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Chronic Fatigue Syndrome
Causes and symptoms
- viral infections
- chemical toxins
- immune abnormalities
- psychological disorders
- muscle pain (myalgia)
- joint pain (arthralgia)
- sore throat
- fever and chills
- tender lymph nodes
- trouble concentrating
- memory loss
- Unexplained continuing or recurring chronic fatigue for at least six months that is of new or definite onset, is not the result of ongoing exertion, and is not mainly relieved by rest, and causes occupational, educational, social, or personal activities to be greatly reduced.
- Four or more of the following symptoms: loss of short-term memory or ability to concentrate; sore throat; tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new type, pattern, or severity; unrefreshing sleep; and post-exertional malaise (a vague feeling of discomfort or tiredness following exercise or other physical or mental activity) lasting more than 24 hours. These symptoms must have continued or recurred during six or more consecutive months of illness and must not have started before the fatigue began.
- Fludrocortisone (Florinef), a synthetic steroid, which is currently being tested for treatment of people with CFS. It causes the body to retain salt, thereby increasing blood pressure. It has helped some people with CFS who have neurally mediated hypotension.
- Beta-adrenergic blocking drugs, often prescribed for high blood pressure. Such drugs, including atenolol (Tenoretic, Tenormin) and propranolol (Inderal), are sometimes prescribed for neurally mediated hypotension.
- Gamma globulin, which contains human antibodies to a variety of organisms that cause infection. It has been used experimentally to boost immune function in people with CFS.
- Ampligen, a drug which stimulates the immune system and has antiviral activity. In one small study, ampligen improved mental function in people with CFS.
Chronic airflow limitation has the highest morbidity rate of any significant chronic pulmonary disorder in the United States and is the second most common cause of hospital admissions. It is difficult to estimate its exact incidence because most diseases of the respiratory tract are not reportable and there is some confusion in definition of terms related to diseases of this type. However, the Social Security Administration reports that CAL ranked only second to heart disease as the cause of disability in men over the age of 40. The incidence of CAL is increasing and, although not all specific causes are known, factors contributing to its development and affecting its degree of severity have been identified. Heavy cigarette smoking is probably the most important factor, and others are industrial pollution, occupational exposure to irritating inhalants, allergy, autoimmunity, genetic predisposition, and chronic infections.
Prevention is best accomplished through education of the public about the hazards of cigarette smoking and air pollution and the need for early detection and prompt treatment of respiratory disorders that could become chronic in nature. The American Lung Association is particularly interested in education of lay persons in these matters and in the prevention of all types of respiratory disorders. This agency, which has local offices distributed throughout the country, is an excellent source of information about prevention and the latest developments in the treatment of respiratory diseases.
As the disease progresses, the symptoms of dyspnea, weakness, and cough become more severe. The patient has difficulty expelling air from the lungs and the cough becomes more productive of thick, tenacious sputum. The patient looks anxious and drawn and may speak in short, hesitant sentences. Symptoms related to disturbances of the respiratory and circulatory systems and acid-base balance may appear as these complications develop.
Chronic airflow limitation is a disease that has no cure; its chronic nature requires an ongoing program of assessment and long-term care that is planned and revised as the patient's needs dictate. Whatever the patient care setting—acute care facility, out-patient clinic, long-term care facility, or home—the elements of care presented below are essential to the effective management of the condition.
When patients are informed about the purpose of the tests and therapy they are more likely to participate in the planned regimen of care and to become motivated to continue carrying out their responsibilities in the management of their illness. Those who work with the patient should clarify the goals and offer encouragement when they make progress toward those goals, no matter how slight the improvement might be. This implies, of course, that all members of the health care team have an understanding of the disease, the meaning of various test values, and the purpose of each aspect of care.
Poor appetite and the potential for dehydration are problems commonly associated with pulmonary disease. Purulent sputum, coughing, and fatigue can contribute to loss of interest in eating. Mouth breathing, increased respiratory rate, and frequent expectorating contribute to the loss of fluid.
Frequent oral hygiene and mouth care can help diminish mouth odor and unpleasant taste. A short period of rest just prior to each meal can help overcome the problem of fatigue. Meals should be spaced so that the stomach is not overloaded at any one time; five small meals, rather than three a day, can help avoid overfilling of the stomach and interference with breathing. Postural drainage and similar procedures should not be done on a full stomach, nor should they be scheduled just before a meal. Adequate hydration can be accomplished by an intake of at least 3000 ml of liquid each day. Unless contraindicated, this should include bouillon, fruit juices, and other liquids the patient finds enjoyable and refreshing.
Physical activity may be severely limited by CAL because of inadequate ventilation and decreased circulation. As with all other aspects of patient care, plans to increase exercise tolerance and promote physical activity should be designed according to the patient's cardiopulmonary status. Techniques to promote muscular relaxation and breathing control are the first step, followed by gradual increase in activity as the patient's progress and general physical condition permit.
