What Can I Do About Chronic Fatigue

How Is Cfs Diagnosed

CFS is a very challenging condition to diagnose.

According to the Institute of Medicine, as of 2015, CFS occurs in about 836,000 to 2.5 million Americans. Its estimated, however, that 84 to 91 percent have yet to receive a diagnosis.

There are no medical tests to screen for CFS. Its symptoms are similar to many other conditions. Many people with CFS dont look sick, so doctors may not recognize that they indeed have a health condition.

In order to receive a CFS diagnosis, your doctor will rule out other potential causes and review your medical history with you.

Theyll confirm that you at least have the core symptoms previously mentioned. Theyll also ask about the duration and severity of your unexplained fatigue.

Ruling out other potential causes of your fatigue is a key part of the diagnosis process. Some conditions with symptoms that resemble those of CFS include:

• sleep disorders

The side effects of certain drugs, such as antihistamines and alcohol, can mimic symptoms of CFS as well.

Because of the similarities between symptoms of CFS and many other conditions, its important to not self-diagnose. Talk to your doctor about your symptoms. They can work with you to get relief.

What Complications Are Associated With Myalgic Encephalomyelitis/chronic Fatigue Syndrome

For some people, the fatigue associated with ME/CFS makes activities of daily living very difficult or even impossible. Research shows that only half of all people diagnosed with ME/CFS work full-time or part-time jobs.

ME/CFS causes significant depression in many people living with the condition. If you experience depression, talk with your doctor â effective treatments are available.

What We Knew Then

First of all, the textbooks of medicine didnt describe an illness like this. In addition, all the usual laboratory tests to screen for various diseases came back normal. At this point, a doctor has two choices: decide to believe the patient and keep searching to find what is wrong, or to tell the patient, There is nothing wrong. Indeed, some doctors seeing people like my patient did just that, adding insult to injury.

Fortunately, many physicians and biomedical scientists around the world became interested in this illness, and over 9,000 scientific studies have been published in the past 35 years. The Institute of Medicine has concluded that the condition, now called myalgic encephalomyelitis/chronic fatigue syndrome is a serious, chronic, complex systemic disease that often can profoundly affect the lives of patients. It affects up to 2.5 million people in the United States, and generates direct and indirect expenses of approximately $17 to $24 billion annually.

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Concluding Remarks And Future Directions

This review suggests that the beneficial effects of nutritional supplements are not random, but that their action is due to the removal of one of the causes of the CFS/ME. There is evidence that supplements may benefit CFS/ME patients therefore, nutritional supplements should be recommended, at least in CFS/ME patients with a biochemically proven deficiency. Studies investigating nutritional interventions in CFS/ME remain very limited most studies have had small sample sizes, and lacked long term followup . Despite the relative consistency in case definition, the studies differed with regard to inclusion and exclusion criteria and reporting participants’ sociodemographic characteristics and clinical features . This heterogeneity in study design makes the application of the findings to the clinical setting more difficult. Therefore, longerterm RCTs in homogeneous populations that use more specific case criteria are now warranted.

In agreement with several previous studies, pacing was consistently shown to be the most helpful treatment, CBT was useful for some patients but not all for all graded training may cause the condition to worsen. However, the results must be interpreted with care, as the participants are not a representative sample.

Dont Overdo It On Good Days

On days when your illness is bad, it can feel impossible to do the simplest tasks. So when you feel better, its tempting to try and cram in all those things you didnt get done.Although the docs tell you not to overdo it on good days, I cant help it. I have so many bad days and Im so far behind, Elizabeth F. told us on Facebook. Last Saturday was a good day. I vacuumed and mopped the whole house, cleaned two bathrooms, did all of the laundry, went grocery shopping at 9 PM, and cleaned out the closet to get a bag together for donation. Then on Sunday the pain was 225 on a scale of 1-10. She feels pressure to get things done when shes feeling well because of that what-if feeling that the pain could get worse.Not overdoing it on good days is a hard habit to adopt, but you have to try. Even though you may be feeling better, your body is still working hard because of your disease and your energy is in short supply. Overdoing it will only make your fatigue worse in the future, he says.

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Pacing Activity For People With Me/cfs

Pacing, or keeping within your available energy, is a self-management strategy to help people with ME/CFS make sure that they dont overdo activity or exercise. It reduces the likelihood of triggering PEM and can help reduce symptoms. Pacing is not a cure for ME/CFS and does not treat the underlying, physical cause of the disease.

The goal of pacing is for activity to be sustainable, so that the person can have some stability in their symptoms and what they can do each day. Pacing should be used in conjunction with rest.

The most challenging aspect of pacing is that PEM is very often delayed by as much as 24-48 hours, which can make it difficult to recognise when youve done too much. Using tools like an activity diary or heart rate monitor help you learn about your body and how much activity you can safely tolerate.

