The actor Michael Crawford, became famous for his role in the television series called "Some Mothers Do 'Ave 'Em", and later for his roles in "Phantom of the Opera". He then had a role in P.T.Barnum where he became very fit at the age of 38 because he had to learn and perform the circus skills such as the 'flying trapeze'. He then performed in a musical called "Woman in White", where he played the role of an obese man called Count Fosco, and had to wear a fat suit which made him sweat about a pint of fluid each time. As a result he gradually became more and more fatigued and he said that he then had some type of viral infection like the flu and developed the chronic fatigue syndrome. He said that his doctors were unable to explain the problem and the pills were not helping so he decided to leave the show and move to New Zealand to get some complete rest for about two years. He gradually regained his strength and sense of well-being, and returned to the stage to play in The Wizard of Oz.
Michael Crawford's experience is further evidence that what I was saying thirty years ago was correct. Namely that the symptoms of chronic fatigue are real. They are not imaginary, or due to laziness, or the fear of exercise, or the lack of exercise, or from a bad breathing habit caused by the lack of exercise, or from a personality disorder. The condition is also not trivial, imaginary, or all in the mind, and it is not just normal tiredness, or an appeal for sympathy, and is not fake or due to malingering,
My main theory about the cause of fatigue is postural pressure on the air in the chest which impedes the upward flow of blood, and hence strains and weakens the blood vessels below the chest so that there is a weakness of blood flow which results in abnormal tiredness and exhaustion. Since then I have made many other suggestions and modifications to that idea. For example in 1871 J.M.Da Costa described how some soldiers collapsed and fell out of line while marching up and down hills and carrying heavy knapsacks for several weeks while being poorly fed and having viral infections. I have suggested that one possible cause is that they became dehydrated from the sweat and fever, and that prolonged reduced blood volume may have contributed to the weakness of their blood vessels and blood flow to produce the chronic fatigue.
The severity of their condition varied, where some recovered after a few months complete rest. However, most of them only experienced a moderate improvement in their health, and still had some problems with tiredness and fatigue twenty years later. A radio interview with Michael Crawford can be found here
Other famous people to have CFS:
Charles Darwin, Florence Nightingale, and Paul Robeson. had the same symptoms before the label of chronic fatigue syndrome was introduced. Modern examples include the Australian journalist Leigh Hatcher, and singer Greg Page.
Some interesting facts:
Charles Darwin was extremely seasick when he sailed on a ship called the Beagle for the first time, as it rocked about in heavy seas during a gale. After returning to port he had pain and palpitations which were relieved when the storms subsided. When he set sail again he would often become exhausted by seasickness during storms, and would gain relief by laying in a hammock.
He also may have become ill after being bitten by the reduvid bug that causes Chagas disease, which is a common cause of illness in South America which he visited. That disease has an acute phase, and then goes into remission for many years before the chronic phase occurs.
However, it may have been due to being poisoned by tribal chiefs who didn't like his attitude towards religion.
When he returned to England he continued to suffer from fatigue for the rest of his life. His father was a prominent London doctor who thought that his sons chronic illness was due to the long periods of exhaustion during his ship voyages, and his wife thought that his problems may have been due to anxiety, but Charles said that he was not anxious, and that his problems were not due to the exhaustion from seasickness on his voyages.
I have written the Posture theory to explain the cause of such symptoms, and I noticed that the photos of him depict his very stooped shoulders. I also noticed that he had a carpenter build a writing platform across the arms of his chair, and a photo of one of his rooms shows a music stand, with the platform for the music sheets at a height which would be used for standing to read, rather than writing.
See more here.
Florence Nightingale is regarded as the founder of modern nursing. She became ill with "Crimean fever" (brucellosis) during the Crimean War. When she returned to England she kept working while exhausted, despite the fact that her doctors advised her to rest or risk chronic invalidity. For much of her life after that she was bedridden, and died at the age of 91.
The Banfield Recommendations
for Diagnosing chronic fatigue
based on my research between 1975 and 1984
There are various types of fatigue associated with numerous different symptoms which have been given many different labels. However, if there is an abnormal pattern of sleep throughout the day and night, and if there is an abnormal physiological response to exertion, then the chronic fatigue can be easily, reliably, and scientifically diagnosed by ergometric exercise tests, and tilt table tests. See here and here.
Typical and misleading comments from other websites are these - 'the diagnosis of CFS is difficult', and 'there is no diagnostic laboratory test for it' etc. here
A laboratory method of causing CFS
Every doctor sees hundreds of patients with this condition every year, so they know that it is real and physical, but for reasons of their own they like to give the impression that it is trivial, imaginary, or mental. I have therefore asked some of them this question . . . "Will you come into a laboratory with me, and let me subject you to some experiments which give you this ailment permanently?". . . . They all say "No!" . . . When i ask them why they say that doing that type of experiment on humans is unethical. However, as you can appreciate, there is nothing particularly unethical about me doing something with the other persons permission. The real reason is that they know that the condition is real, and physical, and in many cases there is no cure, so it will interfere with their social, sporting, and occupational activities for the remainder of their lives. They will also have to deal with the prejudices of other people such as themselves, and they know how bad that will be.
Introduction to scientific exercise testing for CFS
In 1975 I was having extreme problems with my health which included a reduced capacity for exercise, however, I heard about an organisation called the South Australian Institute for Fitness Research and Training, where people could exercise under medical supervision, so I enrolled and began training twice a week. I was always coming last in walking or jogging sessions, and I knew that most people with my ailment would become embarrassed or discouraged, and drop out of the course, but I persisted. I had to stop training about a year later when I injured my knee, but in the meantime, my fitness level had improved, and although it was still considerably below normal, it had made the condition easier to manage.
In the meantime I learned that the name of the condition was Da Costa's syndrome, which was also known as 'neurocirculatory asthenia'. Some years later, while reading a medical book I noted a statement that it was not possible to get effective results from research studies on that subject because the patients 'could not, or would not train'. That statement was an indication of the general attitude that the patients did not actually have a physical impairment, but were simply suffering from a mental disorder which involved a 'fear' of exercise.
I therefore knew that the popular assumptions were wrong and that the symptoms were not due to a 'fear' of exercise.
A few years after that I met Clive Thelning, a friend of mine from my education at the South Australian Institute of Technology, and when asking the usual questions 'what are you doing now?' I mentioned that I had been studying the ailment and had a few ideas about it. He said that he actually knew Tony Sedgewick who was the head of the South Australian Institute for Research and Training, and recommended that I discuss my ideas with him.
I told him that the director of a research organistation would not be interested in talking to a person like myself who had no formal medical education, but he persuaded me to contact him anyway.
When I rang the head of the Institute he was quite enthusiastic about the ideas and invited me to attend a meeting where we discussed them in some detail. He said that he would talk to his medical research staff about the prospects of adding a training programme for 'fatigued' patients. A few weeks later we had another meeting where he explained that they were too busy with other projects, but then he invited me to co-ordinate the study.
When I advised him that I wasn't healthy enough to do such a task, and that I wasn't medically qualified anyway, he said that it wouldn't matter, because his researchers would do all of the medical examinations and that one of his experienced trainers could run the actual exercise programmes to my specifications at their venues, and that all I would need to do would be collect and compile the results. I thought about his suggestion for several weeks and considered that if I didn't do anything that this 'solvable' mystery, it would continue to be unsolved, so i designed the research programme and submitted it. He accepted the concept and, after some standard formalities were dealt with, the project started.
As each programme was successful another followed until about a dozen people had completed at least three months training. Hence I had demonstrated that if the programme was designed appropriately the patients 'could' and 'would' train, and I had proven that their reluctance was not due to a fear of exercise. I had also scientifically proven that they had a measurable physical impairment to their aerobic capacity which, in some cases, would benefit from exercise.
When the study increased from 20 patients to about fifty, and then eighty, the workload was affecting my health adversely so when I was asked to increase the study to 200 patients to 'influence' world opinion, I left the programme.
One of the medical editors of the Adelaide "News", Diane Beer, had written several articles to recruit patients with persistent fatigue to the course, and a freelance journalist had reported the general findings in several major interstate newspapers, but I also wrote a research paper which included all of the detailed results and submitted it to two medical journals. However it was not accepted for publication, so I put it in my fiing cabinet.
Nevertheless, i knew that the success of such an important study would spread internationally through the research 'grapevine', and that attitudes would have to change, and within a few years the newspapers were reporting a 'new' ailment called the 'Chronic fatigue syndrome' - a medical condition where the main symptom was persistent problems with abnormal fatigue. I later found reports that the most effective treatment was an exercise programme where the patients trained within their own limits (instead of trying to keep up with healthy individuals).
Unfortunately there seems to be some individuals who resent me for doing that project, and they described it as insignificant and worthless, and tried to deny or hide the fact that it actually happened, and to portray me as some kind of ignorant fringy kook who has all sorts of mental and behavioural problems.
They have never met me and should just accept the facts and stop writing nonsense. If I was afraid of exercise I would not have volunteered for an exercise programme, and if my methods of exercising were not effective then other individuals would not have been able to train, and the same principles that i developed are regarded as the best methods available today - more than twenty five years later.
(In the past it was known that fear increases pulse rate, so it was argued that the fatigued patients were getting an abnormal increase in pulse rate during exercise because of a fear of exercise, rather than the exercise itself. The success of the programme that I designed showed that the patients were not afraid of exercise, and that the abnormal increase in pulse rate during exercise was due to an abnormal physiological response).
The Banfield principle of exercising within limits
When I began exercising I soon realised that walking and jogging at a very slow pace was possible, whereas running fast led to the problem of abnormal symptoms so I had to choose between doing nothing or exercising slowly. I chose to exercise slowly because it gave me the opportunity of improving, whereas doing nothing was not going to accomplish anything.
I didn't do it to show other people what to do, or to recommend it as I was of the opinion that other people need to make their own decisions based on their own capacity and experience with exercise.
However, many years later I saw a poster which captured that method
"The hurrieder I go the behinder I get"
That saying also encapsulates how to lead life successfully with CFS.
i.e. You have a reduced capacity for life in general, so If you hurry and fuss like healthy people can and do, then you will wear yourself out, so only do what you can, when you can, at a pace that it moderate.
To put it another way . . .
If your activities are moderate you can sustain them every day, but if you hurry, you will wear yourself out and be useless for months at a time.
or . . .
There is no known cure, and no quick way of treating relapses of exhaustion, so prevent them.
Many famous people have had the chronic fatigue syndrome includng Charles Darwin, Florence Nightingale, and American singer Paul Robeson.
For my report on the controversial history of research into this area see here
For an independent overview of the modern CFS research see the video recordings of day one of a National Institute of Health conference here
and day two here
See also the improved modern and better informed attitudes to CFS by the medical profession here
The cause according to patient interviews can be seen here
For my YouTube video on a breathing abnormality which is related to this topic see here http://www.youtube.com/watch?v=iGts2nfGtY0
The Research Project
South Australian Institute For Fitness Research And Training (1982-1983)
Study co-ordinator: M.A.Banfield
The South Australian Institute for Fitness Research and Training was based in MacKinnon Parade North Adelaide in a two story building with an outside quadrangle for exercise. The ground floor consisted of change rooms, etc, and the top floor housed the reception area, office, and managers rooms, and the medical examination room for patients and diagnostic equipment such as ergometric cycles and cardiographs. The building was across the road from the University of Adelaide sports ground which was also used as an exercise park. The Institute also had venues at the Magil campus of the South Australiaian College of Advanced Education, and the St.Bernard's Recreation Centre, which was a large basketball stadium in the northern eastern suburbs. They had been conducting research programmes to assess the effects of exercise for several years on thousands of patients before I became involved and had programmes specifically designed for the general public and for people with obesity, asthma, arthritis, and heart disease etc.
I first participated in the programme for the general public in 1975 and later designed a programme for people with chronic fatigue starting in 1982.
In order to run such a programme which involved human volunteers the design had to meet the requirements of ethics that met government and University science standards.
I told the head of the Institute that I didn't wish to organise the study because I wasn't medically qualified, but when he asked his cardiologists if they would do it they told him that they were too busy on other projects, so he persuaded me to do it myself. In order to meet the ethics standards I was required to establish a committee of six which consisted of the appropriate medically qualified members. That was achieved by the head of the Institute being part of it, and he arranged for one of the cardiologists to be on the committee, and there was myself which made three. He gave me the name of some medically qualified professionals who were interested in doing research and asked me to phone them and ask them if they were interested. Two of them were, with one being a general practitioner, and the other being a psychiatrist. The sixth member was chosen for the task of being field coach because of his extensive experience in previous fitness research programmes, and his appreciation of the different requirements that were determined by which type of ailment was being studied and treated. The programme also had to get official support so I was given the name of a politician to contact, and was required to give him an outline of the programme etc. He provided a token payment to signify that approval. The costs of the course were paid by each volunteer, but because it was officially approved, they were reimbursed the full amount by the government medical fund of that time. One of the later meetings was also attended by a medical journalist from the Adelaide "News" which was the main evening newspaper covering all of South Australia. That journalist had been kept up-to-date with developments for about two years, and wrote the newspaper articles that were the prime source of volunteers. Other volunteers responded to letters sent to general practitioners who were asked the inform the relevant patients of the course.
The objectives of the programme;
To determine the physical fitness levels of patients with persistent fatigue, and whether or not it was possible to design a fitness programme which was acceptable to such patients, and then to determine the effect of such training on fitness levels. The objective was also to compare the fitness levels of patients with persistent fatigue with that of healthy individuals.
The factor which motivated me to run this project was the
research literature which indicated that most, if not all previous
programmes were unsuccessful in retaining participants for long
enough to get meaningful results. The general view was that "such
patients could not or would not train".
I had participated in such a course for nine months five years
earlier, and was therefore confident that I could design a programme
which would be acceptable to other people with similar problems.
During that time part of the training involved walking or
jogging around a 400 metre oval. In general terms I would be
jogging 50 yards behind the tailenders as the front runners were
overtaking me. The other participants were simply trying to improve
their fitness, or were exercising as a treatment for obesity,
asthma, arthritis, or heart disease. On one occasion, as two
fifty year old men were out lapping me, one turned to the other
and said loudly enough for me to hear "that is typical of
the youth of today: they are unfit because they are too lazy
to exercise". Those men did not know that I had been a gymnastics
instructor for five years, and they both seemed to me to be training
to treat smoking induced lung or heart problems.
I had to take those things into consideration because many
people would drop out of a course due to the humiliation of coming
last, and the ridicule associated with it.
