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« on: April 08, 2006, 03:52:35 pm »

Diagnosis: Diagnostic Testing
The Role of Laboratory Tests in Diagnosis of Chronic Fatigue Syndrome
Dr. Charles W. Lapp

Current diagnosis of chronic fatigue syndrome (CFS) is based primarily on whether or not the patient's symptoms fit the case definition of the condition established by the Centers for Disease Control and Prevention (CDC). So laboratory testing in the person suspected of having CFS should be conducted for two reasons: to exclude other plausible causes for the patient's symptoms and to identify disorders that are con-current or that may contribute to poor health.

The authors of the 1994 CDC criteria for CFS closely studied the tests  most helpful in excluding other causes of chronic fatigue and settled on the battery shown below1.

Unfortunately, there is no one diagnostic test that can be recommended at this time, although research is underway. Some studies have actually demonstrated the futility of performing more extensive studies in making the diagnosis of chronic fatigue syndrome2.

Of course, if disorders with overlapping symptoms are suspected, then specific studies should be obtained to confirm or rule out those diagnoses. For example, a person with suspected systemic lupus erythematosis should have antibody and complement studies performed, and a person suspected of multiple sclerosis should have an MRI, lumbar puncture or measurement of evoked potentials. It is beyond the scope of this article to discuss the differential diagnosis of chronic fatigue syndrome in detail, but the chart below  provides a list of diagnoses that have many features in common with CFS, and these should be excluded by history, examination and appropriate testing.

In the past, many researchers tested for immune status, infectious agents and disorders of the endocrine or central nervous systems. However, with experience we have learned that it is no longer necessary to perform such studies unless the patient is clearly informed of the investigational nature of the tests, the testing is done as part of a protocol-based research study or the diagnosis is in question.

We know, for example, that the hypothalamic-pituitary-adrenal axis is suppressed in CFS3, which leads to low 24-hour cortisol levels, flat ACTH response curve, and even low growth hormone (somatomedin, IGF-1) levels. Numerous studies have demonstrated punctate T2 weighted lesions within the cerebral convexities of CFS patients4&5, and SPECT scanning has repeatedly demonstrated a pathological decrease of blood flow in the cerebrum and mid-brain6. We also know that the immune system is characteristically up-regulated in CFS, but that natural killer cell activity is typically low. As a result, latent pathogens may not be fully suppressed, and serology for herpes viruses (like the Epstein Barr virus), chlamydia species or mycoplasma, for example, may show reactivation or positivity more commonly in persons with CFS than in the general population.

So, aside from the exclusionary tests mentioned above, what should you order when CFS is suspected? I personally tend to order an antinuclear antibody (ANA), a Lyme serology (ELISA with a reflex Western Blot for borderline or positive tests), tilt table testing for dysautonomias and polysomnography. The first two should be strongly considered if there is any suggestion of frank arthritis or the patient has frequented a Lyme-endemic area. The tests are relatively inexpensive and lupus and Lyme disease so closely mimic CFS and are so imminently treatable that the diagnoses should not be missed for the sake of conserving resources.

The downside, however, is that borderline ANA and Lyme ELISA tests are not uncommon in CFS7, and such indeterminate results may trigger both anxiety and more indiscriminate testing.

Tilt table testing is used to demonstrate the dysautonomia that occurs in up to 96% of persons with CFS8, including neurally mediated hypotension, symptomatic orthostatic tachycardia and milder forms of orthostatic intolerance. These dysautonomias are treatable, and appropriate therapy can significantly reduce the symptoms of CFS. Unfortunately, one cannot clinically predict who will or will not have a positive test, nor can one predict the type of dysautonomia9, so virtually all patients can benefit from the study.

Tilt table testing is relatively expensive and must be performed properly at centers with empathy and good understanding of the orthostatic intolerance seen in CFS8. Therefore, this procedure may not be available to all patients.

There is a high incidence of sleep apnea and other sleep disorders occurring in conjunction with CFS. The recognition and management of such sleep disorders can markedly improve symptoms and prevent secondary complications, such as weight gain, hypertension and even stroke. Patients at high risk (history of snoring, apneic periods, gasping awake, obesity and hypertension, short neck and/or retrognathism) should be strongly considered for sleep monitoring.

While they are admittedly less accurate than inpatient studies, home sleep monitoring studies can be quite helpful in ruling out sleep apena they are less expensive, much less intrusive and frequently available from sleep centers. The clinician will have to rely on a history from the patient or family if restless legs, periodic leg movements or myoclonus are suspected, however, because home monitoring generally does not include any muscle monitoring11.

Tests and Reasons

Test
Complete blood count (CBC)
Reason
Helps rule out anemia, leukemia and other blood disorders as well as collagen vascular disorders such as lupus.

Test
Blood chemistry
Reason
Confirms normal blood sugar, electrolytes, renal and liver function, calcium and bone metabolism and serum proteins.

Test
Thyroid function studies
Reason
Confirms normal thyroid function, a common cause of muscle aches and fatigue.

Test
Sedimentation rate
Reason
General indicator of  inflammation, infection and collagen vascular disorders.

Test
Urinalysis
Reason
Excludes infection, renal disease and possibly collagen vascular disorders.


Conditions that share some symptoms with CFS

Autoimmune
Behcet’s syndrome
Dermatomyositis
Lupus erythematosis
Polyarteritis
Polymyositis
Reiter’s syndrome
Rheumatoid arthritis
Sjogren’s syndrome
Vasculitis

Blood
Anemia
Hemochromatosis

Endocrine
Addison’s disease
Cushing’s syndrome
Diabetes mellitus
Hyperthyroidism
Hypothyroidism
Ovarian failure
Panhypopituitarism

Gastrointestinal
Celiac disease
Crohn’s disease
Irritable bowel syndrome
Sarcoidosis
Ulcerative colitis

Infectious
Bacterial endocarditis
Chronic brucellosis
Hepatitis
HIV infection
Lyme disease
Occult abscess
Poliomyelitis/post polio syndrome
Tuberculosis

Parasitic infection
Amoebiasis
Echinococcosis
Giardiasis
Toxoplasmosis

Fungal infection
Blastomycosis
Coccidomycosis
Histoplasmosis

Malignancies
Hodgkin’s disease
Lymphoma

Metabolic/toxic
Ciguatera poisoning
Exposure to toxic chemicals, heavy metals, pesticides
McArdle’s syndrome

Neuromuscular
Fibromyalgia
Muscular dystrophies
Multiple sclerosis
Myasthenia gravis

Psychiatric
Alcohol/drug abuse
Anxiety disorder
Depression
Hyperventilation syndrome
Manic-depressive illness
Schizophrenia

Others
Dysautonomias
Narcolepsy
Sleep apnea
Sweet’s syndrome
Wegener’s granulomatosis  [/size] [/color]

References

Fukuda K et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Annals of Int Med.1994; 121(12):953-59.
Lane TJ, Matthews DA, Manu P. The low yield of physical examinations and laboratory investigations of patients with chronic fatigue. Am J Med Sci.1990;299:313-18.
Demitrack MA et al. Evidence for impaired activation of hypothalamic-pituitary-adrenal axis in patients with chronic fatigue syndrome. J Clin Endocrinol Metab.1991;73:1224-34.
Buchwald D et al. A chronic illness characterized by fatigue, neurologic and immunologic disorders, and active human herpesvirus type 6 infection. Ann Intern Med.1992:116 (2):103-13.
Schwartz RB et al. Detection of intracranial abnormalities in patients with chronic fatigue syndrome: comparison of MR imaging and SPECT. Am J Roentgenology.1994;162:935-41.
Schwartz RB et al. SPECT imaging of the brain: comparison of findings in patients with chronic fatigue syndrome, AIDS dementia complex, and major unipolar depression. Am J Roentgenology.1994;162:943-51.
Bates DW et al. Clinical laboratory test findings in patients with chronic fatigue syndrome. Arch Int Med.1995;155:97-103.
Bou-Holaigah I et al. The relationship between neurally mediated hypotension and the chronic fatigue syndrome. JAMA.1995;274:961-67.
Personal communication with Dr. Peter Rowe at Johns Hopkins University, Baltimore, Md.
Buchwald D et al. Sleep disorders in patients with chronic fatigue syndrome. Clin Infect Dis.1994;18 (1):568-72.
Victor LD. Obstructive sleep apnea. Am Fam Phys.1999;60 (8):2279-86.
Dr. Lapp practices internal medicine at the Hunter-Hopkins Center in Charlotte, North Carolina.He is also a Clinical Associate Professor of Family and Community Medicine atDuke University. 
« Last Edit: May 17, 2006, 05:36:23 pm by Kathy » Logged


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« Reply #1 on: April 08, 2006, 04:03:22 pm »

Treatment: Supportive Therapy


With no known cause or cure for chronic fatigue and immune dysfunction syndrome (CFIDS), treatment is based on relieving symptoms and, more specifically, the severity of symptoms. Treatment options are supportive in nature in that they can provide a measure of comfort and symptom relief without the use of medications.