Suggestions on how to pace yourself include:

Problems With Current Research

Research into this important illness is hampered by small sample sizes, different definitions, and the lack of a coordinated approach. CFS is probably not one illness, and it is likely that the different phenotypes are due to different underlying biological pathways requiring different treatment approaches. This may explain the relatively low response rate to current treatments. To develop better treatments, we need larger trials with carefully characterized participants to understand more about treatment response. We need to develop treatments in the areas identified previously where there is no evidence for effective treatment. This includes the treatment of CFS and comorbid mood disorders, CFS in primary school children, those who are severely affected, and those with refractory fatigue. We also need to start to develop an understanding of the biology of CFS/ME and whether different biological pathways are associated with different disease phenotypes. Some early studies with small sample studies suggest that an omic approach to dissecting out the different subtypes may help to clarify different biological pathways. This approach will require a large bioresource of well-characterized patients.

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What Are The Symptoms Of Chronic Fatigue Syndrome

Symptoms of CFS often mimic the flu. The following are the most common symptoms of CFS. However, each person may experience symptoms differently. Symptoms may include:

• Sensitivity to light
• Low-grade fever

The symptoms of CFS may look like other medical conditions. Always talk with your healthcare provider for a diagnosis.

Myalgic Encephalomyelitis/chronic Fatigue Syndrome: Essentials Of Diagnosis And Management

• Alison C. BestedAffiliations
• Lily ChuCorrespondenceCorrespondence: Address to Lily Chu, MD, MSHS, Independent Consultant, 16 Lorton Ave, Unit 4, Burlingame, CA 94010.
• Nancy G. KlimasAffiliationsInstitute for Neuro Immune Medicine, Dr Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
• Jose G. MontoyaAffiliationsDr Jack S. Remington Laboratory for Specialty Diagnostics, Palo Alto Medical Foundation Research Institute, Palo Alto, CA
• Irma R. ReyAffiliationsInstitute for Neuro Immune Medicine, Dr Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL

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Build Peace And Relax

CFS can be debilitating both physically and mentally. Suffering from persistent exhaustion, reduced brain cognition, chronic muscle and joint pain, stress, and even guilt takes a toll on the body, and psyche.

Long-term stress control and relaxation must be a vital portion of any protocol used to overcome chronic fatigue syndrome. While seemingly impossible, its imperative that sufferers of CFS do their best to effectively manage stress, and rest.

The Power of Rest

Rest means more than just sleep. Dedicate one day per week when you dont have any responsibilities or commitments. Truly commit to a full day of rest. This gives your body and mind a much-needed respite helping to fight stress, anxiety and exhaustion. Its also important during the week, if you are having a particularly difficult day, to not overtax yourself.

While regular exercise supports wellness and helps to diminish stress, individuals with chronic fatigue syndrome need to exercise at a controlled intensity. High-intensity workouts can leave you drained for several days.

Exercise Therapy

Exercise therapy has been shown to help with fatigue, mental clarity and depression in patients with chronic fatigue syndrome. According to a study released in the European Journal of Clinical Investigation, individuals with CFS were recommended to perform aerobic activities, at the clinic twice per month, in combination with at-home exercises for roughly 5-15 minutes in duration, five days per week.

Sleep

Chronic Fatigue Syndrome: Gradually Figuring Out Whats Wrong

In 1983, a health professional in her 30s walked into my office and said, Ive been healthy all of my life. A year ago, I came down with some kind of virus sore throat, aching muscles, swollen lymph glands, fever. My fatigue was so bad I was in bed for nearly a week. Many of the symptoms gradually improved, but the terrible fatigue and difficulty thinking have not gotten better. Theyre so bad I cant fulfill my responsibilities at home or at work. This illness is affecting my brain, stealing my energy, and affecting my immune system. Its keeping me from realizing my dreams.

Theres a piece of advice attributed to a famous physician, William Osler, that every medical student probably has heard: Listen to your patient. The patient is telling you the diagnosis. But I wasnt sure it applied in this case.

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Try Smaller More Frequent Meals

Many people with chronic fatigue often feel too tired to eat or dont feel hungry. If youre losing weight or struggling to eat enough throughout the day, Groppo recommends trying smaller meals more frequently or adding small snacks between each meal. Eating more frequently may help keep your energy up. Smaller portions may be easier to tolerate as well.

Mild Pain Relievers And Nsaids

CFS/ME patients may benefit from NSAIDs, which are commonly used to relieve pain and reduce inflammation. In this context, the NSAIDs include ibuprofen and naproxen. They sometimes relieve frequent or severe joint and muscle pain, headaches, and fevers .

Other prescription medicines include anticonvulsants, also called antiseizure medicines. These drugs are sometimes prescribed for pain and sleep problems. They seem to work best when used for nerve pain. Antidepressant medicine is also prescribed to ease depression and anxiety, to enhance the ability to concentrate and to improve sleep quality . For their part, narcotic medicines are sometimes prescribed for pain that is not relieved by overthecounter drugs. Narcotics are generally reserved for the most severe cases because of the risk of addiction, and are used only for a short time .

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Boost Your Vitamin D Intake

Many people are deficient in vitamin D, a nutrient that is vital for a healthy immune system and may play a role in energy and fatigue. Your body can produce its own vitamin D when exposed to sunshine and you can get some vitamin D from your diet, such as from fish and fortified milk, but if your vitamin D levels are very low you may need to take a vitamin D supplement. You can talk to your doctor about whether you should get a blood test to check your vitamin D levels.