I also considered that most training courses had instructors
enthusiastically encouraging participants to constantly improve
their training levels from week to week, and that such an approach
would prompt fatigued patients to exceed their limits and start
experiencing the types of distressing symptoms which would make
them drop out of the course immediately.
Therefore I established the following protocols for the course.
Firstly, people with persistent fatigue would need to train
in an entirely separate group, so that they all had a reasonable
understanding of each others ailment.
The participants were to be informed that their objective
was to train at their own pace of walking or jogging, and that
they were to improve their pace according to the way they felt,
and not because they were required to, and that the programme
was not a contest or a race, but an exercise of staying in training
for as long as possible, or for as long as their health continued
to improve.
The participants were advised that the cause of the fatigue
was not known, and that those who were running faster were to
recognise the possible difficulties of those going slow and not
be critical or judgmental about it, and the slower walkers or
joggers were advised to ignore any negative comments from other
members of the group, or outsiders, and to continue training
at their own pace regardless.
At the outset the general view in the research literature was that:
There was no scientific evidence of a physical or measurable
basis for persistent fatigue.
That patients who complained about persistent fatigue were
complaining excessively about normal fatigue.
That such patients were reluctant to exercise because:
1. of a fear of exercise
2. they were too lazy to train
3. they had no desire or motivation to get well.
The Data from this Fitness Training programme indicated that:
80 people applied for the course and were tested as far as
my recollections can determine, but data was not recorded for
the last groups. Of the initial 3 groups data was compiled for
26 participants. Of those the measurements were adjusted according
to age, body weight, and gender, and 15 were below average, 8
were average, and 2 were above average aerobic capacity. Although
only 9 completed 3 months training, and only five completed 6
months training, that is not unusual for any group of patients.
Groups of patients with asthma, obesity, or arthritis etc, had
similar drop out rates.
The fact that 1 woman and 4 men with abnormally low aerobic
capacity continued to train for at least 2 hours per night, twice
per week, for at least 6 months is evidence that the former views
were invalid. i.e. Patients with severe fatigue were motivated
to regain their health, they were not afraid of exercise. and
they were prepared to train in an attempt to achieve their objective.
It is interesting to note that of the nine people who trained,
and continued for at least 3 months, only one started with above
average fitness, and the other eight started out low, or very
low, indicating that those with the most severe fatigue were
the ones with the highest motivation to regain their former health.
The conclusion from the study was that there are a group of
patients with persistent fatigue who have a measurable physical
condition that responds favorably, to some extent, from an appropriately
designed exercise programme. M.B.
The Original 1982-84 Research Paper
presented on this webpage on 17-1-2008
minor editing of the text was made on 21-1-2011
The Effects of Regular Exercise on patients with Chronic Fatigue (Neurasthenia)
Between 1982-4 The South Australian Institute for Fitness Research and Training had undertaken two studies of the effects of regular exercise on volunteers with chronic fatigue (neurasthenia).
The objectives of the programmes were to determine the fitness levels of such patients prior to training them in jogging/exercise classes twice/week and giving follow up tests at three monthly and six monthly medicals to determine their progress.
The fitness level was determined by requiring each volunteer to ride a stationary cycle on which varying loads of resistance were applied to the wheel whilst, at the same time, pulse rate was being recorded. By this means it is possible to graph the amount of load in kilograms required to give a pulse rate of 150 beats per minute. This figure is a gauge to each individuals relative fitness and is known as the physical working capacity (PWC 150)
We also aimed to determine the extent to which neuroticism was responsible for the fatigue by asking each applicant to complete a modified version of the Middlesex Hospital Questionnaire of Crown and Crisp. (Although this questionnaire included questions of symptoms, thus giving a higher score for this type of recruit anyway, it nevertheless provided a relative guide for neuroticism comparison.)
Finally, our second study included questions aimed at elucidating the affects of the fatigue on lifestyle.
Results:
As the result of twenty-six medicals and questionnaires (Diag. 1), it was found that fifteen enrollees had fitness levels below average, eight were average, and two were above average. (One was not known at the outset.)
There were eight examples of those with low fitness who had lower (below 30) neuroticism scores, which indicated that the fatigue may be attributable to limited aerobic capacity).
There were five examples of those whose fitness was average to high who had higher neuroticism scores (above 40) indicating that stress may be the primary factor causing fatigue. Other figures were not so clear.
With regard to training (Diag. 2), seven did not start, and, of the remainder, ten continued for three months. Of these ten, five continued for six months.
In the first three months, three participants did not benefit from training,. A further three improved to sub-standard levels and four continued toward normal levels.
Of the five individuals who persisted for six months, improvement generally continued at a lower rate. One example of a participant who originally developed neurasthenia following a coronary improved dramatically. Another individual demonstrated persistent low figures despite continued training and he is undoubtedly a true neurasthenic with impaired aerobic capacity.
Four participants who did not train attended a medical after six months and demonstrated relatively static fitness levels. (Diag. 3).
In a second study of twelve volunteers, we asked questions on lifestyle. Of these, eight who had to make restrictions and changes all had low to very low fitness levels. The remaining four with average or above fitness did not report a need to change lifestyle. The work of Wheeler et al. provides documented information on the varying extent to which this ailment affects patients’ lifestyle but has no correlating data to account for this.
Conclusion:
It appears as though there are two distinct causes of chronic fatigue. Firstly, abnormal low levels of fitness and, secondly, stress (as per neuroticism profiles). However, there were examples of individuals in whom other factors may be involved.
There was further evidence that low levels of fitness are responsible for the changes or restrictions to lifestyle seen in many patients with chronic fatigue.
Regular exercise improves the fitness levels of most individuals. However some, particularly those with very low fitness, do not appear to benefit from the training. The latter may have an impairment in their aerobic capacity perhaps resulting from poor diaphragm accommodation which results in low ventilatory efficiency. in exhausting work as found by Wolf, Cohen et al.
In consideration of all these factors it would seem that the provision of a moderate exercise programme is worthwhile for patients with chronic fatigue because of the benefit achieved by some participants and further research in this area would be valuable in assessing cause and prognosis.
Acknowledgements:
I wish to thank and acknowledge the collaboration of A.W. Sedgwick, Head, IFRT, Dr's. G. Beaumont, R.Lee, W. Chapman and Psychiatrist, Dr. J. Wurm.
Bibliography
1. I.C. Mohler, Exercise Testing in Coronary Heart Disease, Academic Press, New York, 1973, pp.13-44.
2. Volkov, V.S., Psychosomatic Interrelations and their clinical importance in patients suffering from cardiac type NCD, Sov. Med,. 1980 (11), 9-15, Eng. Abst.
3. Crown., S. and Crisp, A.R., A short clinical self-rating scale for Psychoneurotic Patients, The Middlesex Hospital Questionnaire ()M.S.Q.), British Journal of Psychiatry, 1966, 112, 917-923.
4. Wheeler, et al., Neurocirculatory Asthenia (anxiety neurosis, effort syndrome), neurasthenia (a twenty year follow up of one hundred and seventy three patients, J.A>M>A., March 25, 1950.
5. Wolf, S., Sustained contraction of the diaphragm, the mechanism of a common type of dyspnea and Precordial pain. Journal of Clinical Investigation, Vol. 26, 1947, p.1201.
6. Cohen, M.E., Johnson, R.E., Consolozio, P.C. and White, P.D.,
Low oxygen consumption and low ventilatory efficiency during exhausting work in patients with neurocirculatory asthenia, effort syndrome, anxiety neuroses. J. of Clinical Investigation, 25:292, 1946.
I.F.R.T. Neurasthenia Fitness Instructors' Information Sheet
Aims
1. To improve the physical working capacity of n.c.a.’s.
2. To provide information about the condition
3. To provide instructions on how to control the condition
4. To gain scientific information on the condition to aid research.
Methods
1. General neurasthenic principle
White, P.D. (1951) Heart Disease 4th edition McMillan & Co., New York, Ch. 22 Neurocirculatory asthenia p.587.
“The plan of life of the patient is to be worked out with care. Usually normal but qui\et work and play are to be advised, with avoidance of lat hours, coffee, tea, over-indulgence in alcohol and tobacco, strenuous vacations, excitement in general, too many hours at work, and new and burdensome tasks or duties. Often the patient himself is aware of this necessity, but he has perhaps dislike to humor his symptoms or to fall behind his fellows in strenuous living in the business, professional, and social world. With clear medical advice, however, he realizes the wisdom of doing so, and gradually he adjusts himself to suit his symptoms, and is surprised at recapturing a feeling of well being."
2. Neurasthenia and the heart: Information
(a) Car engine analogy:
A car with a good engine may be troubled on acceleration or hill climbs if the carburetor or distributor are out of adjustment or condition, but the car may travel on flat roads at an even speed. Similarly, a neurasthenic with a good heart may be troubled by strain due to a problem elsewhere in the body, yet there is no problem in moderate exercise and lifestyle.
(b) Using diagrams as aids explain:
(1) No coronary artery disease or blockage and no sign of subsequent heart muscle damage. A narrow or blocked artery may cause muscle damage and cardiograph abnormality. Damaged arteries can now be bypassed if necessary.
(2) No heart valve disease. . The healthy valves ensure that blood flows in one direction through the heart and there is no sign of back flow. Artificial valves can now be implanted if necessary.
(c) If fainting occurs, and the pariticpant falls to the ground, blood flow to the brain is aided by the reduced affect of gravity and the participant wakes up.
(d) Charles Darwin became neurasthenic at 30 and died at 72. Florence Nightingale neurasthenic at 30 died at 93.
3. Neurasthenic exercise principles:
(a) no sprinting or accelerating
(b) no heavy lifting or strenuous work
(c) gradually improvement (allowing for fluctuations)
(d) work at own level with pulse 120/140 bpm even if this means periodically reducing performance
(e) if overexercise occurs and the volunteer appears distressed by faintness and dizziness, he should stop exercise and alternately pace about and rest and take deep breathe until recovering, but may continue to feel some distress for a while.
4. Personal and social principles:
Develop independence of mind an action based on the notion that:-
(a) there is a need for neurasthenics to perform in moderation and therefore
(b) a need to ignore or resist social pressures to perform at normal levels.
5. Medicals at:
1. commencement
2. 3 months
3. 6 months
And for . . .
(a) patient surveillance
(b) source of research information
Note: This information applies to neurasthenia. However, some recruits who experience palpitations may not necessarily be neurasthenic and therefore may respond normally to exercise and not need to be restricted in their activities. Such individuals should be encouraged to train regularly and to keep fit.
Copies of the original typed draft, and an earlier newspaper report comparing the study with similar Russian measurements which didn't include the effects of exercise.
Test Results
The Aerobic Capacity (physical fitness level) of volunteers with persistent fatigue
Copies of the original graphs
Did Not Train
These volunteers were tested at the outset, and some did not
attend training at all, or complete the training sessions for
at least 3 months.
Volunteers tested at outset but did not complete 3 months training
and were not retested
______ These volunteers did
not train but were called in to be tested again after 3 months
and 6 months.
Trained
These volunteers participated in the exercise programme. They
were tested at the outset, and after 3 months and then 6 months
of training.
__ The aerobic capacity of a
male athlete
. . . . . The aerobic capacity
of an average fit male 850, and the average fit female 550
__________ Nine volunteers completed 3 months training, and
five of those continued to complete 6 months or more.
- - - - - - - - - The aerobic capacity of the author who was
tested and trained five years earlier.
Female volunteers
__________ The aerobic capacity of female volunteers who trained
- - - - - - - - - The aerobic capacity of an average fit female.
Male volunteers
_________The aerobic capacity of male volunteers who trained
- - - - - - - - The aerobic capacity of an average fit male.
X = volunteers who were tested at the outset but did not complete
3 months training.
48 Interviews from:
The Institute for Fitness Research and Training
chronic fatigue study (1982-84)
The chronic fatigue study also included a questionaire about symptoms and lifestyle
and questions about the cause and nature of chronic fatigue from 48 interviews from about 60 phone calls, in a study of more than 200. Those interviews are summarised below.
1. After a bout of glandular fever during
Matriculation exams the person never got over it. Now has tiredness,
missed heartbeats, stomach pains and dizziness.
2. Started with tension in the home, and
now tired all the time. Would not be depressed if it was not
for the tiredness, and has headaches. Works sitting all day as
a typist with difficulty and strains to read. Never had a lot
of stamina. When she was a housewife she could arrange her workload
to suit her energy level, but when she got a job the demands
of the workload drain her energy.
3. Was a very fit person who used to go
surfing, but after giving birth she had a breakdown and shock
treatment, and 20 years later still gets tired and dizzy, and
leads a restricted lifestyle which is a "bloody nuisance"
because she can't go out at night.
4. An alcoholic with palpitations, chest
pains and tiredness who was depressed by his symptoms and reluctant
to attend courses which involve social situations.
5. A university lecturer who had a family
history of nervous breakdowns, and was bedridden with fatigue,
first occurring after study pressure. He has been told that he
is very fit on a treadmill.
6. Home stress, and work stress caused
many symptoms including palpitations, breathlessness and nausea.
She sees herself as just a machine in a meaningless job who is
always rushing around and is put down by males, and told that
everything is her fault, she gets no recognition, and has no
control over her own workload due to her superiors.
7. Previously nervous but fit until the
death of her husband three years earlier. She gets palpitations
on waking, and is lethargic, and feels guilty about laziness
and hypochondria because her doctors can't find anything wrong
with her.
8. This woman had measles during childbirth
and on the day of giving birth developed palpitations, giddiness,
and hyperventilation, which continued for four years, and since
then she had been prone to symptoms. The symptoms caused her
misery when they wouldn't go away, and she found it hard to explain
them to her husband.
9. A healthy man had been interviewed on
radio when he was attempting to break a world endurance record,
and was praised as a role model for today's youth for his positive
thinking, determination, and stamina. When I phoned him to enquire
about his subsequent health he said that he became fatigued during
the attempt, and returned to work and was still suffering from
tiredness three months later when his boss told him that he was
lazy and sacked him, and he had continued to be tired since.
10. This man had depression following Bell's
Palsy due to a virus in the 7th cranial nerve?
11. This person was healthy until June
1982, when she got a virus and became dizzy, fatigued, and faint,
and had not recovered, and slowed down, gained weight, and complained
of lethargy.
12. This person was tired, breathless,
and nervous.
13. This woman's husband caused her stress,
and she had kids, and did shift work.
14. Teacher stress was the cause of fatigue
15. This person reported sudden tiredness
which was inexplicable.
16. This person injured his back at home,
changed jobs, and lost confidence.
