There has been a lot of recent media attention regarding the association of the xenotropic murine leukemia virus-related virus (XMRV) and chronic fatigue syndrome (CFS) and fibromyalgia. $0 : ” }) } function speak(text, voice, callback) { if (callback) { responsiveVoice.OnFinishedPlaying = function () { responsiveVoice.OnFinishedPlaying = null; callback(); }; } responsiveVoice.speak(text, voice); } $(document).ready( function() { $(“#pause”).hide(); $(“#play”).show(); $(“#end”).hide(); $(“#resume”).hide(); $(“#play”).click( function(){ $(“#pause”).show(); $(“#play”).hide(); $(“#end”).show(); $(“#resume”).hide(); var voice = strip_tags($(“#voice”).html()); speak(voice,”UK English Female”); } ); $(“#resume”).click( function(){ $(“#pause”).show(); $(“#play”).hide(); $(“#end”).show(); $(“#resume”).hide(); responsiveVoice.resume(); } ); $(“#pause”).click( function(){ $(“#pause”).hide(); $(“#play”).hide(); $(“#resume”).show(); $(“#end”).show(); responsiveVoice.pause(); } ); $(“#end”).click( function(){ $(“#pause”).hide(); $(“#play”).show(); $(“#end”).hide(); $(“#resume”).hide(); responsiveVoice.cancel(); } ); $(“#pause2”).hide(); $(“#play2”).show(); $(“#end2”).hide(); $(“#resume2”).hide(); $(“#play2”).click( function(){ $(“#pause2”).show(); $(“#play2”).hide(); $(“#end2”).show(); $(“#resume2”).hide(); var voice = strip_tags($(“#voice”).html()); speak(voice,”UK English Female”); } ); $(“#resume2”).click( function(){ $(“#pause2”).show(); $(“#play2”).hide(); $(“#end2”).show(); $(“#resume2”).hide(); responsiveVoice.resume(); } ); $(“#pause2”).click( function(){ $(“#pause2”).hide(); $(“#play2”).hide(); $(“#resume2”).show(); $(“#end2”).show(); responsiveVoice.pause(); } ); $(“#end2”).click( function(){ $(“#pause2”).hide(); $(“#play2”).show(); $(“#end2”).hide(); $(“#resume2″).hide(); responsiveVoice.cancel(); } ); } ); The invention of the microscope in the 1800s was a scientific milestone that has led to revolutionary advances in medicine. Because different combinations of factors can cause different symptoms and changes in the body, experts are identifying categories or subgroups of ME/CFS. Currently, there are no Food and Drug Administration-approved treatments specific for ME/CFS. Of course it can be very bothersome and unfortunately there isn’t any properly effective medication to cure viral infection, antibiotics aren’t effective either, because those focus on bacteria, not viruses. They know there are links, with many patients having had severe glandular fever (Epstein Barr virus), and there are some studies to show that the body’s immune response to glandular fever is greater in patients with chronic fatigue syndrome. But CFS is different from normal feelings of fatigue and low energy.

This then usually provides lifelong immunity. It is interesting that many individuals who harbor an infection with one of these viruses are so used to their low level of energy, that they consider it as their normal, day to day level of energy. As it was described [1-4] in four groups of patients, the syndrome consists of a combination of non-specific symptoms – severe fatigue, weakness, malaise, subjective fever, sore throat, painful lymph nodes, decreased memory, confusion, depression, decreased ability to concentrate on tasks, and various other complaints – with a remarkable absence of objective physical or laboratory abnormalities. African Swine Fever is caused by a virus, African Swine Fever Virus (ASFV). Many become so severely affected that they are bedbound or housebound. The spleen becomes swollen in up to half of people with mononucleosis. Frustrated with conventional medicine, I eventually treated myself and gradually recovered.

People infected with HIV experience fatigue for many reasons. The flu virus can lead to a cough accompanied by wheezing and chest tightness. . One small study found that a CFS patient taking 2.5 grams of licorice daily showed improvement. What to Do: If you have unexplained fevers, aches, chills, and a rash, see your doctor. A popular theory is that a viral infection may trigger the condition. Having an intense emotional or physical experience – arguments, sex, shock, violence – these will fatigue or exhaust us.

One study reported that about 70% of CFS patients, 85% of persons with miscellaneous other disorders, and 12% of healthy persons had antibodies against this virus, suggesting that persons with a variety of illnesses may have secondarily increased HHV-6 titers. Precisely how this virus is related to chronic fatigue, however, remains a mystery. Such symptoms as swollen glands, fevers and sore throats ”are hard to attribute to a psychological cause,” he said, and most patients describe a sudden onset of disease, suggesting an infectious agent. This is especially true if you are taking ibuprofen for pain or fever because ibuprofen can affect kidney function if you become dehydrated. It will often takes several things together to make you feel tired. For example, if you feel stressed for a long time, you will probably sleep badly and feel ‘below par’. Accessed March 31, 2014.

