Chronic fatigue and joint problems

Dear Ask The Doctor: Diagnosed with chronic fatigue syndrome since early June this year. Been off work and unable to pursue my hobby of belly dancing which I used to teach. Joints flaring up again. Tests for rheumatoid arthritis negative and xray of right hand clear. All I have been offered is physiotherapy. No referral to a rheumatologist. I intend to ask for this when doctors back from holiday. I could be depressed but am more of a fighter. Should I insist on seeing a rheumatologist instead of being fobbed with yet more and more Ibuprofen? Fortunately I am able to take these but know they are not suitable for long term use.

Dear Claire: Sometimes Fibromyalgia coexists with chronic fatigue syndrome. It is difficult to diagnose it because there are no tests to do so, then you have to pay attention to symptoms like: sore spots in the muscles (tender points), aches and pains for at least three months, fatigue, sleeping problems, anxiety and depression, dizziness, memory problems. I recommend you to get a consultation with a Rheumatologist; also a psychologist and a Physical therapist are very useful. The treatment options include: medication (like “Cymbalta”) and other drugs (most of them are anti-depressants). You will benefit of Cognitive Behavioral Therapy which helps you to learn what triggers the pain so you can cope with it, also muscle relaxation and stress management techniques like meditation. The exercise may help you too, because the more active you are the less pain and depression you have, to learn an exercise routine you can use a Physical Therapist to teach you. So, in summary try to get enough rest, practice a consistent exercise routine, keep yourself active and learn techniques that relieve your stress. You may consult another doctor for a second opinion, that’s up to you.