Definition
In 1988, the Center for Disease Control developed the criteria for Chronic Fatigue Syndrome, or CFS. The classic definition of Chronic Fatigue Syndrome is a severe onset of fatigue that has been ongoing for at least six months and is associated with at least four or more of the following symptoms:
- Inability to concentrate / impaired memory
- Headaches
- Feeling tired after a night of rest
- Muscle aches and pain
- Pain in two or more joints
- Sore throat
Importance of Proper Diagnosis
It is important to rule out other underlying diseases such as thyroid disease, diabetes mellitus, multiple sclerosis, and rheumatoid arthritis. These studies should include lab studies for anemia, thyroid disorders, electrolytes and phosphate.
Other diagnostic studies should include upper GI, lower GI series,
and a possible endoscopy. Viral studies may also be useful in aiding in the diagnosis of CFS.
A meticulous clinical exam is most useful.
The medical history should include:
- Sleeping habits and patterns
- When the symptoms of fatigue began
- Aggravating symptoms or events, such as menstrual cyle
- or stressful events
- Recent viral infections which emerge as a prodrome to CFS
- Diet – use of artificial sweetners, soda pops
- Bowel habits
- Joint pain
- Muscle fatigue / weakness / pain
- Frequent sore throats
- swollen or tender lymph nodes
- Mini mental status examination– to check for impaired
Over a period of months and sometimes years, the more severe symptoms of CFS slowly appear. Many patients have suffered from 6 months up to several years of being tired and fatigued, after having been misdiagnosed and treated with various medicines labeled for different diagnoses.
Once a diagnosis has been established, then the treatment should begin. Treatment is determined by the clinical picture.
For example, one patient may present complaints of IBS, fibromyalgia, fatigue, inability to concentrate, headache and lymph node tenderness. Another patient may present symptoms of headache, fatigue, sore throat, sleep apnea and depression. Therefore treatment must be individualized.
It cannot be one shoe size fits all, such as it is with anti-depressants and arthritis and lymph medicines, and as is the unfortunate standard of care in the United States today!
Chronic Fatigue Syndrome & The Victorian Era - Victory O Lord!
Chronic Fatigue Syndrome and its complex of symptoms have been known since antiquity, even in Biblical writings. Noted physiologist and researcher on Fatigue, Dr. Starling, described the prophet Moses as having symptoms of Fatigue Syndrome. Starling pointed to the 19th century painting Victory, O Lord! by Sir John Everett Millais, in support of his thesis. (1870, City Art Gallery, Manchester.)
It is interesting that while the medical profession totally missed the importance of Chronic Fatigue Syndrome among women, in the keen eyes of painters a vivid picture can be reconstructed: - a housewife getting easily tired even before noon (note that some evening fainting spells could be due to NMH, neuronally mediated hypotension), and living with symptoms of fatigue, so called taking an afternoon nap. This later evolved into "afternoon tea". (In the early 1840's and 1850's, an afternoon tea ceremony became a fashionable event among Victorian era ladies.)
Tea drinking served two purposes: first, tea provided a uniquely slow release of caffeine as a stimulant, which did not cause palpitations and heartburn as did drinking coffee. Secondly, tea provided a strong anti-oxidant which helped fatigue symptoms. In fact, in people who drink tea regularly Chronic Fatigue Syndrome is uncommon.
Even during the later half of the 19th century Victorian era, there are numerous paintings reflecting tired, fatigued ladies slumped on the "fainting couch". This artistic theme appears consistently in many Victorian erapainters; some examples of Fatigue are as follows:
James Whistler,
Symphony in White No 3, 1866.
Federico de Madrazo,
Condesa de Vilches, 1853,
Museo del Prado, Madrid.
The benefits of drinking tea as a health food are numerous and we have found in our research that drinking 3 cups of green tea (or black tea) a day is extremely beneficial in the treatment of Chronic Fatigue Syndrome.
Fibromyalgia
More than two thirds of patients with Chronic Fatigue Syndrome have diffuse muscle pains. There are many similarities such as sleep disorders, and symptoms of depression.
