ASK THE EXPERT: Dr. Whitman, Rheumatologist, Answers Your Questions About Chronic Fatigue

by HSS on the Move

Q1: How do you differentiate chronic fatigue syndrome from other factors that contribute to fatigue?

The name Chronic Fatigue Syndrome (CFS) suggests that the fatigue is chronic and that it does not come and go the way the rest of us experience normal fatigue. Chronic Fatigue Syndrome usually results from never getting restful sleep and usually waking up tired. Several underlying diseases may also lead to the problem: an autoimmune connective tissue disease (Lupus and Lupus-like diseases), a hormone disorder (low thyroid values or low cortisone values or low sex hormone values), a chronic infection (Tuberculosis, blood infections, chronic viral infection, chronic urinary tract infection), chronic pain that keep you from getting restful sleep of any cause, chronic immune deficiencies (low gamma globulin levels), chronic vitamin or mineral deficiencies (b12, folate, magnesium and others). These conditions can eventually lead to the equivalent of a sleep deprived state and you mind becomes confused, disorganized, and tasks you easily did before become very difficult. For example, math majors can have difficulty balancing their checkbooks.

Q2: How would someone be tested for chronic fatigue syndrome?

There is no specific diagnostic blood test or imaging study. CFS is a clinical diagnosis where a previously productive person who is not mentally ill becomes chronically tired and disorganized and sleeps poorly. We have to be sure that they do not have something obviously correctable and if not, try various remedies to see if they can be helped to get better.

Q3: What are the symptoms of chronic fatigue syndrome?

Fatigue, insomnia, wakes up tired always, disorganized; has difficulty getting things done they could easily do before.

Q4: How is CFS related to rheumatology?

Some doctors believe that lack of restful sleep leads to trigger point tenderness and chronic muscle and joint pain also know as fibromyalgia. It is also believed that CFS represents the worst cases of fibromyalgia in which the patients not only have chronic pain, but because they are so deprived of restful sleep that they also become disorganized and can’t do many things that they were good at before. If you can restore their normal sleep wake cycle, over time some can recover. Sometimes other co-existing medical conditions also need to be fixed in order to restore patients back to the original abilities.

Q5: What are common treatments for chronic fatigue syndrome?

Medications and supplements that can help to fight insomnia, reduce musculoskeletal pain, fight depression and correct underlying medical illness. These can include vitamin b12, thyroid hormone and cortisone if appropriate, antibiotics if infection is present, gamma globulin shots or infusions if immune deficiency exists. If fibromyalgia exists, the FTA-approved drugs are Cymbalta and/or Lyrica. No one has the magic bullet medication for all patients with fibromyalgia, and about 20% of the patients struggle to get completely well despite our best efforts. It is important to consult with your physician before starting any new medications or supplements.

Dr. Whitman, an experienced rheumatologist, has an active clinical practice treating patients with a variety of musculoskeletal and autoimmune diseases. Dr. Whitman brings more than 30 years of experience and an extensive knowledge base to HSS.