Dr Peter Grant
Aboriginal Health
Internal Medicine
Landmark Study - Reducing diabetes complications
Diabetes Guidelines - Practical Points
Drug Treatments in Diabetes - a brief guide
Chronic Fatigue Syndrome
Diabetes - the Glycaemic Index
Pollens in Asthma and Rhinitis
Chronic Fatigue Syndrome
Executive Summary
The term Chronic Fatigue Syndrome (CFS) refers to a symptom complex of marked and prolonged fatigue for which no identifiable cause can be found. Other symptoms frequently present include generalised muscle weakness and pain, low-grade fever, sore throat, painful lymph nodes in the neck and armpits, exacerbation of fatigue after moderate or strenuous exercise for periods of 24 hours or more, transient pains in a number of joints, and various disturbances of neuropsychological function including confusion, irritability, poor concentration and visual changes. Despite the range of other symptoms being extensive, none are essential for the diagnosis to be made in the presence of profound fatigue of 6 months or more duration. Chronic fatigue syndrome is frequently seen in association with psychiatric illnesses such as depression and anxiety but has not been shown to be causally related to any particular psychiatric disease.The cause of chronic fatigue syndrome remains unknown at this point in time. A number of research teams throughout the world have investigated possible links to a number of virus infections (including Epstein-Barr virus, enteroviruses and poliomyelitis as well as and fungal agents (in particular, Candida albicans). Despite extensive studies, the evidence that CFS is caused by any particular infective agent is equivocal. Nor has it been shown that physical or mental stress cause chronic fatigue syndrome.
Chronic fatigue syndrome occurs more commonly in women with a peak incidence in those in the third and fourth decades. Despite media references to the condition being more common in those in middle income and groups, evaluation of social status of cases indicate that CFS occurs with about equal frequency in all social classes. In general, no forms of treatment are shown to alter the course of the condition. Recovery is reported in a number of studies to be facilitated by rest complemented by a supervised program of gentle exercise. In general, no forms of medication have been shown to alter the course of the disease although treatment of specific symptoms is recommended when present. The prognosis varies greatly across the spectrum of cases reported to date, with the majority of sufferers eventually recovering after a period of one to ten years.
Chronic Fatigue Syndrome
Introduction
The term 'Chronic Fatigue Syndrome or CFS refers to a symptom complex which has chronic fatigue as its pivotal feature. The definition of fatigue accepted by most research groups is fatigue of new onset lasting more than six months with a 50% reduction in activity. There are a number of other characteristics which are frequently found in those diagnosed with the condition but, unlike chronic fatigue, none of these characteristics are considered to be essential for the diagnosis to be made. The minor and major diagnostic criteria suggested by Holmes et al. (1988:387-389) are recorded below.Terminology
The definition of chronic fatigue syndrome of Holmes et al. (1988:387-389) has generally been accepted by other medical authorities with the exception of the United Kingdom (infra vide) where an alternative diagnosis of postviral fatigue syndrome is favoured. For the purpose of this work, Holmes et al.'s definition is preferred. There are a large number of conditions previously described which are now held to satisfy most of the criteria of chronic fatigue syndrome. These include myalgic encephalomyelitis (ME), post viral fatigue syndrome (PVFS), chronic fatigue and immune dysfunction (CFIDS), post-infectious fatigue syndrome (PIFS), neurasthenia, fibrositis myalgia and "Yuppie flu".Wallace (1991:943) divides the various synonyms into two groups: epidemic and endemic. Synonyms in the former group include: epidemic neuromyaesthenia, Adelaide epidemic, Royal Free disease, Iceland disease and Lake Tahoe disease, whilst synonyms in the latter group include: myalgic encephalomyelitis, fibrositis myalgia, "Yuppie" flu, idiopathic chronic fatigue syndrome, Epstein Barr disease and chronic infectious mononucleosis. The eponyms in the former group derive from areas of the world where epidemics have been documented. These epidemics give some support to the hypothesis that, in some circumstances at least, the condition is transmissible. The synonyms for the endemic form of CFS appear to be based largely on the unproven assumption that infective agents have a role to play in the causation of the condition. Despite this expectation, plausible studies have yet to corroborate such a view.
Definitions The range of synonyms reflect the diversity of opinion that exists within the medical community as to whether or not chronic fatigue syndrome is a disease and, if so, what the disease complex entails. Some writers point to the general scepticism of many practitioners in the past as to the validity of the diagnosis. They hold that many practitioners consider the diagnosis is a misnomer in that patients with features of CFS are instead suffering from some form of psychiatric illness (with chronic depression being the most common) or are suffering a delayed convalescence to an infective process (such as infectious mononucleosis).
More recent research generally fails to support either of these viewpoints. Firstly, several working groups have recently recommended that co-existing psychiatric illness should not exclude consideration of the diagnosis of chronic fatigue syndrome when a number of the other minor criteria are present in addition to chronic fatigue (infra vide). In addition, some psychometric studies indicate that the response times of those with CFS are often significantly reduced whilst response times in those with depression and other psychiatric ailments are not significantly altered. Moreover, Kirmayer et al. (1989:940-948) hold that the profound muscle ache after exercise seen in CFS is not a feature of depression.
The situation is further compounded by inconsistencies in working definitions. A major source of confusion in this regard arises from the original definition promulgated by the Centres for Disease Control, Atlanta. Holmes et al (1988:387-388) of the CDC confirm that their original definition was intentionally restrictive to maximise the chances that research would identify associations if they exist. In more recent times, other working groups have recommended that the pre-existence or co-existence of psychiatric disease of itself is no longer sufficient reason to exclude considering a diagnosis of CFS.
The criteria of Holmes et al. (1988:387-9) are:-
Table 1. Diagnostic criteria for chronic fatigue syndrome For diagnosis, both major criteria must be present, plus the following minor criteria: (1) at least 6 of 11 symptoms and at least 2 of 3 physical signs or (2) at least 8 of 11 symptoms.
| Major criteria |
|---|
| 1. New-onset fatigue lasting longer than 6 months with a 50% reduction in activity. |
| 2. No other medical or psychiatric conditions that could cause symptoms. |
| Minor criteria | |
|---|---|
| Symptoms (must begin at or after the onset of fatigue) | |
| 1. Low-grade fever (ie. 37.5C to 38.6C) | |
| 2. Sore throat | |
| 3. Painful cervical or axillary lymphadenopathy | |
| 4. Generalised muscle weakness | |
| 5. Myalgias (muscle pains) | |
| 6. Fatigue lasting 24 hours or more after moderate exercise | |
| 7.Headaches | |
| 8. Migratory arthralgia | |
| 9. Sleep disturbance (hypersomnia or insomnia) | |
| 10. Neuropsychological complaints (one or more of the following: photophobia, visual scotomas, forgetfulness, irritability, confusion, difficulty concentrating, depression). | |
| 11. Acute onset (over a few hours to a few days) | |
| Physical signs (documented by a medical practitioner twice at least 1 month apart) | |
| 1. Low-grade fever | |
| 2. Pharyngitis (non-exudative) | |
| 3. Cervical or axillary lymphadenopathy | |
The British perspective as expressed at the Green College Working Group meeting in 1990 is slightly different in that the general term recommended for all cases of chronic fatigue is "post viral fatigue syndrome".
Evaluation of postulated aetiological factors
Kroenke (1991:44) holds that the relative roles of psychological and organic factors remain controversial in the search for the cause of chronic fatigue syndrome. A number of factors need to be considered in this regard, including:-- (A) the historical evidence of an epidemic nature of the disease;
- (B) the traditional emphasis given to infective illnesses as the prodrome for the syndrome;
- (C) the relatively high incidence of pre-existing and co-existing psychiatric illness of various types among patients with chronic fatigue; and
- (D) misconceptions concerning the role of stress in the development of CFS.
California: The first recorded epidemic occurred in doctors and nurses in several hospitals in Los Angeles in 1934. Reported symptoms included muscle weakness, involuntary muscle contractions and twitching, clonic movements and cramps in affected muscles and muscle inco-ordination. Pain was extreme in the back and extremities and lasted for a number of months. Sensory changes were also a common feature, including hyperaesthesia, paraesthesia and areas of anaesthesia - sometimes following the distribution of a nerve trunk and sometimes a whole extremity. Vasomotor and trophic changes , excessive sweating or abnormal dryness of skin, coldness, cyanosis and brittle nails were also commonly reported. Inflammation of the joints occurred in one-third of adult cases, with a third of these being transitory and the remaining two-thirds developing permanent arthritic changes in the joints involved.
Iceland: In early winter in 1948 to 1949, an extensive epidemic broke out in the town of Akureyri in Iceland. Women were affected more than men, although the sex ratio was equal less than 20 years of age. The illness spread rapidly but was confined to the town. It did not appear to be spread by water, milk, food or sewerage but instead by close contact with those affected. In 1955, 39 patients of the 1948 epidemic were re-examined. Of those more severely affected, only 25% had completely recovered, 52% had residual muscle tenderness and 65% had objective neurological signs. Of those only mildly affected in 1948, only 44% had recovered fully with 50% having muscle tenderness and 19% having residual objective neurological signs.
Adelaide: A few months after the 1948 Akureyri epidemic, an epidemic of poliomyelitis occurred in Adelaide. By 1951, 800 patients had been admitted to hospital with a condition called "epidemic neuromyasthenia" with symptoms indistinguishable from poliomyelitis but without microbiological evidence of poliomyelitis. Recovery was delayed for many patients for up to 2 years.
New York State: Similar to Adelaide, a widespread epidemic of poliomyelitis in New York State in 1950 occurred with a number of patients having features distinct from those of polio in the absence of any microbiological evidence of poliomyelitis. Muscle aching and weakness were predominant symptoms in this subgroup who lacked the classical muscle wasting characteristic of poliomyelitis.
Cumbria: A GP in Cumbria reported an outbreak of a disease similar to that described in Iceland in 1948 wherein 233 cases were recorded in a practice population of 1675 people, an incidence of 14%. The illness was thought to be spread by contact. Recovery for many patients was delayed for many months and, in some cases, several years. The features were similar to those described by Holmes et al. (1988) listed above. No virological evidence of either Coxsackie or echo virus infection was found although the clinical picture was suggestive of either of these infections.
Great Ormond Street: A further outbreak of 'epidemic neuromyasthenia' occurred at this hospital for children in 1970 and 1971, with 145 of the 1900 total staff being affected (mostly nurses). Interestingly, a number of children had been referred to the hospital in the preceding years with unexplained symptoms similar to those that the affected staff members developed and similar to those described by Holmes et al.
Comment: Jenkins (1991) raises the question of whether these epidemics represent an epidemic form of post viral fatigue syndrome transmissible by an unidentified agent but does not give any firm answers. He argues that the recognition of such epidemics is more likely to occur in an institutional setting, especially health institutions, for obvious reasons and suggests that the recognition of low-grade epidemics in the community would be more difficult when only two or three cases a year occur in each general practice. The failure to recognise epidemics in the community in the past is also held to be a product of the lack of recognition given to the condition disease surveillance agencies (such as the Centres for Disease Control in the USA and the Surveillance Centre for Communicable Diseases in the UK) until recently. Jenkins also notes that no institutional epidemics of chronic fatigue have been reported since 1970.
Recommendation: These case reports suggest a condition which is transmissible in the community resulting in epidemics of illness with symptoms indistinguishable from those described for CFS. Given the uncertainties expressed by Jenkins as to exactly what that agent was, it is recommended that the epidemic form of disease be treated as a clinical entity distinct from the endemic form of the disease. B. Traditional models of infections as a cause of endemic chronic fatigue syndrome There has been extensive research undertaken to determine whether or not one or more biological agents cause CFS of either epidemic or endemic type. To date, no agent has been shown to satisfy the required criteria proposed by Koch so as to be held to have a causal role in this regard. For the reasons given below, the majority view of the research community is that such associations are at best to be treated as having temporal significance for some patients without it being possible to infer an aetiological link. The evidence on which this assertion is based in presented below in summarising the findings to date for the more common agents under consideration.
