Dr Kerryn Phelps, Health Editor, with Tracey Grimshaw, Channel Nine 'Today'
GRIMSHAW: To medical news now, and Chronic Fatigue Syndrome (CFS) is a debilitating condition which can cause headaches, muscle pain, concentration complaints, among other things. But it can also lead to much more serious health problems if left unchecked. However, this week the Royal Australasian College of Physicians has come in for some criticism after publishing guidelines advising doctors not to treat the condition as a disease, suggesting rather that Chronic Fatigue may be all, or at least partly, in the mind. We're joined now by 'Today' Health Editor, Dr Kerryn Phelps. Morning, Kerryn.
PHELPS: Good morning, Tracey.
GRIMSHAW: This is going to be a controversial one because it seems there are conflicting views of what Chronic Fatigue Syndrome is, ever since it was first identified. Is that right?
PHELPS: Absolutely correct. And I think there has been quite a lot of misunderstanding of the guidelines that have been put out for doctors as well. It's come out under The Medical Journal of Australia, it's clinical guidelines for doctors. And this is very welcome, because I think there has been… this is a very real attempt to gather all of the information into one cover that we know about CFS, and also to say what we don't know about it, which is just as important.
GRIMSHAW: And just as voluminous, isn't it? It would seem to me, from looking at it, that we don't know more than we know.
PHELPS: Exactly. I mean, one of the criticisms that's been raised, as you said in your introduction, that it's been said in this guideline, that it can't be treated as a disease. Now, that's actually a misquote from this. It actually said it can't be classified as a disease, because we don't know the underlying cause, or the disease process. There is no question, and the guidelines make this clear, that this is a condition, an illness, which has the ability to cause quite a lot of disability in people who suffer from it, and I think that it is very important that that is recognised by doctors who are dealing with patients who have this syndrome.
GRIMSHAW: Let's look at the symptoms of Chronic Fatigue. Are the sort of symptoms that the guidelines say have to be identified before Chronic Fatigue can be diagnosed?
PHELPS: Well, the first thing is Chronic Fatigue, terrible tiredness, with minimal exertion, lasting for more than six months. Impaired short-term memory or concentration. A lot of people describe a sore throat that just won't go away; tender lymph nodes; muscle pains; joint pains without arthritis; headaches that change their pattern, a new type of headache, more serve than before; unrefreshing sleeps, they might sleep for a long, long time, but not feel refreshed; and after exercise feeling just terribly uncomfortable for about 24 hours afterwards.
GRIMSHAW: Kerryn, if we look at those symptoms, though, people could suffer those symptoms for any number of reasons, and it would seem to me that there have been people, anecdotally, diagnosed with CFS, coming from Glandular Fever, and coming from depression, resulting in the same symptoms, but completely different causes.
PHELPS: Well, this is the point that is also made. That this is a very heterogenous group of problems that probably feed into being called Chronic Fatigue Syndrome, and until we get a clearer idea of that actual disease process going on - how it affects the immune system, how it might affect the brain, and so forth - then we are going to be, to an extent, just having to work on an individual patient by patient basis. And the first thing that we have to do is to rule out other causes of these symptoms, like an under-active thyroid, like coeliac disease, like a whole range of different syndromes, that could cause similar sorts of symptoms.
GRIMSHAW: Do we know yet how much of CFS is mental, and how much is physical?
PHELPS: Well, the important point that you have to make is that nobody is saying that this is all in the mind, but what we are saying is that there is a psychological dimension to Chronic Fatigue Syndrome, that somebody may become very depressed, agitated, anxious, because they can't do what they used to be able to do. And it's important that the medical profession, when they are dealing with people with this syndrome, recognise that. Sometimes the depression will be alleviated by antidepressants, the pain might be alleviated by antidepressants, you might have to use non-steroidal, anti-inflammatory medication to help with the pain. These are symptomatic types of treatments. You might have to look at different ways of managing sleep problems, even see a sleep specialist. Some people might even discover that they have got a sleep disorder that is causing their symptoms. So, it's very complicated, it's difficult, but the medical profession is making a really serious attempt to try and gather all the information, and give people reliable advice.
GRIMSHAW: Okay. It's a nightmare. Thanks for being with us.
PHELPS: Thanks, Tracey.