Adequate rest is essential, but the hazards of immobility must be avoided, especially in patients who are fearful that any physical activity may precipitate an exhausting episode of coughing and dyspnea. The goal is to provide sufficient rest so that the body's natural restorative processes can work, but to avoid long periods of sleeping and lying in bed during the day.
When the patient's cardiopulmonary condition is such that bed rest is prescribed, care is taken to avoid complete physical inactivity, which will only serve to increase problems of inadequate ventilation and muscle weakness. Proper positioning is essential and should be such that the neck is extended, with the chin well off the chest. Support under the thighs while the patient is supine will release tension on abdominal muscles, thereby facilitating movement of the diaphragm for deep breathing and effective coughing. The arms and hands should also be supported on pillows and positioned away from the sides to allow for maximum lung expansion without elevation of the upper chest. A foot board is placed so as to maintain good posture, promote comfort, and ensure good muscle tone in the legs and feet.
Contact with others who have an upper respiratory infection should be avoided, as should being in large crowds during the season when such infections are common. A high level of resistance should be maintained through good personal hygiene and adequate nutrition. Vaccines to guard against influenza are recommended. Patients should be taught to watch for changes in color and amount of sputum. If a change in sputum or any other symptoms of infection appear, this should be reported.
Hydration is considered especially valuable in improvement of ventilation. Inhaled air should be moist so as to thin the secretions for removal and soothe the irritated mucous membranes. This can be accomplished through the use of vaporizers and humidifiers, either for environmental humidification in the patient's room or in conjunction with oxygen therapy and the administration of aerosols. Oral intake of fluids is also important. Bronchodilators, usually in the form of aerosols, sometimes as oral medications, are usually prescribed. The aerosol method of delivery depends on the ability of the patient to breathe deeply so that the medication reaches the lower segments of the respiratory tract.
Controlled deep breathing patterns are especially helpful in emptying the lungs and providing adequate ventilation. The patient with CAL is taught to expand the lower chest and to use the accessory muscles and diaphragm to improve the breathing pattern. Performance of these breathing patterns is important because patients probably are not in the habit of breathing in the most effective manner, making optimum use of remaining pulmonary function. The patient is taught slow, controlled, and steady breathing. Respiratory effort should be concentrated on slow expiratory flow through parted or pursed lips. Pushing the air out of the lungs too forcefully can bring on collapse of the airway structures. During instruction, the caregiver watches for signs of exhaustion and warns against overdoing the deep breathing until the patient has adjusted to it. A correct breathing pattern should be coordinated with all of the patient's daily activities so that it becomes habitual and is done without too much thought.
Effective coughing does not come easily to patients with this condition. They may have experienced too many episodes in which a dry hacking cough has caused exhaustion, increased dyspnea, and prevented removal of tenacious sputum from the air passages. They must be convinced that, when done correctly, coughing can remove mucous plugs and relieve rather than produce dyspnea. Patients should be warned that explosive coughing is not very effective, can damage the airways, and can lead to exhaustion. The objective of coughing is to move secretions upward gradually so that they can be expectorated.
Postural drainage is also valuable in facilitating the removal of mucus from the air passages. The various maneuvers involved in this procedure are designed to take advantage of gravity flow as a means of clearing specified segments of the air passages when normal air flow is not sufficient to move secretions or stimulate the cough reflex. Chest percussion and vibration may be employed during postural drainage to loosen secretions. oxygen therapy is used as a supportive measure when there is decreased oxygenation of arterial blood. It can be administered to ambulatory patients being cared for at home. Blood gas analysis is an excellent guide in determining the need for initiating oxygen therapy and for monitoring dosage.
chronic fatigue syndrome (CFS),
The prevalence of CFS in the U.S. is currently estimated at 800,000 (0.5% of women and 0.3% of men). Prevalence is apparently not affected by race or socioeconomic status. CFS was first defined by the U.S. Centers for Disease Control in 1988. According to the case definition as revised in 1994, CFS consists of both (1) persistent or relapsing fatigue not resulting from exertion or relieved by rest, having a clear-cut onset, lasting for at least 6 months, and causing substantial (for example, 50% or more) reduction in the level of physical activity, and (2) simultaneous occurrence of 4 or more of the following symptoms for at least 6 months: headache, muscle pain, joint pain, sore throat, tender cervical or axillary lymph nodes, prolonged malaise after physical exertion, failure to be refreshed by sleep, and cognitive deficits (for example, impairment of attention, concentration, and short-term memory). Physical findings are typically unremarkable. However, many patients experience postural tachycardia and delayed orthostatic hypotension. Although routine laboratory tests yield normal results in CFS, special studies have detected certain abnormalities (for example, elevation of inflammatory cytokines, increased numbers of CD8-activated cytotoxic T cells, depression of natural killer-cell function, inactivation of the 2,5 ribonuclease-L antiviral defense pathway, and downregulation of the hypothalamic-pituitary axis manifested by low levels of ACTH and cortisol) in some but not all patients. A complex deregulation of immune response triggered by viral infection has been suggested as the cause of CFS. An influenzalike onset is more common during winter than in other seasons. Psychiatric comorbidity is common, but the current consensus is that CFS is not induced by chronic anxiety or depression. Of numerous treatments that have been used in this disorder, graded exercise and cognitive-behavioral therapy have been most effective. Tricyclic antidepressants, selective serotonin reuptake inhibitors, and nonsteroidal antiinflammatory drugs have been helpful in relieving pain and sleep problems for some patients. On long-term (for example, 5+ years) followup, 20-50% of adult patients with CFS show some improvement but only 5-10% regain full function.