The search for a biological agent appears to be a product of the frequency with which CFS patients report symptoms interpreted as being consistent with an acute "viral" illness preceding the onset of chronic fatigue syndrome. Lloyd et al. (1990:527) for example report that 75% of the patients they interviewed gave such a history, with the majority having a healthy premorbid status. Manu et al. (1993) found that 70% of CFS patients (versus 30% of controls) attribute their illness to a viral cause. Despite this perception, studies which have looked at the frequency of infection with a range of viruses have, in general, failed to substantiate that a particular virus is more common in those with CFS (see Shafran 1991:730-9 and Kroenke 1991:44-55) compared to the natural rate of asymptomatic infection in the general community. Winters and Quinet (1992: 260-270) state that the evidence supports persistent viral infection in only a small percentage of CFS patients.
Epstein Barr Virus (EBV): This agent (a type of herpes virus) is generally accepted as causing infectious mononucleosis (or glandular fever); a condition seen most commonly in adolescents and younger adults. Kroenke (1991:49) states that "EBV was incriminated as a cause of chronic fatigue syndrome in the mid-1980s but that a critical appraisal of the evidence casts strong doubt on this hypothesis". One of the difficulties in attributing a role of EBV as a cause of CFS is that EBV is ubiquitous in the community, with 95% of healthy persons over the age of 30 have serologic evidence of past infection with EBV. Moreover, whilst it is well known that a number of acute cases of infectious mononucleosis have a protracted recovery (termed "chronic mononucleosis") with many having high levels of IgG-VCA (1:320 or higher) and elevated anti-ECA (1:40 or higher), this profile is also seen in 50% of the healthy community. Furthermore, antibody titres to cytomegalovirus, measles virus and various herpesviruses are also often elevated in patients with CFS.
These elevations are now generally viewed as an epiphenomenon of the mild immunologic abnormalities found in some patients with CFS (see Holmes 1991:S53-55). In other words, the presence of antibodies to a range of viruses in some patients with CFS may equally likely have occurred after the onset of CFS and are due to decreased resistance of the body's immune system to a range of viruses normally present in the community.
Enteroviruses: Approximately 70 serotypes are described for this group of viruses which are members of the family Picornaviridae. Three types have been suggested at various times as having played a role in the onset of PVFS, namely: polio, coxsackie and echo. A possible role for polio virus is suggested by the experiences of the Akureyri epidemic in Iceland in 1948 (described above). Interestingly, not only was no isolate of polio made in the Akureyri group but also no outbreak of poliomyelitis occurred in the Akureyri area in 1956 (at a time when it was rampant in the remainder of Iceland). In addition, Akureyri children were found not to produce antibodies to polio 1 in 1956 but developed unusually high titres when given its vaccine, suggesting previous exposure to polio virus 1.
Kennedy (1991:809-814) alludes to a number of studies that suggest a role for the Coxsackie viruses in the causation of post viral fatigue syndrome (PVFS) and gives his support to the possibility that this virus is responsible for a number of cases of PVFS. In saying this, however, Kennedy accepts that the immunological evidence of preceding Coxsackie infection in these cases is inconsistent.
He also states that high levels of antibodies to Coxsackie B virus are widespread throughout the general community in the absence of PVFS, making the data difficult to interpret. Furthermore, Kennedy states that no plausible biological mechanism has been formulated to explain how Coxsackie viruses cause PVFS to date. The conclusion drawn by this author is that Kennedy's study provides some indirect support for Coxsackie virus infection as a possible precipitant of some cases of PVFS but does not provide support for a role for Coxsackie viruses as a causal agent for CFS.
Gow and Behan (1991:874) report an extensive study of Coxsackie antibody titres in Scotland in the 1980s which failed to confirm initial suspicions of a role for Coxsackie based on early findings of raised IgM titres for Coxsackie in a number of cases. The larger well-controlled study failed to show any significant difference in antibody titres between cases and controls. Gow and Behan's own findings in relation to Coxsackie revealed that 20% of PVFS cases had enteroviral genome for Coxsackie virus in their muscles. A similar incidence is reported by Cunningham et al (1991:858). These finding, however, are entirely consistent with the hypothesis discussed above that CFS affects the immune system and allows infection with one or more of a range of viruses ubiquitous in the community to occur, since the rate of sero-conversion in the general community approximates these levels.
Other viruses : Elevated titres of various types are reported to be more frequent in CFS patients than in the general population with the authors of the reports suggesting that these agents play a role in the causation of CFS or its variant PVFS. For example, Yamanishi (1992:2612-6) reports elevated titres of human T-lymphotropic virus (HTLV) and HTLV type II. He cites a number of studies that report an increased incidence of human herpesvirus type 6 in CFS patients as well. Lloyd et al.'s Australian study (1990:526) describes three cases where sero-conversion to Ross River virus occurred, as well as sero-conversion to EBV in two cases, mumps virus in one patient and Coxsackie B virus in another. Dowsett et al. (1990:528) report sero-conversion to a range of viruses [apart from EBV (33%) and enteroviruses (31%)] such as hepatitis A (2 cases), respiratory syncytial virus (2 cases), parvovirus (2 cases), influenza B (1 case), varicella (1 case) and rubella (1 case) within the 420 patients with PVFS in their study group.
Conclusions The existence of a wealth of studies reporting sero-conversion to a large number of agents should not be taken to mean that any of these agents have a causal role to play in the development of CFS (or even PIFS for that matter). All of the studies identified to date rely on retrospective serologic evaluation of CFS patients and extrapolate the findings to suggest that the presence of serological marker for a particular virus should be taken to mean that the agent has caused the CFS. There are obvious flaws in this type of logic that greatly weaken the conclusions drawn. Firstly, no prospective studies appear to have been conducted to date to show that infection with a particular type of virus is followed by the development of CFS. Secondly, many retrospective studies fail to recognise the possibility that CFS is the primary condition which in turn predisposes to secondary infection with any one of a range of viruses. Thirdly, most studies fail to publish regional statistics to indicate the frequency with which sero-conversion to the type of virus under consideration occurs in the healthy general population.
C. Psychiatric diseases and chronic fatigue syndrome The question of what is the exact nature of the relationship between psychiatric disease and chronic fatigue syndrome remains one of the most controversial aetiological issues concerning CFS. Despite this controversy, it is worthwhile comparing and contrasting the views of a number of authorities on different aspects of this issue.
The first aspect is whether the pre-existence or co-existence of a psychiatric illness should preclude the diagnosis. As discussed above, the support given by the CDC to excluding those with any form of psychiatric illness originally was intentionally artificial in order to establish guidelines for initial investigation. In more recent times, a number of other authorities have adopted the view that pre-existing or co-existing psychiatric disease should not exclude a person from inclusion in the CFS diagnostic group if the other criteria are met (see Holmes et al. 1988).
The second aspect is whether any form of psychiatric disease has a causal role in the development of CFS. A number of earlier papers from the United Kingdom (Wessely and Powell 1989:940-948), Canada (Taerk et al. 1987:49-56) and the United States (Kruesi et al. 1989:53-56) suggested that patients were likely to have psychological disorders before the onset of CFS, raising the possibility that CFS may occur in "psychologically vulnerable" individuals. A more recent study by Hickie et al. (1990:534-540) found that the premorbid incidence of major depression was 12.5% in those with CFS; a rate similar to estimates of major depression in the general community. Hickie et al. also found that the premorbid incidence of psychiatric disease in his control group with major depression was in the order of 62%. One other point made by Hickie et al. was that 50% of the CFS group subsequently developed a psychiatric illness, most often depression, during the course of their CFS.
The findings of Woods and Goldberg (1991:908-918) are similar to those of Hickie's group in relation to the sub-group considered to have post-viral fatigue syndrome. The classification posited by Holmes et al (1988) also supports the notion of psychiatric disease being most likely an outcome rather than a precedent for CFS. Sharpe (1991:989-1005) adds to this by recommending that in deciding whether or not a person has chronic fatigue syndrome, only those with major psychiatric illnesses such as schizophrenia, other major psychoses and manic depression should be excluded from consideration in the CFS group.
The third aspect concerns consistent differences reported in those with CFS versus those with primary psychiatric disease in relation to cognitive, psychological and psychomotor functioning. Whilst Jamal and Miller (1991:815-825) were unable to detect any consistent abnormalities for a range of neurophysiological parameters in those with CFS compared to normal controls, Behan and Bakheit (1991:793-808) describe pronounced difficulties in dealing with mental tasks requiring intense concentration and an inability to initiate and carry out any complex sequences of thought compared to those with depression. They also point out that those with CFS are not troubled by the inability to experience pleasure, including sexual libido and ability, that mark those with primary psychiatric illnesses with a component of depression.
Other features of CFS include marked sleep disturbance, irritability, lack of guilt feelings, definite forgetfulness despite normal memory function on formal testing and, in some cases, hypersensitivity to light and noise and frightening hypnogognic nightmares. One other common symptom related to sleep is pronounced nocturnal sweating.
Lloyd (1990:530-533) makes reference to a number of studies that have shown that CFS patients have unique patterns of psychological impairment not seen in patients with depression or in normal controls. For example, studies by Sandman at the University of California found that CFS patients demonstrated a unique pattern of impairment of memory recall tests, made worse by brief disruption of the test by showing a video clip. Likewise, Prasher et al.'s (1990:247-253) neurophysiological study of CFS sufferers showed prolonged latency in cognitive event-related potentials not present in patients with depression. A number of other authors also make reference to notable reductions in a range of cognitive functions in CFS patients.
The postulate that CFS leads to a reduction in psychomotor and other cognitive abilities has not been universally endorsed however. David (1991:966-988) questions the validity of the conclusions drawn by Prasher et al. and opines that similar cognitive deficits have been documented in primary depression, schizophrenia and borderline personality disorders. He cites the findings of Millon et al. (1989:131-141) and Atlay et al. 1990:141-149) that the PVFS patients they studied did not perform suboptimally on psychometric testing. David considers that further studies might serve to clarify this issue better. In light of this, it would appear to be premature at this point to recommend the use of psychometric testing as an adjunct to the diagnosis of chronic fatigue syndrome.
D. Misconceptions of the role of physical and mental stress in the development of CFS Whilst there is a common perception in the lay community that the title of Chronic Fatigue Syndrome infers a role for either mental or physical stress or both in the development of the condition, there is little evidence in the literature to support such a view. Whilst a number of authors have investigated the role of stress in relation to a number of other conditions characterised by chronic fatigue, none of these conditions appear to satisfy the criteria for CFS promulgated by the major authorities cited in this work. Several authors (Makowska et al. 1992:323-333; David et al. 1990:1199-1202) in reporting a possible role for stress make mention of self-reported domestic and family stressors as the primary source rather than work-related stress. Stricklin, Sewell and Austad (1990:31-34) in a relatively small study of 25 women identify a statistically significant difference (p less than 0.001) in the self-reported incidence of stress in those with "epidemic neuromyasthenia" (a synonym for CFS) compared to an equal number of healthy women. The study group, however, were also found to have statistically significant differences in their psychological profiles compared to the healthy group.
Cathebras et al (1993:168) suggest that people with pre-existing psychiatric conditions are more likely to report increased levels of stress. Melamed et al. (1993:469-474) define a distinctly different condition they term the "burnout syndrome" as a consequence of increased physical or mental stress or both. Ng (1992:294-295) and Waylonis (1992:343-348) note an increased level of self-reported stress in patients with fibromyalgia., a condition they hold to be distinct from other conditions causing chronic fatigue. None of the major authorities cited in this work make mention of mental or physical stress or both as having a role to play in the onset of chronic fatigue syndrome.
