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THE ENIGMA OF CHRONIC FATIGUE

Q: I'm only 30 years old but have been feeling fatigued for months and months. I've seen a couple of doctors, but they can't seem to find anything. After doing a bunch of tests, the second one said that I may have chronic fatigue syndrome. What can cause my fatigue, and what is chronic fatigue syndrome?

-- K.L., Cape Cod, Mass.

A: Fatigue is one of the most common symptoms reported to doctors. Related complaints include weakness, tiredness and lethargy.

Sometimes these symptoms can be explained by just being "tired" from overexertion, poor physical condition, sleep disturbances, obesity, poor nutrition and emotional problems.

It's also true that as we get older, unless we work very hard at keeping fit, we typically are less energetic. It's also important to note that excessive worrying, especially without doing anything about it, can cause anxiety and fatigue.

If these more obvious conditions don't appear to be a primary reason for the fatigue, extensive diagnostic testing may be needed to look elsewhere.

For example, many diseases cause fatigue. These include thyroid problems, congestive heart failure, infection, chronic obstructive pulmonary disease, sleep apnea, anemia, autoimmune disorders and some cancer. Other causes include alcoholism, drug side effects and psychological disorders.

The first step to overcoming this problem is to identify the cause. Blood tests can be helpful to determine if any of these diseases are present.

To help your doctor determine if other tests would be useful in finding a cause, you need to provide a complete history of all of the changes in your health, including fatigue. In particular, I suggest that you keep a diary to record your level of fatigue throughout the day and from day to day. Look to see if there is anything that you do that increases or decreases fatigue.

There is a disorder called chronic fatigue syndrome. It is a recently recognized condition and one that is not yet well understood. It is not just fatigue -- it is unexplained, long-term, debilitating fatigue.

No cause is known, but studies have shown abnormalities in the immune system, indicating that a person with this syndrome may be reacting to an infection or allergies, or that the body's own immune system is attacking other cells.

The syndrome affects people differently. There is no one symptom that easily suggests chronic fatigue syndrome. No one exam finding or laboratory test result can confirm a diagnosis of chronic fatigue syndrome.

But chronic fatigue syndrome occurs mainly among adults, 20 to 50 years of age. This syndrome is not often diagnosed in the elderly, but perhaps that will also change in the future.

I suggest that you talk with you doctor and more fully discuss whether you have chronic fatigue syndrome. If you do -- because treating this syndrome can be very complex and require multiple types of interventions -- you may want to get a referral to a doctor that treats many people with the syndrome.

Write to Allen Douma in care of Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y. 14207; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.

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