Chronic Fatigue Syndrome has made the CDC’s priority list


By: Dr. Chandani D. Fernando
   Chronic fatigue syndrome (CFS) has been around for many years and affects people of all ages and occupations.
   According to the Centers for Disease Control (CDC), the number of people afflicted with CFS is growing, along with public awareness. In fact, the CDC recently listed chronic fatigue syndrome as a "Priority 1" in its infectious disease category, along with diseases such as cholera, hepatitis C, malaria and tuberculosis.
   While some patients recover within a reasonable amount of time, others are sick for extended periods. Because the illness encompasses a wide variety of symptoms, it is difficult to diagnose and can be quite frustrating for the patient.
   Because CFS affects each patient differently and is often an invisible illness, it is helpful for the patient to seek treatment from a compassionate, understanding physician who is committed to the time-consuming process of ruling out other potentially serious illnesses.
   There is a variety of serious illnesses that are associated with profound or chronic fatigue, including AIDS; anemia; cancer; pulmonary disease; diabetes mellitus; syndrome X; imbalances of the endocrine system; heart failure; Lyme disease; malnutrition; mononucleosis; renal failure; sleep disorders; multiple sclerosis; lupus, and heart disease. This is why it essential to seek treatment and rule out these possible causes.
   Fatigue is not well understood. It is thought that an imbalance in the supply and demand of nutrients in the body’s cells or an imbalance between the accumulation of waste products and the body’s need for waste removal at the cellular level may lead to fatigue. Medical experts who have studied CFS and its symptoms extensively believe that infection may be at the root of the syndrome.
   Whatever the causes, it is not something that should go unrecognized or untreated.
   The symptoms most often associated with CFS include:
   • Sore throat
   • Painful cervical or axillary lymph nodes
   • Unexplained generalized muscle weakness
   • Prolonged fatigue (lasting at least 24 hours)
   • Generalized headaches
   • Migratory painful joints without swelling or redness
   • Areas of lost or depressed vision
   • Visual intolerance of light
   • Forgetfulness
   • Excessive irritability
   • Confusion
   • Difficulty thinking
   • Inability to concentrate
   • Depression
   • Non-refreshing sleep
   A patient may have one, two, or more of these symptoms; there is no set number required to make the diagnosis. There are no specific lab or radiology tests used to diagnose CFS. Rather, chronic fatigue syndrome is a diagnosis of exclusion, in which other conditions are ruled out before a patient is said to have CFS.
   Dealing with it requires embarking on a long-term journey with your physician. As a patient, you will be asked to grade your symptoms as mild, moderate, severe or absent. Expect your physician to interview you about your concerns and to inquire about the amount of emotional support who receive from family and friends. Because CFS rarely makes a person look sick, it is not unusual for those dealing with these symptoms to experience doubtful reproach from others, which can contribute to feelings of depression. Depression is often a big part of CFS. It is unclear whether it contributes to the syndrome or is a result of it.
   Treatment is symptom-driven. Physicians treating CFS typically see their patients every four-to-six weeks to monitor treatment and energy levels. Anti-depressants and pain relievers can moderate or alleviate depression and pain. To combat tiredness, patients are asked to improve their energy levels through daily aerobic exercise and a diet rich in fruit and vegetables and low in saturated fats. Over time, the goal is to alleviate all or most of the symptoms so that the patient can function normally.
   If you experience the major signs of CFS, such as fatigue that is out of proportion with your level of activity; muscle and joint aches that make you feel like you just ran a marathon, or an inability to wake up feeling refreshed after a good night’s sleep, take note. Because it is difficult to remember details about how you are feeling from week to week or month to month, keep a simple daily journal so that you can chart your progress. Use your internal scale and judge how you feel compared to three months ago.
   Note any external pressures or changes, as well. This will help you recognize when it is time to call your physician and begin the process of ruling out other serious conditions. Know that there are treatments available for all the symptoms associated with chronic fatigue syndrome, so keep a positive outlook. The importance of maintaining a healthy attitude cannot be overstated.
Dr. Chandani D. Fernando is board-certified in internal medicine and infectious diseases; she is on staff at The Medical Center at Princeton. This article was prepared in collaboration with Lorraine Seabrook.