DEAR DR. DONOHUE: After seeing two doctors for a year, I have finally been diagnosed as having chronic fatigue syndrome. What can you tell me about it? Is there a treatment, and what is the cause? – B.R.

Chronic fatigue syndrome – CFS – remains a bewildering illness in search of a cause. In this syndrome, the definition of “fatigue” is an exhaustion that does not vanish after a night’s sleep. It’s not the same thing as sleepiness. In addition to immobilizing fatigue, patients can have memory problems and an inability to concentrate. They might have sore throats, and the nodes of the neck and under the arms are frequently large and tender. Muscles and joints often hurt.

Many of these symptoms are common to other illnesses. A poorly functioning thyroid gland, an adrenal gland that is not working, anemia, liver disease and depression are a few examples of illnesses where fatigue is a prominent feature. The investigation of CFS, therefore, hinges on excluding all those illnesses that have similar attributes. There is no lab test, X-ray or scan that can furnish proof of the CFS diagnosis. There are, however, many tests that can identify the illnesses that imitate this syndrome.

Although a cause of CFS has not been uncovered, some feel it might be the aftermath of a viral infection. That link has not been firmly established.

There is no specific medicine for CFS. Medicines borrowed from other illnesses can alleviate some symptoms. A low dose of the antidepressant amitriptyline, for example, can sometimes restore refreshing sleep. Anti-inflammatory medicines like Motrin can take the edge off muscle and joint pain. As preposterous as it sounds, an exercise program frequently restores energy. The program must start out modestly with a short walk, then a gradual increase in time and energy. Most get better — slowly as that might happen.

Readers interested in more information on chronic fatigue syndrome can order the pamphlet on that topic by writing: Dr. Donohue – No. 304, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: During my annual physical, the doctor offhandedly said I had the makings of a cataract. He brushed off my questions. I am quite worried. How urgent are cataracts? Should I see an eye doctor? – W.R.

Your doctor could tell half of his patients over 65 that they had the makings of a cataract. Such a statement does not indicate the need for any urgent action. The rate of cataract progression is unpredictable, but most grow slowly, and most never need surgery.

You don’t have to see an eye doctor on an emergency basis.

It is the patient who tells the doctor when cataract surgery is necessary. That point is the time when it interferes with vision or when it causes a disabling glare.

If you smoke, stop. Smoking is an ingredient in the cause and progression of cataracts. Sunglasses that block out ultraviolet light are another preventive against cataract formation. If you spend any time outdoors, you should wear a pair.

DEAR DR. DONOHUE: I have a salty taste in my mouth. It doesn’t come from salt use, since I am on a low-salt diet and I never add salt to food. Is it a sign of a vitamin deficiency? – G.L.

It is more likely a sign of gum or tooth infection. The starting point in discovering a cause is your dentist’s office.

Rarely – very, very rarely – it is a sign of a deficiency of zinc, niacin (a B vitamin) or vitamin B-12.

Check your medicines with your doctor. Some can leave a salty taste in the mouth.

Chewing sugarless gum that promotes saliva production keeps your mouth moist and can often abolish the salty taste.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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