What is chronic fatigue syndrome?
Chronic fatigue syndrome (CFS) is a complex disorder characterised by persistent, excessive fatigue that is not improved by bed rest and may be worsened by physical or mental activity. Affected persons experience a loss in their level of activity and are not able to work or exercise as much as they were capable of doing before the onset of illness. Concentration, memory and sleep may be impaired.

What are the causes of chronic fatigue syndrome?
The cause of the illness is not known. It may be due to endocrinological or immunological problems, viruses, toxins, heredity or a combination of these.

What are the symptoms?
The symptoms include excessive fatigue, joint/muscle pains, headaches, sore throat, swollen neck glands, mental fogginess, appetite disturbance and stomach problems. Hypotensive reactions, leading to faintness, sometimes occur, and sleep patterns are likely to be disturbed. Victims may develop new allergies and may become prone to hyperventilation under stress. Depression is not unusual. The severity of symptoms may differ from patient to patient and may also vary over time for the same patient. Symptoms are liable to increase with stress; some patients become bedridden and completely disabled.

How is the condition diagnosed?
A detailed medical history is taken and a complete physical examination of the patient is required. Certain laboratory tests of the blood and urine may also be needed to help identify other possible causes of the symptoms and physical findings. Other tests like blood urea nitrogen test, alkaline phosphatase, complete blood count, creatinine, ESR (erythrocyte sedimentation rate) and thyroid stimulating hormone test may also be done to exclude other diagnoses. “Glandular fever” may need to be ruled out.

What is the treatment?
Treatment is directed mainly at relieving the symptoms.

* A strong correlation exists between stress and the progress of the disease. Adequate rest, therefore, may produce favorable results. Stress reduction is important and relaxation techniques, yoga or meditation can help.
* Moderate exercise may be suggested, depending upon the tolerance level of the person. A carefully planned daily routine can help maximize performance.
* The intake of alcohol, caffeine, sugar, and fats should be reduced. Nutritional supplements are sometimes prescribed if the diet has become inadequate. Foods that can trigger allergies need to be considered, and an avoidance diet may be appropriate.
* Drugs to improve sleep or to induce relaxation may be suggested.
* Antidepressants and other drugs to treat anxiety or panic disorder may be given in some cases.
* Pain may not be adequately controlled by simple medications, whereas massage may help. Abnormal blood pressure, whether low or high, will need to be treated.
* Endocrine therapies, or corticosteroids, are not usually advised.

Experimental drugs have not provided significant benefit. Vitamins, antioxidants and herbs have not been shown to be of value, although tonics such as ginseng and ashwagandha may be worth investigating.

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