# "Dr. Donahue" Column



## M&M (Jan 20, 2002)

This was posted to the Co-Cure Mailing list. Might not hurt to write him, if any of us actually have the energy, as he is obviously misguided, and uneducated in this area!









> quoteate: Mon, 12 Jul 2004 09:48:35 -0400Subject: NOT, ACT: Dr. Donohue column of July 11th recommends graded exercise until 1 hour activity achievedToday (Sunday, July 11th) the following letter appeared in the "Dr. Donohue"advice column. I read it in the Grand Rapids Press, but "Dr. Donohue" is asyndicated column, by North America Syndicate, Inc., so I presume it appearsin many newspapers. I hope he will receive a flood of mail correcting hismisperceptions. Elsie Owings West Michigan CFIDS Support Group *EXERCISE MAY HELP EASE CHRONIC FATIGUE SYNDROME* Dear Dr. Donohue: My doctor has given me a provisional diagnosis of chronicfatigue syndrome. He is running more tests. Which one tells if I have thisillness, and how is it treated? -- B.B. Chronic fatigue syndrome is an illness in search of a cause and of adiagnostic test. No cause has been found, and no test establishes thediagnosis. The tests your doctor is running are to exclude other illnessesthat cause profound tiredness -- illnesses that include a sluggish thyroidgland, diabetes, lupus, anemia and adrenal gland malfunction. Depression isanother consideration. There are no tests for this elusive illness, but there are guidelinesthat make its diagnosis possible. The definition of fatigue is a feeling oftotal exhaustion not relieved by sleep or rest. Fatigue must be present forsix months, and it must be of such magnitude it has forced people to reducetheir workload and social lives. In addition to fatigue, four of the following signs and symptoms have tobe present to put the diagnosis on firm ground. A diminution of memory andconcentration is an important element. Sore throat, at some stage, often ispart of the picture. Lymph nodes in the neck and under the arms might beenlarged and tender. Muscles can ache, as can joints. Getting headacheswhen you never use to is another symptom. Physical exercise leaves CFSpatients completely spent. Exercise is an essential part of treatment. It sounds ridiculous to askan exhausted person to exercise, but the rest imposed by fatigue leads tomuscle weakness. Exercise can be started at a modest level, such as fiveminutes of walking or biking a day. Every week, the length of time shouldbe increased by three to five minutes until the goal of a full hour ofactivity is attained. Medicines such as Elavil can promote sleep.Readers may write to Dr. Donohue at P.O. Box 536475, Orlando, FL 32853-6475"


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## M&M (Jan 20, 2002)

I thought I would share the rough draft of the letter I'm planning on sending Dr. Donohue. This way, if any of you also would like to send him a letter, you can cut and chop mine, and add or take away to it, so you don't have to start from scratch. (I know how that fries our brains)


> quoter. DonohueNo. 304Box 536475Orlando, FL 32853-6475Dear Dr. Donohue,I read your column in my local paper quite often. I have enjoyed reading it, as you have often times spoken about many of the illnesses I have, and you seem to give a nice general base of information to build on. I am writing you in regards to the column you ran Sunday, July 11, 2004. The headline read "Chronic fatigue syndrome eludes diagnosis, but is real". First, I must applaud you for not discounting the existence of this disease. I appreciate that, at no point, did you ever imply that this disease is psychiatric, or just a disorder of malingers. However, some of the information you shared was not only incorrect, but could potentially be very dangerous for those of us who suffer with this disease. You said that exercise is an essential part of treatment. This is so true, and I agree wholeheartedly with you about that in particular. I do, however, take issue with the following statement you made:"Every week the length of time should be increased....until the goal of a full hour of activity is attained."You provide no source material, nor do you cite any studies to back up this conclusion. And, as a patient and an advocate, I feel you should retract this misleading, and false statement. To back up my allegation that your statement is wrong, I provide for you some information regarding Chronic Fatigue Syndrome from the Centers For Disease Control:"Decisions regarding treatment for CFS or any chronically fatiguing illness should be made only in consultation with a health care provider. The health care provider, together with the patient, will develop an individually tailored program that provides the greatest benefit. This treatment program will be based on assessment of the patientï¿½s overall medical condition and current symptoms, and will be modified over time on the basis of regular follow-up and assessment of the patientï¿½s changing condition. .....Physical ActivityAn appropriate amount of physical activity is required by everyone for physical and emotional well-being. Patients with CFS are no exception. A key consideration for patients with CFS is to know how much to do and when to stop the activity. Regardless of the level of activity a patient with CFS may attempt, the most important guideline is to avoid increasing the level of fatigue.In general, health care providers advise patients with CFS to pace themselves carefully and encourage them to avoid unusual physical or emotional stress. The paced activity can be counter-productive if it increases fatigue or pain. A regular, manageable daily routine helps avoid the "push-crash" phenomenon characterized by overexertion during periods of better health, followed by a relapse of symptoms perhaps initiated by the excessive activity. Although patients should be as active as possible, clinicians may need to explain the disorder to employers and family members, advising them to make allowances as possible. Modest regular exercise to avoid de-conditioning is important. The program of exercise and/or the exercise itself should be supervised by a knowledgeable health care provider or physical therapist. Such supervision is particularly important for severely compromised patients."Clearly, the symptoms and severity of Chronic Fatigue Syndrome vary from patient to patient. Some patients are so disabled that they are confined to a wheel chair. To suggest that there is only one set of guidelines for exercise in all patients, is to infer that patients who are more disabled by their symptoms have somehow caused, or could somehow remedy, their situation, simply by exercising more. This is the same line of reasoning doctors used many, many years ago with Polio patients. Now, evidence has surfaced that the "exercise until it hurts" ideology was not only foolish, but very harmful to patients in the long run, as many are now developing Post-Polio Syndrome.I feel that the misinformation you provided will perhaps cause much pain and exacerbation of symptoms in patients who are not more well-informed. All patients with Chronic Fatigue Syndrome should regularly see a physician specializing in this disorder, and should only pursue any course of treatment under strict medical supervision. This includes any and all exercise programs.Overall, I enjoyed the article you wrote about Chronic Fatigue Syndrome, and I appreciate that you validated those of us who suffer from it. I look forward to reading more of your columns in the future.Sincerely,


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## moldie (Sep 25, 1999)

Well, I do agree that some exercise is helpful, but too much can be harmful too. I doubt that I could ever exercise for one hour straight. I'm just trying to get about twenty minutes straight. I am always spent after that twenty minutes. There just seems to be a threshold limit, and I think whatever one is able to maintain is great. It is so variable from day to day and from person to person. For instance, if there is a low pressure, then my threshold seems to be a lot lower. If one is experiencing a flare, of course it is going to lower, and it might be better to just rest for a period of time. Some of what he says is true, but he probably just doesn't get the whole picture having not had the experience himself. Sometimes, I think a doctor will see a patient that improves with exercise, and it might be that the patient didn't really have cfs. The tests to prove that one has cfs or fms are not that perfected yet. Some of the ones that might be helpful in diagnosing it are too invasive or too expensive. Perhaps, there is another road block because of another money issue too. Not enough funding for research. Then, if it is identified, the cost for disability might be another factor.Just my random thoughts on the subject.M.


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