Why Chronic Fatigue Patients Need to See a Specialist

In The New York Times this Sunday, Dr. Lisa Sanders’ column Diagnosis made me realize how important it is for a patient with Chronic Fatigue to see a specialist.

FATIGUE CAN BE MORE DANGEROUS THAN YOU THINK

This week’s story (entitled: “Oversalted”) was about a 19 year old male who struggled for almost 2 years with debilitating fatigue that went undiagnosed. He went to the Emergency room several times where he was told he had a virus and was dehydrated. He was given IV fluids and sent home to rest. However, his symptoms involved not just fatigue but nausea and stomach discomfort as well. He also had a low blood pressure which is somewhat unusual for a young man. The clue to his story was that one of the ER doctors noticed his sodium in his blood was low and told his mother that he should eat more salt. His mother was perplexed. She said he seemed to eat a ton of salt: she always found salty crackers in his bedroom. Eventually, the young man was taken to a specialist and diagnosed with Adrenal Failure, also called Addison’s disease.

WHAT IS ADDISON’S DISEASE?

Addison’s disease’s most famous patient was President John F. Kennedy. President Kennedy almost died while undergoing back surgery at New York Hospital. It was realized his adrenal weren’t functioning and his blood pressure bottomed out. During the recovery from his back surgery, he was put on adrenal hormones which he required for the rest of his life.

Adrenal failure presents with a myriad of signs and symptoms. A doctor observing an Addison’s patient might be impressed by a full body tan, especially if it occurred in the non-summer months. The reason these patients are tan is that the lack of adrenal hormones cause the secretion of ACTH from the pituitary which leads to melanosis (tanning of the skin). Only a few diseases present with a year round tan.

Another clue to this patient’s problem was the low sodium and high potassium levels in the blood. The imbalance of these electrolytes is due to the missing adrenal hormones that are needed to keep the proper levels. The low sodium makes the patient crave salt to try and replace the body’s missing stores. Patients with Addison’s disease can go into crisis and die- from an infection, or from a surgery. This is why it is so important to evaluate the symptom of fatigue. The good news is that Adrenal failure can now be treated via oral replacement therapy with cortisol and if necessary Florinef.

PATIENTS WITH FATIGUE NEED RECEPTIVE DOCTORS

One of the medical directors at my hospital used to tell the staff that patients who complained of fatigue were more or less hypochondriacs. The physician was a well-known medical researcher, but he didn’t particularly like listening to a patient’s history (he preferred meetings where doctors sat around and presented cases like Dr. House). The nuances of the diagnosis in “Oversalted” would have been completely lost on him, considering he wasn’t willing to dive deep into the history of a fatigue patient.

However, at Mitchell Medical Group we are “in the trenches” with our patients, searching for clues to explain their underlying fatigue. We use a variety of diagnostic blood tests to uncover unusual causes of fatigue, and we have an array of Vitamin therapies to help bolster our patients health until the fatigue resolves.

- Dr. Dean Mitchell
Mitchell Medical Group, NYC

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