DEAR DR. DONOHUE: For more than a year I have felt so washed out that I barely can take care of my home and children. I have been to four doctors and have had all sorts of tests. No diagnosis has been given to me. The last doctor says I could have chronic fatigue syndrome, and I am going to see him again. I know nothing about this and would greatly appreciate any information you can give me on cause and treatment. My husband has become quite frustrated with me. — N.C.

 ANSWER: Chronic fatigue syndrome is difficult to explain and to diagnose. One reason is that there is no single test that proves a person definitely has it. Furthermore, fatigue is a universal complaint with many possible causes, but the cause of chronic fatigue syndrome hasn’t been identified. Doctors have considered a bevy of viruses, defects of the immune system and malfunctioning of the adrenal glands. No cause has been proven, but the search for one continues.

 What defines the syndrome is persistent or relapsing fatigue, not due to exercise and not relieved by rest. The fatigue is of such magnitude that it forces a person to reduce the level of customary work to a fraction of what it used to be. Affected people also cut back on their social interactions. Four or more of the following have to be present to merit the diagnosis: impaired memory or concentration, or both; sore throat; muscle pain; joint pain; headaches; unrefreshing sleep; and exhaustion after physical activity that once was quite tolerable.

 An important part of the workup is searching for all the known causes of fatigue, a formidable task. Your last doctor sounds as though he’s conducting such a search.

 No single treatment suits all chronic fatigue patients. However, a graded exercise program is universally advised. “Graded” indicates that people start out very modestly and gradually increase the exercise tempo. This syndrome leads to deconditioning, and that adds to a person’s inability to cope with physical and mental performance.

 The booklet on chronic fatigue syndrome clarifies some of the thinking on this syndrome and its treatments. Readers can order a copy by writing: Dr. Donohue — No. 304, Box 536475, Orlando, FL. Enclosed a check or money order (no cash) for $4.75 U.S./ $6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

 DEAR DR. DONOHUE: My right elbow (I am right-handed) has been killing me for more than a month. When I drop my arm straight down and turn the palm of my hand so that it faces outward, the pain is centered at a bony bump at the side of the elbow next to my body. It came on me all of a sudden. I don’t recall any injury. Any thoughts? — D.T.

 ANSWER: The bony bump you feel is the medial epicondyle, a protrusion that is the site for the attachment of muscle tendons that bend the hand downward. It’s inflamed. The condition is called medial epicondylitis. The usual cause of inflammation is overuse. Golfers often get it; it’s also called golfer’s elbow.

 Rest is important. Apply ice to the painful area three times a day for 20 minutes. If ice isn’t bringing relief, switch to heat. Nonsteroidal anti-inflammatory drugs control pain and ease inflammation if there’s no contraindication to your taking them. Advil is an example.

 If things haven’t resolved in two weeks, see the family doctor. A shot of cortisone to the inflamed site can hurry things along.

 DEAR DR. DONOHUE: When my brothers, sisters and I were young, we were not allowed to drink anything with our meals. My mother said that drinking interfered with digestion. As an adult, I can’t get a forkful of food down without taking a drink. Is there anything to this digestion theory? — M.M.

 ANSWER: Not a thing. Liquids don’t interfere with digestion. Some people need fluids to swallow; others don’t. Whichever works is perfectly OK.

 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.