Chronic Fatigue Syndrome Posses Challenges to Doctors and Frustration To Patients
The following is a reproduction of a Millennium Health Centre editorial article which appeared in the Seaway News newspaper in Cornwall, Ontario, Canada. The content is shortened to accommodate a newspaper space allotment. As such, it is not academically cited with references. These are available, so please feel free to email your questions.
Dr. Stephen F. Jones B.Comm., N.D.
Doctor of Naturopathic Medicine
It's a reality that as caring health care providers, doctors, nurses and all primary care givers want to be able to 'cure' their patients. This desire to ease suffering, however, is increasingly being challenged by newer illnesses that are not fully understood and for which there is no 'magic' medicine.
Chronic Fatigue Syndrome (C.F.S.) is one such 'newer' illness. The general definition of C.F.S. is a severe, on-going exhaustion that leaves the patient without the energy or strength to perform normal daily chores, let alone work. Its symptoms, aside from the fatigue, can include memory problems, muscle pain, headaches, sleep problems, heart problems, bowel problems and weakened immunity.
Despite the increasing number of patients complaining of such fatigue, one review suggested that 70% of family doctors are reluctant to diagnose C.F.S. (Woodman et al, 1995). This is may be because a single, absolute test that would state definitively that a patient has C.F.S. is not available. Nor is a specific 'C.F.S. drug' available. Rather, the doctor must examine the numerous possible causes of C.F.S. and figure out what may be playing a role in the individual patient's case.
The real challenge is that conditions such as thyroid disorders, Lupus, Multiple Sclerosis, Lyme's Disease and hormonal disorders can all cause the same symptoms as C.F.S. Doctors must first do blood work to rule out all of these as possibilities and then investigate for other factors believed to cause C.F.S. itself.
First, one should test for viruses believed to play a role in C.F.S. such as Epstein Barr (a cause of mononucleosis) and Hepatitis C. These viruses, as well as other infectious 'agents' (such as enteroviruses, influenza and candida) have been associated with C.F.S. (Exp Mol Path, 2002). While none of these have consistently been found in all C.F.S. patients, they are present frequently enough to warrant proper investigation. If they are found, then the right treatment can be pursued.
As well, recent study has shown that 62% of C.F.S. patients have 'antibodies' to a critical brain chemical called serotonin (Eur J Med Res; 1995). These antibodies cause a deficiency of this serotonin which in turn can cause insomnia, worsened fatigue, greater pain and other symptoms. Acknowledging this common problem, the patient can be given natural medicines that are directly turned into serotonin (to make up for the deficiency). Drugs like Prozac, Celexa and Effexor will, unfortunately, not increase overall serotonin levels.
Next, doctors should examine a patient's various hormone levels, especially adrenal gland hormones. The Journal of Chronic Fatigue (8(2); 2001) and the Townsend (Oct.; 2002) have revealed that deficiencies of an adrenal hormone called DHEA are frequently found in C.F.S. patients. Similarly, low levels of estrogen and testosterone are frequently found in C.F.S. patients. With proper testing these imbalances can be corrected with the appropriate treatment.
With thorough testing, the individual C.F.S. patient can have a treatment tailored to their individual circumstances. Nutritional deficiencies, however, should always be a starting point, as C.F.S. patients have frequently been found to be low in many critical nutrients required for cellular energy production (Alt Med Review, 2000). Ironically, many patients are frequently on medications (such as Losec, Prilosec or simple antacids) that can cause further depletion of these critical nutrients.
Replacement of these nutrients, especially via intravenous (I.V.) infusion, has been shown to yield significant, long-term energy improvements in the C.F.S. patient. Moreover, doctors who use these I.V. treatments can simultaneously include medicines to stimulate the immune system, help the liver 'detoxify' chemicals and replace the essential nutrients needed for cells to produce energy, all in one treatment.
Beyond clinical nutrition, specific treatments can be offered to increase deficient adrenal hormones, kill any infectious 'agents' and to remove any toxic materials, all of which have been linked to causing C.F.S. Sleep medications can be used if required, focusing on non-addictive natural medicines like Tryptophan. If absolutely needed, medications like Trazodone, Lorazapam and even Amitriptyline can be explored with the patient's doctor.
In all, C.F.S. is a challenging illness for both the patient and doctor. The good news is that medical research is increasing our treatment options. Be sure you have been provided with all options.
If you have any inquiries or requests for future columns, please contact the Seaway News or email Dr. Jones at email@example.com.