Epidemiology
The mean age of onset in most series is reported as being 35 years. The large majority of cases are said to occur between the ages of 18 and 60 years. Most studies report a predominance of females although the ratios vary widely. For example, Dowsett et al. (1990:527) report that 73% of patients shown to have CFS were female. Wallace (1991:942) suggests a female to male ratio of 2:1 in a number of studies. The female to male ratio reported in a recent Australian study by Lloyd et al (1990:522) was 1.3:1.The popular perception of the media that the condition is more prevalent in the middle and upper social classes is not substantiated by objective analysis. Lloyd et al. (1990:522) found an equal distribution across all social classes. Wallace (1991:947) likewise has found the prevalence of CFS to be about equally distributed across the social classes, with a slight over-representation in Classes 4 and 5 (ie. lower socio-economic groups). He was unable to identify any particular sub-groups more likely to develop the disease. These findings serve to dismiss the media perjorative of "Yuppie flu" as a misnomer. As well, the findings fail to show that endemic CFS is more common in particular occupations, unlike the situation for epidemic CFS (supra vide).
There is a wide variation in the incidence of the disease with near universal acceptance that the prevalence of the condition is probably higher than reported. This is particularly so for epidemiological studies conducted using the original CDC criteria which exclude inclusion of suspected cases with psychiatric disease. Hence, Price's figure of prevalence of less than 1 in 10,000 people as reported by Kroenke (1991:44) is a gross under estimate of the true prevalence.
Lloyd et al (1991:522) suggest that the prevalence of 3.71 in 10,000 (95% confidence interval: 26.8-50.2) obtained from their Australian study is conservative. Ho-Yen and McNamara (1991:324-6) suggest a rate of 13 in 10,000 in a UK study. To date, there have been no major studies reported to suggest an increased or decreased prevalence according to region or climate.
Investigations
Medical investigation of patients suspected of having CFS has two main objectives. The first objective is to exclude the existence of other diseases known to cause chronic fatigue. The second objective is to search for evidence of co-existing infections such as the viruses listed above. Since there are no tests to date to corroborate a clinical diagnosis of CFS, investigations should be limited to satisfying these two objectives and need not be extensive unless an individual patient's history justifies it.Kroenke (1991:50) recommends the following investigations be performed routinely: complete blood count, determination of erythrocyte sedimentation rate, biochemistry profile (including electrolytes, serum creatinine and serum transaminases) and thyroid function tests.
He suggests that more elaborate investigations such as sleep studies, radiological imaging and endoscopy should be limited to only those with the appropriate clinical symptoms. Whilst Kroenke does not recommend serologic testing for Epstein Barr virus, cytomegalovirus or other viruses as a routine, it is to be expected that many patients will already have such tests done by their primary practitioner where an infectious cause is suspected (e.g. those who fulfil Wallace's criteria of "post-infectious fatigue syndrome"). Serological investigations need not be exhaustive. When patients present early in the stage of the disease (within the first two months), it may prove useful to repeat the serologic tests after six weeks to allow for more accurate interpretation of the results.
As well, there would appear to be little justification for performing highly technical imaging tests such as computerised axial tomography (CAT scanning), magnetic resonance imaging (MRI), positron emission tomography (PET), single-photon emission computed tomography (SPECT) or BEAM (a brain scan that incorporates measurements of electrical brain activity). Nor does Kroenke recommend the use of sophisticated immunologic testing or detailed neurophysiologic testing as neither have been shown to produce useful results in the ordinary clinical setting. The same can be said for psychometric assessment in light of what has been said above.
Differential diagnosis
Since chronic fatigue syndrome is essentially a diagnosis of exclusion, a comprehensive differential diagnosis schedule is presented here to (a) assist in identifying a range of other serious and life-threatening ataemia, hypoglycaemia, myophosphorylase deficiency and phosphofructokinase deficiency. Muscle pain made worse by exercise is seen in metabolic muscle disorders, in illnesses giving rise to myoglobinuria and in some lipid storage myopathies, particularly in patients with carnitine palmityltransferase deficiency. Many of the metabolic and endocrine conditions listed above are rare.
In some cases, the differential diagnosis needs to be expanded to take account of unusual presenting symptoms in addition to profound fatigue. This is especially so when a patient reports symptoms such as (1) balance disturbances, (2) claudication, (3) gastrointestinal symptoms or (4) fluid retention. The differential diagnosis in the first category should include recurrent, acute and chronic labyrinthitis. In the second category, ischaemia of the cauda equina and occult spinal multiple sclerosis bear consideration.
In the third group, occult gastro-intestinal malignancies need to be excluded. In the fourth category, fluid retention and fatigue are prominent symptoms of the fluid retention syndrome whilst fluid retention is also reported in PVFS (Behan and Bakheit (1991:801). Finally, exclusion of a range of psychiatric ailments is indicated when a patient presents with one or more psychiatric symptoms.
Treatment
A number of trials have been conducted in recent times to assess the likely benefits of a range of treatments for CFS. To date, no type of therapy has been shown to attenuate the course of the disease. Instead, treatment protocols tend to focus on ameliorating the symptoms of the condition rather than seeking to cure the condition. In general, treatment strategies should be directed at treating the major and disabling symptoms.Kroenke (1991:53) gives some useful guidelines in this regard. He recommends that depression be treated selective by the use of anti-depressants which are non-sedating such as desipramine hydrochloride or fluotexine hydrochloride (Prozac). In severe cases, referral to a psychiatrist in the early stages is recommended. When myalgias are a major problem, non-steroidal anti-inflammatory drugs may be prescribed in the absence of contraindications.
Rest combined with a program of gentle exercise is also held to be appropriate in the majority of cases. This may necessitate a prolonged absence from work when the work duties require moderate or strenuous exertion. For those with less demanding positions, exclusion from the work place is not mandatory although long-term placement on lighter duties (for periods of six to twelve months with regular review) should be seriously considered, depending on the requirements of the work environment.
Any decision to maintain a patient in the work environment represents a balance between the severity and likely chronicity of the condition and the likely socio-economic effects of being displaced from the work force for a protracted period of time. Both Kroenke et al. (1988:929-34) and Straus et al. (1988:855-862) report lower recovery rates and a greater likelihood of clinical relapse can be anticipated in those with chronic fatigue for several years or longer.
A number of therapies have been trialed and shown to have little, if any benefit. Several other treatments are currently under investigation as to their benefits. In the former category should be included antibiotics of any type (including long-term antibiotic therapy), transfer factor (a low molecular weight protein extracted from donor leucocytes), interferons, interleukin-2, acyclovir, immunovir (inosine pranobex), immunosuppressives (such as cyclophosphamide, azathioprine and corticosteroids), vitamins, most 'special diets', treatments aimed to eliminate candida and other fungal infections (such as nystatin, ketaconazole and amphotericin B), herbal remedies, homeopathy, acupuncture, aromatherapy, reflexology, colonic irrigations and a number of other pseudo-medical therapies (McBride and McCluskey 1991:904).
In the second category, the evidence that they alter the course of the disease is either minimal or has yet to be substantiated in properly designed and controlled studies. Therapies that fall in to this category include supervised diets aimed to eliminate salicylates, amines and glutamate (Loblay and Swain 1986:169-177), ampligen (mis-matched double-stranded RNA), intravenous therapy with pooled immunoglobulin, calcium blocking agents to counter exercise-induced fatigue and amantadine (McBride and McCluskey 1991:897-880). In the absence of solid evidence that any of these therapies significantly alter the course of the disease, none are recommended for the treatment of CFS at this point in time.
Course and prognosis
The prognosis for the epidemic outbreaks of chronic fatigue has already been discussed above with estimates being given of the outcome for a number of epidemics documented up until 1970. In light of the assertion made earlier that epidemic fatigue is likely to represent a distinct form of chronic fatigue, no further reference is made here to the prognosis of epidemic CFS. Any comments on course and prognosis in this section refer to recent studies of the endemic form of CFS.The course of CFS is highly variable, depending on the severity of the condition and the premorbid state of the patient. Convalescence is widely accepted as being aided by ensuring adequate rest in conjunction with a supervised regimen of gentle exercises. Lloyd et al. (1990:522) found that 43% of CFS patients in their study group were unable to attend to work, housework or school during the course of their illness. Aggravating factors of established CFS as reported by Dowsett et al (1990:527) include physical and mental stress (100%), intercurrent infection (42%), climactic changes or hot baths (12%), surgery, immunisation and hormonal disturbances (9%) and psychoactive, anti-arthritic or steroid drugs (5%).
Gold et al. (1990:48-53), and Kroenke and Mangeldorff (1989:262-266) found that 40 to 50% of patients show improvement within 12 months but do not indicate if this meant complete recovery. Kroenke et al. (1988:929-934) and Straus et al. (1988:1692-1698) indicate that lower recovery rates and a higher rate of clinical relapse can be anticipated for those who have fatigue for several years or longer.
The Green College working group indicate a similar prognosis. Behan and Bakheit (1991:801) agree with Kroenke that whilst it is difficult to give general guidelines for all PVFS patients, their experience has been that when the illness has been present for a year or more than the prospects of a full recovery are generally poor. The numbers who enter this state are reported to be but a small group of all PVFS patients. A larger number are reported as undergoing complete remission whilst the majority of patients are reported as being able to lead a life wherein they are able to modify their lifestyle and work environment so as to avoid stresses likely to make their illness worse. Interestingly, they report a number of female patients who entered a remission during pregnancy with relapse during the puerperium.
Similar figures are given by Dowsett et al (1990:527) in reporting the outcomes for a group of 420 CFS patients. They found that the duration of the illness was less than 12 months in 9% of cases, 1 to 2 years in 32% of cases, 3 to 10 years in 47% of cases, 11 to 20 years in 8% of cases and 21 to 60 years in 4% of cases. The illness was reported as improving in 31%, fluctuating in 20%, a steady level of disability in 25% and no remission or worse in 24%. No indication is given as to whether or not any of the 420 patients were beneficiaries of disability income support.
Conclusions
The major criteria of chronic fatigue syndrome is new-onset fatigue lasting more than 6 months in the absence of any other medical or psychiatric cause of fatigue. In addition, Holmes et al. (1988:387-389) list 11 minor symptom criteria and 3 minor physical sign criteria as being suggestive of the disease wherein the diagnosis of chronic fatigue syndrome can be made when (1) a minimum of 6 of 11 symptoms and at least 2 of 3 signs are present or (2) at least 8 of the 11 symptoms are present. These criteria are listed above.There appear to be two main forms of chronic fatigue syndrome, epidemic and endemic. The history of the former group has been reviewed at length in this paper. For a number of reasons, it is not clear whether epidemic CFS is the same disease as endemic CFS; for the purpose of this work the two groups are held to be distinctly different. Accordingly, this author is of the view that the conclusions drawn here are relevant to endemic CFS but may not hold true for the epidemic form of the disease. A key distinction between the two groups is that, whilst there is a body of evidence that epidemic CFS is caused by a transmissible agent (as evidenced by the numbers of hospital staff affected in a number of epidemics), there is no good evidence to suggest that the endemic CFS is transmissible.
Using the Green College working group recommendations, endemic CFS (which they term "post viral fatigue syndrome" or PVFS) is held to encompass two sub-groups, namely one comprised of patients with disease of spontaneous onset (which they term "chronic fatigue syndrome" or "CFS") and another consisting of patients proven to have an infection associated with the onset of chronic fatigue (which they term "post infectius fatigue syndrome" or "PIFS"). For the purpose of this paper, the British term "PVFS" is held to be entirely synonymous with the term CFS used in other countries in the world. A number of authorities suggest that a range of viruses and other infections may be responsible for the onset of CFS. The viruses considered by proponents of this hypothesis are ubiquitous in the community and in almost every case cannot be said to relate to exposure to a particular environment or particular type of occupation.
There is also a contrary body of medical opinion which suggests that any infective agents found to be present have not caused CFS but rather are secondary or coincidental to its manifestation. An plausible, alternative explanation is that CFS is a condition of spontaneous onset which manifests in a way similar to viral infections.
Under such a model, the identification of a particular viral strain is held either to be coincidental to the condition or is a secondary event which follows changes in the patient's immune system as a result of CFS. Recent research findings are consistent with this counter view.
