu-like symptoms.

Patients with CFS/ME often have difficulty carrying out simple activities of daily living. Quality of life with chronic fatigue syndrome can be severely compromised; in severe cases the patient can be confined to bed.

Fatigue in CFS/ME patients is commonly exacerbated by minimal physical or mental exertion – this is known as post-exertional malaise.

Many of the symptoms of CFS/ME are due to dysfunction of the autonomic nervous system.

Patients with chronic fatigue syndrome sometimes develop allergies and intolerances as part of the illness. In some cases these are severe enough to warrant the diagnosis of Multiple Chemical Sensitivities (MCS).

Fibromyalgia and irritable bowel syndrome are conditions that are often considered to be related to chronic fatigue syndrome.

Some patients with CFS/ME develop a condition known as postural orthostatic tachycardia syndrome (POTS). Patients with POTS develop dizziness or faintness on standing up.

There is much overlap of symptoms between CFS/ME, chronic inflammatory response syndrome (CIRS) and tick-borne diseases.

CFS/ME is usually caused by a combination of factors which may include infections (viral or bacterial), stress, poor adrenal function and, occasionally, exposure to toxic chemicals.

Dr Dobie performs a wide range of tests in an effort to deterrmine the underlying causes of each case of chronic fatigue.

EBV (glandular fever virus) is one of the most common causes of chronic fatigue syndrome. Most patients with glandular fever make a full recovery after 6-8 weeks, but some patients are left with lingering fatigue that can develop into chronic fatigue syndrome.

Other infection that can trigger the onset of chronic fatigue include Ross River virus, cytomegalovirus (CMV), hepatitis, Mycoplasma, influenza and tick-borne diseases.

Poor function of the adrenal glands is one of the factors that can contribute to the onset of CFS/ME. Poor adrenal function is known as adrenal insufficiency; fatigue caused by poor adrenal function has sometimes been referred to “adrenal fatigue”.

There is no diagnostic test for chronic fatigue syndrome. Routine blood tests are often normal. The diagnosis is based on the patient’s clinical history, symptoms, physical examination and the exclusion of common medical causes of fatigue.

Dr Dobie designs an individualised treatment program for each patient with chronic fatigue. He bases the treatment program on what he considers to be the main underlying causes of the patient’s illness.

Treatments used for CFS/ME by Dr Dobie include:

  • Lifestyle modification
  • Nutritional supplements (sometimes given intravenously)
  • Dietary advice
  • Medications
  • Treatment of underlying infections
  • Management of associated allergies and sensitivities

Many of the nutritional supplements prescribed by Dr Dobie for CFS/ME act by increasing the production of ATP in the mitochondria. ATP is the main energy molecule of the body and the mitochondria are sometimes known as the “powerhouse” of the cell.

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