Fatigue is a common complaint of people who are not sleeping well or who are stressed, but severe or clinical fatigue may leave a person with generalized weakness and make it hard for him to initiate or maintain activity. People may also have difficulty with concentration, memory and emotional stability. Dr. Jamal Mikdashi, a rheumatologist at the University of Maryland Medical Center and an associate professor of medicine at the University of Maryland School of Medicine, explains how to tell whether a person might have chronic fatigue syndrome.
• When symptoms last more than six months, doctors may consider chronic fatigue syndrome (CFS), which often starts with sudden fatigue associated with an upper respiratory infection. However, after the infection is treated, these patients still have overwhelming fatigue, altered sleep patterns and difficulty concentrating.
• The Centers for Disease Control and Prevention estimates that 1 million Americans may have CFS. Bed rest does not alleviate the fatigue, and physical or mental activity may make it worse. There has been debate surrounding the definition of CFS, so the CDC published a working-case definition that requires the exclusion of other conditions that produce fatigue. Patients should consult with a health care provider to see if the fatigue is caused by anemia, cancer, HIV, kidney disease or other illnesses.
• There are no specific tests to diagnose CFS. Despite years of research, the cause is unknown. Infections, immune-system dysfunction, hormone-metabolic disorders and low blood pressure may be involved in the development of this condition. Depression and sleep disturbances also contribute to its severity.
• Many CFS patients are dissatisfied with their medical care and may feel that their doctor is not communicating well with them. A trusting doctor-patient relationship is critical; the physician should acknowledge the patient's complaints. Patients should feel confident that their medical team is working with a plan to establish treatment goals, with an emphasis on helping patients accomplish daily activities, return to work and maintain interpersonal relationships.
• A multidisciplinary treatment plan with exercise therapy and cognitive behavioral therapy is effective for CFS patients and can also be beneficial for patients who have fatigue from an unknown cause. Good sleep habits and gentle physical fitness should be encouraged. Antidepressants may also be helpful for patients with symptoms of depression. Patients with CFS should understand that this condition does not cause organ failure or death. Several factors, including older age at onset, persistent CFS symptoms and other psychiatric and medical conditions, make it less likely that the patient can recover completely to his previous energy level.
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