LIFELONG HEALTH Chronic fatigue’s virus link a big step forward

— One of the most common complaints that doctors get behind clinic doors is also the daily refrain for millions of Americans: “I am so tired!”

While everyone can claim feeling tired or weary at some point during the week, for adults with chronic fatigue the exhaustion is so severe that it interferes with the ability to function normally and participate in any meaningful activity. Beyond the relatively common feeling of being sleepy or drained, this level of fatigue is crippling and frustrating and, from a medical perspective, treatment is often unsuccessful.

However, hope is on the horizon for people with chronic fatigue. Researchers may have found the underlying cause, which could point to more successful treatment options.

The diagnosis of chronic fatigue has challenged physicians for decades. Until recently, there were no clear markers to identify the illness, and symptoms were so varied that treatment options werelimited. Many physicians even claimed that chronic fatigue was not a “real” illness.

In a paper just published in the prestigious journal Science, researchers identified a virus similar to HIV in the majority of patients with untreatable chronic fatigue. The virus, xenotropic murine leukemia virus, or XMRV, was detected in 67 percent of 101 patients with chronic fatigue syndrome and in only 4 percent of healthy individuals. Because of the similarity between the two viruses, medications that essentially suppress the AIDS virus will most likely also suppress or eradicate XMRV. For millions of patients with chronic fatigue, this finding represents ahuge step forward in the battle to end this challenging disease. In addition, the presence of the XMRV virus validates and explains the symptoms of chronic fatigue.

For patients without the clinical diagnosis of chronic fatigue, there are many other medical factors that can contribute to feeling unreasonably sleepy. One of the most common reasons for fatigue is a sleep disorder. This can be as simple as poor sleep hygiene - working too hard, being too stressed, staying up late, etc. Or it can be a more serious abnormality such as sleep apnea and restless leg syndrome. Incorporating proper sleep habits and identifying any underlying medical problems can prove extremely helpful in combatingthis type of fatigue.

Fatigue is also a common symptom of depression. Many depressed patients have sleep disturbances and hormonal imbalances that contribute to fatigue. In this case, medications and therapy can help improve symptoms dramatically.

In addition, all types of medications - prescribed and over the counter - cause fatigue. For example, drugs prescribed for insomnia, including Tylenol PM, can cause severe fatigue throughout the day. Always discuss medications with your physician and your pharmacist; ask them if any of the drugs cause fatigue. If so, ask about alternatives with fewer side effects. Remember that adding a medication is easy, but most physicians are very reluctant to stop treatment.

Many patients with fatigue have underlying illnesses. For example, many cancer patients complain of fatigue as do those with infections such as tuberculosis and inflammatory conditions such as rheumatoid arthritis. If the illness improves, the fatigue lessens.Sadly, for many patients with chronic illnesses, fatigue is an accepted side effect and relief rarely occurs. In this instance, providing understanding, support and symptom treatment with antidepressants and painkillers may help.

Finally, for some patients battling fatigue there is no apparent treatable cause. In addition to chronic fatigue, this is often labeled as fibromyalgia, which is thought to be related to disturbed sleep because it interferes with normal muscle function, causing pain and depression. Others could be diagnosed with chronic infectious mononucleosis or a nutritional and immune imbalance. In most cases, treatment is unsuccessful and patients are left frustrated. Sadly, for patients with persistent symptoms and no identifiable cause, finding a physician who will listen to the problem and continue to help despite the challenge is difficult.

In every form, fatigue is a serious problem that can affect daily life. For patients struggling with chronic fatigue, the recent breakthroughs in research are very exciting, and while it may take many years to ultimately find the correct approach to treatment, it’s clear that a continued investment in basic research is paramount infinding cures to disease.

Dr. David Lipschitz is the director of The Longevity Center at St. Vincent Infirmary Medical Center. More information is available at:

drdavidhealth.com

High Profile, Pages 43 on 10/25/2009

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