Chronic Fatigue Syndrome

The origin of this elusive, debilitating illness, remains unclear, even though more than 10,000 New Zealanders and between 36,000 and 126,000 Australians are reported to suffer from its fatigue-based
symptoms. A multifaceted approach may be the best. 

What is happening

Doctors aren't sure why chronic fatigue syndrome (CFS) develops, although you may remember having had a bad cold or flu before coming down with this malady. Its lingering exhaustion, sore throat, problems with memory and concentration, muscle and joint pain, headaches, depression and myriad other symptoms can all make it difficult to work, sleep or go about your daily activities.
           It is hard to know why CFS causes such a wide variety problems, because so little is known about the illness and how it affects your body. One theory is that CFS is due to an overactive or underactive immune system, and so you may hear it referred to as chronic fatigue immune dsyfunction syndrome (CFIDS). Another theory is that a virur or other germs may be to blame, although no single infection has been pinpointed. Imbalancesin stress hormones and brain chemicals, and very low blood pressure, have been noted in some with CFS, suggesting that nervous system abnormalities may play a role. In Europe, CFS is often referred to as myalgic encephalomyelitis (ME), which means brain and muscle inflammation. Researchers still cannot find any consistent patterns to explain the far-flung symptoms. It may well be that CFS results from a combination of factors.
  CFS is a relatively new disease--it was first reported in medical journals in the 1980s, though earlier case histories suggest that it has probably been around much longer--and many still disagree sharply about its definition and causes. It may therefore be difficult to find a doctor skilled in its treatment: some physicans even dismiss it as being psychosomatic, or 'all in your head'. Given the scope of the problem, however, an increasing number of health care professionals are becoming versed in the care and management of chronic fatigue syndrome, and therapies are available.

LIKELY FIRST STEPS

• Begin medical treatments, such as pain relievers for muscle aches and sleep aids for insomnia.
• Consider antidepressants or anxiety relievers. Depression or anxiety may be making you feel worse.
• Ease gradually into a regular exercise program, pacing yourself as you go.
• Find a counsellor trained in cognitive-behavioural therapy.

QUESTIONS TO ASK

• Could an underactive thyroid be causing or worsening my fatigue? Can you test for this?
• What can I do improve my focus and concentration?
• Will I be tired for the rest of my life, and how can I deal with that?
• I'm obviously so sick, why do some doctors doubt that CFS actually exists?

Treatments

Even though there's no known cause or cure for CFS, treating your symptoms will make you feel much better. A variety of therapies can help you improve enough to eventually resume all or most of the activities you enjoyed before becoming ill. You will most likely benefit from what's called a 'multidisciplinary' approach, which combines conventional medicines with lifestyle changes, an exercise program and counselling. Self-help is very important.

                                                   Treatment Options 

MEDICATIONS
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NSAIDs                                                  For relief muscle aches and pains.
----------------------------------------------------------------------------------------------------------------------------    Antidepressants                                      Promote sleep and help outlook.

LIFESTYLE CHANGES
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Moderate exercise                                    Start slow and build up.
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Energy diary                                             Helps you plan for energy highs and lows.
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Good diet                                                  Provides nutritious underpinning.
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Improve sleep habits                                Important to combat fatigue.
 

Procedures------------------------------------------------------------------------------------------------------------------------------
 Psychotherapy                                        Cognitive-behavioural therapy for stress.

 NATURAL METHODS---------------------------------------------------------------------------------------------------------------------------------
 Relaxation techniques                                 Reduce stress and increase sense of control.
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 Acupuncture                                                Decreases pain and increases energy for some.
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 Nutritional supplements                               Selected herbs and vitamins can help.

 A healthy eating program, scaling back on activities, getting plenty of rest, reducing stress and learning to accept your symptoms and limitations will go along way towards getting you on the road to recovery. In addition, you may also find relief in various alternative therapies, such as acupuncture and relaxation techniques. An increasing number of mainstream physicians re now taking these approaches seriously.

TAKING CONTROL

• Choose a doctor who is knowledgeable about CFS. Many physicians are unfamiliar with this illness, and some can even be dismissive. Patient associations and support groups may help in locating a good practitioner for you. Doctors and therapists trained in pain management or headaches may also have skills for treating your symptoms.
• Take it easy. It is important to set limits and realistic goals. You may have to forego many of the activities you enjoyed before becoming ill, at least for a time. Find new interests or hobbies that work better with your restricted schedule.
• Deal with your feelings. Helplessness and depression are coming with CFS. New classes of drugs, however, can really help. Just remember that your goal is to feel better, and don't be embarrassed  about taking drugs or seeking out a professional counsellor.
  

Medications

No medicines will 'cure' CFS, but some may help with specific symptoms. For sore muscles and other aces paracetamol (Tylenol) or NSAIDs (nonsteroid anti-inflammatory drugs) may bring relief. The latter include pain and inflammation relievers, such as aspirin or ibuprofen (Nurofen); use them with care because. NSAIDs may cause side effects suh as gastrointestinal bleeding. The newer prescription anti-inflammatories called  COX-2 inhibitors, such as celecoxib (Celebrex), may be safer, although long-term studies are still continuing.

>When can I expect to start feeling better?If you start a program outlined by a doctor familiar with CFS, you will actually begin to feel condsiderably better is as little  as two or three weeks. This is because your physician will be selecting medications aimed at your most troubling symptoms, such as poor sleep or persistent much aches. In fact, treating the symptoms of CFS is relatively easy. when your symptoms diminsh, your overall energy will improve considerably.

  Antidepressant drugs may also help to relieve symptoms and treat underlying depression. The older tricyclic drugs, whiche include amitriptyline (Endep, Tryptanol) and doxepin (Sinequan), may be more effective than newer ones, such as the SSRIs fluoxetine (PROZAC) and nefazodone (Seroze). Recent studies suggest tricylics promote deep sleep and interfer with nerve pathways tht transmit pain. Other treatments may improve sleep (See on next) or alleviate additional symptoms of CFS.