An Introduction to Chronic Fatigue

1. A Presentation to the Foothills Fibromyalgia/CFIDS Support Network April 25, 2006 BY: Jean P. Patterson, Member Design help by: Chris Patterson, Member An Introduction to Chronic Fatigue

2. An Introduction to Chronic Fatigue Some Interesting Facts • Often the subject of disbelief and sometimes jokes, Chronic Fatigue Syndrome (CFS/CFIDS) is estimated by published medical researchers to affect 400,000 to 900,000 adults in the United States. • Many people with CFIDS have become unemployed or forced to live on disability. • Research studies have had mixed results, hampering understanding and the development of suitable treatments. • Standards for identifying CFIDS patients are slowly being agreed upon.

3. An Introduction to Chronic Fatigue The Definition Since 1994, Chronic Fatigue Syndrome (CFS/CFIDS) has had a definition: • Persistent or relapsing fatigue of at least 6 months duration that is not alleviated by rest • This fatigue must cause significant reduction of activities. • The fatigue must not be explainable by medical or psychiatric conditions.

4. An Introduction to Chronic Fatigue Additionally there must be least 4 of the 8 following agreed upon symptoms: • After activity, fatigue that is out of proportion to the activity • Impaired memory or concentration • Non-refreshing sleep • Headaches • Muscle Pain • Joint Pain • Sore throat • Tender cervical nodes (neck)

5. An Introduction to Chronic Fatigue Trying to Diagnose CFS/CFIDS 2003International CFS Study Group Recommendations to Standardize Measurements of the Major Symptoms • (1) The Medical Outcomes Survey Short Form-36 (SF-36), to measure functional impairment • (2) The Checklist of Individual Strength (CIS) or the Multidimensional Fatigue Inventory (MFI) to provide a measure of the individual’s fatigue that would not change from doctor to doctor • (3) The CDC Symptom Inventory to document the occurrence, duration and severity of the patient’s symptoms

6. The SF-36 determines functional impairment in 8 areas: Limitations in physical activities (physical function) Limitations in usual role activities because of physical health problems (role physical) Limitations in usual role due to emotional problems (role emotional) Bodily pain General health perceptions (general health) Vitality (energy and fatigue) Social function General mental health The MFI assesses: General fatigue Physical fatigue Mental fatigue Reduced motivation Reduced activity An Introduction to Chronic Fatigue

7. An Introduction to Chronic Fatigue • The scores for each part of the SF-36 are totaled. • The scores for each part of the MFI are totaled. • For both the SF-36 and the MFI, higher scores indicate greater impairment. • A special formula combines the above scores with The CDC Symptom Inventory results to create a final score that indicates the severity of the patient’s symptoms. • This score could be understood by any physician who treats CFIDS patients.

8. An Introduction to Chronic Fatigue • Other physicians are working on alternative tests. • One such test is the tilt table test. • In this test the patient lays on a table and is raised from laying to standing a little at a time as his/her blood pressure is measured. • The doctors are finding that many CFIDS patients have a lower blood pressure in the vertical position than in the sitting or laying position. • These patients improve when they consume more salt, raising the blood pressure.

9. An Introduction to Chronic Fatigue Treatments • A 2001 study showed that treatment of CFIDS and fibromyalgia (FM) patients according to their symptoms resulted in significant improvement. • The effectiveness of treatments varies not only from drug to drug but from patient to patient. • The physician and patient may have to work together to find the best drug or non-drug treatment to ease the patient’s symptoms. • At present, the drugs and substances being tested/used are generally the same ones used by and for fibromyalgia patients. • Additional tests are being done on Ampligen, Isoprinosine, thalidomide, anti-TNFa, monoclonal Ab, growth hormone, cortisol, plasma expansion, and sympathetic and parasympathetic stimulants/inhibitors.

10. An Introduction to Chronic Fatigue Nancy Klimas, MD’s Recommendations • To determine or eliminate CFIDS: have CBC, metabolic panel, and celiac tests performed. • Have the intracellular B-12 vitamin checked. • To quiet the inflammatory response, use peppermint flavored extracts containing omega-3 fatty acids; but the Vitamin E should not exceed 400 mg per day. • Women need minerals, men need vitamins, particularly the B’s. • She mentioned studies that the following also may be helpful: N-acytylcysteine, alph lipoic acid, NADH, Vitamin C, magnesium, sodium, zinc, l-tryptophan, L carnitine, co-Q10, and essential fatty acids.

11. An Introduction to Chronic Fatigue Peter Rowe MD’s Recommendations/Comments • He agreed with Dr. Klimas and also added that he has found that 400mg of vitamin B-2 (Riboflavin) a day is helpful for migraine headaches. • A CFIDS patient under the age of 10 is rare. Usually CFIDS starts at puberty. Charles Lapp MD’s Recommendation • He also agreed with Dr. Klimas and reminded that malic acid is good for fibromyalgia.