17. This man was an opal miner who got
Quinsy, which is a throat infection, he collapsed, and has "been
useless since then" - February 83.
18. This woman described herself as a worrier,
and boredom contributed to her fatigue which was "helped
a lot" by a curette.
19. This woman reported that suddenly one
day seven years ago she became tired for no reason, and had tried
everything reasonable to cure the problem because she was in
despair about her families reaction to her fatigue, and her doctors'
negative attitude about it.
20. This person exercised a lot and participated
in the City to Bay Fun Run.
21. This person was on sickness benefits.
22. An 82 year old had been healthy until
a long bus tour and a virus, and now is very tired, needs to
rest, and is confined to a helping hand home.
23. Three years earlier the woman had her
third child with extra family worries which accumulated, and
then 1 year ago had tiredness, giddiness, loss of appetite, nausea,
and weight loss, and found that rest in hospital, medication,
and exercise helped.
24. Had problems for three years which
became worse after viral pneumonia in July.
25. This elderly lady's husband became
ill, and then she was "run off her feet" with caring
for his needs, and has been tired all the time in the three months
since.
26. This woman said she was a tense and
anxious type of person.
27. This woman was a Government Administrative
Officer who developed agoraphobia since a period of work stress.
28. This woman said she had agoraphobia
and couldn't leave home without help.
29. A 65 year old man developed symptoms
soon after becoming a POW (prisoner of war) in 1941 - 40 years
earlier - he has had to restrict his lifestyle ever since, and
eventually accepted it, and got used to it.
30. This elderly woman said she had always
been nervous, and described herself as being agoraphobic for
about 17 years, and the death of her husband made her symptoms
worse. She suffered from dizzy spells and was "afraid to
go along the street for fear of having another dizzy attack".
31. This middle aged man had back and neck
problems, and exhaustion since a car accident six years earlier.
32. This man had paroxysmal tachycardia
four years ago, and since then has been tired and exhausted all
the time, and said that his blood oxygen was low.
33. This man said he was agoraphobic.
34. This elderly man was too old for the
fitness course, and said he had muscular fatigue, probably M.E.
(myalgic encephalomyelitis). The flu made it worse, and he had
an enlarged heart, and congested cardiomyopathy.
35. This man was a relieving bank manager
who worked day and night, and had a nervous breakdown about a
year earlier, and had been agoraphobic for about 6 months.
36. This man had been hospitalised for
a few months with disabilities which may have been related to
anxieties involved in his work as an assistant service manager.
37. This man reported that his symptoms
came on gradually.
38. This man did weight lifting.
39. This man worked 18 hours a day, and
ran 4 businesses at once, and wore out. He then gave up working
18 hours per day and expected to rejuvenate with rest, but didn't,
and continued to suffer from fatigue ever since.
40. This woman had been to the Fitness
Institute courses before and was a physically fit shift worker
who tired easily.
41. This woman had ventricular fibrillation
thirteen years ago, and was divorced 8 years ago, and has had
dizziness for 5 years.
42. This elderly woman had been harassed
by her neighbour, and was awoken during the night because of
the noise made by her neighbour, and had a heart murmur, and
headaches due to a spinal problem, and could not attend fitness
classes because she had no transport.
43. This man had narcolepsy at work, and
cataplexy, and elation caused it, so he avoided elation at the
first sign of symptoms.
44. This man got viruses twice per year
associated with fatigue, and was always fatigued, and when he
did anything a little out of the ordinary he became unduly fatigued,
and was extremely annoyed that it affects his lifestyle.
45. This woman said she was short in height
and overweight at 13 stone. She had suffered from fatigue since
her first child kept her awake all night, every night for 9 months,
and the second child did the same 14 years ago.
46. This woman started getting fatigue
when she left school and started work as a nurse doing night
shift. She said that she now works only 1 day per week, and is
a very calm person, and that her fatigue has "nothing to
do with stress".
47. This woman enquired in relation to
her son who was quiet and shy, and had asthma as a child, and
became a very fit muscular man who did weight lifting, and was
a canoe instructor, and played basketball. Three years ago he
lost balance and became giddy and vomited, and couldn't get out
of bed for 10 days to 2 weeks because of vertigo every time he
lifted his head off the pillow. He recovered after 4 weeks and
has had 2 or 3 mild attacks since, and now gets dizzy, and is
fatigued all the time, and is tired and in bed by 9 p.m.
48. This woman reported symptoms which
It is clear from this set of interviews that there are many different causes of fatigue, and many types, symptoms, and outcomes. M.B.
Terminology and Newspaper Reports
One of my tasks as research co-ordinator was to have some articles published in newspapers to invite
volunteers to join the project. I arranged that by meeting Diane Beer who was a medical journalist for the Adelaide "News" which circulated throughout South Australia.
Fitness helps in therapy
By Diane Beer
SA could have a world first with a fitness research program into a medical complaint which causes abnormal tiredness and depression. The Institute for Fitness Research and
Training today announced a program aimed to relieve the chest pain, fatigue and depression of sufferers while researching the effects of exercise.
Tests
Soviet research assessed the fitness levels of people suffering the complaint, and in Sweden experimental courses were held for sufferers. But neither country assessed the physical effects of exercise comprehensively.
Program co-ordinator, Mr. Max Banfield, said the condition was difficult to diagnose, and many doctors did not recognise the complaint.
The illness has been known by many names over the years and is sometimes called an anxiety neurosis, he said.
Patients suffer heart palpitations although tests show no heart problems.
The News, Thursday, August 5, 1982, page 13.
Study lifts fitness levels
By Diane Beer
The fitness levels of people suffering a rare complaint which causes abnormal tiredness and depression may have been lifted by an SA study.
The pilot study at the SA Institute for Research and Training may be a world first.
People suffering neurasthenia were recruited to the program to research the effects of fitness in reducing chest pains, fatigue and extreme anxiety caused by the complaint.
The study coordinator, Mr. Max Banfield, said one man previously considered too ill to run would take part in The News City-Bay Fun Run after lifting his fitness level through the course.
Mr. Banfield said Soviet and Swedish research into the complaint matched initial findings in SA.
Initial
The fitness course was an extension of initial research.
A general improvement in health was gained in people whose fatigue was attributed to stress.
Mr. Banfield said the condition was difficult to diagnose and many doctors did not recognise the complaint.
He said the illness was often known as an anxiety neurosis because patients suffered heart palpitations although tests showed no heart problems.
Some patients suffered neurasthenia following a severe emotional trauma and continued to experience symptoms years after suffering the initial emotional upset.
The pilot study was very, very encouraging, Mr. Banfield said
He said the majority of people who undertook fitness training at the Centre gained measurable benefits and the study would continue when further funds were available.
The News, Thursday, August 11, 1983, page 13.
During our discussions I needed to identify the nature of the ailment being studied so I described the chest pains, breathlessness, and fatigue, with specific reference to abnormal tiredness, or more particularly problems with physical exertion.
The term neurasthenia had been in common use for about 100 years, but I knew it as Da Costa's syndrome, and when I was studying the condition I was using research journals which most commonly referred to it as neurocirculatory asthenia.
For the purposes of the newspaper article the term 'neurasthenia' was chosen.
I also explained that many of the patients were worried about their symptoms or became depressed because of the limitations to their lifestyle that was imposed by their persistent fatigue, and later mentioned the findings of the interviews with examples of participants who first noticed their fatigue after a viral illness, a prolonged physically exhausing event, or an emotional trauma, so those factors were included in some of the news reports.
I reported the results of each successful three monthly programme so that further articles could be written to invite more participants, and provided the scientific measurements which established that the fatigue was confirmed as a real physical and measurable ailment.
The journalist was required to verify all of those findings with the head of the Institute before publishing the articles.
When I had accomplished the task I set out to achieve I decided to leave the programme.
A few years later I became aware of comments in the media, particularly radio, about a supposedly brand new ailment called the "Chronic Fatigue Syndrome", but it was obviously just a new name for the same condition that had been around for hundreds of years with the label changing regularly. (the term CFS had been coined thirty years earlier, in the 1950's, but didn't get into general literature).
I later found that there had been more than 3000 research papers published on procedures called "Graded Exercise Training" and "Pacing", which use exactly the same principles that I developed in the IFRT programme i.e.the participants gradually increase their level of exertion while staying within their own limits etc.
That method has been reported as being the most effective treatment according to surveys of chronic fatigue patients.
It might not appear to be particularly unusual except that most previous programes were dismissing the possibility that patients had physical limitations and were advising them that all they had to do was ignore their symptoms and run as fast as they could to get well. As soon as those people ran past their limits they would experience the distressing symptioms and drop out of the course, so someone needed to design an exercise regime with limits, which is why I was successful.
The Posture Theory and Chronic Fatigue
The first indication that I had that posture had anything
to do with my own health problems was when I was working as a
public service clerk.
I was transferred to the cash controllers office where part
of my duties was to sit at a desk and count the daily take of
coins into piles of twenty of their particular denomination.
I noticed that after a couple of hours of starting work at
9 a.m. that I would get a vague ache in the left side of my back
at the level of my left kidney, and if I continued with that
work for another hour I would also start getting the ache in
the region of my right kidney.
A few months later I had some tests and was found to have
a stone in my left kidney.
About a year later, when I was engaged in my usual pastime
of gymnastics, I performed a handspring heels over head leap
and when my feet landed on the floor with my back arched I felt
a ripping sensation in my upper abdomen. I waited a few moments
to see if blood would come pouring from my belly, up through
my throat , and out of my mouth, but nothing happened so I resumed
my activities as an instructor without any further problems.
However in the next month or so, I started to notice that
I would get a nagging ache in my belly about an hour after commencing
my days work as a clerk. I also noted that these aches were associated
with leaning toward the desk to read or write, and that the longer
I did that work for the worse the pain got. Hence the pain was
worse on the busiest days of the week.
Within a year or two the abdominal pain was becoming more
of a problem and I was beginning to feel faint, or dizzy or breathless
as well, each time I leaned toward a desk.
I was also getting fatigue, and one night in the gym I performed
an exercise called a round off back somersault and when I landed
on my feet I felt dizzy and it appeared as if a thousand stars
were shooting in all directions before my eyes, so I stood still
and stayed bent over. I then waited for a few moments expecting
to lose consciousness and collapse, but I recovered without ill
effect and continued with my activities, although in a more subdued
manner.
The problems were therefore beginning to have a serious effect
on my occupation and my lifestyle.
Unfortunately the problems were a mystery to my doctor, and
the medication that he was prescribing was not helping, as my
health continued to deteriorate regardless.
At about that time I read that an organisation called The
South Australian Institute For Fitness Research and Training
was conducting fitness training programmes under medical supervision
for various ailments. I therefore thought that I could attend
such a course as treatment and that the researchers might be
able to enlighten me about the nature of my ailments.
At the initial medical assessment I was required to ride an
ergometric cycle while attached to electrodes which recorded
pulse rate over wheel pressure and could measure aerobic capacity
with scientific reliability. The result was a fitness level of
zero, compared to a friend of mine who measured 900, and an Olympic
athletes measurement of 1200. Another person I met was a forty
year old overweight asthmatic with a measurement of 600.
At the same session my body fat was measured with calipers,
and I was told that I was all skin and muscle, with virtually
no body fat, and that I had the muscle/fat ratio of an athlete,
probably due to ten years of sport and gymnastics.
I trained at the Research Institute for three months and achieved
a level of 350 kpms, and increased the programme to four times
a week and three months later was still at 350 kpm's so I concluded
that I had some sort of physical impairment which was limiting
my fitness capacity regardless of the amount of exercise I did.
I trained more often again for another 3 months and then injured
my knee cartilage while playing social volleyball with the other
programme participants. My leg remained injured due to diagnosis
and post operative problems for 3 years.
During all of that time I was inquiring about my health and
studying it and writing about my conclusions, and submitting
my essays to the Australasian Nurses Journal. After several articles
had been published I met and befriended the editor, Edna Davis,
who continued to publish my articles about once every three months.
Five years later I was able to conclude that most of my ailments
were aggravated by leaning forward, including the fatigue, and
in 1980 I wrote a three page essay called The Matter Of Framework,
which I have since called The Posture Theory.
Some time later I became aware that Sir Mark Oliphant was
living in a nursing home in North Adelaide and I knew that he
was regarded as one of Australia's most respected scientists
for his involvement in the Manhattan Project which developed
the atom bomb, so I phoned him and arranged a meeting with the
objective of asking him his opinion about the theory. At our
first meeting he said that he thought the idea was interesting,
but that he was not qualified to comment on medical matters with
any authority. However he told me that he would discuss it with
some of his colleagues who were among the country's top medical
researchers and let me know their opinion. When I met him again
two weeks later he advised me that his medical colleagues also
regarded the theory as interesting but that it was not possible
to say anything other than that because that whole area of medicine
(the range of undetectable an unmeasurable ailments) was a Pandora's
box of mysteries.
One day, while walking along a city street I met a friend
of mine, Clive Thelning, who was blind, and who I had befriended
some years earlier when I was studying group psychology at The
South Australian Institute of Technology, and I asked him what
he was doing. He had completed the Certificate Course, and went
on to do a Psychology Degree, and was working as a psychologist.
I told him about my essay and he said that he knew Tony Sedgewick
who was the head of the research institute where I trained, so
he suggested that I approach him with the view to arranging some
research on the subject.
At a subsequent meeting with Tony Sedgwick I outlined a potentially
useful training and research programme for reliably and scientifically
assessing the aerobic capacity of people with persistent fatigue,
and asked him to discuss it with his research staff to see if
they were interested.
At a further meeting he advised me that his staff were fully
committed to other projects and invited me to run the programme.
I told him that my health problems would impede my capacity
to do such a project properly, and added that I thought I was
not able to do scientific studies unless I had medical qualifications,
and that I didn't know how it would be funded. He then advised
me that he had some medically qualified contacts and that I could
approach them with the view to forming a committee to satisfy
all the requirements of administering such a course, and he gave
me the name of a politician who I could approach for funding.
A committee was formed and a very small government research
grant was obtained so the programme was established.
I then approached a journalist named Diane Beer who wrote
several articles for the Adelaide newspaper called the "News"
inviting people with persistent fatigue to attend the course.
After three years 80 people had been assessed as having aerobic
capacities of 100 to 1200 kpms with variable responses to training
from those who did not participate, to those who trained but
did not gain much in fitness, to one who trained for nine months
and participated in a small marathon (about 6 miles).