A Sjogrens Syndrome Segue

Sjogrens Syndrome is of interest because of its growing association with POTS in particular. A Johns Hopkins 2014 case series used a high resolution magnetic resonance neurography to diagnose abnormal dorsal root ganglia in ten Sjogrens Syndrome patients.

The authors pointed out that the burning sensations found in SS often do not follow the typical stocking and glove pattern that occurs with most people who have small fiber neuropathy. They called small fiber neuropathy a surrogate marker of DRG neuronal loss but noted that the unusual distribution of SFN in SS can complicate getting an SFN diagnosis. Plus, some SS patients with burning or raking pain may have dorsal root ganglia problems without having small fiber neuropathy.

Five of the ten SS patients in the study had abnormal DRGs. The fact that none had evidence of small fiber neuropathy, and that two of the patients improved markedly on IVIG therapy, suggested that dorsal root ganglionitis by itself can cause these burning, painful sensations. It also suggested a new way to search for sensory ganglionitis.

In any case, the finding of sensory ganglionitis in Sjogrens Syndrome suggests that it may not be long given the proper studies before its also found in POTS, FM and ME/CFS.

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Facts About Chronic Fatigue Syndrome

• The CDC estimates up to 2.5 million Americans have ME/CFS.
• Anyone can get it, including children and teens.
• It’s most common in women in their 40s and 50s.
• Women are more likely to develop it than men.
• Most cases are mild or moderate.
• About 1 in 4 people with the condition have severe symptoms.

If you have mild ME/CFS, you can probably manage on your own. Moderate symptoms can make it hard for you to move around. For example, you might need to sleep in the afternoons.

Severe symptoms can impact your quality of life and abilities as badly as if you had lupus, heart disease, or rheumatoid arthritis.

How Does It Happen

Doctors dont know what causes ME/CFS, but they have identified different underlying abnormalities in people with the condition.

Immune system problems: Several parts of the immune system are different in people with ME/CFS. Some research indicates that these abnormalities may cause the symptoms of the illness. Fortunately, people with ME/CFS dont have a defective immune system in the way that people with HIV/AIDS do.

Energy production: In you have ME/CFS, the cells in your body have trouble making enough energy.

Brain abnormalities: Abnormalities show up in pictures of the brain , in levels of brain hormones, and in the brains electrical system . These abnormalities can come and go, and arent necessarily permanent.

Blood pressure and pulse issues: When you stand, you blood pressure could drop and your heart might start to beat faster. You might feel faint or pass out if your blood pressure drops too low.

Genes: Some studies have found abnormalities in the structure of certain genes. Others point to abnormalities in the way certain genes are turned on and off inside your cells. Studies of identical and non-identical twins indicate that some people inherit a genetic likelihood for getting the illness.

Serotonin and cortisol: Several studies indicate that serotonin, a major brain chemical, plays an important role in ME/CFS symptoms. People with the illness have low levels of cortisol, a hormone the body releases in response to stress.

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Diagnosis Of Chronic Fatigue Syndrome

• Laboratory tests to exclude other causes of symptoms

At least one of the following manifestations is also required:

• Difficulty thinking

• Feeling of light-headedness or dizziness when standing up that is relieved by lying down

The frequency and severity of the symptoms should be assessed by a doctor. If people do not have these symptoms at least half of the time with moderate, substantial, or severe intensity, doctors reconsider the diagnosis of chronic fatigue syndrome .

Criteria for diagnosis are important mainly because they help doctors communicate clearly with each other when they study a problem. However, when treating a specific individual, doctors focus more on that person’s symptoms rather than the criteria.

Treatment Plans For Me/cfs

There’s no single way of managing ME/CFS that works for everyone, but there are a number of treatment options.

The National Institute for Health and Care Excellence says you should be offered a treatment plan tailored to your symptoms.

Your doctor should discuss all of the options with you, and explain the benefits and risks of any treatment.

They should work with you to develop a treatment plan that suits you and takes into account your circumstances and preferences.

You may need advice about making lifestyle changes, specialist treatments, or a combination of both.

If your symptoms are severe, your doctor should ask a specialist for advice.

Your treatment plan should be reviewed regularly.

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Get The Care You Need

Visit your doctor every few months to help track your symptoms and check for any need to change your treatment.

Get specialized care if you need it. For example:

• A rehabilitation specialist can help you treat pain and improve your ability to do your daily tasks.
• A pain management specialist can offer a number of pain treatments.

Sign “release of information” forms so that your doctors can work together as a team.

What Is Chronic Fatigue Syndrome

Chronic fatigue syndrome is a complex illness marked by extreme or debilitating fatigue that is not improved by rest. This condition includes other symptoms that may come and go. Chronic fatigue syndrome can affect your ability to think clearly, sleep or perform ordinary activities without exhaustion.

The cause of chronic fatigue syndrome is unknown. Some experts think two or more contributing risk factors might work together to cause it. This illness is most common in white women between 40 and 60 years old. However, it may be underdiagnosed in other groups of people.

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