A candid conversation between the primary treating physician and the person with CFIDS (PWC) is essential to finding therapies that may prove helpful.

Supportive, symptomatic therapy is individualized. The following dimensions should be considered as treatment is planned: the PWC's medical, social and financial resources; general physical, mental and emotional health status; personal preference and individual abilities.

Therapy Options

Exercise/Physical Therapy/Massage 
Therapies to help PWCs maintain some level of flexibility and muscle tone may be needed to relieve pain and reverse deconditioning that may have occurred. There are conflicting opinions on the benefits of exercise because of the resulting relapses and fatigue that PWCs often experience. A physical therapist or exercise physiologist, together with the PWC, can develop a personalized plan that maximizes the capabilities of the PWC while ensuring that symptoms are not exacerbated by too vigorous exercise. Generally, the PWC begins very slowly (1-2 minutes of gentle stretching each day for a week) and gradually increases activity level (add one minute each week, as tolerated.) Even severely affected PWC's may benefit from an activity plan that is individualized to their situation.

Occupational Therapy
CFIDS can have a profound effect on a PWC's ability to work. The inability to perform on the job may require minor adjustments for those with mild symptoms, while those with more severe symptoms may be unable to work at all. An occupational therapist can assess the PWC who remains on the job and recommend approaches to help utilize energy more efficiently. Disabled PWCs who are considering a return to work or need to develop energy-saving strategies may also benefit from a consultation with an occupational therapist.

Nutrition Therapy
A well balanced diet provides a healthy foundation for everyone. The American Dietetic Association's food pyramid guidelines are designed to promote good nutrition. PWCs who have allergies, digestive disorders, and other food-related problems may wish to visit a registered dietitian who can outline nutritional needs (and necessary supplements), determine substitutes for problem-causing foods that have been eliminated from the diet and provide tips for meal planning and preparation that help conserve energy.

Dietary/Herbal Supplements 
Several dietary and herbal supplements are reported to have immune- and energy-boosting properties and some PWCs have experienced symptom improvement when taking these products. Using common sense to ensure safety when taking these supplements is important. The primary treating physician needs to be informed of any supplement use to avoid the possibility of interactions with medications being taken, as well as to help track response to therapy. PWCs need to be alert to products that come with outlandish promises and "magical cures" and thoroughly investigate these product claims before purchasing and using the product.

Sleep Therapy
Unrefreshing sleep is a much-reported symptom and is one of eight symptoms in the CFIDS case definition. Sleep management techniques may help PWCs. Sleep studies can be done to identify any primary sleep disorders to rule out an underlying physiological cause for sleep disturbances such as sleep apnea. Sleep centers can also assist PWCs with various sleep management techniques. In addition, PWCs need to be alert to the possibility that some medications and supplements may interfere with sleep.

Mental Health Counseling 
Anxiety and depression are potential effects of CFS as PWCs strive to cope with the life-altering changes that occur with a chronic illness. The primary treating physician may conduct a brief mental health evaluation and, if necessary, make a referral to a mental health professional who can conduct a more in-depth assesment and assist the PWC in making positive adjustments.

Cognitive Behavioral Therapy (CBT)
This form of therapy combines cognitive therapy with behavioral therapy and focuses on the person's thoughts, assumptions, beliefs and habitual reaction to these thoughts and beliefs. During CBT, PWCs learn methods to help re-direct thinking processes and take steps to modify their reactions. Relaxation techniques, such as deep breathing or meditation, are often utilized in CBT. There is evidence that this therapy has helped some PWCs cope better with the effects of a chronic, unpredictable illness, although it doesn't offer a cure.

Summary
In addition to the modalities suggested above, complementary therapies, such as acupuncture, yoga and tai chi can offer some benefit. Overall, it's important to remember that responses vary: what works for some people does not work for others. PWCs often try multiple diverse treatments for symptom relief. PWCs who are aware of treatment options and are willing to frankly discuss these with their primary treating physician will likely have greater opportunities for symptom management.

Articles of Interest

Acupuncture for CFIDS By David Hoh
Cognitive Behavioral Therapy: Implications for CFS Reported by Vicki L. Carpman
Occupational Therapy; A new approach for persons with CFS By Lucy Swan, MOT, OTR and Gloria Furst, MPH, OTR
Rehabilitation of the Patient with CFS; A physical therapy approach
By Sue Ann Sisto, MA, PT
Should you exercise? For PWCs, it’s an important but an individual question
By Patti Schmidt
Sleep Disorders Dr. Charles W. Lapp
Tai Chi Chuan: A Pathway of HopeBy Janet Quillen
« Last Edit: May 17, 2006, 05:35:02 pm by Kathy » Logged


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« Reply #2 on: June 15, 2006, 09:39:03 am »

Chronic Fatigue Syndrome: Cause Unknown, Diagnosis Difficult

Chronic fatigue syndrome, or CFS, is a complex disorder characterized by weakness and a profound fatigue that is not improved by bed rest. The illness can be worsened by physical or mental activity. People with CFS most often function at a much lower level of activity than they were able to before the illness began. In addition to these features, patients report various nonspecific symptoms, including weakness, muscle pain, impaired memory and/or mental concentration, insomnia, and fatigue lasting more than 24 hours after exertion.

In some cases, CFS can persist for years. The cause of CFS has not been identified and no specific diagnostic tests are available. Moreover, since many illnesses have extreme fatigue as a symptom, care must be taken to rule out other known and often treatable conditions before a diagnosis of CFS is made.

Definition of CFS
There has been much debate about how best to define CFS. In general, in order to receive a diagnosis of chronic fatigue syndrome, a patient must satisfy two criteria:

Have severe chronic fatigue of six months or longer, with other known medical conditions ruled out by clinical diagnosis, and
Have four or more of the following symptoms at the same time: significant trouble with short-term memory or concentration, sore throat, tender lymph nodes, muscle pain, pain in several joints without swelling or redness, headaches of a new type, pattern or severity, unrefreshing sleep, and malaise (symptoms such as discomfort, weakness, or nausea) lasting more than 24 hours after activity.
The symptoms must have continued or recurred during six or more months of illness in a row and must not have started before the fatigue.

Other Commonly Observed Symptoms in CFS
In addition to the primary defining symptoms of CFS, a number of other symptoms have been reported by some CFS patients. The frequencies of occurrence of these symptoms vary from 20% to 50% among CFS patients. They include abdominal pain, alcohol intolerance, bloating, chest pain, chronic cough, diarrhea, dizziness, dry eyes or mouth, earaches, irregular heartbeat, jaw pain, morning stiffness, nausea, night sweats, psychological problems (depression, irritability, anxiety, panic attacks), shortness of breath, skin sensations, tingling sensations, and weight loss.

Clinical Course of CFS
It is vital to understand the clinical course of CFS. This knowledge is required to simplify communication between physicians and patients, to evaluate possible new treatments, and to address insurance and disability issues. The clinical course of CFS varies considerably among persons who have the disorder; the actual percentage of patients who recover is unknown, and even the definition of what should be considered recovery is subject to debate.

Some patients recover to the point that they can resume work and other activities, but continue to experience various or periodic CFS symptoms. Some patients recover completely with time, and some grow progressively worse. CFS often follows a cyclical course, alternating between periods of illness and relative well being. Recovery is defined by the patient and may not reflect complete symptom-free recovery. The Centers for Disease Control and Prevention (CDC) continues to monitor patients enrolled in a four-city surveillance study conducted by the CDC from 1989 to 1993.

About 50% of those patients reported "recovery," and most recovered within the first 5 years after the illness began. No characteristics were identified that made one patient more likely to recover than another. At the start of the illness, the most commonly reported CFS symptoms were sore throat, fever, muscle pain, and muscle weakness. As the illness progressed, muscle pain and forgetfulness increased and the reporting of depression decreased.

Other Conditions Can Cause Fatigue
There are many clinically defined, frequently treatable illnesses that can result in fatigue. These include hypothyroidism, sleep apnea and narcolepsy, major depressive disorders, chronic mononucleosis, bipolar affective disorders, schizophrenia, eating disorders, cancer, autoimmune disease, most hormonal disorders, subacute infections, obesity, alcohol or substance abuse, and reactions to prescribed medications. Diagnosis of any of these conditions would rule out a diagnosis of CFS, unless this other condition has already been treated and no longer explains the fatigue and other symptoms.

Similar Medical Conditions
In addition to illnesses that cause fatigue, a number of other conditions have been described that have a group of symptoms to CFS. Although these illnesses might have a primary symptom other than fatigue, chronic fatigue is commonly associated with all of them. These include fibromyalgia syndrome, myalgic encephalomyelitis, neurasthenia, multiple chemical sensitivities, and chronic mononucleosis.