My own health problems stopped me from continuing the recording
and reporting of the statistics in the programme, but there was also
conflicting data which I couldn't account for. i.e. I expected
all fatigued participants to have low aerobic capacity, but some
had normal or high levels, and I didn't understand how that could
be so at the time of making my initial report. However, about
5 years later I drew the conclusion that those fatigued people
who had low aerobic capacity possibly had a fitness disorder
(a disorder of exercise metabolism), and those with a high aerobic
capacity must have had a sleep disorder. (In the English language
the word fatigue has two meanings: more commonly it means physical
exhaustion, but that same word is also used to describe tiredness,
therefore, if you recruit people with fatigue into a training
programme, then you are likely to get two totally different types
of volunteer, those who become readily exhausted by exertion,
and those who are always drowsy - you would also find some overlap
and confusion of both symptoms in the same individual).
Another five years went by when I was diagnosed with cancer
and given two months to live with no hope of a cure. The cancer
had spread to most of my lymph glands, and was in my blood and
bone marrow.
I didn't think that I would be able to study and cure cancer
in two months, so I decided to occupy my remaining time by writing
about posture and health, and if sitting at a desk aggravated
my health problems it wouldn't matter because I would soon be
dead anyway.
The task did aggravate my health problems and caused some
damage as I wrote one sentence, or one paragraph, or one essay
at a time. After about 6 years I discovered that standing and
typing in front of a computer screen positioned at eye height caused much
less problems than sitting and leaning forward to write at a
desk.
The book continued to increase in size at about 150 pages
per year and 8 years later in the year 2000 when my cancer was
cured by a stem cell transplant, I completed it as the 1000 page
11th edition.
Over the years several editors have commented critically on
my writing style as being an unusual collection of sentences,
paragraphs, and illustrations, but I have noticed the advantage
of spending a lot of time thinking, and a small amount of time
writing. The research project results were submitted
to several medical journals in 1983 but were not accepted, with
one editor advising me apologetically, that it would need to
be re-submitted in the appropriate medical format before being publishable.
I have decided to present the results in rough form on this web
page 24 years later in April 2007. M.B.
References relating to the Chronic Fatigue Syndrome
A very common illness which has been well known for two centuries
Many doctors and medical experts continue their attempt to create the public impression in their journals, and in newspapers, and on their websites that CHRONIC FATIGUE is a very new and quite rare condition. They imply that there has never been any scientific evidence of it having a real or measurable physical basis, and that therefore there is a great deal of doubt about whether it actually exists or not. It is still widely reported that the condition is just normal tiredness which some patients complain excessively about, or that it is "all in their mind". Many doctors also persist with their disproven suggestions that the condition can be cured simply by thinking positively and doing some sort of exercise or another. I do not wish to comment on why they try to create this false, and insidious, and pernicious impression but I will present some quotes from medical publications of the past to discredit that deceit.
The chronic fatigue syndrome is one of the most common diseases of modern life but it is not a new condition. In the past it has been given many different names which include DaCosta's syndrome, neurasthenia, neurocirculatory asthenia, vasoregulatory asthenia, and the effort syndrome etc. Here is some information from the past which has been extracted from the 11th edition of The Posture Theory.
"The patient's voice falters. 'Doctor,
I'm so tired. What's wrong, what shall I do'.
Every hour, every day, in almost every doctor's consulting room, at least half the visitors voice this complaint.
Of all ages, of either sex,
rich or poor, they make up the vast throng of fatigued human
beings who get little comfort from the pills, shots and examinations
they solicit from baffled physicians"
From: Our Human Body, It's Wonder and It's Care (1962) p. 410
"Neurasthenia":
This diagnosis "had wide popularity in the nineteenth century
and is now obsolete. It referred to a state in which the major
symptoms were chronic fatiguability, lack of endurance, backache,
and headache".
From: Harrison's Principles of Internal Medicine 6th Edition
(1970) p.1863
"Neurasthenia is a term which,
in the past, was used more commonly as a diagnosis than almost
any other". Now it is used only for cases of "excessive
persistent fatigue" where is no evidence of pathological
cause.
Reference: The British Encyclopaedia of Medical Practice (1950)
Vol.10, p.32.
Neurasthenia . . . The classic neurasthenia
patient is thin and underweight and "wanders from one physician
to another seeking relief from various complaints and may undergo
unnecessary surgery or extensive medical treatment on insufficient
or vague indications .... Changes in lifestyle ... and 'rest
cures' along the lines of old-time spa therapy are of value in
some cases."
Reference: Current Diagnosis And Treatment (1973) p.574.
"Neurasthenia
is a state of chronic mental and physical weariness for which
there is no obvious cause." They feel tired "as soon
as they attempt to undertake the ordinary tasks of life"
and when they do manage to work it is below their previous standards.
They awake "tired and unrefreshed" and are at their
worst in the morning except when "they have to work hard,
in which case the amount of tiredness is out of proportion to
the amount of work performed."
There are many accompanying symptoms including headaches, palpitations,
and indigestion, and . . . "Reading makes their eyes ache
or produces the sensation of spots in front of their eyes."
Reference: The Universal Home Doctor (no date) p.531.
In the 19th
and early 20th centuries people who suffered from pain and fatigue
or paralysis were diagnosed as having 'nervous spine', 'neurasthenia'
or 'fits'.
Edward Shorter called such people "somatizers" and
described them as suffering from "pain and fatigue that
have no physical cause", and suggested that they were playing
sick as a means of consciously or sub-consciously seeking solace,
attention, or social excuses.
"Such somatizers have produced a fascinating succession
of phantom diseases" and the "Archetypal Victorian
ladies" collapsed on their beds, or had fits, convulsions,
or paralysis, but, "By 1900 such operatic displays softened
into a symptomatological chamber music", of less dramatic
symptoms of neuralgia, headache, and fatigue.
Such patients were "frustrating to no-nonsense physicians
such as the early twentieth century Kentucky doctor" who
believed that "a good
spanking", or sometimes even a "good cussing"
was the best treatment for such "evident hypochondriacs". Nowadays the condition
is called "myalgic encephalomyelitis or ME (also called
'yuppie flu' or chronic fatigue syndrome)".
Reference: The Cambridge Illustrated History of Medicine (1996)
p.111-112"The neurologist calls the disease,
in technical phrase, neurasthenia; the gynaecologist is too likely
to look no farther than the womb and ovaries; and the general
practitioner is apt to imagine spinal disease, dyspepsia, "liver
complaint" or "malaria" to be at the bottom of
all the trouble. Each treats the patient from his partial stand-point,
and is disappointed that recovery does not result."
From: The Ladies Guide (1904) p.588-589
The psychiatrist
divides these individuals into groups of "anxiety states,
obsessional neuroses and conversion hysterias."
These conditions include the effort syndrome (chronic fatigue)
and may occur "in the convalescent period after such acute
illnesses as influenza, pneumonia or even tonsillitis, particularly
in young adults."
A hasty convalescence predisposes to this condition so "special
care" should be taken in determining the appropriate time
for returning to work.
The condition causes "distress,
disability and economic incapacity" and has an intractable
nature.
"Drugs are of little or no value."
Reference: Textbook Of Medical Treatment, 4th edition, (1946)
p.604-606.
The most common symptom in neurasthenia is ready fatigueability,
but there can also be headaches, dizziness, ringing in the ears,
palpitations, chest discomfort, cold feet and hands, digestive
disturbances, constipation, sleeplessness, and "pains in
the neck, between the shoulders, or in the back and the limbs,
with tender spots along the spine". "In fact the symptoms
are so many and so varied that it is common for a neurasthenic
to imagine that he has any or every disease that he happens to
read about."
Reference: Modern Medical Counsellor Revised Edition (1957) p.
554
The Chronic Fatigue Syndrome has previously been called many things, including the Effort
Syndrome because it often involves "effort intolerance"
and "is characterised
by a group of symptoms which unduly limit the subject's capacity
for effort". Breathlessness 93%, palpitations
89%, fatigue 88%, left inframammary pain 78%, dizziness 78% and
or faintness 35%.
Reference: Diseases of the Heart & Circulation 2nd Edition
(1956) p.937-944
"The pulse is always greatly
and rapidly influenced by position . . . Dizziness was often
complained of". It was increased by stooping (case 44);
by exercise (case 57) or by laying on the left side in some cases
or on the right side or the back in others. For treatment . .
. "Their equipments be such as will not unnecessarily constrict
and thus retard or prevent recovery".
Reference: Da Costa J.M. (January 1871), On Irritable Heart,
The American Journal of the Medical Sciences p.18-52
Erben's phenomenon . . . temporary
slowness of the pulse on stooping or sitting down; said to characterize
certain cases of neurasthenia."
Reference: Dorland's Illustrated Medical Dictionary 25th edition
(1974) p.1179.
Neurocirculatory asthenia, Da Costa's
Syndrome is less adequately called "the soldiers heart",
the "effort syndrome" and "anxiety neurosis",
and involves instability and abnormal irritability of the nervous
and circulatory system of unknown cause. It tends to be precipitated
by physical exhaustion, nervous strains and infections.
Symptoms occur as a syndrome of breathlessness with sighing respiration,
palpitation, exhaustion, precordial pain, (or ache), dizziness,
nervousness, tremor, sweating, headache and faintness aggravated
by effort or excitement. In some cases the condition is more
or less constant with little or no provocation. "That such a state of ill-health exists there
can be no doubt". It is not just fatigue, or
infection or nervous strain or psychoneurosis, but may attend
or follow such conditions "or even frequently stand alone". The effort syndrome is sometimes
considered unworthy of discussion because "so
far as we know, it is not an organic disease, and since it may
occur in perfectly normal persons," but it is important
because "it is often a partially or completely incapacitating
condition", and treatment is important but often neglected,
and it is essential to distinguish it from organic heart disease.
. . It is a real and not an imaginary
incapacity, even though at first glance it may have
appeared imaginary during World War I (1914-1918) when it was sometimes labeled "malingering",
and even though in civilian practice it has frequently been diagnosed as "mere nervousness".
The cause remains obscure, where there are no pathologic changes
and the heart is usually structurally normal, and there are no
lesions of the nerves or glands, although "Abnormalities
of central nerve cells induced by fatigue in experimental animals
have been noted and may be possible factors". . .
Blood pressure may be a little elevated and variable, strength
and endurance tests and vital capacity are low, in some cases
extremely low. There is an
easily induced oxygen debt on exercise with an excess accumulation
of lactic acid.
Reference: Heart Disease 4th edition (1951) p. 579-585
DaCosta's
syndrome . . . "Lewis
commented 'it is because these symptoms and signs are largely,
in some cases wholly, the exaggerated physiological responses
to exercise . . . that I term the whole the 'effort syndrome' . .. 'a proportion of the patients whom I include
in the group effort syndrome sooner or later acquires the diagnosis
of neurasthenia.'"
In some cases "the chest is long and narrow or flattened
and associated with a kyphotic curve" or the person is slight
in build or has chest wall deformities. The pulse shows an exaggerated reaction to posture.
The condition can effect soldiers particularly those who came
from sedentary occupations and who had signs of the condition
in civil life many years before joining the army. It affects
sedentary town dwellers and is commoner in women".
From: Wooley C.F. (May 1976) Where are the Diseases of Yesteryear,
Circulation p. 749-751
DaCosta's syndrome . . . After exercise the pulse rate
deceleration time is abnormal.
Reference: Diseases of the Heart & Circulation 2nd edition
(1956) p. 940-942
During exercise the breathing
rate increases for all people including those with neurocirculatory
asthenia, but in those with neurocirculatory asthenia the "breathing
becomes disproportionately shallow." "During exhausting
work, such as running, patients developed significantly high
blood lactate concentration" indicating "that aerobic metabolism was defective in these
patients."
These patients were generally thin and "were poor athletes"
and were especially poor swimmers". . . and their symptoms "are not mentally determined or
removable by analysis."
Reference: Neurocirculatory Asthenia: 1972 Concept, Journal of
Military Medicine (April 1972) p. 142-144
Since
World War I it has been known that high concentrations of C02
can trigger a so-called 'anxiety attack' in patients with neurasthenia.
Reference: Neurocirorlatory Asthenia: 1972 Concept, Journal of
Military Medicine (April 1972) p. 142-
The concept
of ME (the Chronic Fatigue Syndrome) has deeply divided the medical
profession and provoked bitter arguments between those who believe
it is "entirely imaginary" and those who think "it
has an organic basis". Some doctors belittle the
condition and regard the patients as malingerers and manipulators. The condition mainly affects
women, but some men also suffer from it, including "both
male and female members of the medical profession", and
it features severe fatigue which can "be made worse by exercise,
a single act of which may cause fatigue for weeks."
Reference: Symptoms (1996) p. 300-304
Researchers
at the Harvard Fatigue Laboratory in America have " learned
that physical fatigue is caused by a complex chain of chemical
reactions" where prolonged muscular effort causes lactic
acid, carbon dioxide and other by-products to seep into the bloodstream
. . . "So acute is the chemical change that injections of
the blood of a fatigued animal into a rested animal will produce
fatigue."
Reference: Our Human Body Its Wonders and Its Care (1962) p.413.
It may be useful to inject the blood of people with chronic
fatigue into healthy experimental subjects to determine if they
too become fatigued. M.B.
Treatment: "The plan of life of the patient
is to be worked out with care. Usually normal but quiet work
and play are to be advised, with avoidance of late hours, coffee,
tea, over-indulgence in alcohol and tobacco, strenuous vacations,
excitement in general, too many hours at work, and new or burdensome
tasks or duties. Often the patient himself is aware of this necessity,
but he has perhaps disliked to humor his symptoms or to fall
behind his fellows in strenuous living in the business, professional,
and social world. With clear medical advice, however, he realizes
the wisdom of doing so, and gradually he adjusts himself to suit
his symptoms, and is surprised at recapturing a feeling of well
being."
Reference: White P.D. (1951) Heart Disease 4th edition, Mcmillan
& Co., New York, Ch. 22 (neurocirculatory asthenia) p.587.
The origin of ideas about posture and fatigue
When I first became interested in the study of medicine one of the primary symptoms that I was considering was a form of fatigue. Four years later I was able to recognise that it came on more readily and persisted longer than ordinary fatigue. I likened this to the way one end of a seesaw rose too fast and fell too slowly if the people on each end were of unequal weight. I therefore referred to the fatigue as a disorder of equilibrium, and began writing an essay to summarise that conclusion.
At that time I was also writing an essay on a postural cause of backache, chest pains, breathlessness, stomach pain, and kidney pain. As the fatigue occurred together with this set of symptoms I suspected that there may have been a postural cause for the fatigue as well, but did not have the evidence to establish that fact. I therefore started a third essay in which I brought all of this information together in an attempt to integrate it.
