Dust bunnies can be fierce and are not to be trifled with. I also let them free range about for a while, but when I see them gather, as if in a horde, I wait to I get a perk of energy and then exterminate with extreme prejudice. I was headed to a s**t hole – some beautiful country and culture, but essentially held in chains by a military hunta. Wasn’t in the military but have found that the “government's wisdom” extends well beyond the army, noting that “Mefloquine was developed in the 1970s at the United States Department of Defense's Walter Reed Army Institute of Research as a synthetic analogue of quinine” – so if the government developed it, you know it must be good, right? I doubt it will come down to one med, but it is possible that CFS is caused in part by a neuro-affecting chemical, as one of some sequence of triggering factors, as perhaps suggested in this thread: Catching.Cancer (http://forums.phoenixrising.me/index.php?threads/catching-cancer.20459/) As an aside, where I was, there was an abundance of climate and topographical variation, and also a fair amount of jungle, so the Lariam seemed to make sense at that time. But I ponder that more now; the forces in play had bans on malaria prophylactics and treatment as they were trying to eradicate some indigenous people with the indigenous mosquito; its cheap and rather Machiavellian warfare – genocide without the overhead - but very effective. The point of ponder now being, is that at the same time, on very good intentions, there was an effort to smuggle in Lariam (small pill in a blister pack, once a week for prevention - that is a whole lot of treatment in a duffle bag). Now I am wondering if that was not a whole lot of trouble in a duffel bag, at least for some. - Things done, days past. Today, spent about two hours with a neurosurgeon for symptom evaluation and some testing, after which his initial assessment conveyed an enlargement in aspects of the brain, pressure and current or past inflammation that had apparently taken out, or flattened, my pituitary (empty sella) and compressed rather important areas of spinal cord/brain to affect function. This had not been caught, or at least noted, by the radiologist. And my internist, who had ordered the MRI for a pituitary check, had apparently missed the empty sella (looks obvious when pointed out), but had partially picked up on some malformation, but dismissed it as not requiring immediate follow up unless accompanied by headache. So, it was yet another self-referral, this time to the neurosurgeon to take a better look at what was going on. Possible causes include genetics, head trauma, previous infection with rocky mountain spotted fever, Lyme disease (not tested recently), some neuro-affecting chemical, or some other current or past viral/bacteriological component. He readily acknowledges CFS, but is not content with its lack of causation- so ordered another, more specific MRI, spinal X-rays, and a tilt test, etc. He also made a referral to a neurologist to get their take on it. Since my insurance is now in full coverage, he also thought a good idea to see Dr. Lapp at Hunter-Hopkins, at least for baseline testing and evaluation. During the session, he specifically pointed out where much ADHD (and much emotion/cognitive function linking to focus, learning, memory, etc.) is thought to be caused in the brain and the role of dopamine in that function, as well as motivation. That was an area of apparent inflammation or past effects of inflammation. So while brain dopamine may not have a causative role in CFS, it certainly can be related to CFS as a symptom. Also of interest, at least to me, in my intake was my history and cessation of cigarette smoking. I had smoked for about 15 years (starting while overseas - rather stressful environment, ciggs can also help keep you regular) and then becoming addicted. I had tried to quit numerous times over the years: cold turkey, nicotine lozenges, the patch, professional hypnosis, Wellbutrin/Zyban, Chantix, and even taking an extended backpacking trip in the Adirondacks with no smokes. None of it worked long term and while in the Adirondacks, I had would have smoked a twig if I could have kept it lit. But then last year, the urge, the addiction just left me in very short time. I went through a slight nicotine withdrawal, but I simply no longer had the desire to smoke, the reward system seemed no longer there – no motivation. Although it will likely never be proven in my case, I find it interesting to note that people with damage to the insula cortex, also have reported an elimination of motivation to smoke. That area possibly seemed affected by the inflammation. I understand that speaking of dopamine in the brain can be like speaking of salt in the ocean, but there are certain locations where it apparently “expresses its functionality” more than others, and with varied results. While many CFS sufferers are apparently full of motivation but lack the ability to act on it, I lack motivation and the ability to greatly act on it. Both represent a change in me. In that case, much suggestive pointing to the area of my brain that seemed to be or had been subject to inflammation. The articles of studies posted above, while they may have many flaws, make no presupposition or conclusion as to why people’s dopamine levels may spike in one area or another as a function of brain anatomy and its affects on neurochemistry, just the findings in the “slacker” vs. “go-getters,” and some commentary along those lines. - I think this is much like the word Fatigue? “Fatigue” also seems ubiquitous and many hold it not to be adequately descriptive of CFS. This was brought up in the thread “Is all of our advocacy falling on deaf ears?” (http://forums.phoenixrising.me/index.php?threads/is-all-of-our-advocacy-falling-on-deaf-ears.20165/) There I had expressed: Some people are also adverse to using the term Adrenal Fatigue, as posted by some in the thread: Adrenal Fatigue: A Possible Element of ME/CFS? (http://forums.phoenixrising.me/index.php?threads/adrenal-fatigue-a-possible-element-of-me-cfs.20166/) Not suggesting Chronic Slacker Syndrome, anymore than any other symptom word replacement of “Fatigue.” At one point, the doc, explaining things to me from my symptom evaluation and a previous MRI, introduced the idea of an “extended brain fart.” Sure everyone has an occasional "brain fart," mine just seemed extended. He did nuance it with a host of medical explanation, and while I suppose I could have ran associations to his initial plebeian articulation, looked up dictionary definitions, thesaurus entries, inferred all manor of things, or taken offense where none was intended, I did not. However, I am also not prepared to go with Chronic Brain Farter, even if it may seem meritorious to some, so I understand there is a place everyone must draw a line. And while I also never considered myself a slacker, I had noticed a change in myself, so that I did - as something inside me. My level of motivation changed from great to - greatly diminished. As for the use of the word, I use it as a US Marine might use the term “Jarhead;” it is OK to do so if you are a US Marine, it may prove regrettable if not. And now, I feel entitled to be able to point to an MRI with a sense of justification and say – here is the slacker inside. Albeit with a slight inflection or intonation in voice to insinuate it is not acceptable for any accusers to remain on the negative connotation of the word, but to move them along (e.g. people who may call me a slacker or have similar notion - seems like extended family not aware of day to day happenings but see the result of illness without understanding, doctors, community at large, etc.) It essentially works to shift the frame of reference from a negative connotation to that of understandability, using a metaphorical conduit. In one way, allowing the meaning slacker = slacker (e.g. dictionary definition and common assumption) then to stating inequality in meaning: slacker does not equal slacker, changing it to slacker is (=) an illness (or symptom of). In similar parlance as one who degrades one who is exhibiting a negative aspect of behavior may then be corrected by explanation of that behavior, in example: they are mentally handicapped, diabetic, autistic, have Parkinson’s or Alzheimer’s, etc., etc., etc. The behavior, with causation in hand, is then taken to be less likely a “character” or “personality fault.” And while it is not cuasitive of CFS, because CFS does not yet have a definitive cause, it points to the etiology of symptom formation. Ultimately, the neuro-doc seemed to echo this idea, with slight positive uptick: - He thought some results may be had one way or another, some improvement to be gained, some chance that symptoms could totally be reversed, but seemed less optimistic about a miracle drug anytime soon.