A normally healthy women suddenly becomes ill. She is so tired she can barely lift her head off the pillow, but no one can diagnose her symptoms, other than to attribute them instead to menopause or nerves. Is this a figment of her imagination?
The patient is usually a Caucasian woman in her mid-thirties. She's active and busy trying to manage a family and a job. Once healthy, both medically and emotionally, she suddenly comes down with a flu-like illness, in which she has a fever, swollen lymph glands, and a sore throat . She experiences an extreme fatigue that is so debilitating she can no longer perform her daily tasks; getting out of bed is even a chore.
But the symptoms don't go away like they do with the flu . They wax and wane for months or even years. Her doctors find no cause for her symptoms. Finally, she is told she has chronic fatigue syndrome , a condition about which little is known or understood. According to Benjamin Natelson, MD in his book Facing and Fighting Fatigue , this is the story of a typical patient suffering from chronic fatigue syndrome.
Chronic fatigue syndrome (CFS) is a debilitating condition characterized by extreme fatigue that doesn't go away with rest. Other common symptoms of CFS include weakness, muscle pain, impaired memory, and sleep disorders .
The Centers for Disease Control and Prevention (CDC) reports that CFS affects more than one million people in the United States. And although no one knows exactly why, it is diagnosed two to four times more often in women than in men. It may be that women are genetically predisposed to CFS, as they are with lupus . Or it may be that women report their symptoms to their healthcare providers more frequently than men do.
CFS is extremely difficult to diagnose. There are no laboratory tests to identify the condition, and CFS shares many of its symptoms with treatable illnesses, often being confused with:
In fact, CFS is diagnosed only after these diseases are ruled out and no other cause for the symptoms is found.
The first step in diagnosing CFS is to obtain a detailed medical history and perform a complete physical exam, followed by a standard battery of tests. If any of the tests suggest a possible explanation for the symptoms, additional tests are conducted to confirm a diagnosis. If no cause for the fatigue is identified, the doctor moves toward a diagnosis of CFS.
Despite its reputation as a vague disorder, the diagnosis of CFS is structured and is made only if a patient meets all of the following criteria:
These symptoms must have lasted or recurred during six or more consecutive months and must not have occurred before the fatigue.
The cause of CFS remains unknown. Scientists have not been able to find any single marker for the condition. Rather, current research suggests that CFS is the result of many factors.
In an article in New Jersey Medicine, Richard Podell, MD, states one common hypothesis, "CFS starts with an acute viral infection. We speculate that there are immune system abnormalities that activate metabolic systems that normally are triggered when a person, for instance, fights a flu. But then the body forgets to deactivate them." This, in turn, causes an imbalance that is characterized by the typical symptoms of CFS.
Just as there is no known cause for CFS, there is no known cure. There are, however, treatments that may be somewhat helpful.
Stress is known to worsen the effects of CFS and is thought to provoke relapses. Patients can avoid stress through the following behavioral modification programs.
Drug therapy is used to relieve specific symptoms. Currently there are several prescription medications being used to treat CFS patients. They include:
Natelson offers the following tips for coping with CFS:
The course of CFS varies from patient to patient. While some people spontaneously recover, others continue to have symptoms that come and go. However, some improvement over time is the rule, rather than the exception. To help cope with what seems to be an incurable condition, Natelson advises his patients to laugh. He says, " Laughing is positive, whereas weeping is negative. Putting more ticks on the positive side makes coping easier and reduces symptoms."
RESOURCES:
CFIDS Association of America
http://www.cfids.org/
The Chronic Syndrome Support Association
http://www.cssa-inc.org/
International Association of CFS/ME
http://www.iacfsme.org/
CANADIAN RESOURCES:
Chronic Fatigue Syndrome
http://www.ncf.ca/ip/social.services/cfseir/
Women's Health Matters
http://www.womenshealthmatters.ca/
References
Chronic fatigue syndrome. Clinical practice guidelines—2002. Med J Aust. 2002;176(suppl:S23).
Kim E. A brief history of chronic fatigue syndrome. JAMA. 1994;272:1070.
Natelson B. Facing and Fighting Fatigue: A Practical Approach. New Haven, CT: Yale University Press; 1998.
Schmidt M. Tired of Being Tired: Overcoming Chronic Fatigue and Low Energy. Berkely, CA: Frog, Ltd; 1995.
Last reviewed May 2008 by Marcin Chwistek, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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