Treatment of Chronic Fatigue Syndrome
A variety of therapeutic approaches have been described as helping patients with chronic fatigue syndrome. Since no cause for CFS has been identified, treatment programs are directed at relief of symptoms, with the goal of the patient regaining some level the function and well-being they had before becoming ill.

Decisions about treatment for CFS or any chronically fatiguing illness should only be made with the help of a health care provider. Currently, most health care providers with experience in treating persons with CFS use some combination of:

Physical activities: light exercise, stretching, or yoga; or therapies such as massage or acupuncture
Education: learning how to adjust activities and behaviors that could make the illness worse
Medications: Pharmacologic therapy is directed toward the relief of specific symptoms experienced by the individual patient. The usual treatment strategy is to begin with very low doses and to gradually increase dosage as necessary and as tolerated. These might include drugs to ease pain, reduce fatigue, relieve depression, improve sleep, and treat anxiety.
Although many experimental drugs and treatments have been promoted for improvement of CFS symptoms, in fact none have been proven to be effective. Some are useless and others can be dangerous. They should be avoided until research has validated their claims.

In addition, a variety of dietary supplements and herbal preparations are claimed to have potential benefits for CFS patients. With few exceptions, the effectiveness of these remedies for treating CFS has not been evaluated in controlled trials. Contrary to common belief, the "natural" origin of a product does not ensure safety. Dietary supplements and herbal preparations can have potentially serious side effects and some can interfere or interact with prescription medications. CFS patients should seek the advice of their health care provider before using any unprescribed remedy.

Researchers continue to work on the complex issues of chronic fatigue syndrome and its treatment, with the hope of one day finding out how it is caused and how to treat or even cure this complicated and difficult illness.  rose

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« Reply #3 on: August 03, 2006, 11:33:15 am »

Chronic Fatigue Syndrome


Chronic Fatigue Syndrome- An Overview

Chronic illness is a term used to represent a condition that is present over a prolonged period. A few examples of chronic illness include hypertension, diabetes and cancer. Of the numerous chronic illnesses known so far, chronic fatigue syndrome deserves special mention.

While it is relatively easy to attribute the cause of diseases like AIDS and tuberculosis to the HIV virus or mycobacterium tuberculosis respectively, the exact cause of Chronic Fatigue Syndrome still remains a mystery. Nobody is immune to developing this condition. It can affect even the healthy!

A person can have it for years, and yet go unnoticed. It can strike following an episode of illness such as cold or can also be associated with high levels of stress. In some cases, it might be difficult for the patient to pinpoint when it all began. There is currently no method by which the severity of the disease can be gauged. The complex nature of the disease accompanied by lack of understanding of this strange disorder has left us with very few treatment options.

Chronic fatigue disorder or CFS is a disorder characterized by extreme fatigue, not resolved by bed rest. The condition can be aggravated by mental or physical activity. Persons suffering from CFS exhibit a substantially lower level of functionality when compared to their counterparts. The presence of non-specific symptoms such as muscle and joint pain, weakness, lack of sleep, decreased alertness and perceived impairment in the ability to concentrate, make it difficult to diagnose the condition.

The disease was originally described as "yuppie flu" as women in their 30s to 40s, with a high level of income reported CFS or rather CFS-like symptoms. It is now known that it can affect people of all ages, despite their ethnic and socio-economic condition.

CFS- Definition

In order to resolve the controversies associated with varying definitions of CFS, an international panel of health professionals with expertise in the area of CFS research in 1994 gathered to arrive at a specific definition that would be helpful in the diagnosis and research of CFS. It was agreed that a diagnosis of CFS should be made only if the patients satisfied the two criteria, mentioned below:

Have severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis; and Concurrently have four or more of the following symptoms: substantial impairment in short-term memory or concentration; 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 lasting more than 24 hours. The symptoms must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue. 



Other Symptoms Associated With CFS

In addition to the above-mentioned symptoms, the patient may experience certain non-specific symptoms, which makes it difficult to diagnose this condition. 

Psychological deficits (irritability, anxiety and depression)
Dizziness, morning stiffness, night sweats
Dry eyes or mouth
Shortness of breadth, chest pain, abnormal heart rhythms, persistent cough
Nausea, abdominal pain, diarrhea
Weight loss, alcohol intolerance
CFS Diagnosis

In order to arrive at a diagnosis of CFS, it is necessary to follow the systematic procedure, recommended by a panel of CFS experts.

 The first step, is obtaining a detailed medical history, followed by a complete   physical examination. 

 The next is assessment of the mental status of the patient. This can be       achieved by a short oral test or a brief discussion. 

This would be followed by a battery of lab tests (blood and urine tests) to identify alternative causes of fatigue, if any. 

If the test results raise suspicion of any other disorder, additional tests may have to be done to confirm the diagnosis, based on which further treatment can be instituted. 

If no other cause for the fatigue is obtained from the multidisciplinary approach, a diagnosis of CFS would be made, provided the symptoms correlate with the CFS definition.

A diagnosis of CFS can be arrived at, only if the following two criteria are satisfied.


Extreme fatigue that results in a substantial reduction in the functionality of an individual, which cannot be attributed to exertion, and not relieved by rest. 

The presence of sore throat, impaired memory or ability to concentrate, tender lymph nodes (cervical/axillary), muscle pain, joint pain, new type of headaches, unrefreshing sleep, depression or malaise following exertion. Here again, 4 or more of the above mentioned symptoms should be present for a period of 4 months or more, to confirm the CFS diagnosis.

If the patient's symptoms are less severe, or if the criteria for CFS diagnosis are not satisfied, the patient is said to have idiopathic (of an unexplained cause) chronic fatigue.


CFS Treatment

As the exact cause of CFS is not known, treatment is largely based on provision of symptomatic relief, helping the patient restore his near normal functionality. It should however be remembered that it may not be possible to achieve this instantaneously. Infact most patients out of anxiety, overexert themselves only to land up with more fatigue and depression. A carefully designed rehabilitation program can overcome all these factors.

It is very essential to discuss the severity of CFS and its impact on functional capability of an individual, with the health care provider who can then draft an individualized health care program. It is equally important to also educate the patient regarding CFS and alert them regarding certain activities that may aggravate the symptoms. Cognitive behavioral therapy, targeted at provision of CFS related education can allow for increased level of activity without increase in the frequency or severity of symptoms. Depending on the patient's improvement, further follow up treatment can be adjusted. Treatment for CFS is currently based on a multi-disciplinary approach.

Physical Activity

It is known that physical activity enhances the physical and mental health of an individual. Patients with CFS may be encouraged to participate in various forms of physical activity. It is however important to ensure that the patient understands his/her limitations to avoid any increase in the level of fatigue.
It is strongly recommended that CFS patients take up a moderate exercise program; under the supervision of a physical therapist or any other health care provider familiar with CFS and its treatment.

Patients can also be advised regarding the 'push-crash' phenomenon, characterized by excessive physical activity during periods of better health followed by periods of fatigue due to excess activity. The exercise regime can incorporate any form of physical activity such as light exercise, stretching, aquatic therapy etc. In some cases where the patient's energy is not severely compromised, the patient may be encouraged to participate in yoga.
In addition to the above-mentioned forms of treatment with an active physical component, acupuncture, massage therapy, self-hypnosis etc can also be suggested. Although these modalities can improve the general well being, they are more effective when combined along with any form of patient-generated activity.

Drug Therapy

Pharmacologic therapy is based on use of certain drugs to provide symptomatic relief to the patient. This form of therapy can be applied only when the underlying symptom cannot be attributed to any known cause and all other differential diagnosis has been ruled out. Owing to increased sensitivity of CFS patients to certain medications, it is advisable to start a drug therapy at very low doses. Depending on the therapeutic benefit and the patient's tolerability, the dose can be increased progressively.

NSAIDs: This class of drugs commonly referred to as non-steroidal anti-inflammatory drugs can be used to relieve the pain experienced by CFS patients. As many of the drugs can lead to dangerous side effects, patients have to be closely monitored regarding the same.

Antidepressants: Tricyclic antidepressants are the most commonly used drugs to treat depression, in addition to providing relief from mild pain and improving sleep. Other class of antidepressants includes monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs). In some cases where CFS is associated with nervous system disorders such as vertigo, skin tenderness, and abnormal limb movements, specific anxiolytic agents may be given to attenuate the associated anxiety. Anxiolytic agents however should not be prescribed for generalized CFS treatment.

Stimulants: Treatment with stimulant drugs may be necessary when CFS is associated with extreme lethargy or daytime sleepiness. Extreme caution is however necessary before such drugs can be prescribed.

Antimicrobials: If the patient is observed to be suffering from current infections, treatment with appropriate antibiotics, antiviral or antifungal drugs may be necessary. Additionally, recurrent episodes of allergy may be managed with non-sedating antihistamines.

