Extremely Tired and Completely Worn Out? What It Could Mean Plus Questions to Ask Your Doctor

Her muscles and joints ached. Her throat was raw and sore and throbbing headaches came on without warning. She felt foggy-headed all the time, and had trouble remembering simple thoughts or following reruns of familiar TV sitcoms. Even though she was bone-tired all the time, she had trouble falling asleep and staying asleep. And there was no stamina for everyday tasks, let alone the activities she enjoyed doing with family and friends. At 41, she couldn't keep up with her 68-year-old mother. She felt like she was going crazy.

Source: Chronic Fatigue Syndrome: New Insights, New Hope

Chronic fatigue syndrome (CFS) is a serious medical condition that can easily be overlooked because it mimics so many other disorders.

Chronic fatigue may be so profound and debilitating that it can affect work, school and family life.

The CDC reports that between 1 and 4 million Americans suffer from Chronic Fatigue Syndrome (CFS).

What are the symptoms of CFS? (Source: U.S. Department of Health & Human Services]

• feeling tired even after sleeping
• muscle pain or aches
• pain or aches in joints without swelling or redness
• feeling discomfort or "out-of-sorts" for more than 24 hours after being active
• headaches of a new type, pattern, or strength
• tender lymph nodes in the neck or under the arm
• sore throat

Partner up

It's important to partner with your doctor or health care provider. By being proactive and an empowered patient you can help get the care and treatment you need. Trust, mutual respect and communication are vital for the doctor/patient relationship. Be honest and open and allow yourself to be in charge of your health.

Before your appointment with your doctor, it's important to be prepared.

Here are some of my tips:

• Take your medical history form with you, which includes a list of your medications. You can download a free personal medical history and medications form here.
• It's always a good idea to have someone with you. A trusted family member or friend can help make sense all the information that is given.
• Keep a journal of your symptoms, and bring it with you. Write down symptoms you may be experiencing. When did the symptoms start? Are they triggered by some activity? How long do the symptoms last? Are they constant?
• Write down any questions. Writing a list of questions in advance can help you stay focused and it will allow you to make the best use of time.

Get the conversation started. Here are a few questions to ask your doctor:

• What are the causes of my symptoms?
• Will the symptoms go away? How long will they last?
• What tests are needed to determine the CFS?
• How is CFS diagnosed? What are the criteria for diagnosis?
• What is the treatment?
• Are there alternative therapies? Over-the-counter medications? Prescriptions? What are they? Will my present medications interfere with any of these new medications?
• Should my diet change? Are there certain foods that I should be eating?
• What lifestyle changes should be made?

These are just a few ideas to help make the most of the office visit. Remember to speak up and take charge of your health. If you don't understand something, ask to have the information repeated and it's okay to take notes during your visit.

To find out who gets CFS, diagnosis, treatment, coping and more, please check out these additional sources:

Chronic Fatigue Immune Dysfunction Syndrome Association of America

Centers for Disease Control and Prevention (CDC) Chronic Fatigue Syndrome Information

The U.S. Department of Health and Human Services - Women's Health

Health in 30® Radio Interview with Kimberly McCleary, President of CFIDS

Podcast from the live radio show on CFS

Please visit Healthin30 for more info and to listen to podcasts from the live radio show, and more.

Follow Barbara Ficarra on Twitter: www.twitter.com/barbaraficarra

Comments

[shadiahm]

St. Thomas --

I suspect you meant to post your comment to another thread, but I did want to assure readers that there is good, reputable research about the substantial physical abnormalities in CFS including:

Moderate Exercise Increases Expression for Sensory, Adrenergic, and Immune Genes in Chronic Fatigue Syndrome Patients But Not in Normal Subjects. Journal of Pain July 2009

Cardiac function fluctuates during exacerbation and remission in young adults with chronic fatigue syndrome and "small heart". Journal of Cardiology August 2009

Anticardiolipin antibodies in the sera of patients with diagnosed chronic fatigue syndrome Journal of Clinical Laboratory Analysis Volume 23, 2009

One of the most startling studies was from a group at the University of the Pacific in 2003 which showed that VO2 Max levels in CFS patients drop from 15-60% the day after a traditional stationary bicycle stress test. You can read the paper in its entirety here (http://www.cfids-cab.org/MESA/Vanness.pdf) (note: PDF). Indeed the ME Society has a fairly significant collection of papers (http://www.cfids-cab.org/MESA/subsets.html) from reputable journals about the biomedical problems in Chronic Fatigue Syndrome.

[StThomas]

It may surprise you, but I don't doubt that chronic fatigue syndome exists, and I know that it's a terrible burden to those who have it. I am sure that if you look, someday the cause will be found, and that before we get there, other things will be found that correlate. I directed my comment to the hypothalamic hypothesis below, in Rmankovitz's post. At present, I am fairly sure that CFS is a clinical diagnosis and a diagnosis of exclusion, made once physical (including psychiatric) causes of tiredness are ruled out. There is no investigation that can be done to diagnose it certainly, and no cure or very good therapies. Rmankovitz's post suggesting "hypothalamic dysfunction" as a cause as if interventions could be made upon it, is too glib, too easy, and not supported as a theory, though it may be a good hypothesis . I was interested in the naltrexone. Is it licensed for CFS.?What is the evidence of its "remarkable" immune system properties?

[shadiahm]

Glad to hear your skepticism is directed at the right target.

Rmankovitz is indeed doing what alternative practitioners do, which is take several ideas with nebulous connections and then argue that their treatment can or could be effective. In this case, it is true that problems with the hypothalam­us-pituita­ry adrenal axis have been a consistent finding in CFS research, and that a (i.e. ONE) recent small study suggested that low-dose naltrexone reduces symptoms in fibromyalgia, a similar but separate disorder. Some CFS specialists have recently started using low-dose naltrexone -- a drug approved for use in treating addiction -- to help with symptom management after patients noted improvements with its use anecdotally. However I've never seen any research to suggest that it has immune-enhancing qualities.

[StThomas]

"From the findings of several researchers in the field..." Go on name six, I dare you!. People who have published in reputrable journals please.

[RMankovitz]

From the findings of several researchers in the field, hypothalamic dysfunction is a likely issue in Fibromyalgia (FMS) and Chronic Fatigue Syndrome (CFS). This dysfunction may result in disordered sleep, subclinical hormonal deficiencies, and immunologic changes. The need for multiple interventions can occur when an illness affects a critical control center (such as the hypothalamus) which impacts multiple systems.

Unfortunately, no single treatment has been found that reverses hypothalamic dysfunction directly. Thus, this situation is different from illnesses that affect a single target organ and which can be treated with a single intervention. For example, pituitary dysfunction itself often requires treatment with several hormones. This effect is multiplied in hypothalamic dysfunction, which affects several critical systems in addition to the pituitary gland.

An unusual treatment that seems to work well for some CFS and FMS sufferers is low dose naltrexone (LDN). Naltrexone is an FDA approved medication. In low doses, it exhibits remarkable properties to boost immune system response and to normalize autoimmune disorders. It is very inexpensive, widely available in generic form, and quite non-toxic.

For general info: http://www.lowdosenaltrexone.org/

Roy Mankovitz, Director
http://www.MontecitoWellness.com