Retrovirus may shed light on mystery of chronic fatigue

Dr Garrett FitzGerald was once sent many patients who suffered from chronic fatigue. He listened with sympathy but believed the condition was psychological

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.
An attack of mononucleosis
One of the reasons why I could particularly empathise with these patients was the occurrence of a similar syndrome after an attack of mononucleosis when I was a medical student. After the acute illness had subsided came profound fatigue, which was accompanied by an inability to concentrate and a sieve-like memory for new material.
The only relief was in sleeping for 14 to 20 hours. Worst of all, the First Med exam was only three weeks away and I had spent most of my 21st year finding myself (in Hartigan’s mostly) as people of that age do.
Naturally, in those days, I didn’t go near a doctor. But help was at hand. In my temporary home, University Hall, there dwelt a student of pharmacy from the bush parts. He was always to be found in an optimistic frame of mind and supremely confident of his abilities as budding apothecary, even though he had only been to college a few wet weeks at the time. He enquired briefly as to the nature of my malady and, presumably satisfied that the tsetse fly was not being added to the stirabout by the Jesuit landlords, rattled a bottle of red capsules which came from his hip pocket.
“Take one three times a day and anytime you feel like another one,” was his expert advice. Of course I took them.
Cunningham’s anatomy book
I digested Cunningham’s anatomy book in four days, read Guyton’s Physiology like a novel, and absorbed Don Hingerty’s biochemistry notes (not mine – I wasn’t there) in a few hours. It was wonderful not to be tired anymore. Rather than a need for umpteen hours of sleep per diem, I managed for weeks with none at all. Whee!
Flying colours – by the skin of my teeth – three weeks later. Naturally, I forgot every morsel of information afterwards and slept until the Munster Final.
Such was the way of the ‘DEXIES’ – Dexedrine, dexamphetamine. Great tablets altogether.