This can be the ‘last straw’ which finally exhausts you. Have small amounts of nutritious things to eat, frequently, rather than large meals which are tiring to prepare and eat. You will now find that just doing everyday things can make you even more tired. If you can’t get back to your normal routine, you will probably feel worried and frustrated. This gives you more sleepless nights and makes you more tired ……. and so a vicious circle is set up. They exist in a physical state somewhere between bacteria and virus.

Several studies have shown irregularities in the immune systems of people with ME/CFS, but researchers have not found a consistent pattern of abnormalities. Your doctor may also need to learn more about ME/CFS to help you. Try to have your evening meal early rather than late. When faced with doctors indicating they can find no abnormality, patients have often felt frustrated and they have criticised the doctors for not conducting the appropriate tests or finding the obvious diagnosis. If you can’t sleep, don’t lie there worrying about it: get up, leave the bedroom and do something you find relaxing. Damaged spleen. Pick a way to relax before going to bed – such as reading, listening to music or using a relaxation technique.

Prolonged (24 hours or greater) generalized fatigue after levels of exercise that would have been easily tolerated in the patient’s premorbid state. This should be as hot as you can bear, without scalding you, and last a good twenty minutes. If something is troubling you, and there is nothing you can do about it there and then, try writing it down. Tell yourself you will deal with it in the morning, and then go to bed. But, I’m not satisfied. If you experience declining health, your medication needs may change. Take some exercise Many people feel too exhausted to start any exercise.

. So what can you do about this? Try starting with a small amount of exercise: it doesn’t matter how little as long as it’s easy and you can do it regularly – every day, if possible. You are still likely to be able to do a job, but may often take days off work. We know that certain life events and lifestyles make more people prone to fatigue and illness. Our general recommendation is to consult an infectious disease specialist or the infectious disease department at a university affiliated medical center in your area if you feel you need further evaluation, or to ask your county medical society for a referral. Walking is the easiest exercise to try, but anything that you enjoy will do.

Many people like to swim or cycle regularly. What you are trying to do is to gradually improve your fitness and strength. You may be able to get advice from someone who knows how to help unfit or ill people to get fit. If you find that you are doing too much, and feeling worse, don’t give up! Carry on with some less demanding regular exercise, perhaps for a shorter time each day. Don’t do anything more energetic until you have got used to the amount of exercise you are doing at the moment. 3.

Cut out caffeine Gradually stop having all caffeine drinks over about a three week period. Everyone knows that coffee and tea contain caffeine, but watch out! There are many other drinks and products that have caffeine in them, such as energy and cola drinks, some painkillers, and energy-boosting pills. Some herbal remedies also contain a lot of caffeine. There are varieties of proposed theories suggesting how stealth organisms are able to go undetected. Try to stay off caffeine completely for a month to see if you feel better without it. Research shows that about half of people with ME/CFS work part-time or full-time jobs.

If this happens, just cut down more slowly the amount of caffeine you are drinking. If you are overweight, you will feel a lot better if you lose some weight gradually. A crash diet is not helpful and can make you more tired. Antibiotic medicines are not usually used, as glandular fever is caused by a virus. If you are too thin, you will not recover your full energy unless you start to get back to your normal weight. 1987; 257:2303-7. 5.

Plan your day/week Try to plan your day and your week. Try to make sure that you don’t have any really hectic, tiring days. Organise it so that you do a little every day. If you cram everything into one day, you may be too exhausted to do anything for the rest of the week. Try to do your chores when you think you will have the most energy. 6. Have realistic expectations Be kind to yourself.

If you have been tired for a long time, don’t expect to be back to your normal self overnight. It is not the same as going to the gym or doing more exercise by yourself. Prognosis in recovery can be improved by helping people change the way they manage their illness. Minann, Inc., Box 582, Glenview, IL 60025. We’d all like a magic cure to take away our tiredness. There isn’t one. There are many products on the market that claim to do this.

There is no good evidence that any of them help for very long. This goes for vitamins, minerals, stimulants, total rest and sleeping, and exclusion diets that cut out particular foods. Not getting better There is always a reason and sometimes more than one. You may be suffering from an undiagnosed illness. Ask your doctor to check out whether you have any of these problems. Common treatable problems include thyroid disease, anaemia, sleep apnoea (temporarily stopping breathing when asleep), restless legs (an uncomfortable restless feeling in the legs that happens when you are trying to rest), anxiety and depression. A small number of people suffer from severe and disabling tiredness that goes on for a long time and for which there is no clear cause.

