Dr Dulcy on chronic fatigue
MANY THEORIES: MORE THAN ONE UNDERLYING CONDITION MAY BE RESPONSIBLE
Syndrome may worsen with physical or mental activity.
Chronic fatigue syndrome (CFS) is a complicated disorder characterised by extreme fatigue that can’t be explained by any underlying medical condition.
This fatigue is not the kind of tired feeling that goes away after you rest. Instead, it lasts a long time and limits your ability to do ordinary daily activities. The fatigue may worsen with physical or mental activity.
The symptom of chronic fatigue also may arise from more than one underlying condition. The cause of chronic fatigue syndrome is unknown, although there are many theories – ranging from viral infections to psychological stress.
Some experts believe chronic fatigue syndrome might be triggered by a combination of factors. Childhood trauma might be another factor that contributes to adult CFS risk in a subset of people. While these findings are important and have the potential to help many people, it is important to realise that not all persons with adult CFS experienced maltreatment as a child.
Childhood maltreatment is just one risk factor for CFS and does not explain how other people with CFS – who did not experience such trauma – developed the illness. There’s no single test to confirm a diagnosis of chronic fatigue syndrome.
SYMPTOMS
Chronic fatigue syndrome has eight signs and symptoms, plus the central symptom that gives the condition its name:
Fatigue that lasts six months or more.
Loss of memory or concentration. Sore throat. Enlarged lymph nodes in your neck or armpits. Unexplained muscle pain. Pain that moves between joints without swelling or redness.
Headache of a new type, pattern or severity. Unrefreshing sleep Extreme exhaustion lasting more than 24 hours after physical or mental exercise.
CAUSES
cause is not known but there may be a combination of factors that affect people who were born with a predisposition for the disorder. Some of the factors that have been studied include:
Viral infections. Some people develop chronic fatigue syndrome after having a viral infection. Suspicious viruses include Epstein-Barr virus, human herpes virus 6 and mouse leukaemia viruses.
Immune system problems. The immune systems of people who have chronic fatigue syndrome appear to be impaired slightly, but it’s unclear if this impairment is enough to actually cause the disorder.
Hormonal imbalances. People who have chronic fatigue syndrome also sometimes experience abnormal blood levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands.
But the significance of these abnormalities is still unknown.
Factors that may increase your risk of chronic fatigue syndrome include:
Age: Chronic fatigue syndrome can occur at any age, but it most commonly affects people in their 40s and 50s.
Sex: Women are diagnosed with chronic fatigue syndrome much more often than men, but it may be that women are simply more likely to report their symptoms to a doctor.
Stress: Difficulty managThe
ing stress may contribute to the development of chronic fatigue syndrome.
COMPLICATIONS
Possible complications of chronic fatigue syndrome include: Depression. Social isolation. Lifestyle restrictions. Increased work absenteeism.
DIAGNOSIS
The symptoms of chronic fatigue syndrome can mimic many other health problems, so there is no single test to confirm a diagnosis of chronic fatigue syndrome.
Consult your doctor if you suspect you might be having CFS so he/she can rule out a number of other illnesses. These conditions may include:
Sleep disorders. Chronic fatigue can be caused by sleep disorders. A sleep study can determine if your rest is being disturbed by disorders such as obstructive sleep apnoea, restless legs syndrome or insomnia.
Medical problems. Fatigue is a common symptom in several medical conditions, such as anaemia, diabetes, SLE, fybromyalgia and underactive thyroid (hypothyroidism). Lab tests can check your blood for evidence of some of the top suspects.
Mental health issues. Fatigue is also a symptom of a variety of mental health problems, such as depression, anxiety, bipolar disorder and schizophrenia. A psychiatrist can help determine if one of these problems is causing your fatigue.
The side-effects of certain drugs, such as antihistamines and alcohol, can mimic CFS as well.
To meet the diagnostic criteria of chronic fatigue syndrome you must have unexplained, persistent fatigue for six months or more, along with at least four of the following signs and symptoms:
Loss of memory or concentration. Sore throat. Enlarged lymph nodes in your neck or armpits. Unexplained muscle pain. Pain that moves from one joint to another without swelling or redness.
Headache of a new type, pattern or severity. Unrefreshing sleep. Extreme exhaustion lasting more than 24 hours after physical or mental exercise.
TREATMENT
Because chronic fatigue syndrome affects people in many different ways, your treatment will be tailored to your specific set of symptoms. Symptom relief may include certain medications:
Antidepressants. Many people who have chronic fatigue syndrome are also depressed. Treating your depression can make it easier for you to cope with the problems associated with chronic fatigue syndrome. Low doses of some antidepressants also can help improve sleep and relieve pain.
Sleeping pills. If home measures, such as avoiding caffeine, don’t help you get better rest at night, your doctor might suggest trying a prescription of sleeping tablets.
There’s no known cure for chronic fatigue syndrome and the most effective treatment for chronic fatigue syndrome remains uncertain. However, there’s evidence that a multipronged approach may be helpful:
Be kind to yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt.
Improve sleep habits. Go to bed and get up at the same time each day. Limit daytime napping and avoid caffeine, alcohol and nicotine.
Pain associated with chronic fatigue syndrome may be helped by: acupuncture, massage, yoga or tai chi.
Graded exercise. In order to improve daily function, more than pacing alone is needed. Previous studies suggest that graded exercise is an effective and safe treatment, but evidence for this remains limited. A physiotherapist can help determine what types of exercise are best for you. Inactive people often begin with range-ofmotion and stretching exercises for just a few minutes a day. Slow, incremental increases in activity then take place over weeks to months. If you’re exhausted the next day, you’re doing too much. Your strength and endurance will improve as you gradually increase the intensity of your exercise over time.
Psychological counselling. Talking with a psychologist can help you figure out options to work around some of the limitations that chronic fatigue syndrome imposes on you. Feeling more in control of your life can improve your outlook dramatically.
Cognitive behavioural therapy (CBT) and self-management strategies are among the most helpful. CBT is often prescribed to help patients with chronic illness cope better with illness and develop strategies that relieve the symptoms of their illness. It has been successful in helping patients with cardiovascular disease, diabetes, and cancer.
For CFS patients, CBT can be useful by helping them pace themselves and avoid the pushcrash cycle in which a person does too much, crashes, rests, starts to feel a little better, and then does too much once again. Often, CBT is prescribed along with other therapies to help CFS patients manage activity levels, stress, and symptoms. CBT can help CFS patients better adapt to the impact of CFS and improve their ability to function and their quality of life.
Dietary changes that have been shown to work: add flaxseed oil to your food, stop coffee, stop consuming junk food, limit dairy intake and eat more and more greens.
Not everyone who has severe chronic fatigue responds to treatment in the same way. People who have a better chance of treatment success tend to have less impairment, focus less on symptoms, comply with counselling programmes and pace themselves to avoid overexertion and underexertion. The experience of chronic fatigue syndrome varies from person to person. For many people, however, the symptoms are more bothersome early in the course of the illness and then gradually decrease.
Emotional support and counselling may help you and your loved ones deal with the uncertainties and restrictions of chronic fatigue syndrome. You may find it therapeutic to join a support group and meet other people with chronic fatigue syndrome. Support groups aren’t for everyone, and you may find that a support group adds to your stress rather than relieves it.