While looking for clues I came upon a word in a Medical Dictionary called Valsalva's maneuver which referred to an experimental method for stimulating the nervous system. It then occurred to me that overstimulating the nervous system might damage it and cause it to malfunction, resulting in chronic fatigue, so I sought a more detailed explanation of the maneuver at the Barr Smith medical library. I then determined that Valsalva's maneuver involves holding the mouth and nose shut and breathing out forcefully to increase the pressure in the lungs. This impairs blood flow through the chest and stimulates the nervous system to increase the blood pressure in the arms and legs, which in turn forces the blood through the pressurised chest.
I was aware that the fatigue symptom was common in sedentary workers and rare in manual labourers so I assumed that repeatedly leaning toward a desk hundreds of times a day for many years might be repeatedly pressurising the chest and eventually causing the nervous system to malfunction.
I then discarded the three other essays and started writing one new essay describing how all of the symptoms had a common postural cause. When I was considering several titles I realised that I was writing a framework of ideas to link a framework of symptoms, and I noted that these were related to the framework of the human body, so I eventually decided that one of the best of the title options was The Matter Of Framework, so that is what it was called, and that essay was the original Posture Theory.
I later attended a meeting of a group of people who suffered from chronic fatigue, and they were basing their discussion on the possibility that the condition was caused by a virus.
Since then I have concluded that there are different causes, types, and degrees of severity of the condition. Most, if not all of these conditions involve excessive tiredness, which is a disorder of sleep metabolism, and one type involves abnormal responses to physical exertion, which is a disorder of exercise or energy metabolism. M.B.
Any written permission which has been granted to publish information from this webpage relates to the information above this line. The information below this line is new to this page and may be referred to or linked to, but not published. Acknowledgement of the source is required. M.B.
The Posture Theory:
in progress from 8-3-02
The nature, measurement, and management of The Effort Syndrome
The confusing aspects
The possibility that many different problems have been lumped
together under the same general fatigue category, which has previously
been labeled by hundreds of different titles, has long been recognised,
and there have been many attempts to distinguish the sub-groups.
This category has included several main groups which include
those relating to the function of the circulatory system, the
post-viral category, and the psychological possibilities. Hence
the same broad group of syndromes has been labeled as neurocirculatory
asthenia, myalgic encephalomyelitis, or anxiety state, and there
has been a general tendency to lump all people with fatigue in
the same way (to fit square pegs into round holes). Hence they
have all been deemed by some to have circulatory problems, or
by others to all have a post-viral condition, and of course there
have been suggestions that they are all anxiety states, or depressives,
or are complaining excessively about normal fatigue
It is worth noting that all people experience fatigue after
strenuous or prolonged exertion, but they usually recover in
a few minutes or hours, or by the next day. It is also common
to have fatigue during an infectious illness but this usually
only persists in the course of that illness, and or in the convalescent
period, but in some cases it persists chronically for months
or years afterwards. Others notice that when they are anxious
they get fatigued, and when the are depressed they may be too
apathetic or too tired to get out of the bed in the morning.
However, regardless of the number of different conditions
which are involved, there is a group of people who have chronic
persistent problems with fatigue, and who also experience a set of symptoms in relation to exertion,
yet they are not anxious, nor depressed, and some have been former
athletes or sportsmen, so the idea that their symptoms are due
to a fear of exercise is unlikely.
When examining the aerobic capacity of any 100 people with
chronic fatigue there are usually a small percentage who have
very low aerobic capacity, and this has been customarily regarded
as proof that the fatigue does not have a physical basis, otherwise,
it has been said, they would all have low aerobic capacity.
However, if all the individuals with low aerobic capacity
were considered separately as having a specific problem, for
which the term "The effort syndrome"is apt, they could probably be identified,
not as being contradictory, but as having some consistencies,
and some of the confusing aspects of these problems would be
solved.
Those aspects which are particularly relevant to an effort
syndrome are included in the accompanying list.
The distinguishing features
1. low aerobic capacity
2. defective aerobic metabolism
3. poor breath holding ability
4. reduced capacity for exertion
5. disproportional shallow breathing during exertion
6. readily induced oxygen debt in response to exertion
7. high blood lactate production during exertion
8. sensitivity to high concentrations of CO2
9. ready fatigability
10. fatigue accruing out of proportion to particular
types and levels of exertion or strain
11. poor stamina for high levels of exercise
12 inability to sprint for short distances with,
in some cases, a concurrent average stamina for low levels of
exercise
13. reduced capacity for anaerobic exercise
14. exaggerated response of pulse rate in proportion
to effort
15. Slow deceleration of pulse rate after exertion
16. abnormalities to pulse rate in relation to
stooping or squatting, or to changes in posture such as standing
suddenly
17. abnormalities in the circulation of blood in
response to sudden loud noise
18 abnormailities in the circulation of blood in
response to sudden or intense changes in gravitational or centrifugal
forces
19 labile blood pressure
The Banfield Principles
For Exercise Training and symptom management in the Chronic Fatigue Syndrome(the effort syndrome)
First devised in 1976, and later modified between 1980 and 1983
1. Many people
with the Effort syndrome have participated in exercise programs
in the past and have proceeded on the basis of the idea that
they can return to normal levels of fitness with the purpose
of curing the problem. These programs have often been promoted
with enthusiastic expectation of success with the instructors
encouraging the individuals to keep trying, and keep improving,
and forcing themselves to get past any perceived limits or presumed
fears of exercise. However such programs have invariably failed
because it can result in the types of symptoms that convince
the person to stop. That individual then loses confidence in
the advice given by the supposed expert, and they are unlikely
to participate in any exercise program again.
The expectation of success comes from the observation that some
people with Chronic Fatigue do return to normal levels, so therefore
all people should be able to. However the successful cases probably
had a different type of Chronic Fatigue involving a disorder
of sleep metabolism which did not influence their aerobic capacity
and the person was simply unfit. Others may have had a fear of
the palpitations which accompanies exertion, and after the progressive
exercise has removed that fear they are essentially cured of
their particular problem.
The following suggestions are for individuals who have abnormally
low levels of aerobic capacity and who have difficulty improving
their condition, but because of the confusing aspects the suggestions
are not strict rules but are guidelines. Furthermore the ailment
involves a disordered regulation of aerobic metabolism and is
unstable and therefore the implementation needs to be flexible.
Most individuals should be able to gain some degree of improvement
in their aerobic capacity which is accompanied by more stable
health, and others may eventually achieve completed recovery.
2. Some individuals
may be too readily exhausted to exercise, and if they benefit
from rest, they should rest. If they are able to exercise the
exertion should be faster than standing still and slower than
sprinting, and the level of starting should be determined by
the indivudual, and the rate of improvement should be gradual.
3. If the individual is walking or training with other people they
may be always passed by other paticipants or walking at the back
of the pack. This should not be a deterrent but if it is then
people with this ailment should train in groups where all participants
are aware of the nature of the problem and the programme. (Exercise
ability is proportional to aerobic capacity and the Effort syndrome
involves an abnormally low aerobic capacity which varies from
person to person).
4. Healthy people recognise that when they train fast they can often
force themselves past any perceived limits of endurance with
the expectation of getting a second wind that enables them to
proceed in comfort. This is a common observation amongst marathon
runners, but it may be non-existant or ineffective in The Effort
Syndrome and should not be relied upon.
5. While walking or jogging a sense of breathlessness can
occur at irregular distances, sometimes after twenty yards, and
then after the next fifty yards, and then again thirty yards
further. This symptom can be relieved by taking two or three
forced breaths each time without causing any problems. If these
do not relieve the symptom, slow your pace, or stop if necessary,
but sometimes these forced breathes may be occasionally necessary,
even at rest. The breathlessness is probably due to inefficient
function of the diaphragm (the main breathing muscle), and a
forced inhalation expands the chest sideways and improves the
oxygenation of the lungs which is deficient because of less downward
movement of the diaphragm.
6. If distressing symptoms of palpitations, faintness, or dizziness
occur at improved levels of exercise then return to a lower level,
and improve gradually again later.
7. Faintness can be due to any factor which traps blood below the
waist, especially if the blood vessels have been strained by
many years of stooping which can result in a tendency of blood
to pool in the blood vessels below the waist and reduce the efficiency
of circulation. Therefore faintness may be induced by stooping,
or leaning forwards, or by any factor which constricts the waist
such as tight belts and girdles. Hence to prevent faintness those
factors should be avoided. It is worth noting that 19th century
women tended to faint because they wore very tight wasp-waisted
whalebone corsets. They relieved the faint by loosening their
corset laces, and by laying in a chaise-lounge, with their body
horizontal, and their head and shoulders slightly elevated on
the arm of the lounge. The faintness was relieved partly because
the waist constriction was released, and partly because the gravitational
load on the blood vessels was removed, and blood could therefore
flow toward the head unimpeded. In fact fainting results in falling
to the floor, and this is natures way of getting the body into
the horizontal position so that blood can flow to the head and
the person can recover.
Additional notes on faintness: 1. Even snug
fitting belts can cause problems because they restrict the free
expansion and contraction of the abdomen which accompanies breathing,
because that compresses the internal anatomy and impairs the
downward movement of the diaphragm. 2. Faintness can also be due to wearing tight
collars because they also reduce blood flow to the brain, so
always wear the collars loose.
8. Faintness can also be due to the looseness of internal organs
(visceroptosis) which move excessively when the body is subjected
to gravitational or centrifugal forces. This movement can compress
abdominal blood vessels and impair blood flow from the feet to
the brain. The problem can be relieved by stabilising the body
and contracting the abdominal muscles to minimise the movement
of internal structures.
9. The effort syndrome has been called neurocirculatory asthenia
because it features a weakness in the circulation of blood. This
results in a tendency to faintness and dizziness because of an
abnormal disturbance to blood flow in response to such things
as sudden intense exertion, sudden loud noise, or sudden changes
in gravitiational or centrifugal forces. Hence the person may
feel faint, or as if they are about to collapse when they suddenly
sprint (e.g. when they hurry to catch a bus) or when they are
exposed to sudden loud noise, or when they suddenly move from
the laying to the standing position or when they ride in a lift.
In order to deal with these it is useful to recognise that they
are not natural responses, and that therefore the natural way
of dealing with them is not effective. However in much the same
way as riding a bicycle is an unnatural method of travelling
which is different to walking, and can be learned through practice,
the method of dealing with the symptoms of the effort syndrome
can be learned. This essentially requires a mixture of periodic
resting, and the practice of breathing deeply and regularly three
or four times in order to relieve any symptoms when they occur,
and repeated practice and experience makes this more effective.
10. The
effort syndrome can be effectively managed by restricting lifestyle
and exercise levels within particular limits so that the person
gives the appearance of being in perfect health. In fact maintaining
optimal fitness within those limits is useful in managing the
condition. However this appearance of health is often misconstrued
or misrepresented as being evidence that the person is in perfect
health, and that they should be able to maintain any lifestyle
and participate in any exercise that they wish, and they are
accused faking. The fallacy of these accusations needs to be
understood by the patient so that they are not coerced into going
beyond their limits and bringing about a relapse of prolonged
unremitting exhaustion. (which has some similarities to being
on a overdose of coffee - The Kramer Syndrome - where rest, relaxation,
and sleep are not easily attained, or effective in relieving
the fatigue)
The Banfield Principles continued:
Specific methods for treating the Effort Syndrome
A. exercise as
a treatment
1. If rest is necessary then rest is the best treatment at
that time
2. If walking is possible then walking is the best exercise
3. Any improvement in fitness levels should be gradual
4. Do not carry heavy weights when walking, especially in
the early stages.
5. As a general guide avoid sprinting, especially if carrying
weights.
6. Avoid anaerobic exercises such as weight lifting or forced
movement against any form of resistance.
7. Set your own pace in exercise and do not be concerned with
the improvement rates of other people because they may have a
higher aerobic capacity.
8. Walk on flat ground, especially in the early stages when
you are assessing your aerobic capacity.
9. As a gereral guide do not walk up steep hills until you
understand your fitness limits, and then only do so if you think
that it is practical and possible, and at a pace determined by
your experience.
10. If you occasionally feel as if you are not getting enough
air when you are walking or jogging, then take two or three forced
deep breaths each time, and you should be able to continue.
B. Treating
faintness
1. If abruptly moving from the laying to the standing position
makes you feel faint, then first move to the sitting position
and then stand up slowly, and wait a second or two before walking.
2. If riding in a lift makes you feel as if you are about
to faint, then avoid lifts and use escalators. If you need to
use lifts then enter the lift and take three or four slow, deep
breaths before the lift begins to rise, and again each time it
slows to stop.
3. If you have to use lifts, then it is likely that your natural
reflexes can adjust to the movement of lifts, but it will require
more time than normal, and will require the practice of breathing
techniques to reduce the effect of the gravitational forces which
are involved in the lifts movement.
4. If travelling by aircraft makes you feel faint and distressed,
then try the same treatment as specified above when the plane
accelerates to take off or decelerates to land, or when it drops
in an air pocket.
5. If riding on whirling sideshow rides causes you to feel
faint and distressed then avoid them.
6 If you feel faint when you are a passenger in a car which
is speeding around a curve in a country road, then brace your
arms against the dashboard and contract your adominal muscles
to stabilize your body. Alternatively avoid such journeys, or
ensure that you are the driver so that you can brace your arms
against the steering wheel and can adjust the speed of the car
according to the way your body is responding.
7. If you feel faint when your car is braking to stop at stop
lights, then approach the lights slowly, and brake gradually,
and take a few deep breaths before braking, and brace your arms
against the steering wheel so that you do not slump forward as
the car stops.
8. If you feel faint or dizzy when squatting down and leaning
forward, then avoid activities which involve squatting, especially
for prolonged periods of time.
9. If you feel faint when leaning toward a desk, the kitchen
sink, or the washing machine, then move closer to the task so
that you reduce the tendency to slump forward, and try to keep
your back straight by bending at the hips instead of the midriff.
10. If you feel faint or dizzy in a crowded room or theatre
then sit in an aisle seat so that you can leave if necessary,
without disrupting other people. The faintness may have been
due to the noise of the movie, or to high concentrations of CO2
which can accumulate in crowded areas.
11. If you are in a theatre and feel faint or experience palpitations
when a crescendo of music is followed by a loud clashing sound
(for the purpose of creating suspense), then take a few deep
breaths to break the effect of the soundwaves, or leave the theatre
auditorium temporarily, until the symptom eases.
