Fatigue is the top symptom reported at a doctor’s office. Fatigue can be brain fog, it can be physical weakness, it can be sleepiness, and categorized in many other ways. It can be an annoyance, or it can be completely debilitating. It can be short lasting, or it can be chronic.

Chronic fatigue is often called an “invisible disability.” One long covid patient described their difficulty explaining it to doctors, family, friends, and coworkers:

“Spend five minutes with me and you’ll think I’m totally healthy. Spend an hour with me, and maybe you’ll notice something if off. Spend all day with me and you’ll realize I can’t function. Spend 24/7 with me… and you’ll be horrified.”

Chronic fatigue has long been ignored by the medical community, and many patients are told it’s all in their head. Some get diagnosed with depression, but don’t feel sad. And it is also hard to explain to friends, family, or coworkers. But there is a corner of the medical community that has been paying attention, and there is a pattern that connects most patients with chronic fatigue.

There are many health conditions that cause chronic fatigue that are very similar, and most patients have more than one. If you have one condition, you are very likely to have other fatigue causing conditions. I guess misery loves company after all. Some of the conditions you may or may not have heard of include Long Covid, POTS, and Fibromyalgia.

This rest of this post is going to include a lot acronyms and medical terms, but for the sake of time, they won’t all be explained here. The main ideas will hopefully still make sense, and the individual terms will have further detail in their own posts.

Below is a diagram of many of these overlapping and assoaciacted conditions.

At the center is the basic Chronic Fatigue Syndrome (CFS), but using the new name for it Myalgic Encephalomyelitis (ME). Researchers and doctors have started using this new name because too many providers were discounting a disease called “Chronic Fatigue Syndrome” as something unserious or fake. Myalgic Encephalomyelitis sounds more like something doctors will take seriously.

Some of the top conditions that are most closely related are:

POTS

Orthostatic Hypotension

Fibromyalgia

Ehlers-Danlos Syndrome (EDS)

Mast Cell Activation Syndrome (MCAS)

Sjogren’s

And frequently these conditions are triggered by an infection, with some of the most common being:

Epstien-Barr Virus (EBV)

Long Covid

Lyme Disease

Various gut microbe infections/overgrowths

The Chronic Fatigue Cluster is what I have named this overlapping disease association. The likelihood of having multiple conditions at once leading to fatigue is important because it means each patient needs a personalized treatment. There is no one treatment protocol for every patient with Myalgic Encephalomyelitis, because a patient with POTS and reactivating EBV would need different treatment than a patient with Sjogren’s and Fibromyalgia. So it is important for each chronic fatigue patient to be screened for all conditions. That way the treatment can be a combo of protocols that treat multiple causes at the same time.

It is common for patients and doctors alike to believe conditions that cause chronic fatigue have no cure, if they believe in chronic fatigue at all. The difficulty with treatment has always been with addressing care in a personalized way. No “one size fits all” stuff. Many of these conditions CAN be cured, and those that cannot still have effective management strategies. But time must be taken with the patient so they are on a plan that works with their level of ability, and their specific combo of conditions.