chronic fatigue syndrome
chronic fatigue syndromeA condition resembling poliomyelitis, which was first described in the mid-1980s in California, often following viral infections (e.g., herpes, hepatitis, CMV) or which may be induced by an unrecognised virus. CFS is defined by a new onset (not lifelong) of unexplained, persistent fatigue unrelated to exertion and not substantially relieved by rest, which causes a significant reduction in previous activity levels. While CFS had been associated with EBV infection, more than half of those with the CFS improve without a change in EBV titers.
Unknown, psychosocial dysfunction has been implicated.
Unexplained persistent fatigue, inability to concentrate, weakness, lymphadenopathy and malaise, severe headache, myalgia, myasthenia, variable cranial and peripheral nerve dysfunction and depression.
None; alleged reported cures are thought to be due to placebo response or spontaneous remission; recuperation requires up to a year.
Chronic Fatigue syndrome symptoms
Four or more of the following symptoms that last six months or longer:
• Impaired memory or concentration;
• Post-exertional malaise, where physical or mental exertion bring on extreme, prolonged exhaustion and sickness.
• Unrefreshing sleep.
• Headaches of a new kind or greater severity.
• Sore throat, frequent or recurring.
• Tender lymph nodes (cervical or axillary).
chronic fatigue syndromeChronic fatigue & immune dysfunction syndrome
A chronic, idiopathic debilitating condition that may follow viral infections–eg herpes, hepatitis, CMV, EBV; CFS is probably a real entity; linked to a combination of CMV and EBV infection Clinical Unexplained fatigue, weakness, muscle pain pain, lymphadenopathy and malaise; CFS is a diagnosis of exclusion; there are no valid tests, treatment consists of relief of symptoms, life style changes; some cases may resolve with time Management None; the 'cures' reported may be mere placebo effect or spontaneous remission. See Fibromyalgia syndrome.
chron·ic fa·tigue syn·drome(kron'ik fă-tēg' sin'drōm)
Synonym(s): chronic fatigue and immune dysfunction syndrome, myalgic encephalomyelitis.
chronic fatigue syndromeThe currently-preferred name for the condition formerly known, with questionable accuracy, as myalgic encephalomyelitis (ME). This distressing condition predominantly affects women and features severe fatigue, muscle aching and emotional disturbance brought on by exercise, sometimes minimal. This complex is found in many conditions and the diagnosis is usually made by the subject after thorough investigation has proved negative. The medical profession is divided as to whether or not this is an organic entity. There is no evidence that the condition involves inflammation of the brain or spinal cord as the earlier name would imply. There is, however, no doubting the distress and disability of the unfortunate sufferers and their families. Also known as Royal Free disease, epidemic neuromyasthenia, Otago mystery disease, Icelandic disease, institutional mass hysteria, benign myalgic encephalomyelitis and the postviral fatigue syndrome. The most effective treatment to date has been cognitive behaviour therapy which is said to effect improvement in about 70 percent of cases.
Patient discussion about chronic fatigue syndrome
Q. I think i might have chronic fatigue syndrome or fibromyalgia. how can i tell the difference? So far, the doctors have not been able to diagnose anything and have basically been putting me on random medications just to relieve the symptoms. Symptoms I have: Fatigue (sleeping thirteen hours +) exhaustion pain in my knees, ankles, and weirdly my elbows. Headaches, congestion. I’ve been really nauseous occasionally and ended up having to go to the ER because of it.
Q. What can cause chronic fatigue? For the last few weeks I’ve been having this strange fatigue, I sleep 12-14 hours at night (I used to sleep 6-7 hours), and I’m tired all day long. It really bothers me. What can is be?
Q. How do you know when your tiredness is a chronic health symptom? Sometimes I'm just overwhelmingly tired and need to lay down for awhile. Then I feel better but then I haven't accomplished a lot. At least after I rest I am able to do things again. What is Chronic Fatigue all about?
I tell you what- here is a very good site I use all the time. You enter a symptom and it gives you all the illnesses that have the symptom. Then you enter another symptom you have and it narrows the list.
I already entered fatigue for you:
and here is a site about chronic fatigue syndrome that you can look for differences: