|
31 of 31 people found the following review helpful:
5.0 out of 5 stars
Best patient-oriented book I've seen on the subject, June 1, 1998
A new book on fatiguing illness is off the presses, with surprisingly *little* fanfare. I *highly* recommend this book to anyone interested in chronic fatigue syndrome (CFS,) its diagnosis, differential diagnosis, treatment and all other diseases that have fatigue as a major symptom. Dr. Natelson is a professor of neurosciences at University of Medicine and Dentistry, New Jersey Medical School and director of the New Jersey Chronic Fatigue Syndrome Center. He is also a principle investigator of one of two federally funded CFS Cooperative Research Centers, along with being the medical director of the Gulf War Research Center of the Veterans Administration Medical Center in East Orange, New Jersey. Aside from his excellent medical credentials, Dr. Natelson's presentation of what is known and not known about fatiguing illness in general and CFS in particular comes across loud and clear as ONE WHO KNOWS. This man *understands* He CARES. In the early chapters, he does an excellent job of examining all the definitions, various terminology, and strengths and weaknesses of various research approaches. Dr. Natelson looks at fatigue, weariness, neurasthenia, functional illness, and other fatiguing illnesses or reasons for fatigue that must be ruled out before the diagnosis of CFS is conferred. He does this in a non-jargonistic, careful, patient and easy-to-read manner. The chapters and topics are logically arranged and flow easily, and most importantly, he is not judgmental about any of the causes of fatigue. He addresses those who have been exhausted all their lives, saying that this represents one extreme, just as the over-energetic represent another. Dr. Natelson does an excellent job in discussing the medical causes of fatigue. He looks at chronic infection in general, then specifically as in AIDS, Lyme disease (fully recognizing the difficulties with lab tests and proper diagnosis in this disease), and tuberculosis. He looks at sleep disorders, again progressing from gen! eral to sleep apnea, restless leg syndrome. He has quite a good outline on MS can be diagnosed, and the similar but distinctly different diagnosis of myasthenia gravis. For MS, he says: "How does a physician make the diagnosis of MS in a patient who has not had repeated neurolgical problems separated from one another by periods of normalcy?" a frequent question. He goes on to state that the MRI becomes a diagnostic tool -- if the lesions are specific, in the "right" places and in the "right" pattern, then that "strongly suggests" MS. But, he goes on to explicate the MRI abnormalities seen in CFS patients: Of 52 patients he studied, nine had the "tiny abnormalities" (commonly called UBOs) that were not specific enough to diagnose MS. Some time later he got in touch with 8; of those 8, three of them had doctors who had dropped the CFS diagnosis, but only two had a pattern of symptoms that pointed to MS. He postulates that patients with severe and chronic fatigue who have nonspecific MRI abnormalities may be in a different class, and may have a mild form of MS. Of particular help, Dr. Natelson looks at the various terms and research, explaining "splitters" and "lumpers" and how these various categories have affected research. He even talks about the selection of normal controls and some of the problems. He has several very good chapters on practical things to do, including one on understanding the doctor. I know, I know, some of us really bristle at the idea of our having to take time to understand somebody we are paying a hefty sum of money to help us!! But, this chapter gives insights into how we can better choose a doctor who WILL help, and also how to communicate more effectively with the ones who DO help. He pulls no punches with regard to how the training process, particularly in the past several years with the huge technological and information explosions in medical science, has been less than perfect! in producing the old-fashioned "physician" -- the guy or gal who holds your hand and leads you through the complexities of being sick EVEN IF he or she cannot cure you. Dr. Natelson looks thoroughly at chronic fatigue syndrome (CFS), what it is and what it isn't, and the role of depression before or after the fact or not at all. He encourages support groups, coaches, experimentation. He is quite aware of all the limitations presently in the care and treatment of CFS, but does offer concrete suggestions about sleep, stress and anxiety reduction, exercise (moving rather than staying in bed kind), and why the various drugs work or don't work. Dr. Natelson mentions looking into alternative treatment and medications, with some frank discussion about the benefits and pitfalls. His guiding principle seems to be six weeks -- if *whatever* it is you are taking or doing does not show obvious improvement or benefit in six weeks, then stop. He also warns about the many false promises accompanying many of the alternative treatments and the psychological and emotional toll that takes. In all of his treatment talk, alternative or "standard" he mentions costs and cost-benefit analysis as one of the major determining factors. All in all, this is a no-hype, honest look at all sides of the issues surrounding CFS, with practical tips based on his experience in treating and supporting the most severely ill patients.
|
by Jacob Teitelbaum
by David S. Bell
by Majid Ali
See all Editorial Reviews
