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Subject: Re: Tired and gaunt
Forum: The Neurology and Neurosurgery Forum
Topic Area:
Posted by CCF Neuro MD on December 21, 1997 at 23:15:11:
In Reply to: Tired and gaunt posted by Scott S. on December 08, 1997 at 17:33:57:
: Dear Medhelp: I am writing because I need your help and advice. I am a white, 30 year
old male, 148lbs, 5ft7in, with good lifestyle habits and in good physical
condition. For quite some time now I have experienced a lot of muscle
weakness and feelings of being gaunt. I am always tired and while resting
provides some short-term relief, it never lasts very long. My muscles feel
fatiqued, rubbery, hard, and heavy. They also burn from time to time. When
I try and exert myself physically, such as lifting a box (15lbs), perform
10 push-ups, 8 sit-ups, or run (maybe an 1/8th of a mile) I start to tremble
and I feel a lot of pressure in my head. When this happens it feels like
something is going wrong chemically. My body seems to be able to get through
the day, but when additional physical exertion is required, it becomes
too much and reacts by trembling. Its as though my muscles are not receiving
the energy they need. My primary care physican in Alexandria, VA and an endrocrinologist at
Georgetown Univ. Hospital (I live in the Washington, DC area) conducted a
number of tests to determine whether I was anemic, had a thyroid problem,
or had diabetes. All of the tests came back negative. From the results
I am a very healthy young man. After we went over the various results, I
asked the endocrinologist whether the weakness might stem from abnormal
catecholamine levels, having conducted some research on your web page, but
he said no. I found my experience at Georgetown a little bit disheartening because when
I told him that I have suffered in the past from depression and I have an
anxiety disorder his eyes glazed over a bit and his face went blank for a second
or two. The expression brought to mind the sort of response a woman might
have received 10 or more years ago (though I imagine it still happens) when
tests were conducted and nothing was found. "Well my patient, your system
is very complicated and there are so many chemical and emotional transactions
involved. It could be anything." I can tell you that I am not depressed. This condition does run in my family,
but I am not a captive of it. I have become discouraged from time to time
and I also become scared because I cannot figure out what is causing me to feel
so gaunt, even after eating a good meal. Stumped, both my primary care
physician and my endocrinologist say they don't know what is wrong, but that
maybe it is chronic fatigue syndrome. The symptoms don't seem to match
particularly well, but CFS seems to be a popular offering when nothing else fits. Before signing off, one last piece of information that may be helpful concerns
an anti-anxiety medication (Buspar) that I pulled myself off of about a year
ago. Each week I reduced the dosage 5mgs. While doing so, I experienced
something rather strange. About an hour after I awoke in the morning and
after I had eaten breakfast (protein shake, cottage cheese, and vitamin C) I
would become amazing weak. It felt as though all of my strength was being
sucked out of me. After pulling off the medication completely this experience
slowly disappeared, but it remains a strong memory. I am not presently taking
any medication. Any recommendations you have would be VERY much appreciated. If you know
of anyone in the Washington, DC area (Georgetown included) who you believe
might help, please send me their name and telephone number. I feel worn
and I want to feel well again. Thank you for your help. Sincerely, Scott S.
=
There are a number of possibilities which come to mind from your description (although withdrawal is not one of them !) it would appear that some of these have been ruled out already by your primary care physician and endocrinologist, and I would agree that this is not a typical picture for Chronic Fatigue Syndrome although the manifestations of this entity are very varied.
Since your symptoms are largely related to muscular function and more systemic disorders have been outruled already this is probably where you should focus next in your search for a diagnosis.
A number of basic tests should a CK which is an enzyme released from damaged muscles, a sedimentation rate which is a screening test for a number of inflammatory muscle disorders and ultimately an EMG which is a test of the electrical activity in muscle and has characteristic abnormalities in various muscle diseases including myasthenia gravis which causes muscle fatigue.
These tests would be best performed by a neurologist specialized in neuromuscular disorders, one will be found in any large neurology group practice.
In order to you get this sort of evaluation I would suggest you request an appointment in a University Clinic neurology department specifically requesting a neuromuscular specialist.
This information is provided for general medical education purposes only.
Please consult your physician for diagnostic and treatment options of your specific medical condition.
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