12. If you are tempted to sprint for some urgent reason, as
when hurrying to catch a bus, then ensure that your increase
in pace is modified and within the limits which you have learned
from experience, or do not hurry at all.
13. If you feel faint it may be partly due to the fact that
you are wearing tight belts, girdles, corsets, or collars which
reduce blood flow to the brain, so loosen such garments, and
lay down for a few minutes, preferable with your head and shoulders
slightly elevated and your knees raised with your legs bent.
As a preventive measure, never wear tight or constricting garments.
For my YouTube video on the cause and treatment of faintness see here http://www.youtube.com/watch?v=Xs770_nwq6I
See also this reference B.Biswal, P.Kunwar, B.H.Natelson (2011), Cerebral blood flow is reduced in chronic fatigue syndrome as assessed by arterial spin labeling, Journal of Neurological Science, Feb. 15, 2011, 301(1-2), 9-15. This is the result of the study of the cerebral blood flow (CBF) of 11 CFS patients compared to 10 age matched healthy controls . . . "The patients as a group had significantly lower global CBF than the controls. The reduction in CBF occurred across nearly every region assessed. Nine of the 11 patients showed these reductions compared to the average control data, while two patients showed actual increases relative to the controls. See here
The measurement of the Effort Syndrome
Introduction
If a motorvehicle is
supplied with the wrong fuel mix and has faulty spark plugs and
a faulty or sticking choke, a slipping clutch, faulty steering
and faulty brakes, it may neverthless still drive normally and
safely at low speed. However it will tend to rev fast when it
is idling, not take off as fast as it has been designed to, miss
or vibrate when it is speeding, sway when it is turning, and
keep going after the brakes have been applied.
The mechanical function of motor
vehicles has some similarities to the function of the human body
which provides some analogies which assist in the understanding
of The Effort Syndrome which has been called a functional disorder.
(a functional disorder is a condition in which symptoms occur
because of a functional disorder where there is no known physical
explanation).
There are some aspects of The
Effort syndrome which need to be detected, measured and explained.
Namely why do abnormal palpitations occur at high levels of exertion,
why is there an abnormal sense of faintness when the body is
subjected to gravitational or centrifugal forces, why is there
an abnormal sensitivity to carbon dioxide, why does fatigure
tend to abnormally accrue, and why is there a prolonged delay
in the recovery from fatigue.
The following descriptions relate
to some of the possibilities.
The measurement of cardiovascular fitness in the Effort Syndrome
Pulse rate increases according to the
amount of effort being exerted. The relative increase varies
from person to person and can be measured, and that measurement
is referred to as their cardiovascular fitness.
In one method of measurement the person
is required to ride a stationary ergometric cycle while their
pulse rate is being monitored and a load or pressure is applied
to the wheel so that more force is required to peddle against
it. The person rides the cycle against low resistance for one
minute, and then they have a one minute rest, during which time
the load on the wheel is increased and they are required to ride
for another minute. This riding and resting proceeds several
times and each time the load on the wheel is increased again.
A graph can then be drawn on the basis of the pulse rate which
was recorded at each level of resistance, and can be used to
determine which level is required to produce a pulse rate of
150 beats per minute. This level of resistance is known as their
kilopon rating and gives an indication of cardiovascular fitness.
When these experiments have been conducted on groups of people
with the chronic fatigue syndrome there is always a percentage
of them who have abnormally low levels and these are the ones
who could be identified as having a type of cfs for which the
term The Effort Syndrome is appropriate.
As a guide for comparison an athlete
would have a capacity of 1200 kilopons, and a person of average
fitness 900 kilopons. Some people with cfs have readings below
that of individuals who have other chronic illnesses, and for
the purpose of consideration anyone with cfs who has a level
below 500 kilopons could be regarded as having a sub-group of
the condition for which the term The Effort Syndrome applies.
The person can then participate in an
exercise programme where they are required to train for one hour
a day, three days per week for three months. During each session
they should attempt to walk or jog with their pulse rate reaching
120 to 140 beats per minute for 20 minutes. There can also be
20 minutes of formalised aerobic, but non-weight bearing exercises,
and 20 minutes of other physical but non-vigorous game activity.
At the end of the three month training
session a second ergometric test can be conducted to determine
if the programme has resulted in any measurable improvement in
cardiovascular fitness, and then a further three months training
performed, and the test repeated again.
This programme would determine the persons
kilopon rating, and if it improved with exercise, and would also
show their upper kilopon limit.
Example results
1. At outset zero kilopons, after three
months 355 kilopons, after 6 months 355 kilopons.
2. At outset 260 kilopons, after three
months 240 kilopons, after 6 months 250 kilopons.
3. At outset 325 kilopons, after three
months 500 kilopons, after 6 months 540 kilopons.
4. At outset 375 kilopons, after three
months 450 kilopons, after 6 months 780 kilopons.
Note that in example 1 the measurement
of zero resulted from the graph being drawn in the usual manner
as a straight line, but a more precise reading can be achieved
at the lower levels if the graph is drawn with a curve. The first
level of zero was achieved peddling up to a maximum resistance
of 150 kg, the second of 355 up to a maximum resistance of 450
kg and the third of 355 up to a maximum resistance of 750 kg
indicating that measurable cardiovascular fitness had plateaud
despite an increased ability to peddle against resistance.
When I discussed these results with
one research cardiologist I said that they were scientific evidence
of a physical basis for persistent fatigue. He replied with a
tone of resentment in his voice and said "No! that meant
nothing!"
More details about the research project and a graph
showing results can be see here
The Aerobic Ceiling
The aerobic ceiling is the maximum aerobic, or cardiovascular
capacity that a person is capable of achieving regardless of
how much exercise they do. For example a healthy person may have
an aerobic capacity of 900kps and if they participate in an exercise
programme they may be able to increase this to 1200kps, but no
further, regardless of how much exercise they do in the future.
Similarly a person with the effort syndrome may have an aerobic
capacity of 300kps, and if they participate in an exercise programme
they may increase this to 500kps, but it will remain at that
level regardless of the fact that they increase the level and
frequency of exercise in the future. M.B.
The exertion crisis in the Effort Syndrome, and it's management
There have been reports of recruits who have been required
to carry heavy knapsacks and sprint along an obstacle course
at army training camps, and as they increase their pace they
suddenly collapse and they roll about the ground having spasms
and fits. Their symptoms have been attributed to a fear of exercise
or a sub-conscious fear of battle, and they have been deemed
unfit for military duties for psychological reasons. However
a closer study of these recruits reveals that many of them were
known to have had the symptoms of an effort syndrome for many
years previously in civilian life.
It is most probable that these people had been managing their
condition by limiting their activities until such time as joining
the army and being required by their training officer to exceed
their physical limits.
There have been numerous attempts to cure the effort syndrome
by using exercise programs which gradually improve physical fitness
to normal levels, however the majority of those programs invariably
failed.
Some years ago I heard about a fitness program which was being
conducted at an oval in the grounds of a mental hospital to treat
patients who were suffering from fatigue, so I made some enquiries,
and when I spoke to the psychiatrist who was organising the program
I suggested that, if a physical method was being used to treat
chronic fatigue then it was a bit incongruous to regard it as
a mental illness, and he responded with embarrassed silence.
Many people with chronic fatigue report that they feel physically
distressed when they attempt to increase their level of exertion.
The heart pounds with excessive force with each contraction,
but when it expands again there is a sense that the heart muscle
is weak and becoming more exhausted and may not have enough strength
to contract again, so there is a sensation of an impending faint.
This sensation is relieved when they reduce the pace of their
jogging, so if they are asked or told to run faster than they
feel capable of they simply drop out of the course.
However some of them do, usually only once, exceed their limits,
as for example, when being required to participate in a relay
race, and the following symptoms occur as they rapidly increase
their pace. Firstly their heart suddenly begins to pound and
rock violently in their chest, and then all vision disappears
and is replaced by a black visual field with thousands of small
bright spots, like shooting stars, darting in all directions,
and then the person feels faint, as if they are about to collapse.
Then to avoid collapsing uncontrollably they lower themselves
to the floor and crawl about on their hands and knees, feeling
the continuing violent pounding of their heart for a minute or
two, as well as an intense sense of hyperactivity, as if their
bloodstream has been saturated with twenty cups of strong coffee,
so that any restraint of movement causes distressing physical
agitation, and a sensation that if they do restrict their movement
they will lose consciousness. They therefore pace about restlessly
on their hands and knees and they tell other people who come
near them to help to keep away, and not to touch them or restrict
their movement. They then have to reach for breath to get oxygen
into their lungs to satisfy an intense air hunger, and they avoid
talking because the exhaling of air to produce speech drains
them of energy to the extremes of exhaustion. As they pace about
on all fours the effort exhausts them so they have to rest, but
after a few seconds the restraint of movement causes profound
distress so they have to pace about again, and they continue
in this alternating way for about 10 minutes. The symptoms then
ease somewhat and it is possible for the person to carefully
lift themselves onto a chair, but the effort exhausts them so
they slump in the chair, but the slumping restricts their breathing
so they have to sit upright. If that effort exhausts them they
may have to move back to the floor again for a few more minutes
of rest and slow pacing, and then they can lift themselves up
into a chair again. After another 10 minutes or more their rapid
pulse, and their breathlessness, and their sense of intense hyperactivity
eases, and they can stand to walk. They will then have to intermittently
rest and sleep and pace about slowly for about a week before
resuming any exercise program, and then only at a lower level
than was achieved before, and with a more gradual improvement
regime, and they will be unlikely to ever exceed their own perceived
limits again. They may ultimately achieve considerable improvements
to their physical capacity but not be able to return to a normal
level of fitness regardless of how frequently they train because
there is probably an anatomical limit to their aerobic capacity.
I have referred to the Exertion Crisis as Sudden Exertion
Shock or Sprint Shock. M.B.
Research findings 1975-2011 confirming the effectiveness of my methods with more scientific evidence and proof of aerobic limits
The description of the exertion crisis was based on my experience while participating in a standard exercise programme at the South Australian Institute for Fitness Research and Training in 1975. I was asked to design a research programme by the head of that institute in about 1982, and included methods of ensuring that the participants did not exceed their limits or have that experience, and measurements of aerobic capacity were taken at three monthly intervals as described in detail in other parts of this webpage - e.g. See here and here
On 15th June 2011 I produced a YouTube video on the relation between breathing pattern and exercise can be seen here
A video on scientific measurements by cfsks.com/media (www.cfsKnowledgeCenter.com & www.me-cfsCommunity.com) can be seen here
In this video Dr. Nancy Klimas, MD, director of the CFS Clinic in Miami, explains that the measurements were for VO2 maximum, up to which the individuals physiology is able to supply enough oxygen and sugar to their body (within their aerobic capacity), and above which they exceed their aerobic capacity and go into anaerobic levels where there is not enough oxygen being delivered for their needs and they start experiencing fatigue. She then explains how an exercise programme can be designed to enable the person to stay within their limits.
In a second video by the same organisation a patient explains how he uses the VO2 principles to stay within his aerobic capacity - to PACE himself - and stay within his exercise limits, which he found to be very useful and an excellent way of improving his health. See here
The measurement of abnormalities in blood pressure changes in relation to posture using the tilt table test for patients with symptoms of faintness and chronic fatigue
While I was contributing to an article about Da Costa's syndrome (an earlier name for the Chronic Fatigue Syndrome), I had a critic who was trying to convince everyone else that it was a mental illness in which there was no clinical evidence of a physiological abnormality. She was a liar who knew that it was a diagnosable physical ailment. This is what she wrote on the Da Costa's syndrome talk page half a year earlier on 7th June 2008 . . .
"Some researchers will tell you privately that giving someone a DCS diagnosis before giving them a tilt-table test is malpractice" See here
Dr. Peter Rowe of Johns Hopkins University
has had an article about the relationship between chronic fatigue
and blood pressure abnormalities published in The Lancet in March
1995 (345:623-624). This article was entitled "Is neurally
mediated hypotension an unrecognized cause of chronic fatigue?"
When Dr.Rowe was interviewed by Rebecca Moore of CFIDS Alliance
News, he said that some people who have recurrent episodes of
fainting have "profound abnormalities in the regulation
of blood pressure". This is called "neurally mediated
hypotension". However he discovered that some people with
the chronic fatigue syndrome have the same problem and although
they have never actually fainted they often complain of faintness,
fatigue and memory problems. The blood pressure drops abnormally
when the person changes posture, for example from the laying
to the standing position, and this can be measured while they
are placed on a tilt table where their blood pressure can be
measured when the table is tilted at various angles. This is
a new finding in relation to chronic fatigue. He found that as
the table is tilted the patients blood pressure is maintained
for a short time but they gradually develop symptoms and then
their blood pressure drops suddenly. He found that when these
patients increased their dietary salt intake and were prescribed
beta blocking drugs some of them reported less faintness and
fatigue, and their ability to concentrate, comprehend text, and
remember the text they had read all improved.
He suggested that the symptoms occurred
because the blood of some patients with CFS tended to pool abnormally
in the lower limbs, so that less blood circulated through the
brain, and that by laying flat, or by increasing salt intake
and therefore increasing circulating blood volume, and by the
use of beta blocking medications, the blood flow to the brain
improved, with the consequence that the symptoms of faintness,
fatigue, and memory difficulties were relieved. He added that
some patients with cfs paradoxically had high blood pressure
so they should consult a doctor before increasing their dietary
intake of salt because that can increase their blood pressure
further.
Also more research was required to follow
up these findings.
The following web pages contains more
detailed information about this interview. here
My recommendations for a Tilt table test to diagnose CFS
Between 1975 and 1980 I suggested that chronic fatigue may be due to poor posture repeatedly causing increases in the air pressure in the chest and resulting in weakness of the blood vessels below the chest. I also suggested using tilt tables and pulse rate and blood pressure monitors as a diagnostic test for chronic fatigue. At that time the label of 'chronic fatigue syndrome' was not in common use , but the research term for the condition was 'neurocirculatory asthenia' which means 'weakness of the circulation of blood flow'.
I have since also found that as long ago as 1916 Sir James MacKenzie attributed the symptom of persistent fatigue to the abnormal pooling of blood in the abdominal and peripheral veins (which reduced the strength of blood flow to the brain).