Irritable Bowel Syndrome (IBS)
IBS is a condition with altered bowel habits with periods of constipation and diarrhea, bloating and abdominal pain. It is also accompanied by other symptoms of fatigue and fibromyalgia.
Da Costa's Syndrome
(Soldier's Syndrome / Effort Syndrome)
The symptoms of chest pain and shortness of breath with minor exertion were noticed among Civil War soldiers. Later on, similar experiences were observed in World War soldiers. This was called Neurasthenia, or Effort Syndrome. It was considered related to stress and emotional shock. (Thomas Lewis, famous British Cardiologist). These patients with neurocirculatory asthenia the symptoms were often ascribed to anxiety and labeled as various psychiatric disorders.
Though not recognized in the literature of the time period, the present author's opinion is that these patients represented a form of Neuronally Mediated Hypotension (NMH) which is characterized by palpitations, chest discomfort, shortness of breath, fatigue and fibromyalgia. So what was described as Da Costa's Syndrome was stress created Chronic Fatigue with prominent symptoms of neuronally mediated hypotension. This condition has all symptoms of CFS along with low blood pressure, usually below 100 systolic.
Outline of Treatment & Importance of Proper Diagnosis, By Paul Gaugin
Avoidance of unnecessary medical procedures and medicines. There is a chronic failure of the medical profession to understand women's diseases. For depression, they labeled it hysteria (disease of uterus); and there is a failure to recoginize subtle differences in the diagnoses of coronary heart diseases in women.
CFS has not been given proper emphasis. There exists a lack of education and understanding, none of the standard medical textbooks adequately address .
Mercury poisoning, dietary paranoia, complex personality disorders and dental and orthodontic problems have crowded the true picture of Chronic Fatigue Symdrome.
In author's opinion, precisely many of the above mentioned factors have lead to the rejection by serious medical researchers the validity of the CFS diagnosis and sensible treatment options.
In the absence of reliable tests, it is impossible to diagnose with 100% certainty some of the borderline
cases. In my experience, the Mestinon Test has proved a reliable test for Chronic Fatigue Syndrome. We have used it in our clinics as a fairly adjunctive test, along with clinical presentation and simple laboratory tests. A low dose of Mestinon (30 mg twice daily) is given to patients with symptoms of CFS and their response is compared to our classic responders. This approach has helped us in many difficult cases.
A good clinical examination, a thorough medical history and some basic simple lab tests are sufficient for the diagnosis of over 95% of patients. Rarely, further neurological and rheumatological work up is needed.
Treatment Strategy
Only an outline treatment has been mentioned. For details we have held workshops at our clinics open to the public.
Diet
AVOID:
- All artificial sweeteners
- Food coloring
- Additives
- Fruits and vegetables grown with fertilizers and insecticides
- Certain meats: cold cuts, heavily cured or smoked meats, canned salami
USE:
- Fresh, organically grown fruits, vegetables, and those which are less chemically treated
- Canned fruit can be used, if in its own juice
- Natural sweeteners such as honey, maple syrup, molasses and brown sugar
Exercise
Special relaxation and meditation therapies, Modified yoga - meditation exercises
We provide extensive training in Oriental meditation and light exercises for the treatment of Fatigue and Fibromyalgia
- Sufi, Buddhist methods of healing, meditation
- Modified Shaitsu technique
For Fibromyalgia, the following are effective, if provided by experienced practitioners:
- Massage therapy
- Essential oil combinations
- Aromatherapy
- Steams / saunas
- Minimize Use of narcotics
Strong analgesics
(use only a very limited amount – mostly for therapeutic massage, saunas and steambaths, aromatherapy, and essential oil combinations) - Mikso / Miksha Oil
(a combination of herb compounds used at our clinic)
Herbal Remedies
Under Medical Guidance, the use of:
- American ginseng
- South American and Chinese herbs (Kola nut, Gurana)
- Fennel seeds
- Cardamom
- Cinnamon
Prescription Drugs:
- Mestinon (30 mg twice daily)
- Florinef (0.1 mg daily)
- Proamatine (5 mg 96 h 3-4 times daily)
- Ultram (50 mg 2-3 times daily for pain control)
Useful Antioxidants
- Goji Berries
- Green Teas
- Pomegranate products
