Narrowing the CFS field with the fatigue scope

Because CFS embraces so many symptoms in addition to plain, old exhaustion, doctors and researchers are working on narrowing the fatigue scope — more clearly defining the intensity and duration of fatigue caused by CFS. By narrowing the fatigue scope, they can concentrate on defining the other characteristics of the illness and more easily determining whether a person has CFS or something else.
The best way for a doctor to narrow down the fatigue and make a correct diagnosis is to ask questions. She determines whether the patient’s fatigue is indeed as prolonged as he says and performs diagnostic tests to eliminate other illnesses that can cause fatigue to narrow it down.

Comparing fatigue to being just plain tired

You know when you’re exhausted, and you usually know why. You’ve been sick. You’re burning the candle at both ends. Emotional tensions or financial problems are stealing your mojo. Your boss is overbearing. Maybe you’re exercising too much. A good night’s sleep, a multivitamin, a day or two off the treadmill, or a couple of weeks on the beach is all you need to recharge your batteries and start feeling like yourself.
However, the most sinister aspect of CFS is that despite how tired you are, nothing you do or don’t do makes you feel any better. The tiredness is like some voodoo curse that destines you to an eternity of restless sleep that doesn’t leave you feeling at all refreshed, but instead, you may have low energy, a depressed mood, and even short-term memory loss. CFS is more of an erosion of health and spirit than a temporary bout of the blues that you can cure with a little R&R.
In addition, CFS fatigue often deepens with exercise, and you can’t even attain some temporary solace with a full night’s sleep — you awaken as tired and sometimes more tired than when you went to bed!
If you do have CFS, the fatigue you experience lasts for six months or more. The level of fatigue may ebb and flow slightly, especially if you have gradual onset CFS, but you never feel energized or refreshed.

Grading the severity of your fatigue

First and foremost, CFS makes you feel overwhelmingly tired, and you don’t feel refreshed no matter how much sleep you get. Your body’s weak, and you can barely stand up without help. Nothing can pull you out of your free-fall —not sleep, not exercise, and not staying away from sugar. You’re eternally exhausted.
Clearly, this overwhelming exhaustion isn’t your everyday fatigue, the fatigue most people feel after a busy week, a sleepless night, pulling an all-nighter, or stuffing themselves full of Thanksgiving turkey and mounds of mashed potatoes.
When is fatigue not CFS? When it goes away after a good night’s sleep, after boarding a plane for a Caribbean vacation, or after you’ve shaken a bad flu. CFS is a complicated condition — and it doesn’t go away that easily. In the following sections, you can see the difference between fatigue and being tired, as well as find out how doctors are trying to narrow the definition of fatigue.

Recognizing the Signs and Symptoms of CFS

Although fatigue for six months is the underlying feature in most cases of CFS, other symptoms must be analyzed, because fatigue must be combined with several symptoms to be considered CFS. And doctors must look at the fatigue on an individual-by-individual case.
CFS is difficult to diagnose because of the following reasons :

• There isn’t a diagnostic laboratory test that can tell you whether you have CFS.
• Elimination is key: Before your doctor can diagnose CFS, she must be able to rule out other “imitators,” such as Lyme disease and mono.
  
• Fatigue can be a red flag for a whole host of other illnesses.
  
• CFS can look invisible (kind of like concealer for the dark circles), and many people come to the doctor without looking particularly sick.
  
• The fatigue in CFS can come and go — and you may have a doctor’s appointment during the “go.”
• Symptoms vary from person to person. CFS is more of an individual illness. Some people can’t get up from their beds, and others go about their days, but in a fog, and then collapse later.
• Doctors can’t find a pattern to CFS symptoms. If you aren’t getting the help you need, seek out another doctor, preferably one with another specialty or an open-minded primary care professional who sees the whole picture.

Fortunately, or unfortunately for you, CFS - doesn’t have just a single symptom, such as muscle pain or headaches. Although a cluster of symptoms adds to your misery, the more you have, the easier it is to paint a more identifiable diagnostic portrait of CFS, simplifying diagnosis and expediting proper treatment as your doctor goes over each symptom in detail, one by one.
Based on the latest Centers for Disease Control and Prevention (CDC) guidelines, eight common symptoms shout, “I have CFS!”

Symptoms of Chronic Fatigue Syndrome

One day, you wake up and realize, “Hey, this isn’t right.” By definition, CFS symptoms must last a long time to qualify as chronic, but the onset of the illness can strike as suddenly as a bump on the head or over the course of a 24-hour flu; doctors call this fast-paced progression of symptoms sudden onset CFS. Or the symptoms can creep up on you slowly like gray hair and wrinkles; the term doctors use for this case is gradual onset CFS. Before I go into more detail about evaluating CFS symptoms later in the chapter, here’s what you need to know about the differences between sudden and gradual onset CFS:

• Sudden onset CFS: People who are suddenly overtaken with a tiredness so heavy that it feels like a weight dropped out of the sky can often pinpoint the exact day on which CFS entered their lives and the exact circumstances that triggered their symptoms. These people are more likely to have experienced the flu-like symptoms associated with CFS, including a sore throat, chills, swollen lymph nodes, or fever, followed by the sustained, long-term fatigue that’s so characteristic of CFS. Because of these “infectious” characteristics, sudden onset CFS appears to be the result of problems caused by a virus or bacterial infection — two commonly suspected causes of CFS.
• Gradual onset CFS: If your CFS occurred over time, with the fatigue and other symptoms associated with it (such as flu-like symptoms, aches and pains, and terrible headaches) progressively worsening over weeks or months, you’ve experienced a gradual onset. A study done in Chicago found that 63 percent of the study’s participants developed CFS gradually. A different study, this time done in Wichita, Kansas, found that 77 percent of the study’s participants developed CFS gradually over time. Because gradual onset CFS is so insidious, creeping up on you while you’ve been going about your life, it can be more difficult to recognize.

As with any condition, the sooner you discover you have CFS, the better able you are to take care of it — and the better able you are to adapt to a new lifestyle. True, you can’t cure CFS, but you may be able to stop it from becoming so debilitating that you become unable to keep up with your daily activities.