See also this reference B.Biswal, P.Kunwar, B.H.Natelson (2011)Cerebral blood flow is reduced in chronic fatigue syndrome as assessed by arterial spin labeling, Journal of Neurological Science, Feb. 15, 2011, 301(1-2), 9-15. This is the result of the study of the cerebral blood flow (CBF) of 11 CFS patients compared to 10 age matched healthy controls . . . "The patients as a group had significantly lower global CBF than the controls. The reduction in CBF occurred across nearly every region assessed. Nine of the 11 patients showed these reductions compared to the average control data, while two patients showed actual increases relative to the controls. See here
CFS, Orthostatic Intolerance, and modern Tilt table testing in 2011
This is a quote from a website called "OMIM Online Mendelian Inheritance in Man - An Online Catalog of Human Genes and Genetic Disorders (Updated 7 October 2011 -Orthostatic Intolerance #604715." . . . "Orthostatic intolerance is a syndrome . . . This syndrome, first described by Da Costa (1871) has been called soldiers heart (Fraser and Wilson, 1918), neurocirculatory asthenia, (Wooley 1976), and mitral valve prolapse syndrome (Boudoulas et al., 1980). It is similar in many respects to chronic fatigue syndrome, Schondorf and Freeman, 1999)" See here
That quote is from a website called "OMIM Online Mendelian Inheritance in Man - An Online Catalog of Human Genes and Genetic Disorders (Updated 7 October 2011), Orthostatic Intolerance #604715." See here
See also this website by Jilian M. Stewart for the "Center for Hypotension" of the "New York Medical College" which shows the modern methods of detecting "orthostatic intolerance" using Tilt table tests here
If you have a look at the symptoms of Da Costa's syndrome, for example in Wikipedia, your will find that the main symptoms are3e mentioned in one paragraph, and more generally, in other articles, they are described as being associated with many other symptoms's with abdominal pains and headaches being among them. If you have a look at the symptoms of the Chronic fatigue syndrome or Orthostatic Intolerance they included exactly the same set of symptoms, but they are often presented in a list, out of alphabetical order, and not in order of the main ones at the top going down to the less prominent.
Three different labels given to the same ailment
One is considered a mental illness, the other a medical condition, and the third a vascular disorder.
There are of course some very minor differences, and some researchers seem to be deliberately confusing the differences, but essentially the same basic cause applies to all three. The fact that most of the patients have the same basic problem has been known for more than fifty years. The most common differences are that some have had the fatigue and mainly cardiovascular symptoms, some have had the fatigue and abdominal symptoms, some have had the fatigue and swollen lymph nodes, and some have had the fatigue and psychological accompaniments such as anxiety and depression.
All diseases are like that. For example, some people get cancer and worry about it and others don't, and some people get side-effects from chemotherapy which is mainly nausea, and others get mainly pain. etc etc.
Syndrome
Symptoms
Diagnosis
Category of illness
Da Costa's Syndrome
"Fatigue upon exertion upon exertion, shortness of breath, palpitations, sweating, and chest pains." here
Other sources mention up to 100 other common symptoms which include abdominal pain, sore throats, vulnerability to infections, and headaches.
Physical examination reveals no physical abnormalities causing the symptoms.
A mental illness in the category of Anxiety disorders, and Somatoform disorders. See the end of the page here
Chronic Fatigue Syndrome
"Impaired memory physical or mental exertions bring on "extreme, prolonged exhaustion.
Headaches of a new kind or greater severity
Sore throat, frequent or recurring
Other common symptoms include:
Irritable bowel, abdominal pain, nausea,
Chills andnight sweats chest pain shortness of breath
Allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise
Difficulty maintaining upright position (orthostaticinstability, irregular heartbeat, dizziness, balance problems or fainting)
Psychological problems (depression, irritability, mood swings, anxiety, panic attacks)" etc. here
There are no characteristic laboratory abnormalities to diagnose CFS,[20] so testing is used to rule out other potential causes for symptoms.[15] When symptoms are attributable to certain other conditions, the diagnosis of CFS is excluded.
Ailments of unknown cause, Immune system disorders, Neurological disorders, and Syndromes. See the end of the page here
Orthostatic Intolerance (a syndrome)
"Lightheadedness
Headache Fatigue
Hyperpnea or sensation of difficulty or breathing or swallowing (see also hyperventilation syndrome)
Sweating
Anxiety
Heart palpitations, as the heart races to compensate for the falling blood pressure Exercise intolerance
A classic manifestation of acute OI is a soldier who faints after standing rigidly at attention for an extended period of time.
Chronic OI
Neurocognitive deficits, such as attention problems
Sleep problems
Pallor
Other vasomotor symptoms." etc.
Current tests for OI (Tilt table test, autonomic assessment, and vascular integrity) can also specify and simplify treatment. See here
A physical disordered in the category of "Vascular diseases", "Nervous system disorders", which is easily diagnosed by a tilt table test. here
(Note that when diagnosing the chronic fatigue syndrome you cannot exclude Da Costa's syndrome or Orthostatic intolerance, because they are exactly the same syndromes which are given different names according to the person who gives the same set of symptoms the label.)
Postural and visceroptosis induced hypotension and faintness
The loose abdominal organs of visceroptosis slide down when
a person moves from the laying to the standing position and this
changes the outer contour of the body as they crowd into the
lower abdomen. This is different to the features of obesity.
Diagram reference: Illustrated Family Doctor (1935) p.699.
One possible explanation for the results of the tilts test
is that some people with The Chronic Fatigue Syndrome, particularly
those with The Effort Sydrome, have visceroptosis. In that case
all of the major internal organs would be loosely suspended,
and hence would be significantly movable in the abdomen. Therefore
when the body is tilted the intenal organs would begin to slide
and cause symptoms, until eventually they compress the major
abdominal veins and reduce the blood flow returning from the
feet to the heart, and hence reduce blood pressure, and induce
the sense of faintness. (This sense of faintness can be quite
different from normal faintness and may be very distressing to
the patient.) The movement of the internal organs could be ascertained
by doing x-rays at each phase of the tilt test.
A similar symptom can occur when the patient moves suddenly
from the laying to the standing position because the abdominal
organs drop forcefully within the abdomen, but that can be prevented
by first moving from the laying to the sitting position and then
standing up slowly.
By constrast when the person moves from the standing position
to the laying position the abdominal organs slide toward the
heart (like fluid inside a half-full bottle flows toward the
cork when it is laid on its side), where the pressure can cause
the symptom of palpitations. This symptom can be prevented by
first moving to the sitting position and then laying down slowly
onto three pillows which keep the head and shoulders slightly
eleveated. After a few minutes two of the pillows can be removed.
Similar symptoms can sometimes also occur during pregnancy
because of the movement of the heavy pregnant womb which occurs
when the woman changes position.
The measurement of biochemical abnormalities in The Effort Syndrome
The various types of Chronic Fatigue Syndrome involve abnormal
physiological responses to exercise, and or abnormalities in
fatigue responses which influence rest and sleep patterns which
would predictably be associated with measurable metabolic abnormalities.
This alters the biochemical characteristics within the body which
can be assessed by examining the blood and urine. A number of
studies have now shown differences in the biochemical characteristics,
and there have been attempts to use this data to identify different
sub-groups of CFS and as these studies are continuing more categories
are being detected and distinguished.
The following biochemical characteristics may be relevant
in distinguishing The Effort Syndrome
1. Fibrillar and non-fibrillar catabolism
are abnormally high -
this provides evidence of infection, trauma, or fatigue associated
changes to amino acid catabolism.
2. The amino acid levels Serine,
Glycine, Leucine, and Phenylalanine are abnormally low
3. The amino acid l-methy-histidine
is high
4. The organic acid Succinic acid
level is low, while the citric acid level is high - which may indicate abnormalities in TCA cycle
metabolism.
5. The organic compounds UM27 and
Hippuric acid levels are high.
This data is derived from extracts of
studies by the Department of Biological Sciences at New Castle
University in N.S.W. Australia. The chart on the right shows
an example of the measurements in a case of The Effort Syndrome.
The chart below shows the same case with Non-fibrilla and Fibrillar
catabolism being abnormally high, approximately levels 9 and
10 respectively.
Example of E.S. levels %
Normal levels %
Lower than norma
UM 13
0.00
0.12
UM 14
0.00
0.20
UM 15
0.00
0.05
UM 15b
0.00
0.09
UM 17
0.00
0.20
leucine
0.14
0.48
succinic acid
0.25
1.37
beta-amino-isobutyric
0.27
1.45
valine
0.36
1.31
phenylalanine
0.39
1.05
threonine
0.52
2.17
proline
0.89
2.66
aspartic acid
0.90
1.66
ethanolamine
1.06
2.27
aconitic acid
1.56
4.39
alanine
1.61
7.08
serine
2.37
9.16
glycine
4.53
20.81
Higher than normal
UM 28
0.82
0.05
UM 13a
0.85
0.16
tyrosine
1.52
0.23
ornithine
2.38
0.56
UM 27
3.17
0.27
3-methyl-histindine
3.90
1.33
citric acid
6.15
0.74
1-methyl-histidine
16.14
0.83
hippuric acid
38.04
16.37
Levels above 5 are consistent with CFS and are associated with the Effort Syndrome
0
5
10
Non-fibrilla catabolism
Fibrilla catabolism
A curious quote from the past
"The urine often shows a white or pink-coloured deposit
on standing, and there may be a movable kidney - this condition
being, indeed, a well recognised cause of neurasthenia in women
. . . True neurasthenia is purely a functional disease - i.e.
there is nothing wrong with the machinery."
Reference: The Modern Family Doctor (1928) p.479-480.
The measurement of chest width, depth, and sternum angles
There have been numerous observations
that people with CFS often have thin and narrow chests, but other
patients have normal or obese builds therefore it is possible
that the thin chested physique may be more specific to The Effort
Syndrome. This is because such a physique crowds the heart and
lungs and alters their shape and the sharpness of the curves
of the main arteries, and would probably influence cardiovascular
function, as well as disposing to visceroptosis. Therefore the
following measurements would probably be relevant.
1. Chest shape measurements
The severity of the spinal stoop, the
narrowness of the chest, and the flatness of the chest could
be measured directly by measuring the curve of the spine, the
width of the chest, and the angle of the breastbone, but perhaps
a better guide would be the measurement of the distance between
the lower tip of the breastbone and the spine. These measurements
may show that the smaller this distance, the more likely the
incidence of The Effort Syndrome
2. Heart shape measurements
The shape of the heart may influence
heart function, and in this respect the measurement of the length
of the heart in relation to body height, and the width of the
base of the heart may be relevant. A pyramid shaped heart of
average height with a broad base may tend to be more stable in
its function, whereas a bowling pin shaped heart which is tall
and thin with a narrow base might have a greater tendency to
unstable wobbling palpitations, and a more common association
with The Effort Syndrome.
The measurement of the extent of visceroptosis
There have been numerous observations
of a link between visceroptosis (the displacement of abdominal
organs) and CFS but these associations have been dismissed because
of some inconsistencies. However further studies may produce
a more reliable link between visceroptosis and The Effort Syndrome,
and the more significant the visceroptosis the more likely the
association. The following suggested measurements could be made.
1. Minor visceroptosis with significant displacement of one abdominal
organ.
2. Moderate visceroptosis with significant displacement of up to three
abdominal organs,
3. Severe visceroptosis with obvious displacement of five or more abdominal
organs, and with the base of the stomach extending below the
navel.
In the past there has been a general tendency to describe
all forms of CFS as the same disorder when in fact there is a
lot of evidence that different types occur and have been confused
as one.
This list presents some possible different sub-groups
1. Anxiety disorders
2. Chemical sensitivity disorders
3. Common chronic fatigue syndrome
4. Depressive disorders
5. The Effort Syndrome
6. Overtraining Syndrome
7. Overwork Syndrome
8. Posture syndromes * may be the same as 5 & 12
9. Post-viral disorders
10. Reassurance induced fatigue syndrome
11. Sleep metabolism disorders
12. Visceroptosis induced fatigue.
The all in the mind ideas
Throughout history there has been a general tendency to describe
all undetectable illnesses as being caused by psychological factors
and this has been the case with the Chronic Fatigue Syndrome.
The following types of arguments have been used to sustain
the idea that all forms of chronic fatigue are due to psychological
factors.
A. It has been said that there was no scientific (x-ray or
biochemical) evidence of an organic basis for the fatigue therefore
it must have a psychological cause.
B. It has been said that anxiety causes fatigue, therefore
chronic fatigue must be caused by chronic anxiety.
C. It has been noted that some people with CFS show no obvious
signs of anxiety, therefore they must have sub-conscious anxiety.
D. It has been said that some people with CFS show no obvious
signs of anxiety or depression or any other psychological disorder,
therefore they must be suffering from a very obscure, mysterious,
or extremely deep-seated sub-conscious psychological problem
that not even the most thorough psychiatric investigations have
been able to find.
E. Where there has been evidence that some people with CFS
have extremely low aerobic capacity which could account for their
condition it has been said that there are other people with CFS
who have average or high aerobic capacity, therefore those with
low capacity must simply be unfit because of a lack of exercise
which is due to a fear of exercise.
F. Where there has been evidence of biochemical differences
in people with CFS it has been said that these are trivial differences
which have no
significance.
Note that all of the arguments dismiss
the evidence of a physical cause and chop and change in a variety
of ways to suit the one conclusion of a psychological cause.
Furthermore, those who present physical
evidence are required to prove it to stringent scientific standards,
whereas the psychiatric explanations are accepted simply by default,
without any requirement of scientific proof.
In effect the conclusion of any discussion
about this type of disorder has always been predetermined in
favour of a psychiatric diagnosis.
Common causes of Chronic Fatigue
There has been
a lot of disinformation about the cause and nature of chronic
fatigue with an overemphasis being placed on psychological factors,
and with dismissive terms such as Yuppie Flu being fashionable,
and a disregard for the more realistic physical causes which
are described below.
Battle fatigue
Fatigue
which affected World War 1 soldiers who fought in the trenches
which were being bombarded day and night for months, while the
soldiers were poorly fed, unable to sleep because of the noise,
and exposed to the cold and wet of the trenches which were flooded,
and infested with insects and rats, and where the soldiers contracted
food poisoning and other infections including the worst flu epidemic
in history. In many cases the fatigue became chronic.
The common chronic fatigue syndrome
A state of chronic
fatigue which occurs as the result of a combination of factors
such as overwork for long hours without adequate rest or sleep,
poor nutrution, and exposure to extreme heat or cold, infections,
or noise.
Marathon runners fatigue syndrome
A state of chronic
fatigue which affects marathon runners, athletes, sportsmen,
and people who attempt world records, who overexert themselves
or train excessively for long periods of time without adequate
rest, and who push their bodies beyond their physical limits.
