Surviving with Chronic Fatigue Syndrome

Anyone can get Chronic Fatigue Syndrome (CFS), although doctors do not usually like to diagnose it in very young children. It occurs most commonly in women in the second and third decades of life. Contrary to popular opinion, CFS is not the preserve of the young and upwardly mobile. Thus, the derog­atory term 'yuppie flu' should be regarded as tabloid trash. Nor is it the preserve of any particular social class or race. Cases have occurred throughout the world, and I am happy to say that this is reflected in the international scientific community: doctors and scientists from all over the world meet on a regular basis to exchange information and to discuss avenues of research.

A great number of patients recover completely, and return to full and active lives. Some of these now run their own business, others pursue a trade or profession, and some even play com­petitive sports at national and international level. Having said that, and although the average duration of illness is said to be three to six years, a minority remain ill for years on end.

We do not know the cause of CFS; and although 80 per cent of cases start in the immediate aftermath of a viral infection, we have so far failed to understand the mech­anism. There is an increasing body of evidence which suggests that the fundamental problem lies in the way the brain works. Thus, several hormonal pathways in the brain are known to mal­function in CFS. Furthermore, the pattern of malfunction is quite different from what one sees in the depressed brain or in the anxious brain - more evidence that CFS is not 'just another form of depression'.

Another significant clue is that up to 50 per cent of patients with CFS have a history of allergic disorders, such as hay fever, asthma, eczema or urticaria. That's a lot more than one would expect from the general population. Similarly, and even more significantly, up to 70 per cent of CFS patients currently show activation of their eosinophils - a very important cell in allergic disease. However, as interesting as they are, these abnormalities - hormonal, brain and immune - are still only scattered pieces of the jigsaw. We have a long way to go before we understand the fatigue states.

CFS is, by definition, a debilitating illness. Affected patients may have to put their lives on hold. It would be impossible for me to describe their frustration, so I won't even try. However, think about the strain their illness brings to bear on their close relationships, their career aspirations, their finances, and, eventually, their mental health. It is not surprising that so many become depressed as a result - indeed, sometimes to the point of suicidal thought. Treating the depression is, of course, helpful. But treating the depression does not remove the fatigue.

What can we do about it?

I want to highlight the 'allergic' aspects of chronic fatigue syndrome (CFS), and I will therefore concentrate on these. The full management plan for patients with CFS is beyond the scope of this text, but briefly sum­marized:

1. Secure the diagnosis with your doctor. This will involve a careful clinical history, a thorough physical examination, and a few basic blood tests to rule out other disorders.

2. Pay a great deal of attention to the sleep pattern. Establish a regular night's sleep by whatever means necessary. This will often require the use of medication - but not the use of sleep­ing tablets. Specifically, correct insomnia, or excessive sleep­ing, or abnormal sleeping hours - all of which occur regularly in CFS.

3. Consider the use of nutritional supplements, but get expert advice on this.

4. Consider the use of intramuscular magnesium injections; again get expert advice.

5. Consider the use of antidepressants, even if there is no evidence of overt depression. The chemical pathways in the brain which are responsible for mood are also responsible for energy levels and sleep patterns. Thus, a drug which affects mood will also affect energy levels.

6. Consider a graduated exercise program, and I emphasize graduated. We know that 'too much too soon' will bring on a relapse. We also know that a properly conducted exercise program is of great benefit.

7. Avoid alcohol, caffeine, nicotine and refined sugars - they only make matters worse.

8. Check out your diet for food intolerance!
Source: Living Well with Chronic Fatigue Syndrome and Fibromyalgia: What Your Doctor Doesn't Tell You...That You Need to Know by Mary J. Shomon