Chronic Fatigue Syndrome
What is it?
If only we knew! The one thing that you can be certain with Chronic Fatigue Syndrome (CFS) is that nothing is certain. The symptoms vary from person to person and the means by which doctors diagnose it also varies. Several lists of symptoms which doctors can use to diagnose CFS/ME have now been published in the UK, USA and Australia. A recent working party set up by the Chief Medical Officer (CMO) in 2002 concluded that CFS/ME is a genuine medical condition, affecting both adults and children alike but that both complementary and conventional treatments can be of limited use to many patients. The situation is not helped by the fact that there are many therapists who claim to have a cure-all treatment and information about various therapies with 100% cure rates are rife on the internet. This can cause a great many raised hopes in sufferers of a miracle cure, which get dashed if they are not one of the lucky ones for whom that particular therapy works.
So how do you know if you have CFS/ME?
The commonly used criteria are reproduced below;
persistent for 6 months or more, unexplained, not relieved by rest, results in significant reduction in day-to day activities
Four or more of the following symptoms which have started AFTER the fatigue:
Poor short term memory/concentration
Tender lymph nodes in neck or armpits
Pain in multiple joints without medical arthritis
Feeling unwell after exercise for more than 24 hours
There are any number of other diseases and illnesses which share a great many symptoms with CFS/ME which is why it can be so difficult to diagnose but also why it can be dangerous to try to diagnose yourself without seeking medical attention. Depression can give all of the above symptoms as can thyroid disease, severe sleep problems (sleep apnoea), heart and lung diseases, cancer, hepatitis, HIV, connective tissue disorders and hormone problems such as Addisons disease (adrenal gland imbalance).
How DO you diagnose CFS/ME?
It is vital for a careful history of the illness to be taken by a doctor as there can be pointers towards any of the alternative diseases listed above within a patient's story of their ill-health. Despite popular belief and claims made by various therapists, there is no one test specific to CFS/ME. Typically, it can be difficult to show any definitive problems with the muscles and nerves, despite extreme fatigue and pain being experienced by the patient. This is why the ME Association now use the term 'myalgic encephalopathy' rather than myalgic encephalomyelitis.
Certain laboratory tests are recommended in order to exclude other diseases:
Haemoglobin and white cell count ('FBC')
Acute phase protein changes ('ESR' or 'CRP')
Liver, thyroid and kidney function tests( 'LFT', 'TFT', 'RFT')
Routine biochemistry ('U and E's', 'creat.')
Urine tests for protein/sugar
What to do next? How can you treat CFS/ME?
The doctor and family to give reassurance, explanation and support. There are a good many people who recover with no specific treatment other than this.
Graded physical activity. Helps to keep muscle tone but needs very careful monitoring as it is all too easy to exceed the threshold over which symptoms can worsen.
Improve sleep patterns. Can use a combination of simple life-style changes such as avoiding day-time naps when resting, with medication either to reduce pain (NSAID) or to aid sleep.
Conventional medication. Used to relieve specific symptoms. Doses need to be small to start with as CFS/ME patients can be VERY sensitive to medication. Although patients become depressed as a result of their illness, not all anti-depressants seem to help people with CFS/ME.
Rehabilitation. Vital in order for sufferers to return to school/work. Counselling or other psychological support can help to regain confidence. Doctors can support staged return to work or applications for benefits.
Support groups, e.g. ME Association www.meassociation.org.uk,
Action for ME www.afme.org.uk (www.a4me.org.uk),
Action for CFIDS/ME www.cfs-news.org,
Association of Youth with ME (AYME),
Blue Ribbon Awareness for ME (BRAME),
National ME Centre and Centre for Fatigue Syndromes www.nmec.org.uk,
Overton Studios Trust www.ostrust.freeserve.co.uk,
25% Group www.btinternet.com/~severeme.group
There is very little hard scientific evidence that any of the above work although there is a research project currently being undertaken at the Bristol Homeopathic Hospital in to the treatment of CFS with homeopathy due to be published soon. However, I know patients who have found each of the above therapies helpful in their recovery from CFS/ME.
So what do I do?
I use a combination of Classical Homeopathy, together with nutritional supplements and advice regarding life-style and general stress-counselling. If I am seeing patients as a GP, I do offer conventional medication but my most important treatment option is to offer hope of recovery from this debilitating illness. 3 out of 4 people will be significantly recovered from their symptoms within 5 years of it starting and it is important to emphasise this. I know a quarter of patients will be unlucky to be left with severe symptoms after this time but I am a firm believer in thinking positive. Patients have been through enough already, telling them that they will never improve will not help them get better. As a doctor, both in the conventional and the complementary field, I have seen what can only be described as miraculous recoveries. On further examination, these miracles often had a very down to earth turning point; unfortunately, it is not always possible to predict when that point will be reached.
To all sufferers of CFS/ME, I send my sincerest best wishes for their recovery and hope that some of the above information may be helpful to them.
© Dr Jeni Worden MB ChB MRCGP MFHom March 2006