Other Forms of Experimental Drugs

Ampligen: it is an artificially synthesized nucleic acid product, known to influence the production of interferons, a class of compounds that modify the immune response of an individual. Although clinical trials done among CFS patients have recorded slight improvement in performance and cognitive ability, the drug has not yet been approved by the FDA for treatment of CFS, owing to limited information available on the safety and efficacy parameters.

Corticosteriods: Based on the fact that some CFS patients have slightly decreased cortisol levels in their urine, possibility of using corticosteroids for CFS treatment has been suggested. This work is however in the experimental phase. Results of the study conducted so far have shown that the beneficial effect may only be temporary, not lasting more than a month.

Dehydroepiandrosterone (DHEA): There are relatively few reports that highlight hormonal changes associated with dehydroepiandrosterone (DHEA) and insulin-like growth factor may lead to CFS. In view of the above possibility, the use of these agents to manage CFS has been suggested. Although some studies have documented a moderate level of symptomatic relief following low dose administration of DHEA, the use of DHEA as a treatment of CFS is still controversial. Additionally, researchers have warned about the use of DHEA in CFS patients with abnormal levels of DHEA and function.

Neurosurgery: It has been hypothesized that certain malformations at the base of the skull can contribute to CFS. Some unpublished reports have suggested nerurosurgery to correct the malformation and reverse CFS. Currently, no form of neurosurgery has been recommended to treat CFS.


Dietary Supplements and Herbal Medicines:

With an increased inclination towards alternative medicine, it is not uncommon to see numerous dietary supplements and other herbal preparations being marketed everyday that claim to benefit patients with CFS or even cure them. Patients are however warned against such unscrupulous claims, as it can lead to adverse effects or cross reactivity between other medicines used for CFS treatment. It is always advisable to consult with the treating physician before using any such form of therapy. Vitamin A, C and B12, iron, zinc, selenium, germanium, magnesium sulfate, adenosine monophosphate, glutathione and melatonin are some of the most commonly referred vitamins, minerals or coenzymes that claim a therapeutic benefit.

Herbal preparations of Ginkgo biloba, ginseng, garlic, comfrey, bromelain, astralagus and others such as borage seed oil, primrose oil, and mushroom extract also claim to offer relief to CFS patients, the effectiveness of which is yet to be established.

FAQs

Which doctor is to be consulted for CFS?

It is very important for CFS patients to seek treatment with a doctor who is familiar with the disorder. An initial consultation with the family doctor or general physician can raise suspicion of CFS. Further recommendation or consultation can then be based on the underlying symptoms and the severity.

Does CFS affect women more than men?

Based on available data, it has been found that the condition is two or more times pronounced in women, as compared to men. However it is not clear if the trend is due to increased susceptibility of women to CFS or due to under reporting of similar symptoms by men.

Is CFS a genetic disorder?

Despite years of research on CFS, it has not been possible to pinpoint the factors causing CFS. A largest ever study conducted at the Centers for Disease Control and Prevention highlights that CFS may have a genetic link. In other words, individuals with certain specific genes may be more susceptivble to develop CFS due to altered activity of the gene. These genes which play a critical role in mediating stress response can either confer an increased or decreased CFS risk. More studies are needed at this juncture to aid better understanding of the role of genetics in causing CFS.

Does CFS affect children as well?

Although the presence of CFS in adults has been well documented, very little is known about the prevalence of CFS among children and young adults. Some studies have documented the presence of CFS in children less than 5 years old. In a sample of 100, 000, nearly 5 to 6 children and 10-19 young adults are likely to suffer from CFS, according to a study condcuted by Australian researchers.
 
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« Reply #4 on: September 15, 2006, 08:35:52 am »

Chronic Fatigue Syndrome: Cause Unknown, Diagnosis Difficult

Chronic fatigue syndrome, or CFS, is a complex disorder characterized by weakness and a profound fatigue that is not improved by bed rest. The illness can be worsened by physical or mental activity. People with CFS most often function at a much lower level of activity than they were able to before the illness began. In addition to these features, patients report various nonspecific symptoms, including weakness, muscle pain, impaired memory and/or mental concentration, insomnia, and fatigue lasting more than 24 hours after exertion.

In some cases, CFS can persist for years. The cause of CFS has not been identified and no specific diagnostic tests are available. Moreover, since many illnesses have extreme fatigue as a symptom, care must be taken to rule out other known and often treatable conditions before a diagnosis of CFS is made.

Definition of CFS
There has been much debate about how best to define CFS. In general, in order to receive a diagnosis of chronic fatigue syndrome, a patient must satisfy two criteria:

Have severe chronic fatigue of six months or longer, with other known medical conditions ruled out by clinical diagnosis, and
Have four or more of the following symptoms at the same time: significant trouble with short-term memory or concentration, sore throat, tender lymph nodes, muscle pain, pain in several joints without swelling or redness, headaches of a new type, pattern or severity, unrefreshing sleep, and malaise (symptoms such as discomfort, weakness, or nausea) lasting more than 24 hours after activity.
The symptoms must have continued or recurred during six or more months of illness in a row and must not have started before the fatigue.

Other Commonly Observed Symptoms in CFS
In addition to the primary defining symptoms of CFS, a number of other symptoms have been reported by some CFS patients. The frequencies of occurrence of these symptoms vary from 20% to 50% among CFS patients. They include abdominal pain, alcohol intolerance, bloating, chest pain, chronic cough, diarrhea, dizziness, dry eyes or mouth, earaches, irregular heartbeat, jaw pain, morning stiffness, nausea, night sweats, psychological problems (depression, irritability, anxiety, panic attacks), shortness of breath, skin sensations, tingling sensations, and weight loss.

Clinical Course of CFS
It is vital to understand the clinical course of CFS. This knowledge is required to simplify communication between physicians and patients, to evaluate possible new treatments, and to address insurance and disability issues. The clinical course of CFS varies considerably among persons who have the disorder; the actual percentage of patients who recover is unknown, and even the definition of what should be considered recovery is subject to debate.

Some patients recover to the point that they can resume work and other activities, but continue to experience various or periodic CFS symptoms. Some patients recover completely with time, and some grow progressively worse. CFS often follows a cyclical course, alternating between periods of illness and relative well being. Recovery is defined by the patient and may not reflect complete symptom-free recovery. The Centers for Disease Control and Prevention (CDC) continues to monitor patients enrolled in a four-city surveillance study conducted by the CDC from 1989 to 1993.

About 50% of those patients reported "recovery," and most recovered within the first 5 years after the illness began. No characteristics were identified that made one patient more likely to recover than another. At the start of the illness, the most commonly reported CFS symptoms were sore throat, fever, muscle pain, and muscle weakness. As the illness progressed, muscle pain and forgetfulness increased and the reporting of depression decreased.

Other Conditions Can Cause Fatigue
There are many clinically defined, frequently treatable illnesses that can result in fatigue. These include hypothyroidism, sleep apnea and narcolepsy, major depressive disorders, chronic mononucleosis, bipolar affective disorders, schizophrenia, eating disorders, cancer, autoimmune disease, most hormonal disorders, subacute infections, obesity, alcohol or substance abuse, and reactions to prescribed medications. Diagnosis of any of these conditions would rule out a diagnosis of CFS, unless this other condition has already been treated and no longer explains the fatigue and other symptoms.

Similar Medical Conditions
In addition to illnesses that cause fatigue, a number of other conditions have been described that have a group of symptoms to CFS. Although these illnesses might have a primary symptom other than fatigue, chronic fatigue is commonly associated with all of them. These include fibromyalgia syndrome, myalgic encephalomyelitis, neurasthenia, multiple chemical sensitivities, and chronic mononucleosis.

Treatment of Chronic Fatigue Syndrome
A variety of therapeutic approaches have been described as helping patients with chronic fatigue syndrome. Since no cause for CFS has been identified, treatment programs are directed at relief of symptoms, with the goal of the patient regaining some level the function and well-being they had before becoming ill.

Decisions about treatment for CFS or any chronically fatiguing illness should only be made with the help of a health care provider. Currently, most health care providers with experience in treating persons with CFS use some combination of:

Physical activities: light exercise, stretching, or yoga; or therapies such as massage or acupuncture
Education: learning how to adjust activities and behaviors that could make the illness worse
Medications: Pharmacologic therapy is directed toward the relief of specific symptoms experienced by the individual patient. The usual treatment strategy is to begin with very low doses and to gradually increase dosage as necessary and as tolerated. These might include drugs to ease pain, reduce fatigue, relieve depression, improve sleep, and treat anxiety.
Although many experimental drugs and treatments have been promoted for improvement of CFS symptoms, in fact none have been proven to be effective. Some are useless and others can be dangerous. They should be avoided until research has validated their claims.

In addition, a variety of dietary supplements and herbal preparations are claimed to have potential benefits for CFS patients. With few exceptions, the effectiveness of these remedies for treating CFS has not been evaluated in controlled trials. Contrary to common belief, the "natural" origin of a product does not ensure safety. Dietary supplements and herbal preparations can have potentially serious side effects and some can interfere or interact with prescription medications. CFS patients should seek the advice of their health care provider before using any unprescribed remedy.