In light of this, any claims that the onset of CFS was as a result of an infection acquired in the work place should be treated as speculative unless (a) the claimant has serological evidence to indicate recent infection with a particular viral agent and (b) there is unequivocal evidence of an epidemic infection within the work place with the type of viral agent infecting the claimant. It is recommended that claims based on alleged infections acquired traveling to and from work should generally fail. Likewise, it is recommended that claims in which it is alleged that an infection is unique to a region to which the claimant has been posted or were acquired during the course of work-related travel should be treated with scepticism unless the conditions of (a) and (b) above are both satisified.
There is no evidence that heredity, genetic or developmental factors play a part in the onset of CFS. Nor is there any consistent evidence that the condition is associated with particular types of occupation, lifestyle, mental or physical stress or pre-existing psychiatric illness. All of the studies of patient characteristics fail to report an increased incidence in any one occupational group, social class or region. The evidence that stress has a contributing role is considered to be equivocal. In particular, there are no studies to show a role for work-related stress in the development of CFS. None of the authorities reviewed here make mention of either physical or mental stress as a cause of CFS. The findings of Dowsett et al. that those with existing CFS report aggravation of their symptoms when exposed to strenuous exercise, other physical stresses and mental stresses is expected, given the nature of CFS and its widespread effects on physical and psychological function.
The onset of psychiatric illness in CFS is shown to be secondary to the impairment of body function in general and the chronic pain that is part of the condition. There is little, if any, evidence to support a role for any form of psychiatric illness or personality type in the onset of chronic fatigue syndrome.
Investigation of CFS patients is aimed mainly at excluding other illnesses as the cause of fatigue. There are no tests which can be considered to be diagnostic of the condition. Accordingly, there would appear to be no justification for undertaking sophisticated serological investigations nor highly technical radiological investigations in the ordinary course of investigation of the disease unless there are good reasons to suspect a serious occult disease (such as malignancy) as the cause of fatigue.
Treatment of the condition is aimed at ensuring an adequate degree of rest in conjunction with a supervised course of gentle graded exercises throughout the course of the illness. Treatment of specific symptoms such as muscle pains and depression are recommended as being appropriate but the use of narcotic and other addictive forms of medication would appear to be inappropriate in all cases. A range of other therapies have been trialed at various times but none have yet to be shown to offer any particular benefit.
Whilst it is not possible to provide specific guidelines to assist in determining the prognosis of individual patients, there is reasonable uniformity of opinion that an improved prognosis is associated with early treatment (including work and lifestyle modifications). Conversely, when the illness is severe or has been present for more than one year or both, the prognosis is generally held to be poorer. Accordingly, early identification of CFS patients is important. In many cases, temporary removal from the work place is recommended (especially those with severe disease) until there is good evidence of a sustained recovery. For the remainder, it is recommended that placement on lighter duties and/or reduced working hours be initiated early in the course of the illness. Unless the patient has severe disease however, there would appear to be little justification for recommending mandatory removal from the work place if the person is not required to undertake moderate or strenuous duties and if suitable changes to the work environment can be made.
Dr Peter Grant pgrant@gil.com.au
Bibliography
Atlay H T, Abbey S E, Toner B B, Salit I E, Brooker H, Garfinkel P E. 1990. The neuropyschological dimensions of postinfectious neuomyaesthenia (chronic fatigue syndrome): a preliminary report. International Journal of Psychiatric Medicine. 20:141-149.Behan P O, Bakheit A M O. 1991. Clinical spectrum of postviral fatigue syndrome. British Medical Bulletin. 47(4):793-808.
Cathebras P J, Robbins J M, Kirmayer L J, Hayton B C. 1993. Fatigue in primary care: prevalence, psychiatric comorbidity, illness behaviour, and outcome. Journal of General Internal Medicine. (May-June) 7(3):276-286.
Cunningham L, Bowles N E, Archard M B A. 1991. Persistent viral infection in muscle in postviral fatigue syndrome. British Medical Bulletin. 47(4):852-871.
David A S. 1991. Postviral fatigue syndrome and psychiatry. British Medical Journal. 47(4):966-988.
David A, Pelosi A, McDonald E, Stephens D, Ledger D, Rathbone R, Mann A. 1990. Tired, weak, or in need of rest: fatigue among general practice attenders. British Medical Journal. (November 24) 301(6762):1199-1202.
Dowsett E G, Ransay A M, McCartney R A, Bell E J. 1990. Myalgic encephalitis - a persistent enteroviral infection? Postgraduate Medical Journal. 66:526-530.
Gold D, Bowden R, Sixbey J, et al. 1990. Chronic fatigue; a prospective clinical and viral study. Journal of the American Medical Association. 264(1):48-53.
Gow J W, Behan W M H. 1991. Amplification and identification of enteroviral sequences in the postviral fatigue syndrome. British Medical Bulletin. 47(4):872-885.
Hickie I, Lloyd A, Wakefield D, Parker G. 1990. The pscyhiatric statusof patients with chronic fatigue syndrome. British Journal of Psychiatry. 156:534-540.
Holmes, G P. 1991. Defining the Chronic Fatigue Syndrome: Problems in Design and Analysis.. Reviews of Infectious Diseases. 13 (Suppl 1): S53-55.
Holmes G P, Kaplan J E, Gantz N M, et al.. 1988. Chronic Fatigue Syndrome: A Working Case Definition. Annals of Internal Medicine. 108:387-389.
Ho-Yen D O, McNamara I. 1991. General practitioners' experience of the chronic fatigue syndrome. British Journal of General Practice. 41(349):324-326.
Jamal G A, Miller R G. 1991. Neurophysiology of postviral fatigue syndrome. British Medical Journal. 47(4):815-825.
Jenkins R. 1991. Epidemiology: Lessons from the past. British Medical Bulletin. 47(4):952-965.
Kennedy P G. 1991. Postviral fatigue syndrome: current neurobiological perspective. British Medical Journal. 47(4):809-814.
Kirmayer L J, Robbins J M, Kapusta M A. 1988 Somatization and depression in fibromyalgia syndrome. American Journal of Psychiatry. 145:950-954.
Komaroff A. 1988. Chronic fatigue syndomes related to chronic viral infection. Journal of Virology Methods. 21:3-10.
Kroenke K. 1991. Chronic fatigue syndrome: Is it real? Postgraduate Medicine. (February 1) 89(2):44-55.
Kroenke K., Mangeldorff A D. 1989. Common symptoms in ambulatory care: incidence, evaluation therapy and outcome. American Medical Journal. 86(3):262-266.
Kruesi M J, Dale J, Straus S E. 1989. Psychiatric diagnoses in patients who have chronic fatigue syndrome. Journal of Clinical Psychiatry. 50(2):53-56. [Erratum published in Journal of Clinical Psychiatry. 1989 50(4):148.]
Lloyd A R. 1990. Muscle versus brain: chronic fatigue syndrome. Medical Journal of Australia. (November) 153:530-533.
Lloyd A R, Hickie I, Boughton C R, Spencer O, Wakefield D. 1990. Prevalence of chronic fatigue syndrome in an Australian population. Medical Journal of Australia. (November) 153:522-528.
Loblay R, Swain A. 1986., Food intolerance., in Whalqvist M, Truswell A. (eds.) Recent Advances in Clinical Nutrition. London. John Libbey. pp. 169-177.
Makowska Z, Kluge G, Sprusinska E. 1992. The influence of occupational and non-occupational factors on chronic fatigue syndrome. Polish Journal of Occupational Medicine and Environmental Health. 5(4):323-333.
Manu P, Lane T J, Matthews D A. 1993. Chronic fatigue and chronic fatgiue syndrome: clinical epidemiology and aetiological classification. Canadian Medical Association Journal. (August 1) 149(3)34-319.
McBride S J, McCluskey D R. 1991. Treatment of chronic fatigue syndrome. British Medical Bulletin. 47(4):895-907.
Melamed S, Kushnir T, Shirom A. 1992. Hyperimmune fatigue syndromes: diseases of the stress response? Journal of Rheumatology. (March) 20(3):418-421.
Millon C, Salvato F, Blaney N et al. 1989. A psychological assessment of chronic fatigue syndrome/chronic Epstein barr virus patients. Psychological Health. 3:131-141.
Ng S C. 1992. The fibromyalgia syndrome. Singapore Medical Journal. (June) 33(3):294-295.
Prasher D, Smith A, Findley L. 1990. Sensory and cognitive event-related potentials in myalgic encephalopathy. J. Neurol. Neurosurg. Psychiatr. 53:247-253.
Shafran S D. 1991. The chronic fatigue syndrome. [Review] American Journal of Medicine. 90(6):730-739.
Sharpe M. 1991. Psychiatric management of PVFS. British Medical Bulletin. 47(4):989-1005.
Straus S E, Dale J K, Tobi M, et al. 1988. Acyclovir treatment of chronic fatigue syndrome: lack of efficacy in a placebo-controlled trial. New England Journal of Medicine. 319(26):1692-1698.
Stricklin A, Sewell M, Austad C. 1990. Objective measure of personality variables in epidemic neuromyaesthenia patients. South African Medical Journal. (January 6) 77(1):31-34.
Taerk G S, Toner B B, Salit I E, Garfinkel P E, Ozersky S. 1987. Depression in patients with neuromyaesthenia (benign myalgic encephalomyelitis. Intermational Journal of Psychiatric Medicine. 17:48-49.
Wallace P G. 1991. Epidemiology: A critical review. British Medical Bulletin. 47(4):942-951.
Wessely S, David A, Butler S, Chalder T. 1989. Management of chronic (post-viral) fatigue syndrome. Journal of the Royal College of General Practitioners. 39(318):26-29.
Wessely S, Powell R. 1989. Fatigue syndromes: a comparison of chronic 'post viral' fatigue with neuromuscular and affective disorders. J. Neurol. Neurosurg Psychiatr. 52:940-948.
Winters E G, Quinet R J. 1992. Chronic fatigue syndrome. Journal of the Louisiana State Medical Society. 144(6):260-270.
Woods T O, Goldberg D P. 1991. Psychiatric pesrpectives: An overview. British Medical Bulletin. 47(4):908-918.
Yaminishi K. Chronic fatigue syndrome and virus infection: human herpesvirus 6 (HHV-6) infection. Nippon Rinsho - Japanese Journal of Clinical Sciences. (November) 50(11):2612-2616.
Discussion
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FMS CFS Gina , ginapaylor@hotmail.com Posted 7/8/2001 11:27 AM I have suffered with these symptoms for 8 years. Exercise is the only thing that allows me to live a somewhat normal life. It is horrible in the beginning, but movement such as walking, yoga or gentle stretching is vital. (Pilates is also helpful. I would be confined to bed or the couch if not for these activities. I walk every day. On good days, I can do 3-5 miles. When I don't feel that I have the energy, then I do a short walk and stretch. This increses my enery level tremendously. Drinking 6-8 glasses of water a day is also a must - I am never without a 36oz. water bottle. I can only say that after much trial and error, this has been helpful for me. Trying anything new should always be done in moderation and only after checking with a Doctor, Massage Therapist or |
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Young children and post viral syndrome Karen, charsley@austarnet.com.au Posted 28/7/2001 5:52 PM My 3 year old had glandular fever in Dec-Jan, and has not been well since, picking up everthing going around - mysterious rashesm gastro bugs, tonsillitis, etc She is tired all the time. I have taken her out of kindrgarten. Anybody else experienced this, I would like to hear from you, as i haven't been able to find any literature about young children with this. |
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INNER REFLECTIONS ~ pOETS CORNER Jiara Kelly, freespiritval66@hotmail.com Posted 8/7/2001 8:34 PM You've © April'94 Jiara.V. Kelly (London) Fighter of the mystery illness..11years on.. |
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Anyone like me out there? Liz O'Neill, liz@llwyngarreg.screaming.net Posted 27/6/2001 8:55 PM For 6 years I have had increasing weakness following exercise in my arms ONLY. When I read about ME, I am struck by the identical descriptions of rapid loss of muscle energy followed by agonisingly slow recovery, in my case often weeks.Pain can be bad, odd sensations (burny, light slight tingle)in the muscle, muscle tends to tense unbidden if bad (WORST aspect). No initial viral infection. Brain no worse than it ever was. Legs just fine! Blood tests negative. Doctors puzzled. Tried numerous therapies (including hypno). So, is there ANYONE like me out there? I'd love to hear from you- I feel very isolated.Liz |
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CFS and pregnancy Sarah, studentmom2boys@aol.com Posted 20/6/2001 7:45 AM Hi, I have CFS and am also 3 months pregnant. If anyone has experienced this please let me know and email me. There is just not much out there regarding CFS and pregnancy. |
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Imagine what it is like to be robbed of your life.. Laura A Willoughby-Snow, in2art@sierra.net Posted 12/6/2001 7:46 PM CHRONIC FATIGUE SYNDROME AWARENESS ______________________________ Imagine a pain so severe that nothing Imagine waking up, not being able to walk. Imagine no one believes! Imagine having the flu for twenty years. Imagine a life robbed; each day gets dimmer. Imagine a world where there is no one around, but you.. in your bed with only your Imagine your only joy in life is an occasional phone call, Imagine taking a shower, and feeling as though you accomplished a new worlds record. Then, calling it a day. Imagine a life filled with so much pain; Imagine living in your head, because it's the only place you can walk to... besides; you'll never get lost on your way back. Imagine watching the world pass by, without so much as a glance... Youth turns it's back; while life passes in the night. Imagine having to ignore all of this, Imagine being 35, or close to the million others who suffer daily with CHRONIC FATIGUE SYNDROME How long must we suffer?
