Chronic Fatigue Syndrome

For over 20 years I have treated hundreds of patients carrying the diagnosis of Chronic Fatigue Syndrome.  My general approach has been to get a complete history starting from the beginning of symptoms and take a fresh look at the patient's variety of symptoms, the time course the symptoms took in developing and try to make sure that a medical diagnosis other than Chronic Fatigue Syndrome might better account for the patient's illness. 

Download Quicktime Player

Of all the chronically fatigued patients I have evaluated in the past, I have been able to diagnose a different underlying condition which is responsible for their symptoms in the vast majority of them.  I am generally hopeful that I will find some other underlying condition because the lack of diagnostic tests and treatments available for Chronic Fatigue Syndrome (if such a thing actually exists) gives little hope for an accurate diagnosis and even less hope for effective treatment.

A diagnosis other than CFS means that I may have a better chance of resolving the patient's symptoms if I can find a different underlying cause.  For the most part, all other potential diagnoses stand a better chance of being treatable than the diagnosis of Chronic Fatigue Syndrome.

Sinus Infections Can Be Misdiagnosed as Chronic Fatigue Syndrome

I have found is somewhat surprising that up to a third of the patient's I have evaluated for CFS simply have a low grade sinus infection as the source of their symptoms.  Many patients even give a history of waxing and waning symptoms and even partial or compete resolution of their symptoms with antibiotics only to have the symptoms return shortly after the course of medication is completed.

How could that be you may think?  Well, many of the patients with a sinus infection also have a low grade immune dysfunction that prevents them from mounting the vigorous immune reaction that is the cause of the symptoms commonly associated with sinus infections (pain, pressure and lots of nasal secretions).  I have had many patients completely unaware they have anything wrong with their sinuses yet on CT Scanning or evaluation by an Ears, Nose and Throat specialist they are found to have a significant amount of infected material in their sinuses.

It actually only takes a very small amount of persistently infection sinus fluid to cause the fatigue, fever and muscle/joint aches that many patients diagnosed with Chronic Fatigue Syndrome experience.  I m convinced that the severity of patient's symptoms are more a consequence of the strain of bacteria abnormally growing in the sinus than of the amount of infected fluid.

Treatment may entail a prolonged course of antibiotic with possible sinus surgery and even possible monthly transfusions of immune globulin also known as IVIG (intravenous immunoglobulin) if the patient is additionally diagnosed with Common Variable Immunodeficiency (CVID).

Patients who require immune globulin infusions seem to often also have a history of other infections such as pneumonia or gastrointestinal symptoms such as bloating, frequent diarrhea or abdominal cramping after eating.

Autonomic Nervous System Dysfunction Can Cause Chronic Fatigue

Additionally, another large proportion of patients diagnosed with Chronic Fatigue Syndrome actually have an underlying autonomic dysfunction which causes part or all of their fatigue.  They suffer most commonly from a condition known as Sympathetic Withdrawal.

Sympathetic Withdrawal is a condition that results in inadequate blood flow to the brain resulting in what can be a profoundly, disabling sense of fatigue. It is often associated with difficulty in concentration, memory and may be so bad at times that the patient can experience lightheadedness to the degree that they will even pass out.

I find that the symptoms of lightheadedness and passing out are often not viewed by patients as significant.  When I point out the fact that almost passing out when getting out of bed in the morning is not normal nor healthy occurrence, many patients will often comment, "Does everyone do that?".

Diagnosis and treatment are often fairly straight forward by means of autonomic testing, a painless and rapid FDA-approved device that quantifies the underlying electrical impulses of the bodies autonomic nervous system.