Researchers continue to work on the complex issues of chronic fatigue syndrome and its treatment, with the hope of one day finding out how it is caused and how to treat or even cure this complicated and difficult illness.
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« Reply #5 on: October 03, 2006, 04:54:53 pm »

Chronic Fatigue Syndrome
Blood Tests
Studies published in 2005 have shown the following abnormalities in blood taken from people with Chronic Fatigue Syndrome (CFS):
Antibodies to Epstein-Barr virus (EBV)
Increased levels of isoprostanes, a marker of oxidative stress

Genetic News
Scientists have made progress in identifying links between certain genetic defects and CFS. According to 2005 research from England, people with CFS are more likely than healthy individuals to have human leukocyte antigen (HLA) class II alleles (variations in substances which produce antibodies to certain immune factors).
Another British study of people with CFS found alterations in 16 specific genes that are involved with immune function, communication between cells and transfer of energy to cells.

Diagnostic News
According to a 2005 Dutch study, the volume of gray matter in the brain is markedly reduced in people with CFS. Such brain shrinkage has been linked to lower rates of physical activity in patients with CFS. This finding could provide a useful tool in diagnosing the illness.
Other research published in 2005 found that certain components in urine were unique in people with CFS, and might be considered as biomarkers of the disease.

CFS Symptoms
CFS causes unexplained chronic fatigue for 6 months or more. In addition to fatigue, people with CFS may experience a range of symptoms including:
Memory or thinking problems
Muscle or joint pain
Sore throat
Headaches
Gastrointestinal problems
Depression
The causes CFS are not known, but researchers think infection, genetics, hormonal imbalances, and chemical toxins play a role.  CFS may occur with many other diseases.

That can complicate both diagnosis and treatment. Many experts now believe that there are different subtypes of CFS characterized by the following:
Immune system abnormalities
Neurological illness
Post-viral disease
Central nervous system and hormonal imbalances
Post-attention-deficit-disorder CFS
Low blood pressure (called neurally mediated hypotension, or NMH)


Introduction
Chronic fatigue syndrome (CFS), also sometimes called immune dysfunction syndrome or myalgic encephalomyelitis (in Europe), is not a new disorder. In the 19th century the term neurasthenia, or nervous exhaustion, was applied to symptoms resembling CFS. In the 1930s through the 1950s, outbreaks of disease marked by prolonged fatigue were reported in the United States and many other countries. Beginning in the early to mid-1980s, interest in chronic fatigue syndrome was revived by reports in America and other countries of various outbreaks of long-term debilitating fatigue.

Fatigue that lasts for more than six months, impairs normal activities, and has no identifiable medical or psychological problems to account for it is referred to as unexplained chronic fatigue. These symptoms can be further categorized as follows:

Chronic fatigue syndrome (CFS). A number of criteria must be met in order for a patient's symptoms to be described as CFS. Six million patient visits are made each year because of fatigue, although only a very small percentage of these can be attributed to actual chronic fatigue syndrome.
Idiopathic chronic fatigue. If the patient's symptoms do not meet the criteria for CFS, then the condition is referred to as idiopathic chronic fatigue. (Idiopathic simply means that the cause is unknown.)

Risk Factors
In studies of large patient groups, between 15 - 27% of people complain of long-term fatigue, but the majority of these cases are explained by other medical or psychological problems. According to surveys, chronic fatigue syndrome (CFS) itself affects over four in every 1,000 Americans and is considered a serious health problem. CFS occurs in both sexes and at all ages and in all racial and ethnic groups. Nevertheless, the true prevalence of CFS is very difficult to ascertain since it is so difficult to diagnose.

Age and Gender
Chronic fatigue is most often experienced by individuals 40 to 50 years old. It is less common in people under 29 or over 60. Most studies have reported the highest rates of CFS are among women, although they do not appear to have more severe symptoms than men with the disorder. Children and adolescents are not immune to its effects. Most studies indicate that girls are more apt to develop CFS than boys, although one study found the incidence of the syndrome to be equal.

Culture and Social Levels
Some studies report that CFS rates are highest in minority groups (African and Hispanic Americans), and people with lower levels of education and occupational status. Previous research reports found that Caucasian women had higher rates of CFS than women from other ethnic groups, but research suggests such estimates most likely reflect the greater socioeconomic ability of Caucasian women to seek treatment.

Depression and Psychological Factors
The link between psychological disorders and chronic fatigue syndrome is problematic because so many of the symptoms overlap. The rates of depression are very high in CFS patients. In one study, 27.4% of patients diagnosed with CFS alone also had a history of depression. (Depression rates were significantly higher in CFS patients who had other conditions, notably fibromyalgia and multiple chemical sensitivity.)

Studies also report that most children and adolescents with CFS suffer psychiatric disorders. Some evidence suggests that psychological factors during childhood may increase susceptibility for later CFS, although these factors are not consistent. For example, in a small 2003 survey, CFS patients tended to have mothers who were overprotective and depressed. In another small study, five out of 13 patients reported sexual or physical abuse during childhood. The bottom line is that studies have not found any consistent association between emotional or personality disorders and CFS to explain any causal role. Some may however, serve as a risk factor for CFS.

Depression, in any case, is very common in the general population. It affects up to one-fifth of all Americans at some point in their lives, and most depressed people feel fatigued.

Conditions That Commonly Occur in CFS Patients
A number of conditions overlap or co-exist with chronic fatigue syndrome and have similar symptoms. In fact, in one study of patients with CFS only 38% of patients had a sole diagnosis. The others also had fibromyalgia, multiple chemical sensitivity, or both. It is not clear if these conditions or others are risk factors for CFS, are direct causes, have common causes, or have no relationship at all with CFS.

Fibromyalgia. Fibromyalgia causes prolonged fatigue and widespread muscle aches and is the disease most often confused with CFS. They also commonly appear together. In one study, for example, 37% of patients who met the criteria for CFS also had a co-diagnosis of fibromyalgia. In fact, many experts believe fibromyalgia is simply another variant of chronic fatigue syndrome or that they may even represent different manifestations of the same disease, with CFS patients experiencing severe fatigue while fibromyalgia patients experience more pain. One researcher compared the relationship of fibromyalgia to chronic fatigue as that of migraine to headache.

A characteristic feature of fibromyalgia is the existence of at least 11 distinct sites of deep muscle tenderness that hurt when touched firmly. The sites often include the following:

The side of the neck
The top of the shoulder blade
The outside of the upper buttock and hip joint
The inside of the knee
Some patients with CFS exhibit similar tender pressure points. Recurrent sore throat, headache, low fever, and depression are also common symptoms of fibromyalgia. Like CFS, fibromyalgia is chronic and not curable.

Multiple Chemical Sensitivity. Multiple chemical sensitivity (MCS) is a term now used to describe a condition in which certain chemicals can cause symptoms similar to CFS in some people. It has also been observed in people with CFS. Experts have come up with criteria to help recognize people with MCS.

The symptoms are reproducible with repeated exposure to a chemical. (These are often common chemicals found in popular products, such as perfumes, fabric softeners, and air fresheners.)
The condition is chronic.
Symptoms can be produced by exposure to the chemical at levels lower than previously or commonly tolerated.
The symptoms improve when the chemical is removed.
Symptoms can be triggered by multiple substances that are chemically unrelated.
Symptoms involve multiple organ systems.
Still, as with CFS and fibromyalgia, some experts are uncertain whether MCS is an actual medical condition or is psychologically based. In one study, for example, CFS patients who believed their problem was chemically triggered were exposed to either an active chemical or a placebo (an inactive substance). Both groups reported symptoms, including those exposed only to the placebo. It should be noted that everyone is exposed to many chemicals on a daily basis, and it is very difficult to determine if chemicals are responsible for specific symptoms.

Eating Disorders. Eating disorders, notably bulimia and anorexia, have been observed in patients with CFS. In one small study, CFS occurred after the development of the eating disorder. It is not clear if there was a causal relationship. The conditions often have over-lapping risk factors, although whether there is a causal relationship is unclear.

Work-Related Fatigue and Burn-Out. Many people who suffer burn-out or fatigue from employment have symptoms that are similar or even identical to CFS. One study of nurses, for example, found that those who were exposed to poor working conditions and threats of accidents faced a higher risk for CFS symptoms than those without these experiences. However, work-related CFS symptoms are usually of much shorter duration. It they persist, however, doctors should not rule out CFS.

Other Conditions that Commonly Co-exist With CFS. A number of other conditions also often co-exist with CFS and, in fact, occur at higher-than-average rates among CFS patients:

Temporomandibular disorder (TMD)
Irritable bowel syndrome
Chronic headaches
Interstitial cystitis
Hypothyroidism
Sjogren's syndrome
Sleep problems
Cognitive problems such as difficulty concentrating, impaired memory, and symptoms of attention deficit disorders


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« Reply #6 on: October 05, 2006, 08:54:40 am »

Chronic Fatigue Syndrome
What is it?

