Saul Marcus, ND - Naturopathic Doctor

247 West 35th street, 10th floor - New York, NY 10001

Phone:(646)330-0388 | Email: saul@drsaulmarcus.com

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 - Chronic Fatigue Syndrome

Summary of actual case - posted with permission of family

This is not a fully detailed description of every visit and protocol (that would be quite lengthy). The purpose of this is to show how individualized assessment is used in breaking down a case and proper treatment.

Initial Visit

Initial plan was some compound homeopathics for energy and sleep. Functional lab tests ordered: saliva cortisol, stool test and porphyrin test for toxicity

2 1/2 week follow up

Sleep is slightly better, except innervated (sleeping more at night). Basically feels the same. Labs show an increased toxic burden (porphyrin test). Cortisol is basically normal.

New protocol includes:

Follow up one week later

Came in for an emergency visit - symptoms actually worsened on the above plan. It was determined that teasel was to strong. It was taken out of plan for now, to be gradually restarted at just 1 drop per day

Came in with additional labs. CBC was "normal" - except for slightly high normal eosinophils on repeated lab tests (about 4.0% - not very much elevated - but this mild elevation was on previous labs as well). Based upon this additional parasitology tests ordered.

One month later

Although still very tired, seeing case turn around.

Urinary frequency and sleep are now normal!

Bone pain is still present

Additional lab tests show elevated anti gliadin antibody (very sensitive to gluten) and antibodies to Entamoeba histolytica (although not typically considered serious, in susceptible people this can cause numerous symptoms and be a major contributing factor to symptoms).

The major turning point was normalizing sleep. Going from 2 hours of disorganized sleep to night, to what was close to a normal sleep cycle in about 6 weeks. Even if every else is done correctly, the body needs to sleep to recover from such illness. Insomnia was not treated with sleeping pills or even sedating herbs. What helped the most was Rhemannia, given according to Chinese Medicine assessment (kidney yin deficiency).

One month later

Went back to medical doctors for extensive testing - the stress of this itself caused a minor setback in recovery

Gastroenterologist found nothing

MRI testing found nothing

Energy gradually improving. Actually began to try exercising. Although this may not sound like good progress, 3 months prior fatigue and muscle pain was so bad - was almost not able to stand and walk.

Note - despite at this point extensive blood work and imaging from numerous medical doctor over past 2 years, the only labs that have show any hint of underlining problem was the slightly elevated eosinophils, Entamoeba histolytica and gliadin antibodies.

Glutamine added to protocol - to aid in repair digestive system function and boost energy.

Isopathics added in - to turn on immune system function.

One week follow-up

Quickly came back concerned over a sore throat since starting isopathics. Was assured that this is a healthy, detoxification response and sign of the immune system turning on. Encouraged to continue with protocol.

One month later

Most symptoms are not present, or very minor (headaches, frequent urination, "hot flashes," increased heart rate, and insomnia),

Fatigue and brain fog and bone pain are still present.

Reports "white" "stringy" stuff coming out in stool - which based upon comparison to online photos appears to be a parasite.

Note: aside from entameba histolytica - no parasite was ever found on lab tests, but it's hard to argue with visual confirmation that the patient is seeing parasite come out.

Summary 4 months later

Gradual improvement although signs of parasite continue. Eventually followed up with an infectious disease doctor who used antibiotics against Entameba histolytica.

After aggressive antibiotic use for 1 month - Entameba histolytica was finally cleared on lab test with infectious disease doctor.

Following this was clear signs of prostate infection. Instead of going back to MD for antibiotics came in for a natural alternative. Isopathics cleared this up in a few days.

After people with severe fatigue have numerous food sensitivities. While it's important to avoid triggering foods, they are often given treatment plans in which foods themselves are considered the enemy. Certain foods such as sugar, conventional dairy, wheat, any junk food, are not healthy. However, severe allergic response to a large range of typically healthy natural foods indicates a different problem.

In this case, he went from being able to eat virtually nothing, to able to tolerate a much larger range of foods once pathogens in digestive system where cleared. So food allergies may be part of a larger problem effecting immune system response, than being the problem in and of itself.