Joel L. Young MD - Understanding and Treating Chronic Fatigue

UNDERSTANDING AND
TREATING CHRONIC
FATIGUE

UNDERSTANDING AND
TREATING CHRONIC
FATIGUE

A Practical Guide for
Patients, Families, and
Practitioners

JOEL L. YOUNG, MD

Copyright 2020 by Joel L. Young, MD

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, except for the inclusion of brief quotations in a review, without prior permission in writing from the publisher.

Library of Congress Cataloging-in-Publication Data

Names: Young, Joel L., author.

Title: Understanding and treating chronic fatigue : a practical guide for patients, families, and practitioners / Joel L. Young.

Description: Santa Barbara, California : Praeger, 2020. | Includes bibliographical references and index.

Identifiers: LCCN 2020011085 (print) | LCCN 2020011086 (ebook) | ISBN 9781440871924 (hardcover) | ISBN 9781440871931 (ebook)

Subjects: LCSH: Chronic fatigue syndrome. | Chronic fatigue syndromeTreatment.

Classification: LCC RB150.F37 Y68 2020 (print) | LCC RB150.F37 (ebook) | DDC 616/.0478dc23

LC record available at https://lccn.loc.gov/2020011085

LC ebook record available at https://lccn.loc.gov/2020011086

ISBN: 978-1-4408-7192-4 (print)

978-1-4408-7193-1 (ebook)

242322212012345

This book is also available as an eBook.

Praeger

An Imprint of ABC-CLIO, LLC

ABC-CLIO, LLC

147 Castilian Drive

Santa Barbara, California 93117

www.abc-clio.com

This book is printed on acid-free paper

Manufactured in the United States of America

Contents

W riters with an important mission to help suffering peoplesuch as the many who suffer from chronic fatigue syndrome (CFS)should, in theory, be allotted extra time to practice their craft by the world. But we all receive the same 24 hours to perform daily mundane and major duties as well as achieve long-term goals. This book is the culmination of a significant long-term goal for me. I have had to protect those precious few moments allocated to writing because, as a practicing physician, late evenings and weekends represent the limited time I could carve out for this project. To this end, I am grateful to my wife, Mindy Layne Young, JD, LMSW, who sacrificed much of our precious private time together to allow me to complete my work. My longtime editor, Christine Adamec, structured and paced me, and I deeply appreciate her wisdom and our collaboration. My colleagues at the Rochester Center for Behavioral Medicine provided me with a forum to develop my ideas; I am particularly grateful to Jaime Saal, MA, for her leadership and for guiding our work with Richard Powell, PhD, on the ASSET rating scales. Melissa Oleshansky, PhD, Aliya Pasik, PA-C, and Mavis Emma Buzzard, MA, LPC, generously provided their clinical expertise. I am indebted to Ann Albrecht, Katie Denean, and Didi Nuclej for their daily support over the many years we have worked together. The Clinical Trials Group helped me execute the research that serves at the foundation of this work. I thank my patients for the privilege of being their doctor and for allowing me a position of trust in their lives. This book is dedicated to those who struggle with Chronic Fatigue Syndrome. I have tried to turn your stories into words on a page that can be read and shared with others in the hopes of advancing understanding and limiting future suffering.

A t my recent medical school reunion, I toasted with the same people I had sat with 35 years earlier. We reminisced about when we clutched our pens while listening to our first lectures on human embryology and when we first cut into the sternum of our willing, forgiving cadaver. In the years since, my lab partner became a noted radiologist, and the president of our class became a superb orthopedic surgeon. One friend has delivered 4,000 babies; another is a top cancer specialist. One of my former classmates chairs a prestigious universitys department of internal medicine, but the most important graduate may be the one practicing family medicine alone in a tucked-away small town where medical services are sparse. As for me, I founded and direct the Rochester Center for Behavioral Medicine, a large multidisciplinary mental health clinic outside Detroit, and I serve as the chief medical officer of the Clinical Trials Groups of Southeastern Michigan. In 1985, all my classmates and I were setting out on a long journey, and although we started in the same lecture halls with the same professors, from there our paths diverged. Over time, each found their passion and callingthe development of this book has been my gravitational pull.

Psychiatry is a most fascinating career path; most encounters with patients are intense, and every 30 minutes or so, I can find myself in uncharted territory. During the course of my career, the specialty has also become more powerfuland thanks to innovations in diagnostics and therapeutics, much more can be done for the good of our patients. Although it is true that full cures are elusive, it is rare that contemporary psychiatry is unable to improve the quality of a patients life.

Individuals with chronic fatigue syndrome (CFS) have proven to be exceptions to this rule. Early in my training, I was drawn to patients who did not quite fit in; and indeed, CFS patients had few places to turn. Their triad of symptomspersistent fatigue, unexplainable pain, and impaired thinkingare familiar to most primary care doctors, but unfortunately, the medical community has been unable to chart a path forward for those who suffer. Unlike other medical problems, no medical specialty owns CFS. A patient with eczema goes to the allergist; a patient with Parkinsons disease sees a neurologist; and if you develop heart disease, you will find care and comfort in a cardiologists office. In contrast, very few physicians have raised their hands to welcome CFS patients to their practices. Neither did I in the early part of my career, when I knew little about the condition; I proclaimed it not part of my specialty and left the treatment of CFS patients to someone else.

At the beginning of my career, my professional interests lay elsewhere, and I became intrigued by the burgeoning field of attention-deficit hyperactivity disorder (ADHD). I started to care for many adults with ADHD and became deeply familiar with the core treatment for ADHD: long-acting stimulant medications. During this time, I had the revelation that many ADHD patients also complained of persistent fatigue, vague but elusive body pain, and a lack of mental sharpness that we call brain fog. Quite by chance, I noticed that after treatment with long-acting stimulants, some of these patients reported significant improvement in classic CFS symptoms, such as fatigue and body pain. After several years, I set out to perform a clinical trial comparing lisdexamfetamine (LDX, currently sold under the brand name of Vyvanse) to placebo in subjects with CFS. The results of my double-blind, placebo-controlled study were positive and confirmed my clinical observations. I presented the findings at a national conference and published a formal paper in a peer-reviewed professional journal. The paper drew some interest, but as is my way, I did not shout out my findings from tall buildings to draw in other professionals. I had other tasks to tend to, and I moved on to the next task.