Chronic fatigue syndrome is a condition that can be debilitating and last for months or years. It is an illness that produces extreme tiredness over a prolonged period of time.

With symptoms so variable, it is often misdiagnosed or is not recognized. Chronic fatigue syndrome is a long-term condition. Many people find that the symptoms are at their worst in the first one to two years. In more than half the cases, the condition clears up completely after several years. In some cases, the syndrome comes and goes over a number of years.

How many people are afflicted?

It is hard to estimate, but some figures indicate around 500,000 people in the United States have chronic fatigue syndrome. It mainly affects women from 25 through 45, but can affect children or adults at any age.

What are the causes?

It's believed that several different factors can cause chronic fatigue syndrome, but the cause is not known for certain. Sometimes it develops after recovery from a viral infection or an emotional trauma such as bereavement. In other cases, there is no specific preceding illness or life event. It's also thought to be associated with depression.

What are its symptoms?

The number and severity of symptoms can vary, however the major symptoms are:

Prolonged severe fatigue lasting at least six months
Impairment of short-term memory or concentration
Sore throat
Tender lymph nodes
Muscle and joint pain without swelling or redness
Un-refreshing sleep
Headaches
Fatigue can also be a symptom of several medical conditions such as:

Sleep apnea, insomnia or other sleep disturbances
Hypothyroidism
Depression
Seasonal Affective Disorder (SAD)
Hepatitis
Anemia
Heart disease
Perimenopause
Nocturnal asthma
Allergies
Alcohol and substance abuse
Domestic violence and abuse
Viral or bacterial infections
Cancer
How is it diagnosed?

If you have had prolonged fatigue for more than six months with no obvious cause, your doctor may suspect chronic fatigue syndrome. A general physical examination may be preformed and you may be asked psychological questions to find out if psychological problems are present. Blood tests may also be arranged. Keep in mind, though, that diagnosis can take some time since there is no specific diagnostic test.

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« Reply #7 on: October 12, 2006, 01:31:05 pm »

Understanding Fatigue in Lupus - and What Can Be Done


 
If you have lupus, you probably know how bad fatigue can be. It's one of the most common symptoms reported by people with lupus. Most lupus patients suffer with it. But exactly what causes this fatigue that goes far beyond just being tired?

A study done at Hospital for Special Surgery almost 10 years ago suggested that depression and sleep problems might contribute to fatigue in people with lupus.1 But in the women studied, those who had lupus did not have more depression than those who did not. However, those who had lupus took longer to fall asleep - and slept for longer periods of time.

Over the years, other researchers have also tried to figure out how sleep and depression might play a role. Others have suggested that lack of exercise might be involved - because exercise can actually give you energy when your muscles get fit.

New Research

Recently, a Canadian group of researchers explored the question and reported at a recent meeting of the American College of Rheumatology.2 They studied 100 women with lupus. The women were given a series of different tests to look at:

the type of their fatigue,


how bad their fatigue was,


how bad their pain was,


whether they were depressed - and if so how badly,


how well - or poorly - they slept,


how much physical activity they did in their leisure time,


whether they were satisfied with the support they received from family and friends.
Finally, the women were examined by a doctor to see the level of their lupus disease activity and the impact lupus already had on their bodies.

What They Learned

As in other studies, they found that people with lupus have much more fatigue than others.

Fatigue can be influenced by everything they explored and more: depression, pain, quality of sleep, quantity sleep, exercise, severity of illness, and satisfaction with your social support network - as well as flares, medications, and stress. And it varies from one patient to the next.

Because fatigue arises from so many different factors, they said treatment should try to find out what factors were involved in the patient being treated - and treat all of them to get at the fatigue. These factors can be treated - modified - changed.

Two Types of Fatigue

One thing that was different about their study was that they separated physical fatigue from mental fatigue. Many other studies have just looked at "fatigue" as one thing.

Think of physical fatigue as "I'm too tired to stand up," or "I just can't walk another block." That's easy to recognize - and you should listen to it. Rest. Sit down or just collapse in bed for awhile.

Mental fatigue can be more difficult to get a grasp on sometimes. "I can't think straight" or "I can't concentrate" or "I keep rereading this paragraph again and again" may be mental fatigue. Or it may be a sign of the cognitive (thinking) difficulties that are part of neuropsychiatric lupus. So any changes in your thinking or concentration should be reported to your doctor - because a change in medication may help. In the meantime, again, rest. Put the book down. Veg out in front of the TV. Cuddle up with your pet. (Studies have proven that stroking a pet can be very relaxing.) Or take a nap.

Physical Fatigue

It was not a surprise that people with more pain and poorer sleep were more likely to have physical fatigue.

Lots of research - in people without lupus - has shown exercise helps reduce depression. But this study had an interesting surprise. Only the lupus-fatigued women who did not score high on depression tests seemed to be helped by exercise. Lupus-fatigued women who were depressed did not get an improvement in physical fatigue from exercise. Does this mean you shouldn't exercise? No! You need exercise for heart fitness, muscle strength and to keep up your energy. It may even help your physical fatigue - because a finding from one research study doesn't apply to everyone.

But look to other means as well. Talk with your doctor about ways to improve your sleep and lower your pain level, especially by reducing your disease activity.

Mental Fatigue

The factors most related to mental fatigue were slightly different. They were clearly:

greater pain severity - again, talk with your doctor about how to reduce your pain level;


higher levels of depression - ask your doctor about referral to a licensed psychotherapist such as a social worker or psychologist. In some cases,r antidepressant medication may also be useful.


lower satisfaction with social support networks - talk with family and friends about what you need from them. Often they may not be aware of how you are feeling inside. Let them know what can help. Establishing an understanding together of the impact of fatigue and how to problem-solve around this is important.
How Do You Cope

Fatigue is profound. It touches you to the core. It can totally disrupt your life. Fatigue itself can be stressful and fatiguing. Because you cannot "see" fatigue, and it can change so much from hour-to-hour and day-to-day, your fatigue can also be confusing to those with whom you live and work. But it's not something you can point to like a swollen joint or a rash. You can be exhausted with fatigue and your friend or family member says, "You look great."

This can be very frustrating. You feel that others just don't get it. Over time, see if you can learn to respond comfortably and assertively to such comments. "I wish I felt as great as I look - but I'm really fatigued right now, and it's important that I rest and take care of myself."

Those words may not be right for you - but you need to find the words that are. Because when fatigue hits, you need to let go and rest. Give in to fatigue when necessary - so you can spring back. Take that temporary break - so you can stand up and think clearly later. Whether it's an hour later or a day later doesn't matter. You will find the right moment. And only you can. Because lupus fatigue is different for everyone - what causes it, when it hits, what helps, when it goes.

Be kind to yourself, work with your doctor, and you will find the path that's best for you. Just don't give up.

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« Reply #8 on: December 02, 2006, 09:20:38 am »

new folder for old post directed at Chronic Fatigue Syndrome to be moved here
« Last Edit: December 02, 2006, 09:43:58 am by Kathy » Logged


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« Reply #9 on: March 10, 2007, 11:06:09 am »

www.CFSFacts.org -- dispelling the myths and providing the facts

Please go visit this blog when you can. She's wonderful at her writings and expression about the CFS  & Drs.
http://journals.aol.com/kmc528/Lifeasweknowit/
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« Reply #10 on: May 29, 2007, 03:43:06 am »

'It is the death of the life that you knew'

One of the most frustrating things about chronic fatigue syndrome is that science has yet to identify its causes.

Research has found genetic anomalies in CFS patients' ability to cope with stress, trauma and infection. There are also abnormalities in blood volume to the brain and immune-system activity.

In many cases, the condition is sparked by a bout of viral infection, such as the flu. Symptoms vary from patient to patient, and over time.


Patients and their families are desperate for emotional support, said Alison Bested, author of Hope and Help for Chronic Fatigue Syndrome and Fibromyalgia.

Many experience stages of grief similar to people with terminal illness, Bested said.

"They go through the same stages - denial, anger and bargaining, all the way up to acceptance - and they need help with that."

Until a cure is found, the best a patient can do is manage the symptoms through lifestyle changes, Bested said.

"CFS is not fatal, but it is the death of the life that you knew," said Tom Sheridan, government relations adviser for the U.S. association Chronic Fatigue Immune Dysfunction Syndrome.

Symptoms can persist for years.

For Lauri Lidstone, a support group is crucial.

"There are three of us - our conversation is in Morse code," she joked.

For more information :
Canada~
Association Quebecoise de l'Encephalomyelite Myalgique. www.aqem.org An English-language support group run through the association meets once a month. Call 514-369-1689.

