Saturday, October 31, 2009

From the Irish Medical Times

Source: Irish Medical Times
Date:   October 29, 2009
Author: Garrett FitzGerald
URL:    http://www.imt.ie/opinion/2009/10/retrovirus_may_shed_light_on_m.html


Retrovirus may shed light on mystery of chronic fatigue
-------------------------------------------------------

Back in the news big-time is Chronic Fatigue Syndrome. A recent paper
in Science reports infection with a gammaretrovirus (XMRV) in 67 per
cent of cases. The virus has been detected from blood and saliva in
long-term sufferers.

Is it time to apologise to all the patients who were diagnosed as
being somewhat cracked? I recall one colleague referring to the
condition as the Muirisheen Durkan syndrome:
   So, goodbye Muirisheen Durkan
   I'm sick and tired of workin'!

For some unknown reason, I was sent many patients with the syndrome
from all over the country. I was almost always impressed by the
genuine nature of the symptoms, having no doubt that there just had
to be something other than psychological reasons underneath.


I could do nothing for them

I listened (often the consultation lasted more than an hour) and
in most instances after investigation told the patients that they
were probably suffering from CFS/ME. I told them I could do nothing
for them in terms of cure or alleviation. The only contribution I
made was to warn them about the quacks which they (understandably)
were attending or about to attend.

One patient was attending a great man in London, who claimed he was
a physician to the Queen (lucky ol' Queen), who kept admitting the
patient to private hospitals over there for infusions of vitamins
and Lord knows what else.

There was no improvement, surprisingly, in a well-nourished, fruit-
eating young female whose gums were not bleeding onto the tablecloth.
He would tell her that she hadn't had enough courses of the infusions
just yet, to stick with them. The patient had sold her house and was
in the process of selling her car to pay the fees for this
Hippocratic artiste.


Money-mad mountebanks

My intervention did nothing for the symptoms, but the patient got to
hold on to her car. Many fell into the clutches of money-mad
mountebanks, chancers, crystal-ball gazers and three-card-trick merchants. Regrettably, most of these were practicing medical doctors.

Some patients who had previously been leading a fully active and
productive life were reduced to being little better than bed-ridden.
The Royal College of Psychiatrists classified the condition as
(partly) a psychiatric illness about 20 years ago and recommended
courses of psychotherapy.

In earlier papers, there was some response to the sessions, most
patients saying that they were a little better.

Some of my patients were depressed. Their symptoms sometimes
responded to SSRIs, but they were left with their original degree
of fatigue unchanged. Some patients seemed to remit spontaneously
after anything from two to 20 years after the onset of the condition.


Accepted the diagnoses

A rare patient improved substantially with psychiatrist-prescribed
Prozac in doses exceeding 80mg/day. Most did not improve. In
fairness, both the Departments of Health and Social Welfare accepted
the diagnoses of ME/Post-viral Syndrome/CFS as grounds for awarding
disability benefits.

Specialists in Internal Medicine generally recommended a program
which included increasing amounts of physical exercise. My own
experience was that almost none of the patients could walk more than
the length of themselves without 'paying' for it - having to recover
in bed for two or three days.

The ME patients' support group lobbied well for their members, but
were despondent about the future. Many patients felt ridiculed (by
the attitude of some professionals) and concealed the diagnosis. Many
had by then lost their livelihoods and their own self-respect and
self-worth.

One swallow does not a summer make. Before deciding that the
retrovirus is actually causative, we await the outcome of further
studies. If these are confirmatory, we wait for the results of trials
of anti-retroviral therapy. As always, the thinking doctor will be
cautious.





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