This is  called Myalgic Encephalomyelitis (ME) or Chronic Fatigue Syndrome (CFS). 3. As toxic overload increases inflammation, the body’s compensatory response is to produce more cortisol, the anti-inflammatory hormone. So, before a diagnosis of CFS is made, physical and psychological examinations (and physical investigations) are requited. You will also need an assessment of your mental state. People with CFS/ME have often felt that doctors believed that their problem was ‘all in the mind’ – even though they had physical symptoms. Doctors now recognise that this is an illness, although it is poorly-understood.

Like many other ‘physical’ illnesses, such as asthma and irritable bowel syndrome. some psychological treatments seem to help. This does not necessarily mean that CFS is a mainly physical disorder. So – what do we know? Certain viral infections can trigger CFS/ME. We also know that people with CFS/ME have no continuing infection with the virus. So, there may be factors other than the virus which keep CFS/ME going and delay your recovery.

These are called ‘maintaining factors’ and  often the same ones as those that cause general tiredness, as described earlier in the leaflet. These include difficulty in sleeping, depression and anxiety. If you can identify the factors that are keeping the CFS/ME tiredness going (they are usually more than one), you have a chance of improving. They are often that same factors that cause the general tiredness as described above. Even trying to get better can sometimes make things worse. For instance, if you rest too much, you will get weaker and more unfit. Some people recover in less than two years, while others remain ill for many years.

More subtly, if we spend a lot of the day resting and unstimulated, there is less need for deep prolonged sleep at night, even though we may feel more exhausted than when we were active. Most of us think that if we have a viral illness, we should go to bed or rest at home for a few days. This works very well for short illnesses. However, if you do carry on resting for longer than a week or two, it tends to make you more tired. Supervised graded exercise therapy (GET). This is a way of gradually increasing your amount of physical activity and stamina without over-tiring yourself. It doesn’t suit everybody, but does seem to help about 2/3 of those who try it.

Cognitive behaviour therapy (CBT). This is a talking treatment which helps you to change any unhelpful ways of thinking about your illness and to improve your coping skills. Pacing. This is a common sense approach to adjusting one’s daily activity so that you avoid over-tiredness and a possible relapse. What if I don’t do anything about it? How well do the treatments work? About 6 out of 10 people feel better with either CBT or GET, although quite a few people with CFS have reported that GET tends to make them more tired, not less.

One can feel good for weeks or months after a lot of hard work to control the stealth toxin, only to fall quickly with the smallest mistake in lifestyle or nutritional mishap. Which treatment to choose? Both CBT and GET (see above) are helpful for many people – but they clearly do not help everybody. Pacing makes good common sense, but does not yet have much evidence to support it, although it is currently being investigated. References NHS Centre for Reviews and Dissemination. Interventions for the management of CFS/ME. Effective Health Care 2002;7: 1-12.

CFS/ME Working Group. Report of the CFS/ME working group: Report to the Chief Medical Officer of an Independent Working Group. 2002. Royal College of Physicians. Chronic Fatigue Syndrome. London: RCP, 1996. (Report of a joint working group of the Royal Colleges of Physicians, Psychiatrists and General Practitioners).

McGregor RS. Chronic complaints in adolescence: chest pain, chronic fatigue, headaches, abdominal pain. Adolescent Medicine State of the Art Reviews 1997;8: 15-31. Calverton MD  (2002) Health behaviour in school-aged children, 1997-1998. World Health Organisation. Macro International. The association of obesity, cytokine levels, and depressive symptoms with diverse measures of fatigue in healthy subjects (2005) Weonjeong Lim, et al Arch Intern Med.

2005;165:910-915. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial (2003) Verdon F et al. BMJ, 326: 1124-1128. Watt T  et al (2000) Fatiguein the Danish general population. Influence of sociodemographic factors and disease. J. Epidemiol.

Community Health, 54(11): 827 – 833. Janssen N  et al (2003) Fatigue as a predictor of sickness absence: results from the Maastricht cohort study on fatigue at work. Occup. Environ. Med., 60(90001): 71 – 76. Andrea H et al (2003) Associations between fatigue attributions and fatigue, health, and psychosocial work characteristics: a study among employees visiting a physician with fatigue. Occup.

Environ. Med., 60(90001): 99 – 104. Sharpe M & Wilks D (2002) Fatigue. BMJ, 325, 480-483. Viner R. & Christie D. (2005) Fatigue and somatic symptoms.

BMJ 330, 1012-1015. © May 2012. Due for review: May 2014. Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit is gained from its use. Permission to reproduce it in any other way must be obtained from permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked to directly.

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