National ME/FM Action Network, the Canadian association for chronic fatigue syndrome and fibromyalgia. www.mefmaction.net

International Association for Chronic Fatigue Syndrome. www.iacfs.net

Hope and Help for Chronic Fatigue Syndrome and

Fibromyalgia, by Alison C. Bested and Alan C. Logan (Cumberland House).
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« Reply #11 on: July 20, 2007, 07:35:03 am »

Chronic Fatigue No Longer Seen as ‘Yuppie Flu’

Donna Flowers, who became ill with chronic fatigue syndrome several years ago after a bout of mononucleosis, working out in her home in Los Gatos, Calif., while taking care of her twins.



For decades, people suffering from chronic fatigue syndrome have struggled to convince doctors, employers, friends and even family members that they were not imagining their debilitating symptoms. Skeptics called the illness “yuppie flu” and “shirker syndrome.”

But the syndrome is now finally gaining some official respect. The Centers for Disease Control and Prevention, which in 1999 acknowledged that it had diverted millions of dollars allocated by Congress for chronic fatigue syndrome research to other programs, has released studies that linked the condition to genetic mutations and abnormalities in gene expression involved in key physiological processes. The centers have also sponsored a $6 million public awareness campaign about the illness. And last month, the C.D.C. released survey data suggesting that the prevalence of the syndrome is far higher than previously thought, although these findings have stirred controversy among patients and scientists. Some scientists and many patients remain highly critical of the C.D.C.’s record on chronic fatigue syndrome, or C.F.S. But nearly everyone now agrees that the syndrome is real.

“People with C.F.S. are as sick and as functionally impaired as someone with AIDS, with breast cancer, with chronic obstructive pulmonary disease,” said Dr. William Reeves, the lead expert on the illness at the C.D.C., who helped expose the centers’ misuse of chronic fatigue financing.

Chronic fatigue syndrome was first identified as a distinct entity in the 1980s. (A virtually identical illness had been identified in Britain three decades earlier and called myalgic encephalomyelitis.) The illness causes overwhelming fatigue, sleep disorders and other severe symptoms and afflicts more women than men. No consistent biomarkers have been identified and no treatments have been approved for addressing the underlying causes, although some medications provide symptomatic relief.

Patients say the word “fatigue” does not begin to describe their condition. Donna Flowers of Los Gatos, Calif., a physical therapist and former professional figure skater, said the profound exhaustion was unlike anything she had ever experienced.

“I slept for 12 to 14 hours a day but still felt sleep-deprived,” said Ms. Flowers, 51, who fell ill several years ago after a bout of mononucleosis. “I had what we call ‘brain fog.’ I couldn’t think straight, and I could barely read. I couldn’t get the energy to go out of the door. I thought I was doomed. I wanted to die.”

Studies have shown that people with the syndrome experience abnormalities in the central and autonomic nervous systems, the immune system, cognitive functions, the stress response pathways and other major biological functions. Researchers believe the illness will ultimately prove to have multiple causes, including genetic predisposition and exposure to microbial agents, toxins and other physical and emotional traumas. Studies have linked the onset of chronic fatigue syndrome with an acute bout of Lyme disease, Q fever, Ross River virus, parvovirus, mononucleosis and other infectious diseases.

“It’s unlikely that this big cluster of people who fit the symptoms all have the same triggers,” said Kimberly McCleary, president of the Chronic Fatigue and Immune Dysfunction Syndrome Association of America, the advocacy group in charge of the C.D.C.-sponsored awareness campaign. “You’re looking not just at apples and oranges but pineapples, hot dogs and skateboards, too.”

Under the most widely used case definition, a diagnosis of chronic fatigue syndrome requires six months of unexplained fatigue as well as four of eight other persistent symptoms: impaired memory and concentration, sore throat, tender lymph nodes, muscle pain, joint pain, headaches, disturbed sleeping patterns and post-exercise malaise.

The broadness of the definition has led to varying estimates of the syndrome’s prevalence. Based on previous surveys, the C.D.C. has estimated that more than a million Americans have the illness.

Last month, however, the disease control centers reported that a randomized telephone survey in Georgia, using a less restrictive methodology to identify cases, found that about 1 in 40 adults ages 18 to 59 met the diagnostic criteria — an estimate 6 to 10 times higher than previously reported rates.

However, many patients and researchers fear that the expanded prevalence rate could complicate the search for consistent findings across patient cohorts. These critics say the new figures are greatly inflated and include many people who are likely to be suffering not from chronic fatigue syndrome but from psychiatric illnesses.

“There are many, many conditions that are psychological in nature that share symptoms with this illness but do not share much of the underlying biology,” said John Herd, 55, a former medical illustrator and a C.F.S. patient for two decades.

Researchers and patient advocates have faulted other aspects of the C.D.C.’s research. Dr. Jonathan Kerr, a microbiologist and chronic fatigue expert at St. George’s University of London, said the C.D.C.’s gene expression findings last year were “rather meaningless” because they were not confirmed through more advanced laboratory techniques. Kristin Loomis, executive director of the HHV-6 Foundation, a research advocacy group for a form of herpes virus that has been linked to C.F.S., said studying subsets of patients with similar profiles was more likely to generate useful findings than Dr. Reeves’s population-based approach.

Dr. Reeves responded that understanding of the disease and of some newer research technologies is still in its infancy, so methodological disagreements were to be expected. He defended the population-based approach as necessary for obtaining a broad picture and replicable results. “To me, this is the usual scientific dialogue,” he said.

Dr. Jose G. Montoya, a Stanford infectious disease specialist pursuing the kind of research favored by Ms. Loomis, caused a buzz last December when he reported remarkable improvement in 9 out of 12 patients given a powerful antiviral medication, valganciclovir. Dr. Montoya has just begun a randomized controlled trial of the drug, which is approved for other uses.

Dr. Montoya said some cases of the syndrome were caused when an acute infection set off a recurrence of latent infections of Epstein Barr virus and HHV-6, two pathogens that most people are exposed to in childhood. Ms. Flowers, the former figure skater, had high levels of antibodies to both viruses and was one of Dr. Montoya’s initial C.F.S. patients.

Six months after starting treatment, Ms. Flowers said, she was able to go snowboarding and take yoga and ballet classes. “Now I pace myself, but I’m probably 75 percent of normal,” she said.

Many patients point to another problem with chronic fatigue syndrome: the name itself, which they say trivializes their condition and has discouraged researchers, drug companies and government agencies from taking it seriously. Many patients prefer the older British term, myalgic encephalomyelitis, which means “muscle pain with inflammation of the brain and spinal chord,” or a more generic term, myalgic encephalopathy.

“You can change people’s attributions of the seriousness of the illness if you have a more medical-sounding name,” said Dr. Leonard Jason, a professor of community psychology at DePaul University in Chicago.
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« Reply #12 on: September 17, 2007, 10:57:28 am »

Chronic Fatigue Syndrome Linked To Stomach Virus



Chronic fatigue syndrome, also known as ME (myalgic encephalitis), is linked to a stomach virus, suggests research published ahead of print in Journal of Clinical Pathology.

The researchers base their findings on 165 patients with ME, all of whom were subjected to endoscopy because of longstanding gut complaints.

Endoscopy involves the threading of a long tube with a camera on the tip through the gullet into the stomach.

Specimens of stomach tissue were also taken to search for viral proteins and compared with specimens taken from healthy people and patients with other gut diseases none of whom had been diagnosed with ME.

Patients with ME often have intermittent or persistent gut problems, including indigestion and irritable bowel syndrome.

And viral infections, such as Epstein Barr virus (glandular fever), cytomegalovirus, and parvovirus, among others, produce many of the symptoms associated with chronic fatigue syndrome.

Enteroviruses, which infect the bowel, cause severe but short lasting respiratory and gut infections.

There are more than 70 different types, and they head for the central nervous system, heart and muscles.

Most of the biopsy specimens from patients with gut problems showed evidence of mild long term inflammation, although few were infected with Helicobacter pylori, a common bacterial infection associated with inflammation.

But more than 80% of the specimens from the ME patients tested positive for enteroviral particles compared with only seven of the 34 specimens from healthy people.

In a significant proportion of patients, the initial infection had occurred many years earlier.

Thank you to Karyl as always for greeat info.
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« Reply #13 on: January 09, 2009, 02:16:26 pm »

The basics: Tired all the time - Try to establish the underlying cause

Jan.09, 2009
Patients present all too frequently with a feeling of being tired all the time. It is easy to become disheartened when yet another patient complains of being tired.

Delving deeper into their symptomatology may, however, prove to be rewarding. Nearly a third of patients who present feeling tired all of the time may have an identifiable pathological process.

Finding the cause
Considering the differential diagnoses will be helpful during the consultation.

In the first instance, it is important to clarify what the patient actually means by tiredness. Do they mean a lack of energy, fatigue, breathlessness, feeling low, day-time sleepiness, insomnia or weakness?



Crohn’s: inflammatory bowel disease can cause persistent tiredness

Asking the patient to tell you more about what they are experiencing by using open-ended questions is invaluable and exploring their ideas on why it happens may give you the underlying cause.

