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Chronic fatigue syndrome
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Chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is a condition that causes immense tiredness to a sufferer, often to the point where they cannot carry out everyday tasks.

Table of contents
1 Introduction
2 The name
3 Symptoms
4 Long term course
5 Activity levels
6 Getting diagnosed
7 Demographics
8 Related illnesses
9 Day to day patterns
10 What causes CFS?
11 Treatment
12 Notable sufferers
13 External links

Introduction

In strict medical terms, the name chronic fatigue syndrome refers only to a pattern of symptoms (see below). It can't be called a disease because there's no medical test that can link all cases (like the HIV test does in AIDS). But many people believe CFS is one illness because so many cases are so similar.

A number of theories have been advanced regarding CFS, ranging from its being a new viral disease, to a new name for an existing disease, to being a form of depression, hysteria or even malingering. People with the symptoms of CFS regard the latter theories as disquieting and insulting.

The name

There are a number of different syndromes which have been at various times identified with CFS.

Symptoms

There are four main categories of symptoms in CFS:

Long term course

Some cases of CFS start gradually, but the majority start suddenly, often triggered by the flu or some other illness. People with CFS may get better after a few years or many years or may not get better at all. No one is sure whether anybody is truly cured or whether their illness has just subsided enough for them to live a more normal life.

Sudden Onset

Most people with CFS report a sudden, drastic start to their illness. Sometimes people can remember a specific day or even hour when they first got sick.

Often, the illness starts with, or is triggered by, another illness. Many people report getting a case of the flu which slowly changes into CFS. Other people have had a case of Lyme disease which is treated fully, but the symptoms change from those of Lyme to those of CFS. Other triggers include car accidents, moves to a new home, and stressful life situations. Some patients say they felt unusual or uneasy for a short period (days or weeks) before the onset.

Gradual Onset

The other cases have a very slow, gradual onset, sometimes spread over years. People with gradual onsets often don't realize there is anything wrong for years because it happens so slowly.

There is no standard course for CFS. Everyone diagnosed with CFS has had it for at least six months; they would not be diagnosed otherwise. It is possible that not all cases of CFS are chronic: some people may have CFS for four months and never get diagnosed. It's also possible that there are people who have CFS whose level of disability is so low they never get diagnosed.

People with CFS may get better after a few years or after many years, or never at all. They may reach a plateau at some constant level of health or may progressively decline. Often, the most prominent symptoms change over time or cycle through time. No one is sure whether anybody is truly cured or whether their illness has just subsided enough for them to live a more normal life. Relapses are common, especially after stressful life events.

Activity levels

Some people are more limited than others. The sickest are bedbound, while some people are self-reliant, and some are able to work or attend school. Some people with CFS can push themselves to do extraordinary things but feel much worse afterward. One notable CFS sufferer is soccer legend Michelle Akers, who reported struggling with the illness for much of the later years of her career. However, extreme sufferers like those confined to bed felt that an active professional athlete "poster child" like Akers only helped to trivialize the syndrome in the eyes of the public (the infamous "Michelle Akers has it and she plays soccer, so why are you complaining?" reaction), and thereby made it much more difficult for those who are highly incapacitated to be taken seriously.

Getting diagnosed

Diagnosing CFS is very difficult. There is no conclusive test for CFS, so doctors must rely on their experience and intuition. Once a doctor suspects CFS in a patient who meets the general diagnostic criteria, the doctor must successively eliminate all other potential testable causes of their set of symptoms. CFS, therefore, is what is called an exclusionary diagnosis.

Historically, many doctors have been unfamiliar with CFS, and some have refused to diagnose it. This situation is rapidly changing, with more doctors willing to diagnose it and more diagnoses each year.

Demographics

Because there is no definitive test to identify CFS — or even agreement about what CFS is — estimates of its prevalence vary widely. Studies in the United States have found between 75 and 420 cases of CFS for every 100,000 adults.

Far more women than men get CFS — between 60 and 85% of cases are women. Minorities and low income people are slightly more likely to have CFS. Though people of all ages can get CFS, and precise statistics are not available, the prevalence among children and adolescents appears to be lower than for adults. Among minors with CFS, about half are boys and half girls.

CFS occurs both in isolated cases and large-scale outbreaks. Blood relatives of people who have CFS are more likely to get it.

Related illnesses

There are some illnesses so similar to CFS that it is hard to distinguish between them. People with fibromyalgia have muscle pain and sleep disturbances. Those with multiple chemical sensitivities (MCS) are sensitive to chemicals and have sleep disturbances. Many veterans with Gulf War syndrome (GWI) have symptoms almost identical to CFS. Post-polio syndrome also bears remarkable resemblance to CFS.

Other disorders with known causes and treatments that may produce CFS-like symptoms are Lyme disease, gluten intolerance (Celiac disease and related disorders), and vitamin B12 deficiency.

Day to day patterns

Payback Effect

One of the most common and recognizable aspects of CFS is what is called "post-exertional malaise," or, more colloquially, the "Payback Effect." When people with CFS exert themselves, their symptoms get worse afterward. Exertion could be physical or mental exercise, doing routine tasks, such as driving, cleaning, or eating, or handling a stressful situation. The harder the exertion and the longer it lasts, the worse the symptoms will be afterward. The payback effect leads to a few typical patterns, sometimes called "The Yo-Yo Pattern" and "The Downward Spiral."

The Yo-Yo Pattern

The Yo-Yo Pattern happens when people work very hard at some activity, but only on good days. This leads to worse symptoms which prevents them from working for the next few days. When they feel better, they work extra hard to make up for the bad days--or just because they're so excited to feel good, but this leads to them feeling bad again...

The Downward Spiral

The Downward Spiral happens whenever feeling bad puts a patient in a situation that makes them feel worse. This is similar to the yo-yo, but in the downward spriral, people don't have time to recover on bad days. Here are some examples:

Duration

These patterns can happen over days, weeks, or longer periods. They can happen together (over different periods of time) or alone.

What causes CFS?

The cause of CFS is unknown, although a large number of causes have been proposed, and several proposed causes have very vocal and partisan advocates. Among proposed causes:

In all likelihood it will turn out that CFS is not a single disease but several, and that for many of these several factors are involved in the development of the disease.

Treatment

The treatments that are proposed and often attempted for CFS are as varied as the suggested causes, and can generally be classified according to the specific cause that they presume. Unfortunately, since CFS symptoms tend to vary over time and will usually get gradually better once the initial crisis is past, it is very easy for someone to become convinced that a particular treatment has helped them (or not), regardless of its true effectiveness.

Location: The medical community has not investigated this theory, but it seems that many people with CFS are very healthy when in certain locations, such as the Caribbean: http://groups.yahoo.com./group/CFS_CFIDS_ME/ As there is no one identifiable cause or falsifiable diagnosis for CFS, there is also no one treatment protocol or "magic bullet". Due to the multi-systemic nature of the illness, and others like it, an emerging branch of medical science, called psychoneuroimmunology is looking into how all the various theories fit together. Hopefully, a comprehensive treatment protocol will emerge as well.

Notable sufferers

Some notable sufferers of CFS are:

External links