If this is not done a lot of money, time, and perhaps patient rapport can be wasted or lost. My procedure for testing for fatigue is described in chapter 11.
PEGGY’S STORY
I had known and treated Peggy, who was a very active 85 year old widow, for 16 years. She had always taken care of herself, eating well and avoiding cigarettes and excessive alcohol. She had suffered a tendency to be overweight, although her blood pressure was always normal. Knee and lower back stiffness and pain, particularly in the winter, and a slightly raised cholesterol had all needed treatment. None of these problems however had caused her great concern and she freely admitted that her motivation to consult me was entirely based on her love of golf. She played two half rounds each week, which provided her with exercise, and what she termed ‘a healthy challenge’. She also met her friends and enjoyed a pleasant social lunch at the club house. She saw her visits to my surgery as necessary maintenance to enable her to continue her one sporting activity, around which her social life revolved.
Peggy’s concern began when she found that her stamina only allowed her to complete two or three holes. This had developed very slowly over a six month period. Routine cardiovascular checks were carried out by her doctor, but nothing was discovered except for the slightly raised cholesterol and a raised uric acid (this was in line with the fact Peggy suffered from mild gout).
Her doctor further requested a bone density scan to assess osteoporosis risk and a full biochemistry and haematology screen. No other imbalances or deficiencies showed. He made it clear to Peggy that at her age she should now discontinue golf and settle for the occasional short walk. He also advised her to lose weight and avoid the foods and drinks that can lead to gout.
She was not happy with her doctor’s diagnosis and even less happy with his recommended treatment.
After Peggy had reassured me that she was sleeping well and that she had not suffered recent infections or stress, I questioned her for more detailed information on her fatigue. She was able to confirm my suspicions that she was also suffering mental fatigue, described by her as a ‘mental fog’. This included poor memory and concentration, and a reduced sense of smell and taste. Peggy also remarked that her hands and feet had been unusually cold over the previous few months.
I requested a morning temperature check and thyroid blood tests. In addition I asked the laboratory to check Peggy’s levels of minerals and vitamin B12.
Vitamin B12 absorption is reduced with hypothyroidism. Lack of this vitamin in humans can cause fatigue, neuralgia, poor memory and general sluggish thinking.
In common with many other nutrients, it cannot be assumed that eating a good diet offers sufficient protection from deficiencies. Food digestion and absorption depends on many interactions, nutrients and enzymes.
Peggy’s morning temperatures showed an average of 96.8°F (36°C). Her vitamin B12 and thyroid hormones were all within the normal ranges, but towards the lower end of each range. Her minerals showed deficiencies in magnesium, zinc, chromium and manganese.
TREATMENT
Peggy was prescribed a course of weekly vitamin B12 injections, a suitable multi-mineral, and a thyroid glandular supplement.
After the third week she began to feel less fatigued and after three months of treatment she was more mentally alert and had returned to her 18 holes of golf each week. It may be necessary for Peggy to continue with the thyroid and mineral support on a low maintenance dosage for the rest of her life, coupled with monthly B12 injections.
Maintenance treatment is often justified and worthwhile to maintain necessary health and morale in the elderly. I firmly believe that the elderly benefit from regular gentle exercise. The value of rest can be overstated, as inactivity can cause joint stiffness, muscle weakening and excess weight. Exercise also improves bone health and reduces the risk of osteoporosis.
FATIGUE — OTHER NAMES
It may be helpful to discuss the various medical titles that have been used in the UK and the USA to define chronic exhaustion.
Myalgic Encephalomyelitis (ME)
This grand sounding name is synonymous with post viral fatigue (PVF) and also interchangeable with chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS). Past definitions for ME have included epidemic neurasthenia, Epstein-Barr syndrome, Royal Free disease and Icelandic disease. The symptoms of ME have also been defined by the media as ‘Yuppy ‘Flu’ or chronic influenza. The chief symptom of ME is chronic fatigue, of a type that requires bedrest but offers little clinical evidence with testing. A history of recurring infections, headaches and muscle pains are characteristic. Observable signs can include throat inflammation and lymph node enlargement in the neck and armpits.
In the US, ME is usually defined as CFS or chronic fatigue and immune dysfunction syndrome (CFIDS). The criteria for diagnosis are similar to ME and many doctors believe that the simple definition CFS will become the internationally recognized title for chronic fatigue.
Post-Viral Fatigue (PVF)
By definition this title describes the chronic fatigue that follows a virus infection. There is usually a history of a viral illness (e.g. Epstein-Barr virus, glandular fever or influenza). The signs are similar to ME and involve lymph node swelling and tenderness. PVF usually shows a history of fever. However, many doctors and researchers have recorded low body temperatures with their ME and PVF patients.
Fibromyalgia
Once known as fibrositis, fibromyalgia like ME and PVS, is often seen as being under the CFS umbrella. The only slight difference being that fibromyalgia patients have mainly muscle-joint symptoms with fatigue, while ME or PVF patients exhibit more symptoms of immune system weakness coupled with their fatigue.
Hyperventilation Syndrome (HV)
Breathing difficulties linked with anxiety and spinal health are found as a common component of fibromyalgia. However, HV is generally seen as a symptom not a cause. It is appropriate to quote Leon Chaitow who has written: ‘After some 15 years of treating fatigue problems and over 30 years of treating musculoskeletal pain problems, I can categorically state that I have seldom, if ever, failed to find at least “some” degree of breathing dysfunction in people with chronic fatigue syndrome (ME) or fibromyalgia.’1
Gulf War Syndrome
Soldiers and other personnel who were involved in the Gulf War have subsequently suffered from chronic fatigue amongst other