Laura A Willoughby-Snow, in2art@sierra.net Posted 12/6/2001 7:45 PM ______________________________ CHRONIC FATIGUE SYNDROME AWARENESS ______________________________
Imagine waking up, not being able to walk. Imagine no one believes! Imagine having the flu for twenty years. Imagine a life robbed; each day gets dimmer. Imagine a world where there is no one around, but you.. in your bed with only your Imagine your only joy in life is an occasional phone call, Imagine taking a shower, and feeling as though you accomplished a new worlds record. Then, calling it a day. Imagine a life filled with so much pain; Imagine living in your head, because it's the only place you can walk to... besides; you'll never get lost on your way back. Imagine watching the world pass by, without so much as a glance... Youth turns it's back; while life passes in the night. Imagine having to ignore all of this, Imagine being 35, or close to the million others who suffer daily with CHRONIC FATIGUE SYNDROME How long must we suffer?
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After Glandular Fever... Rebecca, martini_is_good@hotmail.com Posted 29/5/2001 8:13 AM Please can someone help! I was diagnosed with Glandular Fever in September, after suffering from Chronic Fatigue Syndrome like symptoms since December 2000. Since then, I have been only operating at 30% of my usualy active self. The Doctors seem very unhelpful, and unsympathetic, and can only seem to prescribe gentle exercise which burns me out completely. I am supposed to be starting my university studies (again) in September, and after over a year of alternating between the sofa and bed am very concerned that I will not be able to keep up. I am already on anti-depressants, which helped me a little mentally, but it is just so depressing when your life revolves totally around the 3 or 4 hours that you are properly awake and 'with it'. Is there anyone at all that can help, or anything, ANYTHING, that could even slightly improve my quality of life at the moment? I'll try it all. Is there a support group, or a recomended Doctor in the UK (preferably the North/midlands)? Good luck to everyone, please write back if you have a suggestion, it would mean so very much to me. Rebecca (19) mont, montanathegreat1999@yahoo.com Posted 12/6/2001 2:06 PM My friend is suffering from gladular fever for the past 2 months now. She had it before when she was younger and now it's back. I really don't understand what's a glandular fever, all I know is she's been very tired all the time even though she's not exercising or anything like that and has a temperature, she's having trouble sleeping, sometimes she don't sleep for like days. I want to help her but I don't know how. PLEASE tell me more about gladular fever. She's been in and out of the hospital for the past couple of months. I was told that there's no specific medication for it, if so then how can she get better? |
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Lupus/Ataxia bbradish, bethbradish69@hotmail.com Posted 18/4/2001 12:29 AM I have been struggeling with Lupus, Ataxia and Chronic Fatigue Syndrome and Seizure disorder Since before March of 2000. It has been very frustrating for myself and for others. There have been pushing me to go more than I can. I am not really depressed. More frustation, I want to do more than my body will let me. It is very difficult for some to understand that I am fatigued and not depressed. Can anyone offer advice? Thank you, Beth |
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Biochoice Immune26 Leslie Toplin, payout1@gate.net Posted 8/4/2001 4:08 AM Have you ever heard of Biochoice Immune26? It worked for me for my Fibromyalgia and Chronic Fatigue. www.legacyusa.com/thestuff Sincerely, Leslie |
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Cytomegalo Virus Cheryl Weaver, cheryl.weaver@thrifty.com.au Posted 13/3/2001 3:44 PM Would like to know more about this virus asap. thank you Cheryl |
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Doctor Contacts? Clare, cmeadows@bigpond.com Posted 21/2/2001 7:22 AM Does anyone know of an understanding Doctor in Brisbane, Australia? Clare, cmeadows@bigpond.com Posted 21/2/2001 7:22 AM Does anyone know of an understanding Doctor in Brisbane, Australia? Caitlin Marshall, caitlinfmarshall@yahoo.com Posted 17/7/2001 2:13 PM I really need to find out about good Doctors, preferably female in Brisbane that have an understanding about CFS. Also if they bulk bill, Thanks Sally Scheppner, schepcarr@earthlink.net Posted 23/7/2001 2:46 PM I have been suffering for many years, off and on, from all the related symptoms. I can only work part-time and even that is difficult. I cannot find a doctor who understands this problem; been told I have everything from depression to 'aging,' to just nothing. Must be all in my head! Does anyone know a doctor in north Florida or Upstate New York who can help me? |
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Prednisone -- helped me with the horrible fatigue hech, hechie@hotmail.com Posted 5/2/2001 8:40 PM To: clifcraft@lycos.com and All on the Forum: i was browsing the NY times CFS forum --- your post jumped out at me ---- when you said that you had taken prednisone for a herniated disk and all of a sudden you felt much better. i had a similar experience about 3 weeks ago when my doctor prescribed a Dose Pak of methylprednisolone for five days. it was the first time in a couple of years that i felt anywhere near like a Normal Person. when i finished the 5 day course, the feeling wore off in about 2 days and it was back to the horrible fatigue and lethargy and inability to concentrate.
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Chronic Fatigue due to Epstein-Barr / CMV Jane Tuljus, carltee@tir.com Posted 28/12/2000 2:49 PM I was diagnosed with an elevated level of Epstein- Barr virus and CMV 2 years ago. I had all the classic symptoms, overwhelming fatigue, heart palpatations, chest pressure, soar throat, muscle aches, joint pain and stiffness, and cognative problems. I was referred to an infectious disease specialist in Birmingham, Michigan. I've been under the care of Dr. A. Martin Lerner for 2 years now and I am completely well. He treated me with bed rest, and a new anti-viral drug called Valtrex. I take 1 gram every 6 hours and drink 6-8 glasses of water a day. The virus is supressed and all of my sympstoms are gone. These viruses however, stay in your blood, and I may always have to take the Valtrex to keep them supressed. I feel wonderful though, and am very thankful to be able to return to a normal life of work and play! Dr. Lerner has been researching EBV and CMV with a team of cardiologists for 13 years and has producted some hard data that is making the CFS community stand up and take notice. He can be reached at 248-540-9866 where his staff can mail out copies of his publications regarding the effects and treatment of these viruses. Perhaps your local physicians can use this information ( which is still in the developmental process ) to properly treat you. Good luck to you all! Jane Tuljus, carltee@tir.com Posted 28/12/2000 2:48 PM I was diagnosed with an elevated level of Epstein- Barr virus and CMV 2 years ago. I had all the classic symptoms, overwhelming fatigue, heart palpatations, chest pressure, soar throat, muscle aches, joint pain and stiffness, and cognative problems. I was referred to an infectious disease specialist in Birmingham, Michigan. I've been under the care of Dr. A. Martin Lerner for 2 years now and I am completely well. He treated me with bed rest, and a new anti-viral drug called Valtrex. I take 1 gram every 6 hours and drink 6-8 glasses of water a day. The virus is supressed and all of my sympstoms are gone. These viruses however, stay in your blood, and I may always have to take the Valtrex to keep them supressed. I feel wonderful though, and am very thankful to be able to return to a normal life of work and play! Dr. Lerner has been researching EBV and CMV with a team of cardiologists for 13 years and has producted some hard data that is making the CFS community stand up and take notice. He can be reached at 248-540-9866 where his staff can mail out copies of his publications regarding the effects and treatment of these viruses. Perhaps your local physicians can use this information ( which is still in the developmental process ) to properly treat you. Good luck to you all! Sam , samjuggins@hotmail.com Posted 1/2/2001 7:43 AM Hi! My symptoms of ME were first recognised 5yrs ago, after several episodes of glandular fever and re-acurrent tiredness, muscle pain, depression etc over a period of 18 months. My ailments increased, forcing me to sign off work for several months. However, I returned to work on a part-time basis which eventually lead to regaining a full time position. (See there can be light at the end of the tunnel). The problem with this illness is that it never leaves you, I am constantly waiting for it to catch up with me once more and have a devasting impact on my life. I admit, that I am scared of this illness returning. Best Wishes to all
Tam, Jemini76@hotmail.com Posted 16/5/2001 1:35 PM I'm having a hard time dealing and understanding all these systoms. When i was pragnant with my last child 6 years ago, the doctors found Epstein-Barr. Not understanging I dealt with all the systoms. I try and talk to my doctor about it but she doesn't seem to understand. Now I'm 3 months pragnant and the systoms has gotten bad again. If anyone knows what would help, I would be thankful.. David, dj_dancemaster@hotmail.com Posted 26/6/2001 12:03 PM hi, one of my friends has cfs but now he's OK, see ya |
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cfs after viral meningitis and Polio from sabine vaccine tracey, bthayes@assoa.nt.edu.au Posted 22/11/2000 8:19 PM I recovered ok from meningitis in 1999 but then became ill with a similar virus??? in July2000. A spinal tap finally tested positive to a type of Polio. Drs have advised me that I was infected from my son who had just had his sabin vacination. Five months later and life is still very difficult. A specialist has diagnosed post viral infection syndrome. It is terrifying to think that I could feel this way for years to come. I would appreciate any feed back and if anyone knows the name of a specialist in this field practising in Australia I would be very appreciative if you could pass the info on. Many thanks. catherine, unikorn@0ptus.com.au Posted 13/1/2001 12:48 PM I have just been told that I have C.F.S. by my Dr. I always thought that c.f.s. was just a state of mind, I can assure you it is not .I have altered vision,muscle spasms, headaches,cramps in my lower limbs,feel constantly tired,irratated by the slightest upset to my non existant routine,&generally frustrated because of my tiredness.I had E.B.V. 2 years ago& spinal surgery 18 months ago,Im curious as to if this is all related? |
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post viral fatigue syndrome Emma Stubbles, sjstubbles@ukgateway.net Posted 13/11/2000 8:16 AM I have been suffering for 11 months and have been prescribed domperidone but found that it has helped little. Have even tried chinese medicine which again had no effect. My symptomes are nausea, dizziness, tiredness (of course!), no energy and loss of concenration. I would appreciate being put in contact with a support group near me, say in the Plymouth, Devon, UK. Emma Sunny Plea, sungod88@hotmail.com Posted 2/4/2001 7:48 PM i an currently studying post viral fatigue syndrome in my third year of uni & think that you should consider the side affect of anti depressant drugs as a possible link to people with post viral fatigue syndrome. Thank you Terry Smith, Rcovie@aol.com Posted 19/4/2001 10:28 PM I have had the above sinc Nov 99, i am 20 years old and i cannot do what most 20 yr olds can do. I do not have PVFS as bad as some of the people on this site, but you all have my sympathies. My biggest problem is i am a footballer, and in my opinion a good one, but for some reason 2 years ago it began, i couldn't do the things that i found so easy before just completeing a game every few weeks is a struggle. This has broken my heart i always felt i was good enough to go on to play the game i love professionally, now i cant even enjoy it not just because of the physical pain but because i cannot play to the standard i know i can. I'm am fed up and completely pissed off with the lack of information, understanding and treatment to PVFS, i have found it hard to believe that in this day and age there is no cure for this disease. I have struggled to find a single person who knows anything about PVFS or who can tell me the best way to go about curing it, or at least helping it. If anyone at all can put me in touch with someone who actually knows what their talking about espiecially from a sporting point of view i would probably marry you, male or female, who cares, only joking i'm just at my wits end with this frustrating disease any help or tips would be appreciated. Thanks Terry |
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hep c/chronic fatigue/fibromyalgia/long-term dis Rhonda, mikely@cape.com Posted 24/10/2000 8:12 PM Hi - I am currently suffering pain, flu-like symptoms from muscle aches to chills, and my long-term disability company is doing a 24 month investigation which has caused me so much stress that my symptoms are aggravated. I have been denied social security 2 times and I have a hearing coming up for that in the next two months. The trouble is when people look at me they think I look fine, therefore, I must be fine. When I look at me, I see the bloodshot eyes, yellowing, tiredness, and I know I am in bed usually by 6 p.m. - plus have 3 children to take care of - 7, 9, and 13. My husband, God bless him, is such a support. Any suggestions - thanks Rhonda Vickie, unmask@earthlink.net Posted 20/11/2000 4:19 AM I have tested positive E-Barr and a very high rheumatoid factor several times but my sed rate was normal. I have been sick for over a year, and have now reached the point that I can no longer work, due to severe cognative dysfunction, extreme pain and exhaustion. Thanks in addvance Candy, Candygirl1@webtv.net Posted 27/1/2001 6:13 PM Anyone uing Aetna? I can use a good Long Term Disability Attorney for CFS. Should probably be class action. If everyone would get together.
