belifnet - A normally healthy woman 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, even getting out of bed is 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, M.D. in his book Facing and Fighting Fatigue, this is the story of a typical patient suffering from chronic fatigue syndrome.
A Chronic Condition
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 approximately 500,000 to 800,000 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 health care providers more frequently than men do.
A Difficult Diagnosis
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 hypothyroidism, sleep apnea, chronic mononucleosis, eating disorders, cancer, autoimmune disease, alcohol or substance abuse, mental illness, or obesity. 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 physician proceeds toward a diagnosis of CFS.
Despite its reputation as a nebulous disorder, the diagnosis of CFS is quite structured, and is made only if a patient meets all of the following criteria:
• Long-term fatigue: severe, unexplained chronic fatigue lasting six months or longer that is not due to ongoing exertion, is not relieved by rest, and results in a substantial reduction in previous levels of activity.
• A unique collection of four or more symptoms occurring at the same time, including:
• impaired short-term memory or concentration
• sore throat
• tender lymph nodes
• muscle pain
• multi-joint pain without swelling or redness
• headaches of a new type, pattern, or severity
• unrefreshing sleep
• post-exertional malaise that lasts more than 24 hours
These symptoms must have lasted or recurred during six or more consecutive months and must not have occurred before the fatigue.
The Cause
The cause of CFS remains unknown. Scientists have not been able to identify any single marker for the condition. Rather, current research suggests that CFS is the end result of multiple contributory stress factors. In an article in New Jersey Medicine, Richard Podell, M.D. states his opinion: "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 flu. But then the body forgets to deactivate them." This, in turn, causes an imbalance that is characterized by the typical symptoms of CFS.
The 'Cure'
Just as there is no known cause for CFS, there is no known cure. There are, however, various pharmacological and nonpharmacological treatment options for managing the condition.
Nonpharmacological Treatments
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.
• Develop a daily routine: A regular, manageable routine helps to avoid the fatiguing "crash" that follows the "high" experienced by periods of good health. Without a regular routine, people with CFS tend to overexert themselves when their symptoms abate, but then suffer from extreme fatigue caused by the excessive activity.
• Initiate proper sleep habits: One of the most effective ways to manage CFS is to eliminate stress factors that cause a disruption in sleep. Physicians advise CFS patients to establish a regular bedtime, avoid too much alcohol and caffeine, eliminate sedatives, and avoid eating late.
• Lose weight: Extra weight means extra work to move around, and extra girth around the neck can block air passages during sleep, which can lead to sleep apnea. Physicians advise patients to start a weight reduction plan under the direction of a trained professional.
• Start a tailored exercise program: Pacing is critical in managing CFS. Physicians caution against an abrupt resumption of exercise, which can cause a flare-up of symptoms. Instead, they encourage gradually reintroduced physical activity. This can mean something as simple as a walk around the block, stretching, tai chi, or yoga.
• Therapy: Trained occupational and vocational rehabilitation therapists can help patients set realistic goals and design strategies for conserving energy, improving functional capacities, and limiting deconditioning.
• Counseling: CFS sufferers often need psychological counseling because they become demoralized by setbacks in their recovery. Cognitive restructuring is one effective technique that teaches patients how to gain control over their emotions. It stresses the importance of eliminating negative thoughts. In his book Natelson explains, "The treatment offers the CFS patient new and effective coping mechanisms to confront the often self-defeating option of staying in bed. And just the thought of taking control of one's life makes any chronically ill patient feel better."
Pharmacological Treatments
Drug therapy is used to relieve specific symptoms of individual patients. Currently there are several prescription medications being used successfully to treat CFS patients. They include:
• Tricyclic agents (i.e. Elavil [amitriptyline], Norpamin [desipramine]) to improve sleep
• Antidepressants, such as Prozac [fluoxetine], Zoloft [sertraline], Paxil [paroxetine], Effexor [venlafaxine], Desyrel [trazodone], and Wellbutrin [bupropion]
• Anti-anxiolytic agents, such as Serax [oxazepam] or Xanax, to treat panic disorder
• Nonsteroidal anti-inflammatory drugs (such as ibuprofen or naprosyn) to relieve pain
Hanging In There Wth The Treatments
Natelson offers the following tips for coping with CFS:
• Find an understanding health care provider
• Question the miracle cure or curer
• Enlist the help of a coach to develop coping strategies
• Develop a strong support network
• Have a positive attitude
The course of CFS varies from patient to patient. While some people spontaneously recover, others continue to have symptoms that wax and wane. 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."