Saul Marcus, ND - Naturopathic Doctor

257 West 39th street, 10th floor - New York, NY 10001

Phone:(646)330-0388 | Email:

Contact Office For Appointment

Assessment of Individual with Fatigue

The following is a basic outline for the initial intake and assessment of someone with a condition related to fatigue. This can apply to Chronic Fatigue Syndrome, fibromyalgia, or any other case of fatigue with unknown cause. It is possible for case history to lead to factors not in the summary. This is only intended as a basic outline, to be modified as needed - not a rigid protocol.

Subjective - Review of Symptoms

Current Symptoms

The following is a brief outline - much more can be covered in a visit - depending upon what direction the case points to.

Past medical history

Objective - Lab Work and Physical Finding

Blood tests

All blood work should be reviewed carefully. Official reference ranges are often very large and have more to do with establishing norms for official diagnosis categories, then determining overall health.

Very sick people may have "normal" blood work. However on closer inspection labs are often not in optimal range. For example, the official reference range for monocytes may go up to 13%, but optimally it should be less than 7%. Anything higher can indicate a chronic infection.

Typically the most relevant blood work includes:

Functional labs

There are specialty labs typically used by "alternative" practitioners: NDs, functional medical doctors, DC, etc. They are generally not covered by insurance. Although at times valuable, it's important to order them carefully or else it turns into a large out of pocket expense. It's also possible for patient to end up with a large collection of functional lab tests that do not show where the problem is - when the problem could be more easily seem through a comprehensive history and some basic in office exam.

Partial list of some functional labs tests:

Physical signs

Sample case history

Link to sample case of client with Chronic Fatigue Syndrome