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post-polio syndrome, hep c ( from b in 1982) and ebv (all at once) Kathleen , RCrane9999@aol.com Posted 18/6/00 12:24 AM Have Post- Polio syndrome, had hep b carrier from blood transfusion in 1982 packed cells, which the B, is now hep C, now doctor says have EBV. I guess the doc figurered oh boy this is it that is why you feel bad, hurt, CFS. I know better. I have sent many a literature to doctors on PPS, tried, several meds, colonic, herbs. you name it. I have a brother who is a doctor, but what i need is a scienctist willing to help this 48 year old lady with 4 kids. i am near bed ridden, and cant figure it out. Is there a place near Redding, California that could help. I dont want to be wonder woman, just a lift and a life with my kids, they need me. e mail RCrane9999@aol.com we can further our talks, in respect to DNA, retroviruses, mutations of all this junk invading my chemistry. Thanks for caring and sharing. what the hec just maybe out of millions just one, will help. |
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Chronic Fatigue Syndrome & Hypothyroidism Jane Birkby UK, birkby@birkby88.freeserve.co.uk Posted 9/6/00 6:54 PM I am so relieved to read of other peoples accounts of their conditions. At last I can stop feeling like a hypochondriac. I have been chronically ill since 1995, I have had most of the symptoms discussed in this forum. I was diagnosed with Under-Active Thyroid around 1992/3, but no investigation into why it was under-active, just that it was. I thought I had only had a mental breakdown in 1995, and have been treated for chronic depression ever since, thinking the low grade fevers and ill feeling were all part and parcel of the depression. I haven't been able to help my mum for at least 6 weeks and I don't think that she or my sister understand or know what the condition can do, so I will be able to show them this information from the internet, and stop feeling guilty and a lay-a-bout. I will now be able to concentrate on my illness and do my best to lessen it's effects over time I hope. Thank you for this web space, and thank goodness for the internet. Jane Birkby Robin, RobinNGabster@aol.com Posted 22/6/00 7:28 AM marion r, marion_and_mickey@sympatico.ca Posted 17/7/2000 11:26 PM Could you please let me know if there is a clinic for this C.F.S. in Ontario, Canada, around Toronto I beleive could be Kingsley????? Thanks Marion. Neil Lochhead, neiljl@home.com Posted 6/8/2000 3:13 PM My wife,Maria,aged 73yrs.,has been suffering with CFS for over 15 years.She is disabled and she is confined to our home for much of her day.She suffers with flu-like symptoms nearly daily and the chronic fatigue is present almost always. Sleep is always a problem and medications are necessary for her to survive. A nights sleep for her usually does little good for her constant symptoms of fatigue with zero energy! Fortunately, I retired two years ago and I care for my wife and do my best to make her as comfortable as possible. I research CFS on the internet and have tried many 'quick fixes' or pills that claim to help her. Nothing has worked to date. If you have any good ideas, please forward them to us. Thank you. Sincerely, Neil Lochhead (for my wife Maria Lochhead) Gina Buntz, origindnc@aol.com Posted 20/8/2000 1:06 AM My mother, who is 77, is suffering from CFS, and has had a low grade, fluctuating fever (99 to 101) since December 15, 1999 to the present. She is under the guidance of her internist and is on colonopen, elevil and trilisate. Yet she's pretty much the same without my relief. She's lost almost 20 lbs. and has a hard time getting back. Is there something more I can do for her? Del Scoville, wolferl@home.com Posted 3/9/2000 9:56 PM I am 32, my symptoms match the what's in this writing. I have been having insomnia and aching muscles for the past eight months. It's now bad enough that I have trouble standing up. I am looking around for a doctor. I am now glad I have an idea what it can be. For the past month I've felt like a hypochondriac comparing my symptoms with that of many different syndromes and diseases. It's quite scary. I'm self employed, and I'm now forced to change my line of work, as I can't perform my job anymore. My family is in total disbelief of my condition, so I have to suffer through with very little help. I am hoping the information here can help bring this to light. Del julian cabell, sirjools@aol.com Posted 26/9/2000 8:13 AM Well then...Ive read this and I`m in two minds...the first is thank God I can end this madness this is exactly what I have, and the other is thank God, compared to some I see, I dont suffer too badly. My problems are sore throats, tiredness, depression, I dont suffer from the muscle aches some talk of, night sweats and lack of meaningful sleep. I have had this for just over a year and my girl friend has got it too...so this must be the infectious type. The bare facts of the matter the search for what makes me ill has led me around the twist. My doctor has been highly unsupportive and my specialist died yesterday and luckily (or unluckily for him..depends how you veiw it!) I came on the web in desperation and found this..the perfect description of my problem. Any researchers or sufferers feel free to contact me..the search to the end of this hell must go on! Be good to yourselves. Julian MoniQue Alponte, ygfs@yahoo.com Posted 22/10/2000 4:19 PM PREDNISONE - A MIRACLE AFTER 11 YEARS OF SUFFERING WITH CHRONIC FATIGUE SYNDROME!! I've had CFS for 11 years. Nothing really ever cleared it up completely. Although it has gone into a type of remission on and off through the years, it never really went completely away......BUT, recently I had to take a steroid called Prednisone for a herniated disk. Low and behold, not only did the sciatic pain go away, but something else I wasn't expecting happened: My CFS symptoms DISAPPEARED COMPLETELY (well, for a couple of months anyway). It appears that Prednisone completely blocks immune response, which as you might have guessed CFS is actually our bodies over-reaction of an immune response. So when Prednisone blocks all immune response, of course the symptoms of CFS are GONE because CFS appears to be just that: an immune response. But, this is not the answer to completely getting rid of our CFS. However, I did get to experience how I used to feel before 1989 when I got CFS, and wow, I forgot how good it felt to be well. To NOT have night sweats every night, to NOT h cliff, clifcraft@lycos.com Posted 27/10/2000 4:08 AM I think most of you people have been living in my back pocket!I am a 44 year old male who has been suffering thru this for 4 0r 5 years now .I began to notice all the 'classic symtems' 4 or 5 years ago i could only work about 4 to 6 hrs a day for a week or 10 days and the i would be down for aweek.Also at the same time i was having chest pain,left arm hurting, elbows etc.... Went to the doc he did series of test,said it was stress.14 months later had acute mi,2 months after that had quintuple (5) bypass surgery,10 months later had 3 stents,2 weeks later 2 ballons.Since i have been in hosp 6 times. Anyway back to the story being a 'MAN' as i was taught i have keep my mouth shut about all my other symptoms,iput them off as part of the cad and pvd,but as i have educated myslf over the last 4 years i realize i am classic CFS. I have a docs appt tomorrow and i am going to spill my guts,i am so tired of trying to be the macho man,i can't keep it up,i need help and i am finially going to be man enough to admit it and ask for help. i could go on and on about this i have been treated for depression,cad,panic attacks,anxiety attacks,gerd,insomnia,muscle cramps,angina etc.......all in the last 3 years .i realize i probably am rambling more later. GOOD LUCK EVERYBODY! Mel, melrissler@hotmail.com Posted 28/12/2000 8:57 PM My wife has been suffering from the symptoms described here for three years. We have not had a successful diagnosis of anything, but all the symptoms fit. We are currently residing near Newcastle, NSW, Australia. If anyone can help us, please e-mail me. Thankyou. Lesley Foll, glenfoll@bigpond.com Posted 8/1/2001 3:02 PM I am 34 years of age and have been diagnosed with Hypothyroidsim and Chronic Fatique Syndrome 4 months ago (now Jan 2001). I read from all the stories most of the same symptoms that I have and people that have had CFS for 10 to 15 years. I would like someone to E-mail me on any success stories and anyone that has helped themselves by way of diet etc would be helpful as well. I am a very positive person and am trying very hard not to get frustrated with the way I feel but it sometimes gets to me. Please help!! Eric, SoldierTAR@aol.com Posted 18/1/2001 1:35 PM I am a 23 year old male and I have been having difficulty keeping myself going ever since I have been in the army. I think that I might have CFS since I have been having muscle weakness, pains throughout my body, concetrating, forgetfulness, sleeping problems, and confusion, for a long period of time now. I don't know how it happened, but I guess it was the amount of stress and strenuous actitity I took while I was in the military. Even though I have been out of the army for 2 years now, I still been having these symptons since then. I have tried herbal supplements like Ginseng, St. John's Wart, Kava Kava, and Feverfew to help me relax and get myself going, but it doesn't help much. I have even tried a variety of anti-depressants, but I am not even depress, and they don't work anyway. I have a little trouble exercising, even to try giving myself a good warm up. My body still feels a little tight and stiff, and I have a hard time loosening up. I can't seem to get myself going t Eric, SoldierTAR@aol.com Posted 18/1/2001 1:35 PM I am a 23 year old male and I have been having difficulty keeping myself going ever since I have been in the army. I think that I might have CFS since I have been having muscle weakness, pains throughout my body, concetrating, forgetfulness, sleeping problems, and confusion, for a long period of time now. I don't know how it happened, but I guess it was the amount of stress and strenuous actitity I took while I was in the military. Even though I have been out of the army for 2 years now, I still been having these symptons since then. I have tried herbal supplements like Ginseng, St. John's Wart, Kava Kava, and Feverfew to help me relax and get myself going, but it doesn't help much. I have even tried a variety of anti-depressants, but I am not even depress, and they don't work anyway. I have a little trouble exercising, even to try giving myself a good warm up. My body still feels a little tight and stiff, and I have a hard time loosening up. I can't seem to get myself going t Pete, kiwis_usa@yahoo.com Posted 24/1/2001 6:24 AM I HAVE HAD CFS NOW FOR 3 YEARS & CONTRACTED IT AFTER HAVING VAXCINES IN THE U.K FOR TRAVEL INTO AFRICA & THEN DRINKING WITH FRIENDS THE NEXT DAY.I KNOW OF THIS HAPPENING TO ONE OTHER PERSON.THIS COMBINED WITH LONG WORK HOURS & MUCH PARTYING WAS TO MUCH FOR MY IMMUNE SYSTEM.NOW MY IMMUNE SYSTEM DOSE NOT KNOW HOW TO SWITCH OFF! HOWEVER I STILL TRAVELED THROUGH AFRICA FOR 6 MONTHS HOME TO NEW ZEALAND UNAWARE WHAT WAS WRONG WITH ME. I HAD SEEN NUMEROUS DOCTERS & NONE COULD TELL ME WHAT WAS WRONG.I NOW LIVE INTHE UNITED STATES & HAVE FOUND A GOOD DR.I HAVE DISCOVERED THAT A SMALL AMOUNT OF EXERCISE,(JOG 15 MIN ONCE OR TWICE A WEEK)PLUS NUMEROUS VITIMINS & ENZYMES TO AID DIGESTION DUE TO LEAKEY GUT PLUS 'A GOOD DIET (I RECOMEND YOU READ 'EAT RIGHT FOR YOUR TYPE')AVOIDENCE OF TOXIC MATERIALS AND A POSITIVE ATTITUDE WILL HELP TO GET YOU THROUGH. I CAN SAY NOW I AM ABOUT 80% RIGHT NOW & HAVE MANAGED TO STAY AT WORK & TRAVEL THE GLOBE WITH CFS.DON,T GET ME WRONG THOUGH ,I DO HAVE MY DOWN DAYS.BUT I KNOW IT WILL GO AWAY SOME DAY.I HOPE THIS HELPS. Mary Lababidi, VenImports@aol.com Posted 10/5/2001 12:47 AM Something to add to my just submitted question, my 9yr old daughter has also been out of sorts for the same amount of time, with low-grade fever every day, saying she doesn't feel good all over (flu-y), although her lab tests come back normal. I cannot believe she also would have CFS, but am otherwise clueless to