The characteristics of what the patient is experiencing should be discussed.

How long has it gone on for? Are they tired all the time or only sometimes? If sometimes, when? What is their lifestyle like? Do they sleep properly?

Are they happy or stressed/depressed? Is their weight stable? What medication/drugs do they take? Do they consume alcohol? Have they experienced night sweats?

Have they suffered any change in bowel habit or rectal bleeding? Are they breathless? If so, do they get breathless at rest or on exertion? Do they experience orthopnoea or palpitations? Do they have a cough or wheeze? Have they got symptoms of diabetes? A menstrual history is essential in women, while features of prostatism should be asked about in men.

Examination
Unless the cause of the tiredness is obvious, a general examination is imperative. Of course, a clear explanation as to why you need to examine a patient for tiredness is essential. Does the patient look depressed, jaundiced, breathless, cachectic, pale or hypothyroid? Do they have finger clubbing, signs of endocarditis, tremor, Dupuytren's contracture, palmar erythema or an abnormal pulse when examining the hands? Moving to head and neck, is there evidence of conjunctival pallor, lymphadenopathy or goitre?

Examination of the heart may reveal evidence of cardiac failure, arrhythmia or a murmur. Features of fibrosis, effusion or primary, metastatic or paraneoplastic disease may be found on respiratory examination.

When examining the abdomen, hepatomegaly may be suggestive of alcoholic or infective hepatitis, or malignancy.

Splenomegaly can be caused by connective tissue diseases, haematological disease such as leukaemia and myelofibrosis and infections. A mass may be palpated in the abdomen suggestive of bowel cancer.

Women may require a pelvic examination. Depression screening questionnaires may be appropriate and recent evidence has shown these to have a good negative predictive value.

Differential diagnoses of feeling tired all the time

Constitutional: poor conditioning, pregnancy.

Infection: TB, glandular fever.

Malignancy: especially when associated with weight loss.

Haematological: anaemia.

Cardiovascular: ventricular dysfunction, IHD, arrhythmia, valve disease.

Respiratory: obstructive/restrictive airways disease, sleep apnoea.

Renal: failure.

Drugs: beta-blockers, antihistamines.

Endocrine: diabetes, hypothyroidism, Addision's.

Neurological: Parkinson's disease, ME.

Gastrointestinal: inflammatory bowel disease, liver disease, coeliac disease.

Psychological: depression, alcoholism, illicit drugs, chronic fatigue, stress.

Investigations
Most patients complaining of feeling tired all the time will have a normal clinical examination. If there is no obvious cause, it is reasonable to organise a series of general blood tests.

Ideally, tests should be tailored to the clinical picture. An FBC may reveal evidence of anaemia or infection. Renal failure and liver disease may present with fatigue. Thyroid function and blood glucose should also be checked. Hypercalcaemia may masquerade as depression and fatigue. An ESR may help rule out inflammatory diseases.

Screening
Women may require a pregnancy test and men a PSA test. Other tests include a glandular fever and coeliac screen.

Heart failure is not always easy to diagnose, but a normal ECG and chest X-ray virtually rules out left ventricular systolic dysfunction. An echocardiogram should otherwise be organised. An oxygen saturation reading may prove useful and sleep studies may be required.

The treatment of a patient who feels tired all of the time will include management of any underlying cause. If no cause can be found then general measures can be put in place. These include decent sleep hygiene, exercise, addressing life stresses, a good work-life balance and a healthy diet. Some patients may elect to have counselling.

Feeling tired all the time is a symptom rather than a disease. It is imperative to be clear what the patient means and to tease out any underlying cause. If a cause can not be found, general lifestyle measures should be encouraged.

    SOURCE: Dr Thakkar
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« Reply #14 on: May 11, 2009, 09:42:36 am »

New Drug Approvals - A Date With Destiny...
Mon. May 11, 2009


The biotechnology sector is a risky investment arena and investing in such companies requires a great deal of patience. Drug companies take years -- even decades and burn a tremendous amount of cash to bring a drug to the market.
Some drugs pass the FDA muster easily, while some struggle through the arcane process of regulatory approval. For a one-trick pony company, which does not have a safety net for failure of the lead compound, the FDA decision can seal the fate of the company.


However, despite the regulatory setbacks, some companies exude a steely determination to bring their drugs to market and their patience has been amply rewarded. Some of the recent classic examples are Dendreon Corp. and Vanda Pharmaceuticals Inc.

Two years after Dendreon's prostate cancer vaccine Provenge was rejected by the FDA, the drug has got a second chance now. Dendreon plans to refile for FDA approval in the fourth-quarter of this year. The stock, which hit a 52-week low of $2.55 on March 9, 2009, now trades around $19.

Vanda is yet other example of patience and an iron resolve. After initially being rebuffed by the FDA last year, Vanda's schizophrenia drug Fanapt (Iloperidone) made it across the finish line by winning the regulatory approval on May 6, 2009. The stock, which hit an all-time low of $0.45 on December 23, 2008, now trades around $9.

The following are the companies, which are expected to hear the FDA's decision on their drugs during this month.

Hemispherx Biopharma Inc. (HEB | Quote | Chart | News | PowerRating), which is awaiting FDA approval of its experimental drug Ampligen for chronic fatigue syndrome, set a new 52-week high of $1.50 on Friday. The FDA decision is due on May 25.

Over the past one-week alone, Hemispherx gained a whopping 160%. The current run up in stock price of Hemispherx can be attributed to the prospects of flu profits. The risk of a swine flu pandemic has boosted the share prices of anti-viral drug companies and Hemispherx is one among them.

Ampligen, which has earned the sobriquet, "a drug in search of a disease", is also in preclinical testing for avian flu in the U.S., Japan and Canada. On April 27, it was announced that the Japanese government is accelerating the Ampligen research program in human volunteers. The recent emergence of a new swine flu strain with high associated mortality in Mexico provides additional significance to the Japanese studies.

Hemispherx's collaborative partner in Japan, Biken Corporation has also successfully completed a series of animal/preclinical tests on Ampligen as an enhancer for seasonal influenza vaccine.

Ampligen has been pacing the sidelines for nearly four decades. Chronic fatigue syndrome, or CFS, for which Ampligen is being evaluated, is a condition in which patients have persistent or relapsing fatigue. There is neither a known cause, nor an effective treatment for CFS. According to the company, the global market for an effective CFS drug is worth over $1 billion. The CFIDS Association of America estimates that four million Americans suffer from chronic fatigue syndrome.


On May 31, 2009, Acusphere Inc, a specialty pharmaceutical company will get to know the fate of Imagify for injectable suspension as cardiac imaging agent for the detection of coronary artery disease, the leading cause of death in the United States.

According to statistics, 16.0 million people in the United States suffer from coronary artery disease, or CAD.

The company submitted the New Drug Application, or NDA, of Imagify in April 2008 and in February 2009, submitted an amendment to its NDA. The amended indication is focused on patients undergoing pharmacologic stress techniques where the risk-to-benefit ratio of Imagify is more compelling than the broader indication that was originally filed.

The CAD is characterized by the accumulation of plaque and early identification and intervention are crucial to prevent it from becoming fatal. A key indicator of the presence of CAD is blood flow (perfusion) deficits in the heart muscle (myocardium).

The current standard for detecting perfusion deficits is through a Nuclear SPECT Stress Test (Nuclear Stress Test), which is expensive, time consuming and exposes patients and providers to radiation.

According to the company, Imagify, which is an ultrasound imaging agent, represents a rapid non-invasive means to identify the presence of CAD before a patient has an event without the use of radiation. Besides, Imagify is also less expensive than a nuclear stress test.

Since bottoming out at $0.02 on March 20, 2009, the shares have risen more than eleven-fold and currently trade around $0.23. Over the past 1 week alone, the stock gained an impressive 109%.

Arca biopharma Inc.  is yet other company, which will be hearing the FDA's decision on its investigational chronic heart failure drug Gencaro (bucindolol) on May 31, 2009.

According to the company, Gencaro, a gene-specific heart failure prevention drug, targets certain genes that other heart medications do not.

If approved, Gencaro will be the first genetically-targeted cardiovascular drug. ARCA holds worldwide rights to Gencaro and, if it is approved, the company plans to commercialize the drug in the U.S., through its own specialized sales force. ARCA intends to seek commercial partners outside the United States.

A companion genetic test for Gencaro, developed by ARCA in collaboration with Laboratory Corp. of America Holdings is also under the FDA review. Targeted therapies use companion diagnostic tests. A companion diagnostic test refers to a specific test that assists physicians in selecting the right drug for the right patient.

Since hitting an all-time low of $2 on January 28, 2009, shares of Arca have gained nearly 400% and currently trade around $10.

According to reports, the FDA approved 24 new drugs (the first-of-a-kind drugs) in 2008, compared to 18 in 2007, 22 in 2006 and 20 in 2005.
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