Date: 3 April 2009
Topic: Response to: Ordering blood tests for patients with unexplained fatigue in general practice: what does it yield? Results of the VAMPIRE trial
Comments by: Jacqui Footman BA(Hons) PGCE, Information Officer, South Molton ME Support Group, North Devon
I am concerned that this article by Koch et al1 may discourage GPs from thorough testing for patients with CFS/ME. At the ME Research UK conference in 2008 Dr Gavin Spickett, consultant leading one of the NHS specialist CFS/ME services, stated that significant numbers of patients referred to the service in fact turned out to have other (more treatable) conditions.
I have a particular and personal interest in this topic in so far as I languished under a diagnosis of CFS/ME for 4 years without further medical testing. I did receive what could be considered the best NHS care currently available for CFS/ME but nevertheless in my prime at age 43 waved goodbye to a promising teaching/management career. I was subsequently found (sort of by accident) to have Crohn's disease, which had clearly gone undiagnosed for many years.
When lupus tests had come back negative, raised plasma viscosity tests had been ignored as unexplainable and few further tests done for several years. Now, some months on from an ileal resection (but after 5 years on Incapacity Benefit) I am eventually less disabled by fatigue. With testing, I recently discovered I also have osteoporosis and low Vitamin D. Many patients with chronic pain are being found to have low vitamin D, and what a simple thing to resolve once the test is done! How much better would my bone density now be if I had been tested and treated 5 years sooner?
I write to urge GPs to take testing and investigation more seriously and to avoid jumping to conclusions of somatoform illness, particularly when fatigue extends to CFS/ME, in order to help prevent further tragic and possibly avoidable losses. Most patient support groups recommend Health Canada's Clinical Guideline for help with this.2
1. Koch H, van Bokhoven M, ter Riet G, van Alphen-Jager JMT, van der Weijden T, Dinant G-J, Bindels P. Ordering blood tests for patients with unexplained fatigue in general practice: what does it yield? Results of the VAMPIRE trial. Br J Gen Pract 2009; 59(561):e93-e100. View abstract online.
2. Carruthers et al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols. J Chronic Fatigue Syndrome 2003; 11(1). Overview available at http://www.mefmaction.net/Patients/Overviews/tabid/122/Default.aspx