Is severe tiredness 'chronic fatigue' or something else? : Story by Dr Martin Scurr

Sly Saint

Sly Saint

Senior Member (Voting Rights)
readers letter
"
My daughter, now 40, had a traumatic birth six years ago — soon after she started feeling unnaturally tired. A private consultant diagnosed fibromyalgia, and she has ME. She has tried everything — acupuncture, counselling, reiki — but the fatigue is crippling.

Name and address supplied."

reply
I understand your concern, as your daughter has been unwell for six years. My feeling is that there is an unrecognised diagnosis in the background.

Fibromyalgia typically causes fatigue, poor sleep patterns, problems with memory and persistent chronic pain — the condition is the most common cause of widespread musculoskeletal pain.

The closest thing we have as a test for it is a physical examination to check for 18 specific points of tenderness in soft tissues.

In some patients, their symptoms of fibromyalgia are very similar to those of myalgic encephalomyelitis (ME), also called chronic fatigue syndrome (CFS).

Like fibromyalgia, ME/CFS is an illness of unknown cause also characterised by fatigue.

In the absence of a test, doctors diagnose it by relying on experience and skill — though I’m afraid too often ME/CFS is given as a fallback diagnosis for those with long-term severe fatigue. Because of the overlap of symptoms it’s not unusual for people to be diagnosed with both conditions.
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My thought is that in your daughter’s case, the issue may be either post-traumatic stress disorder (PTSD), or protracted postnatal depression.

PTSD can be triggered by a single terrifying event — there is no doubt from your longer letter that this happened to your daughter in childbirth. Similarly, postnatal depression is a common but misunderstood and frequently ignored condition that can last for years, leading to general malaise, such as you describe in your longer letter.

I urge you to help your daughter see a consultant psychiatrist, who can assess her on the basis of a detailed appraisal of her history and symptoms.

Suitable treatment can then begin and there is reason for optimism. The first step is to ask her GP for a psychiatric referral.
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Is severe tiredness 'chronic fatigue' or something else? (msn.com)
 
It's unfortunate that the daughter's traumatic birth isn't described. Did she have a prolonged birth which resulted in permanent damage to bladder/bowel? A stillbirth? Did she have a catastrophic bleed? Was she given a caesarean and have her bowel punctured and develop sepsis, and/or lose her bowel? Did she have prolonged post-natal depression?

I'm sure that there are many more possibilities that obstetricians could come up with. There simply isn't enough information to allow readers to have an informed opinion or make up their own minds about what happened and what might be happening now.
 
But Jonathan, that near miss, when the family conference decided not to go with counselling, may have resulted in you suffering [near miss] PTSD -- hence your pain is psychological --- and my fee is ----
 
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