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Treatments for chronic fatigue

Q: I enjoy your column and need your excellent advice. My 32-year-old son has suffered from chronic fatigue syndrome for several years. The condition is worse now, and I'm concerned that a GP doctor is treating him.

What category of specialist should he see for a second opinion, and what drugs are acceptable for this condition? He also takes an antidepressant. Thank you for your advice.

-- J.M., Newport News, Va.

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, not sleeping well, obesity, poor nutrition or too much stress.

As we get older, unless we work hard at keeping fit, we are often less energetic. It's also important to note that excessive worrying, especially without doing anything about the underlying cause, can cause anxiety and fatigue.

The first step in overcoming chronic fatigue is to identify the cause. And if these more obvious conditions don't appear to be the reason for your son's 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, fibromyalgia and some cancers. Other causes include alcoholism, drug side effects and psychological disorders.

To help his doctor determine what tests would be useful in finding a cause, your son needs to provide a complete history of all of the changes in his health, including his fatigue. In particular, I recommend that he keep a diary to record the level of fatigue throughout the day and from day to day. Specifically, try to determine if there is anything he does that increases or decreases fatigue.

There is a disorder called chronic fatigue syndrome (CFS). 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. A very important part of this definition is that no specific cause of fatigue can be found. It mainly occurs in adults, 20 to 50 years of age.

No cause has been found for CFS but some studies have shown abnormalities in the immune system. This suggests 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. Some research has shown that increased oxidative stress is a factor in some people.

This syndrome affects people differently. There is no single symptom that easily suggests CFS. No one exam finding or laboratory test result can confirm the diagnosis. Part of this variation probably stems from CFS having multiple subtypes.

There are no really good treatments for CFS. But the most effective are graded exercise programs and antidepressants, particularly the ones based on serotonin. But it takes an extraordinary amount of discipline for a person to exercise when they are tired.

There is no specific medical specialty that treats chronic fatigue syndrome. Probably the two most important factors determining the suitability of a given doctor are how many patients with CFS he/she has treated, and how well he/she and patients communicate with each other.

If your son is concerned about his treatment, I recommend that he talk with his doctor and ask for a referral if he needs additional consultation.

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