Positive Health Online

This completely revised and updated book reviewing fatigue, or, as it is popularly known, TATT (tired all the time), provides a strong platform to help the doctor or healthcare provider evaluate the complex array of symptoms associated with fatigue, aiding appropriate diagnosis and focused treatment.

This book, primarily addressing the layperson and the one in four people complaining of feeling tired all the time, demonstrates considerable empathy for the fatigued person and at the same time dispassionately details the criteria to help individuals identify and self-assess the likely basis of their fatigue. Through a clear explanation of what 'energy' is or feels like, Dr Fitzgibbon has somehow managed to put into words the experience of fatigue.

This book should go a long way to further de-stigmatize depression and mental health problems. Through many case history examples the author demonstrates with clarity the symptoms that might, for example, separate true depressive illness from sadness; and how depression may masquerade in the guise of physical symptoms leading to inappropriate investigations and management.

Diagnostics is considered a strength of the medical profession and this book is exemplary of that vital skill. There is a commitment to understanding the person as a whole, integrating both mind and body. Indeed, a substantial part of the first part of the book is devoted to explaining how depression, anxiety, phobias, panic attacks, hyperventilation and hysteria manifest as symptoms and the physiological basis for many of these unpleasant experiences. Where relevant, strategies for alleviating the symptoms through stress management and breathing techniques are given.

A strong case is given for the use of anti-depressant therapy based on appropriate diagnosis of the underlying cause of the fatigue. Dr Fitzgibbon states that depression is the most common disorder identified in those who present with fatigue and responds well to appropriate treatment on the basis of firm evidence of psychiatric symptomology.

A good account is given of fatigue as a symptom of physical disease including the world-wide prevalence of iron deficiency anaemia, B12 and folate deficiency and thyroid imbalances. A reference to the underlying factors contributing to the fatigue many women feel at menopause would have been worth a discussion. A full chapter is dedicated to nutritional deficiencies. There is also good coverage on caffeine use and abuse, the effects of low blood sugar and microbial infections.

I can go part-way along with Dr Fitzgibbon in recommending that fatigued individuals major on carbohydrates. However, my own personal experience as well as that of many clients is that an excess of carbohydrates can contribute to fatigue and weight gain/ obesity. The author's account of fatigue and obesity omits any mention of this phenomenon.

Current research into the 'Insulin Resistance Syndrome' contests the high carbohydrate approach and some researchers now propose a new hypothesis arguing that both the quantity and quality of carbohydrate are important in explaining the high prevalence of type II diabetes mellitus.

Dr Fitzgibbon gives a particularly useful description of the differences between an infection with Candida albicans and Candida allergy and the management of each. A particular strength of the book is the section on Food Allergy and Intolerance. Dr Fitzgibbon, also author of Could it be an Allergy?, is an Allergist with a special interest in fatigue.

The link between man and his environment is sensitively explored in the chapter entitled 'Multiple Sensitivity Syndrome'. This chapter includes a potent account of a personal story that changed his life, including his whole approach to medical practice. As is often the case, the 'personal experience' can motivate the rational mind to find a scientific basis to explain the experience.

Dr Fitzgibbon admonishes the medical practitioner who tells their patient 'there is nothing wrong with you'. What he feels should be said is 'our technology has not yet reached the point where we can explain your symptoms'.

The author categorically recommends that the reader does not accept the label of idiopathic fatigue ('we don't know the cause of it') until they are sure that all possibilities have been considered.

Dr Fitzgibbon leaves the reader in no doubt about his opinion regarding 'charlatan' practitioners of the 'alternative' kind. His opinions are made overt more by 'inference' than by solid accounts of disreputable practice involving expensive and questionable treatments.

Equally, Dr Fitzgibbon is most reprimanding of medical 'ostriches' that dismiss their chronically fatigued patients 'out of hand' and offer no satisfactory treatment at all, leaving their patients to the mercy of unscrupulous 'alternative' mercenaries. He is, however, kind enough to state that 'some sufferers may even be given appropriate advice with regard to rest, activity, diet and nutritional supplements' by the 'alternative' practitioner.

Whilst I have genuine empathy for the author's candid viewpoint in regard to 'poor practice' of any kind, the fundamental lack of awareness demonstrated for the concept of a 'well-trained' alternative practitioner with appropriate advice as to how the public can access one through professional registers is, I believe, inexcusable in the year 2001.

It appears a genuine intention of the author to enable the fatigued sufferer to get the best support available. In my view, medical doctors could best support their patients by collaborating with 'alternative' practitioners who are well-trained in their respective disciplines. Preventative health care and the management of chronic health problems are considered among the main strengths of well-trained alternative/ complementary practitioners.

The author devotes the last part of the book to chronic debilitating fatigue, fibromyalgia and chronic fatigue syndrome. He offers useful assessment tools and a treatment strategy for chronic fatigue.

The potential use of nutritional supplementation in the management of chronic fatigue was given almost as a 'throw away' comment under Miscellany in the penultimate chapter of the book. This was disappointing considering the accumulating body of research in this field.

In the closing chapter 'In Pursuit of Relief' many threads are drawn together highlighting the need to explore the many possible causes of fatigue and the importance of addressing a variety of possible causes that could be simultaneously contributing to fatigue.

Overall, this book achieves its main objective by helping people to identify the cause of their tiredness; it allows them to distinguish between Chronic Fatigue Syndrome (CFS) and possible other causes of their symptoms, thus enabling them to seek appropriate help for their condition.