what is wrong with her. Could there be a connection? I am worried about her. Mary Lababidi, VenImports@aol.com Posted 10/5/2001 12:42 AM I have been sick for over six months. Very sick. Minimally functional sick. With three small daughters and a family run business. It started, as best I know, with the flu. It never got better. I was just diagnosed with CFS, and wonder if I should consider going to Mayo when my children finish school next month. My physician here in Madison is good, but very limited in what I could/should be doing. I had back surgery last summer, hoping to have another child. I am 39. Now I have this illness, and cannot imagine considering pregnancy at this time. I need to get better! Is Mayo a good choice? Thank you so much for the opportunity to ask. Emil, emil_heskey@astaga.com Posted 16/5/2001 10:15 AM I have had undiagnosed PVFS for 13 years. This was self researched as the closest diag I received was asthma caused by overexercise. I have found ways to work around and am fully active. I have Budisonide (steroid) for the supression of any bad case, plenty of vit-c, antiox and squiline to round out the diet. Thats easy next on is a fitness regime that doesn't trigger the problems (walking + swimming 3 times a week) and finally a mental position that keeps it in perspective (this was the hardest as all sufferers will know). I had some very bad years but life can be fine. Think holistically paul wightman, paul@cpd2.usu.edu Posted 1/6/2001 10:55 AM hello i'm from logan, utah. i'm 42, male, i've had CFS for many years, and am collecting some good resources via many hours on the internet the internet on CFS. if you'd like a copy of the info. i've gathered, let me know. if you could cover the copies and the postage, i'm happy to share the info. for those who can't put in the time researching. thanks, paul thanks, chritsina, redjewell366@cs.com Posted 14/6/2001 10:53 AM To whom this may concern, Since I got the vaccines for my profession in September 1994 I have had several MMR and HIP B vaccines. Every time I get my titers checked they say I am still not immune to the disease and I end up getting another shot making a total of 4 measles vaccines in my life and 5 HEP B vaccines. In 1995 I had the diagnosis of I am on a stimulate during the day to keep me awake and a sleeping pill at night to help me stay asleep. I feel like a robot. I am also on continuous Motrin to stop the pain from my joints and muscles. (Even though these meds help and without them I am really bad off, I still am tired and I am still in pain off and on throughout the day) COULD THE HEP B VACCINE BE WHAT IS CAUSING THIS? Thank you so much for reading all of this. I am just so desperate to feel like I used to. I have three children counting on me. So many people said I have changed since 1995 (including my husband who has since divorced me). What ever the problems are I am desperate to fix them. Please let me know if you can help me in any wayÖ
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hypothyroidism Lisa Ryan, daisyduck35@hotmail.com Posted 28/5/00 5:24 AM To whom it may consern, recently, I have diligently been trying to find the cause of numerous symptoms, consisting from chronic fatigue, weight gain, depression, all the way down to achiness, and tingling hands and feet. I have suspected hypothyrodism for years, but the blood tests always say normal. I read some different studies, and found out that my condition may not show up in a blood study. There fore, after 6 years of searching, my doctor ordered a blood test on antibodies from the Thyroid. And the Eptein Barr Virus test. I just received my results, and true to my suspitions, my thyroid is not producing antibodies as it should be, and my test was positive for the EBV. I have been thinking that alot of symptoms people have been suffering could indeed be do to their thyroid. My question is; herbal treatments such as Olive Tree branch Extract, and many others have shown to be helpful in treating the SYMPTOMS of the EBV. Could you give me information on any studies you might have for either of these. Sincerely, Lisa Ryan (S.E. Michigan) Lisa Ryan, daisyduck35@hotmail.com Posted 28/5/00 5:24 AM To whom it may consern, recently, I have diligently been trying to find the cause of numerous symptoms, consisting from chronic fatigue, weight gain, depression, all the way down to achiness, and tingling hands and feet. I have suspected hypothyrodism for years, but the blood tests always say normal. I read some different studies, and found out that my condition may not show up in a blood study. There fore, after 6 years of searching, my doctor ordered a blood test on antibodies from the Thyroid. And the Eptein Barr Virus test. I just received my results, and true to my suspitions, my thyroid is not producing antibodies as it should be, and my test was positive for the EBV. I have been thinking that alot of symptoms people have been suffering could indeed be do to their thyroid. My question is; herbal treatments such as Olive Tree branch Extract, and many others have shown to be helpful in treating the SYMPTOMS of the EBV. Could you give me information on any studies you might have for either of these. Sincerely, Lisa Ryan (S.E. Michigan) |
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Ross River Virus and Children Teresa Hamilton, tkh031@hotmail.com Posted 25/5/00 9:55 PM Thanks for this very informative article. My 12 year old son was diagnosed with Ross River Fever just over 12 months ago, and has experienced continuing difficulties ever since. He was extremely ill for about 6 weeks and a graduated program had to be implemented to get him back to school. He is currently experiencing muscle & some joint pain, severe sleep disturbance (insommnia & early waking), loss of appetite, lethargy and school refusal & depression. Some days, he is simply unable to get out of bed to go to school. All blood tests are normal. There appears to be a lack of understanding and knowledge about the course of the Ross River virus in children, and he is currently viewed as a child with a probable anxiety/depressive disorder. I am a mental health professional and have doubts about this possible diagnosis. I would appreciate any information on this topic. Many thanks |
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Somethings to help you with FIbromyalgia/Chronic Fatigue 'ZASU', zasu98@aol.com Posted 8/5/00 1:59 AM I have found that FIBROMYAGLIA and CHRONIC FATIGUE SYNDROME are very much similar. (They did not mention the fact of irritable bowel syndrome,or senstivity to smells in this article.) Please note, if you will keep warm,or lie in the sun.your aches will lessen.Keep the feet warm,to reduce the pains. The 'over the counter' medicines,and DARVOCET do NOT help reduce your aches. If you keep busy with normal activites and push yourself, you will be sore the next day for hours. (So when they tell you to exercies you want to scream.)This is a very,very cruel disease-- people think you are lazy,or a hypochondriac.It's limiting because you can't spend the entire day at an amusement park with family-- without frequent rest stops.There is no cure. The reason we get 'depressed' is because we go without sleep over extended periods of time. Then they give you 'ELAVIL' to reduce your spasms-- and RESTLESS LEG SYNDROME'. When you take it you gain weight.When you stop it ;or take it 'late',you have MORE spasms.I would not wish this disease on an enemy. There is one sleeping pill that has good effects.Called AMBIEN. ALthough it is a narcotic, and the insurance won't sell more than 14 at a time,and your MD must SEE you in person and not call it into the pharmacy....it DOES allow you deep sleep,with no 'hangover effect'. We need the deep sleep ('R.E.M.'-- Rapid Eye Movement sleep,to repair ourself at the cellular level) Kristy Marchetti, kkristy72@hotmail.com Posted 26/5/00 7:19 AM This is to all the people with fibromyalgia. There is a way to treat and overcome fibromyalgia I had it mildly and no longer have it , but my friend who has helped me so much, had it very bad she was in bed all the time until she came upon a company called 4/life research that has natural products for this problem. She is now free of fibromyalgia. Dr. Elrod has a book called Reversing Fibromyalgia Here is what Dr. Rob Robertson, M.D. said about it 'REVERSING FIBROMYALGIA will bring hope to millions of people who have been battling this debilitaing syndrome. Dr. Elrod writes with the wisdom of the research scientist and the compassion of the great humanist who wouldn't accept the conventional wisdom that fibromyalgia was untreatable.It is treatable it is reversilbe, and much of the credit quite justly is owed to Dr. Elrod.' I know that you can overcome fibromyalgia, it is possible, with the right combination of product you can do it. I now work for the company 4/life research and would like to help you with fibromyalgia. call this nubmer on mon 7:30pm ET for Fibromyalgia focus 1-212-796-1701,pin 4223# then Email me at kkristy72@hotmail.com or you may call me directly at 1-801-771-3740 If no answer please leave a message and I will call you back. Sincerely Kristy Marchetti, kkristy72@hotmail.com Posted 26/5/00 7:17 AM This is to all the people with fibromyalgia. There is a way to treat and overcome fibromyalgia I had it mildly and no longer have it , but my friend who has helped me so much, had it very bad she was in bed all the time until she came upon a company called 4/life research that has natural products for this problem. She is now free of fibromyalgia. Dr. Elrod has a book called Reversing Fibromyalgia Here is what Dr. Rob Robertson, M.D. said about it 'REVERSING FIBROMYALGIA will bring hope to millions of people who have been battling this debilitaing syndrome. Dr. Elrod writes with the wisdom of the research scientist and the compassion of the great humanist who wouldn't accept the conventional wisdom that fibromyalgia was untreatable.It is treatable it is reversilbe, and much of the credit quite justly is owed to Dr. Elrod.' I know that you can overcome fibromyalgia, it is possible, with the right combination of product you can do it. I now work for the company 4/life research and would like to help you with fibromyalgia. call this nubmer on mon 7:30pm ET for Fibromyalgia focus 1-212-796-1701,pin 4223# then Email me at kkristy72@hotmail.com or you may call me directly at 1-801-771-3740 If no answer please leave a message and I will call you back. Sincerely |
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Children and CFS ? Sheryl, loschool@jps.net Posted 20/4/00 9:22 PM Several children in our area in Northern California have a prolonged illness with symptoms mirroring CFS. My daughter has been ill 2 months. Sheryl |
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ROSS RIVER VIRUS AND EPSTEIN BARR JODIE P, DEVPOP@HOTMAIL.COM Posted 8/4/00 11:18 PM I AM WRITING BECAUSE I HAVE BEEN DIAGNOSED WITH EPSTEIN BARR AND ROSS RIVER VIRUSES. THE ONLY WAY TO FIND OUT IS TO GET A BLOOD TEST.MY THROAT SWELLS UP,I GET HEADACHES AND MY WHOLE BODY ACHES WHEN I COME DOWN WITH IT .IT KEEPS YOU IN BED FOR WEEKS AT A TIME. IT IS SOMEHOW RELATED TO HOW STRONG YOUR IMMUNE SYSTEM IS ON HOW TIMES YOU CAN BE DOWN WITH IT. I HAVE BEEN TO A NATRAPATH AND IT SEEMS TO MAKE A DIFFERENCE.I WOULD APPRECIATE IF ANYBODY OUT THERE HAS ANY INFORMATION ON THESE VIRUSES AND HOW TO REDUCE THE EFFECTS IT WOULD BE GREAT. THANKYOU. |
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c,ebv r.reich, flaruthir@aol.com Posted 10/3/00 9:58 AM i have had this condition for 9 years. please recommend a doctor familiar with this in my area-south florida, ft. lauderdale, boca raton, etc. r.reich, flaruthir@aol.com Posted 10/3/00 9:58 AM i have had this condition for 9 years. please recommend a doctor familiar with this in my area-south florida, ft. lauderdale, boca raton, etc. r.reich, flaruthir@aol.com Posted 10/3/00 9:58 AM i have had this condition for 9 years. please recommend a doctor familiar with this in my area-south florida, ft. lauderdale, boca raton, etc. debbie, www.debjoeb@aol.com Posted 9/4/00 7:24 AM I have been suffering from ebv for 5 years. After taking 2 years off from work to rest, I went back to work and have been for 2 1/2 years. I have had good days and bad..until last week. I had been working overtime (12-13 hours a day) for the past 3 weeks. Consequently I crashed (who wouldn't?) and have found myself out of work for the past two days sleeping for 16-18 hours a day with joint pain and headaches. Here we go again I thought. I am seeking a specialist in the Boston area, as well as information regarding studies on stress and its role in ebv. Thank you. MIKE, STRONGHEART100@aol.com Posted 5/4/00 8:37 PM I LIVE IN CENTRAL ILLINOIS IF ANYONE KNOWS A DR. IN THIS AREA OR GUIDE ME TO FIND ONE I WOULD GREATLY APPRECIATE IT I WAS JUST FIRED FOR THIS PLEASE HELP THANKS MIKE |
