Ask The Doctor

Chronic Fatigue Is Not in Your Mind

Dear Dr. Garner,

I am tired all the time. I have aches and pains in my muscles and joints. I feel like I’ve done a day’s work and it’s only the morning. I am very worried and depressed.

Do you have any idea what could be causing this?

Fatigued in Flushing


Dear Fatigued,

I am dedicating your question to Dorothy Zbornak (of “The Golden Girls”). In one episode, Dorothy wasn’t feeling right, and was tired all the time. She went from doctor to doctor. She was labeled as “nuts” by most, making her feel even worse.

Finally a doctor who knew about chronic fatigue syndrome told her what she had. Knowing the diagnosis and instituting some treatment made life tolerable for her.

Your symptoms sound as though you might have chronic fatigue syndrome, but first let us talk a little about the disease.

Struggling with being overtired or overworked is something that most of us experience. It becomes more worrisome when we cannot find the cause for fatigue that just does not go away.

Chronic fatigue lasts longer and is more severe than regular everyday feeling tired. Being tired all the time affects you emotionally, psychologically and physically. We are not talking about being sleepy. We are discussing a condition that causes someone to feel overwhelmingly tired, sometimes so severe that a person feels as though he cannot hold his head up straight or conduct normal activities.

In some cases, chronic fatigue is a sign of an underlying medical problem such as cancer or heart attacks. Most of the time, however, the fatigue can be traced to a specific situation. It is critical that you see a doctor if your chronic fatigue is associated with rectal bleeding, severe pain in the belly, back or headaches. Chest pain and shortness of breath is another indication to get right to the hospital.

When one has chronic fatigue syndrome, they often have difficulty with memory, depression and insomnia. While predominantly thought of as a problem for adults, this debilitating disorder can also affect children and adolescents. Up to 2.5 percent of children or adolescents suffer from chronic fatigue syndrome.

To make the diagnosis, symptoms should be present for six months or more. Some symptoms include: frequent or recurring sore throat, swollen lymph nodes, muscle pain and joint pain, headaches, unrefreshing sleep and exhaustion and sickness after physical exertion.

Scientists have not been able to identify what causes chronic fatigue syndrome. Some of the possible causes include infection and arthritis-like conditions.

Managing chronic fatigue syndrome can be very difficult. There is no cure or “magic drug.” People with chronic fatigue syndrome must closely monitor their health. A team approach is necessary which includes doctors and patients. A treatment plan must be individualized.

I am often asked how much of chronic fatigue syndrome is a psychological condition, and how much is really a physical condition. The answer is that it is virtually impossible to separate the psychological aspect from the physical causes of chronic fatigue syndrome. Once your doctor has ruled out other conditions, and you have had symptoms for six months or more, a diagnosis can be made.

Chronic fatigue syndrome can lead to depression, social isolation, lifestyle changes and difficulty performing a job. Treatment can include antidepressants, physical therapy, and psychological counseling.

Learning how to reduce stress and improve sleep habits can help. Pacing yourself and not trying to do everything at once is another method. Alternative therapies such as acupuncture and medication have been recommended. Massage may be of benefit. Many people find it helpful to join a support group. The main thing to remember is that this is a real disease, and the symptoms are real – it is not in your “mind.”

Dr. Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET TV, Tuesdays at 8 p.m. on Time Warner Channel 97, Cablevision Channel 30 and Verizon FiOS on Demand.

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