DEAR DR. DONOHUE: I am tired all the time, and I wonder if I get enough sleep. I sleep between seven and eight hours a night. What’s the recommendation? My wife says I have chronic fatigue syndrome. Would vitamins help me? What would? – O.S.

ANSWER: Fatigue and sleepiness are not the same thing. The distinction is important. Sleepiness is the inability to stay awake during the day, and its causes are many. Narcolepsy is one example. Too little sleep time is another. The recommended hours of sleep vary from person to person. The amount of sleep needed is the amount of sleep that makes a person feel rested the following day. For most people, that averages about eight hours.

Fatigue is exhaustion that is not abolished by rest. Even eight hours of sleep cannot undo fatigue. Chronic fatigue syndrome is a complex condition whose main symptom is a lack of energy for an extended period of time even when the person gets sufficient sleep. Before a doctor can make that diagnosis, all fatigue-causing illnesses must be explored – depression, sleep apnea, anemia, a poorly functioning thyroid gland and illnesses such as rheumatoid arthritis.

If a doctor makes a diagnosis of chronic fatigue syndrome, the battle to overcome it is a protracted one. Vitamins don’t help. There is no Food and Drug Administration-approved medicine for it, but sometimes a stimulant drug like Ritalin is given a brief trial to test its effectiveness.

More than drugs, a supervised, structured exercise program is better medicine. Such a program begins modestly with a short walk. From that point, the time and tempo of the walk are gradually increased until the person can manage half an hour of brisk walking every day. If people with chronic fatigue syndrome plunge into an overly ambitious exercise program, they can make matters worse. Slow progress is the key to success.

The booklet on chronic fatigue syndrome gives the details of this illness and its treatments. Readers can obtain a copy by writing: Dr. Donohue – No. 304, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: When young infants, shortly after birth, become jaundiced and it clears up by itself, could that be hepatitis C from the mother? Please enlighten. – M.A.

ANSWER: In whites, jaundice is seen as a yellowing of the skin; in people of all races, it’s seen as a yellowing of the whites of the eyes. The yellow color comes from bilirubin, a pigment found in red blood cells. When the liver is working normally, it clears bilirubin from the blood. Jaundice, therefore, is a sign of a sick liver.

In newly born infants, jaundice can be something that results from the newborn’s immature liver – a liver that hasn’t yet geared itself to handling bilirubin. This is called physiologic jaundice of the newborn. It begins on the second or third day of life, peaks on the fourth day and begins to subside by day five, when the liver achieves the ability to dispose of bilirubin.

Sometimes, even this normal jaundice can cause problems if the blood bilirubin levels are quite high. At high blood levels, bilirubin can diffuse into the brain and damage it. In cases where the bilirubin is high, babies are exposed to light – phototherapy. Light inactivates bilirubin and prevents brain damage.

Serious illnesses also cause a rise in infant blood bilirubin levels. An overwhelming infection does it. So can many liver illnesses.

Hepatitis C is uncommonly transferred from mother to infant. When it is, symptoms appear weeks after birth.

DEAR DR. DONOHUE: My doctor says I need surgery to correct a fallen uterus and bladder. I understand I will need a catheter passed through my abdomen to urinate normally after surgery. Can you explain this? – P.J.

ANSWER: Some people, after any surgery, need a temporary catheter to urinate. It is passed through the urethra, the tube that empties the bladder to the outside, and it’s in place for only a very short time.

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. Readers may also order health newsletters from www.rbmamall.com.