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burnout syndrom oda, maggieoda@hotmail.com Posted 31/1/00 5:15 AM I want to know more about the burnout syndrom. Can you tell me more about this, send me books references? Thank you |
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Legal Battles Barb, barev@home.com Posted 30/9/99 5:45 AM Hi there! I am a 31 yr old female in BC Canada currently suffering and fighting with insurance companies, and peers regarding this matter. I am so fortunate to have an excellent doctor and assistant to support and give me the reinsurance I need -often. Recently the Insurance co my company provided me with for my Long term disability benefit - Aetna Life - has terminated me. Any one else had problems in dealing with the insurance companys. I have currently hired a lawyer to help, but as any of you know this just makes life even more frustrating. I would appreciate any experiences or input you may have..... Thanks So Much! Barb Amanda, amanda.mcgregor@talk21.com Posted 18/6/2001 1:13 AM I am in the unlucky position of being immersed in the UK legal and medical battles / politics regarding ME. Due to a car accident that wasn't my fault I had a mild relapse of ME, I was sent to a neurologist who is intensely arrogant and doesn't believe in ME, he belittles the illness whilst teaching at four of the biggest Universities in London. He is now turning my life upside down in a way that the 30ft heavy goods vehicle that ran me across the motorway was not capable of doing. I have also recently seen that the biggest spokes person for ME/chronic fatigues syndrome in the UK is S. Wessley, a misled psychiatrist who will be talking on Monday June 18th at the World Congress of Neurology, Earls Court, London - The ME/chronic fatigue sufferers in the UK need help. |
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McArdle`s disease Ricardo Sterde, sterde@yahoo.com Posted 14/5/99 10:19 AM I'd like to know as much as possible about it, i've been doing researches on it for a master degree report, whatever you have please send me. thank you very much. Ricardo, Brazil. |
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new research on CFS and POTS Christopher Calder, calder@clipper.net Posted 19/11 9:14 There has been a great deal of new research on chronic fatigue syndrome and postural orthostatic tachycardia syndrome (POTS). You are invited to visit my Web page on these topics at: http://www.clipper.net/~calder/POTSWEB.html Sincerely, Christopher Calder Judy, riccijklm@aol.com Posted 4/4/00 11:35 AM I have worked in a grocery store for 20 years, I stand in one spot and position for 6 hours a day. I have all the symptoms for CFS and POTS. My second advice DR. started me on physical therapy. I know this is'nt the answer. Please send advice or imfornation. |
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Chronic Fatigue Syndrome Hayley Mckay, kmckay@seven.com.au Posted Saturday, August 22, 1998 16:2 I am a 17 year old female who is currently suffering from chronic fatigue syndrome. I appreciate the information that you have displayed, it helps me to understand why i am so tired, and to learn to accept it. If possible, it would be greatly appreciated if you could send me some more information that i could read about this illness. Thankyou greatfully, Hayley Mckay
Hayley Mckay, kmckay@seven.com.au Posted Saturday, August 22, 1998 16:2 I am a 17 year old female who is currently suffering from chronic fatigue syndrome. I appreciate the information that you have displayed, it helps me to understand why i am so tired, and to learn to accept it. If possible, it would be greatly appreciated if you could send me some more information that i could read about this illness. Thankyou greatfully, Hayley Mckay
Phil Clarke, tclarke@wr.comm.au Posted 24/11 7:44 just would like to add the comment that ANY writing on the subject of CFS in the present climate cannot avoid being factional. Understanding of CFS currently requires reading articles by several independent factions and comparing them - with the addition of personal observation. There is no Absolute Truth in CFS - it is an intensely bitter political area of medicine - in part caused by the perceived overlaps with Gulf War Syndromes and Multiple Chemical Sensitivities and Fibromyalgia etc , ahull@mpx.com.au Posted 31/8/99 2:33 PM I am a 24 year old male, who has been frustrated by fatigue and headaches over the last 12 months which at one stage forced me to resign from my job and spend seven months out of the work force. I used to be highly active playing sport up to seven days a week now walking 20 minutes to the shops and back wears me out. It is also frustrating because all the tests I have had done show that I should be a perfectly healthy young man. The doctor's are trying to tell me that all the tests are clear so that should ease my mind. They sound as if they are trying to find a way to blame the symptoms on depression or stress (of which I suffer neither). How can I get them to consider chronic fatigue as a possible cause, or am I just going to have to go insane trying to tell them that what the tests are saying and what my body is telling me are not the same thing. Please help?
Paul H. Embry, Paul@embry.com Posted 5/3/00 7:34 PM I may very well have this. I suffer from severe joint pains, neck pain, back pain, lately my ankles are swollen badly, my legs are stiff, I feel weak, especially in my lower extremities, my left foot is totally numb and my left middle toe is useless, it hangs on my sock and my pants, folds back and is very painfull, my right foot is starting to become numb, my back is numb at times, to the point of not being able to scratch an itch. I can no longer read, I fall asleep as soon as I start, I fall asleep at the computer, eating a meal usually has a profound effect on my ability to stay awake. I retired twenty months ago, I couldn't stay awake at work, I sweat from mental or physical strain, also I wake up soaked a lot of times. My body temperature is usually low,96.3 or so is not unusual. I'm on antibiotic therapy for severe kidney stone disease, I believe caused by my sweating. I could go on and on, the most interesting aspect is that I'm taking 80 mg of Adderall daily, still I can't stay focused and it doesn't keep me awake. Do you know of a Doctor in the Indianapolis Indiana area that might be able to shed some light. Thanks, Paul r.reich, flaruthir@aol.com Posted 10/3/00 9:58 AM i have had this condition for 9 years. please recommend a doctor familiar with this in my area-south florida, ft. lauderdale, boca raton, etc. r.reich, flaruthir@aol.com Posted 10/3/00 9:57 AM i have had this condition for 9 years. please recommend a doctor familiar with this in my area-south florida, ft. lauderdale, boca raton, etc. r.reich, flaruthir@aol.com Posted 10/3/00 9:57 AM i have had this condition for 9 years. please recommend a doctor familiar with this in my area-south florida, ft. lauderdale, boca raton, etc. P.LENNON, Pglenn49@aol.com Posted 20/3/00 12:27 AM I AM NOT SURE IF THIS IS WHAT I HAVE OR NOT. WHEN I WA 5 I HAD POLIO.SINCE THEN I HAVE ALWAYS BEEN TIRED.I WOULD COME HOME FROM SCHOOL ND TAKE A NAP AND THEN GET UP AND DO HOMEWORK.NOW I AM 50 AND HAVE TROUBLE STAYING AWAKE TO DRIVE TO WORK AFTER I HAVE BEEN IN BED SINCE 8:OO THE NIGHT BEFORE.I EVEN FIND MYSELF TRYING TO KEEP MY EYES OPEN WHILE WORKING.I ALSO HAVE PAIN IN MY HANDS SO BAD THAT I CAN'T SLEEP.PLEASE HELP ME,WHEN I TELL THE DOCTOR THAT I HAD POLIO AND ASK IF THAT MIGHT HAVE ANYTHING TO DO WITH THIS THEY ALWAYS SAY NO. ' Gina Buntz, origindnc@aol.com Posted 21/3/00 7:06 AM I am writing on behalf of my mother. She has been ill since early December of '99. She has fatigue and has low-grade fevers. So far extensive tests are negative as to the cause. Do you know of a doctor in the Southeast Michigan area who has knowledge and expertise in handling patients with chronic fatigue/epstein-barr virus? Thank you. mrs wallace, mdwal@aol.com Posted 29/3/00 10:06 AM I WOULD LIKE TO FIND A SPECIALIST IN CFS - IN THE GREATER HARTFORD AREA(CONNECTICUT) THANKS Barbara Whitcher, djwhitcher@aol.com Posted 6/4/00 7:44 AM On March 22, 2000, I donated a kidney to a younger brother who has PKD. Just days prior to the surgery I was terrified to see that recent blood work suggested I might be sufferening from EBV or CFS. I had suffered from a recent bout with bronchitis and sinusitis, so I just shrugged it off and let it pass. Is it possible that I could be suffereing from CFS or EBV? I printed out information from your website and will try to digest it this afternoon so I can ask questions of my doctor tomorrow morning at my appointment. Can you please suggest a physician in Yakima, Wasington, or Seattle, Washington or Portland, Oregon, area who speicializes in these illnesses? Since surgery I have been having trouble with insomnia, pain control, profuse sweating and controling my emotions. I have an appointment tomorrow to see my internist, so hopefully she can give me some answers and much needed relief. Thank you for your assistance. Barbara paul mcguinness, LpoolMcG@aol.com Posted 12/4/00 9:20 AM in the recent past one of the major tv networks had a story regarding people who had surgery at the back of the lower neck in order to increse the blood flow to the brain. does anyone recall the show and have detail on which network etc etc Geri Gigliotti, Lilpee@aol.com Posted 19/4/00 1:26 PM I am a 32 yr old female. For the past 3 yrs I have been going rounds with my dr trying to find a cause for my exhaustion. I had to sell my business in '98 and did nothing for almost a year. The gastrointestinal problems, poor concentration, tiredness even when trying to be moderate(even just walking in the park)with exercise,muscle tenderness, headaches(Bufferin has become a best friend)the worst part is the inability to get a restful night sleep. Any information on vitamins, diet changes etc. Can you tell me any DRs in the Philadelphia area in this field. help is greatly appreciated Thank you in advance. Geri Larry, Talon55014@aol.com Posted 25/4/00 10:42 AM I would like to suggest that maybe CFS could be linked to toxic exposures. I was exposed to Naphtha in 1998 and have many of the symptoms that your page describes. I also had elevated liver test and other symptoms from the exposure, but I also now have the same symptons that you describe here. Thanks for making this page. strep[hen tassie, steroe@aol.com Posted 24/4/00 5:48 AM I have several of the symptoms ie., sore joints, muscles for no apparent reason. Insomnia. Many times after a full 5 or six hours sleep I can go back to sleep in my easy chair. I take several medications for sugar diabetis and high blood pressure daily. I would appreceate a physicians mane in my area or a medical group within 100 miles that I can see to be tested. I have excellent traditional medical insurance and am not too restricted in where I may go. My zip code is 079028. Your recommendtions would be appreciated. Tommie, opsahlflyboy@aol.com Posted 25/4/00 4:04 AM For over a year now I have struggled with the possiblity of having CFS, I'm depressed, tired, lack concentration at work and home, a good nights sleep is a thing of the past, I don't eat right and I have gained 30lbs in 18 months. I use to run 7 miles a day , 7 days a week and worked out and a regular basis. Now doing everyday chores makes me exhausted. Please send me more information on this syndrome and how to fight the effects it has on me. |
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