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Posted at: May 18, 2019, 10:14 AM; last updated: May 18, 2019, 10:14 AM (IST)

Tired out

Extreme, long-lasting fatigue or chronic fatigue syndrome can often be misdiagnosed. There is a need for awareness about it as its incidence is on the rise in India

Dr M Udaya Kumar Maiya

Chronic fatigue syndrome (CFS) is a long-term condition of a complex nature. While the causes are not yet known, its impact can be quite significant. The symptoms of CFS can vary from one person to another, causing varied physical impact. In medical parlance, this condition is also referred to as myalgic encephalomyelitis (ME). It is estimated that this problem afflicts about 17 to 24 million people globally.  There are no official estimates for India but the number of cases is rising. 

There is no apparent permanent cure for CFS, and it is difficult to diagnose as well. Extreme fatigue on its own is generally taken seriously. It can also be taken as a symptom of many other diseases. Hence, there are chances of misdiagnosis or a delayed diagnosis.  

Diagnosing the syndrome

One of the major challenges in establishing CFS is the absence of any standardised test. The typical way is to eliminate other likely causes for the symptoms to reach a conclusion. An early identification of the problem can facilitate quicker symptom management. As part of the diagnostic process, the patient undergoes physical and mental examination on various parameters to zero-in on the actual problem. The physician generally enquires about recent travel, insect bites, infections, substance or alcohol dependence etc. This is followed by various tests and monitoring of medication given.

Diagnosis happens usually after three to four months of monitoring the situation and establishing the pattern in which the symptoms occur. During this period, multiple regular blood tests are conducted to check whether the symptoms are caused by other likely illnesses. A more intensive examination of the patient may be required if there is uncertainty about the cause of the symptoms. 

Managing the problem

CFS is an incurable, but manageable ailment. The severity of the disease varies from person to person, and it is highly recommended that those suffering from the symptoms to contact a specialist and follow recommendations. Treatment can only help keep the symptoms under control. Alongside medication, they are often required to make changes to their daily lifestyle to cushion the impact of this ailment.

Treatment is usually long and can include medication or cognitive behavioural therapy. Most people recover with treatment, although it may take two years or even years. Those who are diagnosed early (within two years of the beginning of the symptoms) respond better to treatment.

Lifestyle and diet changes are recommended. The diet should include more protein, moderate amount of carbohydrates and more antioxidants and good fats like omega 3. probiotics should also be included regularly.

Avoid sugary and refined foods as they suppress the immune system and increase inflammation, lead to a rapid rise in blood sugar, followed by a crash (hypoglycaemia). It can cause fatigue, anxiety and cravings. Avoid caffeine as it is a diuretic and aggravates adrenal exhaustion, and amplifies anxiety, stress and fatigue-related symptoms.

A break from gadgets can check mental fatigue. Arm yourself to tire out the fatigue. 

Symptoms

A panel at the Institute of Medicine, USA, in a report on CFS suggests a simple four-point criteria for its diagnosis: extreme fatigue lasting at least six months, complete exhaustion after even minor physical work or mental exertion, not feeling refreshed even after sleep and cognitive impairment (brain fog).

Fatigue: Fatigue or burn-out is a condition where a person’s ability to undertake routine tasks is greatly diminished. In the eventuality of CFS, fatigue usually lasts for about six months or longer from the time of starting medication. It must be understood here that in the context of CFS, fatigue is not the feeling of exhaustion or lack of motivation that a person might experience after a long journey or a strenuous work day. Those affected with CFS are typically not able to feel rejuvenated even after sleep, rest or a vacation. In fact, rest might even worsen the situation in certain cases. CFS makes it difficult to carry out even the basic everyday tasks like carrying a food tray, taking a shower, cooking or taking a walk.

Problems with sleep: People affected by CFS experience various sleep disorders. The most common problem is waking up exhausted, even after resting throughout the night. There are some disorders that can result in sleep that doesn’t provide rest such as insomnia (lack of sleep), hypersomnia (too much sleep), sleep apnea (a condition where a person temporarily stops breathing while sleeping), shallow sleep, light sleep, and body clock disorder (unable to sleep until daybreak). 

Cognitive disability: People suffering from CFS face several types of cognitive challenges. They might become forgetful and find it difficult to recall conversations or losing their belongings. They often find it tough to keep up with the narrative of films or books. Basic cognitive tasks or simple problem solving might cause severe energy depletion. 

Alternatively, CFS-affected people start losing their way even in their familiar environment like neighbourhoods. They may not recall simple directions, locations or to follow written instructions. They may find it difficult to sit or stand up from a certain position. They experience dizziness, might faint, or have blurred or darkened vision. 

— The writer is medical director, Portea Medical

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