Monday, February 7, 2011

Chronic Fatigue

Fatigue is one of the most common symptoms in patients that consult me. It is usually the presenting symptom but is invariably associated with many other symptoms, many of which are not volunteered by the patient. Modern clinical visits are usually quite short and focus on the presenting symptom without due consideration of the importance of the whole picture. Thus, it is mindful of the parable of the “blind men and the elephant”. A group of blind men were asked to describe an elephant. One found the ear, another the trunk and so on. Each described the elephant in terms of the small area examined and was certain that he had described the elephant. It led, of course, to accusations of inaccuracy of observation between them. Each was guilty of missing the “big picture”. Diagnosing disease is sometimes like that.
For this reason, when a person seeks an appointment with me through my office, a questionnaire is automatically sent to the ‘would be” patient, who is asked to fill it in and bring it for the office visit. The most important part of the consultation is the history and I begin by asking the patient the main reason for coming. Then, I ask “When were you last quite well”? It is often surprisingly difficult to pinpoint this and I frequently find that the very first symptom experienced goes back many years and even back to childhood.
So let me describe a typical hypothetical case of a person reporting with the major symptom of fatigue. The patient is a 35-year old married woman with two children. On questioning, she states that she cannot remember when her very first symptom appeared but she had a lot of colds and “flu-like” episodes in childhood and received many antibiotic treatments. She had some academic problems through school and missed a lot of school days because of illness. Her fatigue began in high school and became an added problem through college. As the years passed, she gradually accumulated other symptoms and her questionnaire reveals many more.
She has difficulty in getting to sleep and keeps awakening through the night and does not feel rested in the morning. She grinds her teeth, has some nightmares and her husband reports that she talks in her sleep and snores. Occasionally she stops breathing and starts again with a gasp. Her hands and feet are cold and she gets “pins and needles” in them. When getting out of bed or standing up from a chair she becomes “dizzy” and has even blacked out once or twice. She has sensitivity to changes in ambient temperature and barometric pressure and develops a headache with an approaching thunderstorm. She consumes two cups of coffee on awakening and takes one with her in the car on her way to work. She claims that she is so fatigued that she could not get to work without it. She has nasal congestion in the morning and, on questioning, notices nasal congestion in the left nostril when lying on her left side. When she turns over in bed the left nostril clears but the congestion shifts to the right nostril. She also claims that she is allergic to many things, each of which causes her to develop nasal congestion and asthmatic wheezing.
Her menstrual periods are irregular and are associated with emotional instability. She has severe cramps and develops a craving for chocolate and salty food snacks. She also notices abdominal pain on the left side at mid cycle that alternates with the same kind of pain on the right side with the next period. She has what is so often thought of as a disease for the gynecologist, premenstrual syndrome (PMS) that is believed to affect as many as 30 million women in the U.S. alone. In fact, it is so common that many women accept it as normal. The causative factors are always multiple, involving genetic risk and the stresses and strains of contemporary lifestyles. By far the most important aspect is diet. Americans do not damage their physiology with breakfast, lunch and dinner. It is what they do between meals and at social gatherings where their intense desire for sweet tasting substances is assuaged. It goes without saying that smoking is the most dangerous of all. I have also noted that coffee comes into this, perhaps in genetically susceptible people, because of its caffeine content and in spite of its content of antioxidants that has been promoted widely. Previous posts on this blog have tried to outline the danger of sugar. Chronic Fatigue Syndrome, Chemical Sensitivity Syndrome, PMS, and Fibromyalgia Syndrome are related in their causative factors and the present medical approach to them is only symptomatically helpful but does not address the underlying cause. I have two sayings that I give to my patients. Eat only “God-made food” and get rid of “the hair from the dog that is biting you”. That refers to the popular things that give us a jolt of pleasure such as sweet and salty things. I once saw a woman that developed her symptoms from just two cups of coffee a day. She thought that I was crazy to suggest that she remove coffee and I told her that she would never know whether I was right unless she tried it. She suffered an agonizing headache that kept her in bed for 48 hours. Then the headache disappeared and her health rapidly improved.
This blog is called “Oxygen, the Spark of Life” and I must again emphasize that the oxygen is useless unless it is consumed in the complex process of oxidation. Yes, it is indeed complex but the human body/brain physiology has evolved and the species has survived as a result of food that was provided by Mother Nature. All we have to do is to obey the rules. Since we know those rules, we are each responsible for our own health unless there is an underlying genetically determined weakness. Even then, the new science of epigenetics tells us that we can indeed manipulate our genes, at least partially, by dietary means and the addition of vital nutritional supplements.

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