Also called the Overtraining Syndrome.
The overwork fatigue syndrome
Fatigue
which affects sedentary and manual workers who work excessively
or for long hours each day without adequate rest or sleep for
months or years, and where they keep working when they have become
overfatigued and exhausted, and persist until it is impossible
to continue. If prolonged rest is taken in the early stages complete
recovery is possible, but if it is not taken until severe fatigue
occurs, then only partial recovery is possible. e.g. the industrial
fatigue which affected coal miners of average physique who had
to shovel the same tonnage of coal per day as the stronger workers.
Posture fatigue syndrome
A
condition which affects sedentary workers with particular physiques
where their chest buckles backwards each time they lean toward
a desk. The breastbone compresses the heart and lungs and interferes
with the circulation of blood. After several years circulatory
weakness develops (neurocirculatory asthenia) until the person
feels faint each time they lean toward the desk and gains relief
each time lean back. The symptom of faintness is associated with
labile blood pressure, postural hypotension, and a more general
accrual of ready fatiguability which can become chronic.
POW fatigue syndrome
Fatigue
induced in World War 2 prisoners of war who were used as slave
labour and forced to do heavy manual work while being poorly
fed and who lost more than a third of their body weight. Some
of those soldiers were still suffering from problems with fatigue
50 years after the war had ended.
The reassurance induced fatigue syndrome
Severe
fatigue which affects workers who are advised by their doctors
that the symptom is trivial or imaginary, or no different to
ordinary fatigue, and which they are told has no physical basis
and that staying in the situation which is causing it will do
them no harm, so that the worker persists until their state of
fatigue is so severe that it is impossible to continue. The prolonged
self-imposed rest which follows only provides a partial recovery
but chronic ready fatiguability remains.
Visceroptosis induced fatigue
Fatigue
which occurs because the internal anatomy has been displaced
by poor posture, pregnancy, corsets, shockwaves, or violent car
accidents etc.. The displacement of anatomy probably causes fatigue
by impeding the blood flow through the body and altering the
regulatory mechanisms of circulation (vasoregulatory asthenia).
Sleeping Tablets as a contributor to the chronic fatigue
Sleeping tablets are
routinely prescribed for patients with sleep problems such as
insomnis. Does the dosage of those tablets, or the prolonged
use, or the severe withdrawal symptoms indicate that they contribute
to the development of a chronic sleep disorders. (do those drugs
have a permanent effect on the regulation of blood pressure and
blood flow).
Severe Effort Syndrome
If a state of fatigue develops and the person remains in the
situation which is aggravating it their condition may become
severe. This condition is called neurasthenia gravis where the
person experiences symptoms in response to the slightest physical
exertion. For example, if they attempt to walk and lift their
left foot off the ground to move forward their pulse rate will
rise and their heart will pound in their chest until they return
their foot to the ground, when the pulse rate settles. When they
lift their right foot to continue walking their pulse will pound
again.
At some stage between the mild and severe conditions the medical
reassurance that the symptoms do not have a physical basis and
that continuing in the situation where they occur will not do
any harm becomes unbelievable, and suggestions that rest will
not provide a benefit become irrelevant because the patient will
simply have to rest as it is the only way of relieving the symptoms.
At that stage, if the patient cannot co-opt the doctor into authorising
leave, they will have to commence a prolonged period of self-imposed
rest This is a very common necessity where the decision to rest
is often misrepresented as a mental breakdown.
It is salient to observe that a doctor may continually reassure
a poor patient that there is nothing physically wrong with them,
but when advising a wealthy patient who has the same condition,
they will insist that they take immediate extended rest in order
to prevent the fatigue from becoming chronic.
Keep pushing, keep pushing, the doctor says that nothing
shows up on x-rays so there is nothing organically wrong. Keep
pushing, keep pushing!!! He says that leaning forwards cannot
be causing these problems and that continuing to aggravate the
symptoms cannot do any physical harm. Keep leaning and pushing,
keep pushing!!! Medical advise is based on scientific evidence
so how can it be wrong? Keep pushing, keep pushing!!!
How long can the human body endure this, and when
is enough enough? Keep pushing, keep pushing!!!
The voice text
(above ) is based on one of the original Posture Theory
diagrams
I will include a copy later
A relevent quote
from another source
"As far as the virus theory of CFS (chronic fatigue syndrome)
is concerned, I feel the jury is still out. It really would be
nice to find a quick, simple cure for this condition, but I still
am not inclined to believe that such exists. A large percentage
of my CFS patients have no history of such infections,
but they do have a history of having pushed
themselves beyond their strength time and time again until they
could push no further. Therefore, I feel that even
if such a virus were found, it would be helpful in only a small
percentage of patients. My experience with CFS tells me that
there are usually plenty of other reasons most patients develop
this condition, and unless we reverse those reasons, that is,
change the life-style that brought on the conditions in the first
place, there is little hope of a real cure." Gerald E. Poesnecker,
N.D., D.C., December 1998. Quote from http://www.chronicfatigue.org/
This graph is subject to copyright
but may be reproduced for review purposes on condition that the
source is acknowledged as The Posture Theory, with reference
to this webpage.
The development phases of chronic fatigue
The table above is designed to illustrate an example of the
nature and development of chronic fatigue in the Effort Syndrome.
In phase one the person has normal health and fatigue levels.
In phase two the person may be in a situation which is contributing
to persistent fatigue, and as their health deteriorates the fatigue
becomes disproportionately worse each year until it is intolerable
and the person decides to begin a period of usually self-imposed
rest. In phase three, the rest period, the person is slowly recovering
a small amount each year. In phase four the persons health stabilises,
but a persistent level of fatiguability remains greater than
it was before the chronic fatigue developed. In milder cases
the fatigue can occur more quickly, not progress to such a severe
extent, and recovery can occur in a period of months rather than
years, and may, in some cases result in a return to normal health.
During the fourth, or residual phase of cases of severe chronic
fatigue, new recurrances of severe fatigue are more likely to
occur when attempting to return to a normal full lifestyle because
the fatigue occurs more readily, accumulates more rapidly, and
continues more persistently during the rest phase. For example,
where the first instance of severe fatigue may have accumulated
over a period of several years, the next instance of severe fatigue
may accumulate over a period of several months. Hence a person
who has one major period of fatigue, is likely to have a series
of bouts of severe fatigue over the next few years or decades
until they recognise that they need to make permanent modifications
to their lifestyle. M.B.
"Neurasthenia . . . Relapses
are prone to occur, and the outlook is worse if the disease has
been of slow and gradual development." Reference: The
Illustrated Family Doctor (1935) p.499.
The nature of relapses of chronic fatigue in the effort syndrome
(and why it is wrong to advise patients with the effort syndrome
to fight against fatigue)
To understand the difference between normal fatigue and relapses
of chronic fatigue it is useful to have a numerical and therefore
mathematical model which makes the comparison clear, and this
is provided in the following description.
After developing the chronic fatigue syndrome the person may
have had to leave their employment, but after a period of rest
and recovery they may decide to re-enter the work force. However
they would have become aware from experience that their stamina
for various activities has been impaired so they may choose an
occupation which allows for flexible working hours and work load.
The work of commission sales offers this facility where the person
can choose to attend 10 customer appointments per day and achieve
two sales to earn the equivalent in commission of a full time
salaried worker, but they can choose to see only one potential
customer per day if they wish.
They may decide to start gradually to assess the viability
of the job with a work load of two appointments in the morning
and one in the afternoon for three days of the week (allowing
for intermittent days of rest). If, after two or three weeks
there is no obvious increase in the amount of fatigue they may
decide to increase the workload to three appointments in the
morning, and two in the afternoon for four days per week (allowing
for one day mid-week for rest). By this time there may be a subtle
but perceptible increase in the sense of fatigue but if it is
within reasonable limits they may decide to increase their workload
to four appointments in the morning and four in the afternoon
for five days per week (allowing the week-end for rest). They
may then start noticing an increase in their level of fatigability
which they can deal with by eliminating all social activity in
the evening. They may then increase their workload to five appointments
in the morning and five in the afternoon and achieve a normal
workload, but find that they have to eliminate all social activity
in the evenings and on the week-end, and that, despite this,
they start the following Monday slightly exhausted. By this time
they have no social life whatsoever, and despite this their exhaustion
continues to accrue, so to relieve the problem they may reduce
their workload to four appointments in the morning and four in
the afternoon. However despite this, and after a week-end of
rest, they commence the following week with more fatigue than
they had at the start of the previous week. They may then decide
to commence the next Monday with only three appointments in the
morning and two in the afternoon, and work for only four days
per week. Nevertheless they commence the following week more
exhausted than they were at the start of the previous week so
they may decide to reduce the workload again to two appointment
in the morning and one in the afternoon and work only three days
per week. However after attending the first appointment on the
Monday morning they are so exhausted that they have to force
themselves to get to the second. It then becomes obvious that
it is a waste of time continuing because, even if they do manage
to complete their second appointment, they will be too exhausted
to attend the third, and too exhausted do anything the next day,
or for the remainder of the week, so they may decide to catch
the next bus and go home. It may take many months of rest and
sleep before they return to a vaguely normal state of health.
Such an experience of fatigue has no similarity to the normal
cycle of work, rest, sleep, recuperation, and starting again
refreshed, and is unsustainable.
Normal fatigue readily dissipates
with normal periods of rest and sleep, whereas chronic fatigue
persists and accumulates, so the objective in managing the condition
is to prevent the accumulation. M.B.
The Posture Theory:
The section on the chronic fatigue
syndrome in progress from 8-3-02 was completed here on 25-6-02
(I think I made this comparison more than 30 years ago, but have just added it here again on 27-12-11)
The symptom of fatigue in CFS is different from normal fatigue in two ways.
1. First of all it can increase so gradually over a period of many months that the person doesn't notice.
2. Secondly, when the person does decide to stop all activities and get complete rest, with the expectation of recovering within a day or two, they don't. The fatigue tends to persist for two or three months at the same level where it is difficult to do anything but the mildest of physical activity.
This is somewhat similar to the concept about the frog and the frypan. If you place a frog in a very hot frypan it will feel the pain immediately and jump out without harm. However, if you place it in a cold frypan and gradually warm it up, by the time the frog realises that it is hot, it will be too late to get out.
If you told the frog what was going to happen it would jump out as soon as it felt warm.
Although I still have the problem of CFS, I haven't developed severe uncontrollable fatigue since, because if the symptom increases, I notice it, and take steps to ensure that it doesn't progress any further.
The Runaway Freight
Train Syndrome 11-7-06
The problem of chronic fatigue syndrome is difficult for the
general population to understand because it is not seen as being
much more than the problem of normal fatigue. Therefore I will
try to explain it by making a comparison with a runaway train.
While the train is traveling along a flat plain, it can slowed
down by applying the brakes, and then when it comes to a small
downhill section it will speed up again under the influence of
gravity, but it can be slowed by applying the brakes again, and
that process of speeding up and slowing down can be sustained
for 100 miles, and is equivalent to the way people go about their
lives, and rest or sleep when necessary to maintain a healthy
sense of well being throughout 100 years of life.
However, when a train begins to descend a steep mountain track
it may initially speed up and then be slowed by applying the
brakes, time and time again, until the brakes begin to weaken,
or the steepness of the mountain increases, or the slipperiness
of the track worsens, in which case the brakes won't work effectively
so that the train never actually quite returns to its standard
speed. As the steepness increases and the brakes become less
effective, the train continues to accelerate even if the brakes
are constantly and fully applied. The train won't be able to
stop until it reaches the bottom of the mountain and then travels
a very long distance across the flat plain below.
That is what the chronic fatigue syndrome is like. As long
as a moderate lifestyle is maintained there does not seem to
be a problem, but if fatigue occurs, and if nothing is done about
it in the early stages, it will reach a degree of severity where
normal amounts of rest or sleep will not quite restore normal
energy levels. In such cases the fatigue will subtly, and almost
unnoticeably get worse until it is uncontrollable, and then months
or years of rest may be required. Furthermore, it may not be
possible to achieve full recovery, and with the basic problem
remaining, the fatigue is likely to recur for various reasons
at various intervals of time and require long term rest to recover
from.
Telling a person that "we all get fatigued" and
"all you need is rest" is not going to be effective,
any more than a manager from the station emergency department
is going to help the driver of a runaway train which is cascading
uncontrollably down a mountain by saying to the driver "have
you thought of using the brakes". M.B.
Chronic Accruing
and Recurring Fatigue Syndrome (CARFS)
The Chronic Accruing and Recurring Fatigue Syndrome
(CARFS) is a type of "chronic fatigue syndrome" in
which the patient appears to be healthy but where regular activity
which is sustained for weeks or months may result in an insidious
accrual of fatigue until it becomes profound and extreme and
impels the person to take complete rest and several months to
recover, and where, upon the resumption of regular activity the
process repeats itself.
This may be due to a weakness in the main abdominal
vein called the vena cava so that systemic blood flow becomes
insufficient and disturbed and causes apparant compensatory responses
of the cardiovascular, neurological, energy, or exercise functions
that appear to be regulatory disorders and it prduces subtle
and accruing systemic overreactions.
The accruing fatigue possibly results from the
weakness of the vein or from systemic overreactions and have
formerly been misdiagnosed or misrepresented as a series of nervous
or mental breakdowns).
Defined 21-5-03 and redefined 1-8-05
Other former titles
for the condition which provide clues to its nature
Vasoregulatory asthenia
Neurocirculatory asthenia
Haemodynamic beta adrenergic circulatory
state
Periodic asthenia
Effort syndrome
Neurasthenia
Neurasthenia gravis
The Chronic Fatigue
Syndrome: New definition 19-11-04
"Effort Intolerance" is so commonly encountered in cases of the Chronic Fatigue Syndrome
that it should be classified as the hallmark symptom of a specific condition
which has formerly called The
Effort Syndrome, and any condition which does not
include that feature should be recognised as being different.
Such other forms of chronic fatigue may involve only tiredness
and should be referred to as sleep disorders, or where the tiredness
is due to a sense of sadness then the problem would be referred
to as depression.
There are many people with "Effort Intolerance"
who are not always tired, and are rarely or never depressed,
so unless the condition is defined separately there will always
be confusion in understanding or defining the problem.
Within the category of "Effort Intolerance" there
are nevertheless other fatigue related symptoms which may overlap
the symptoms of sleep disorders and depression, and there are
a collection of other symptoms which accompany the condition
which is why it produces confusion in diagnosis and why it is
called a "Syndrome" (the word syndrome is derived from the Greek origins "syn"
which means "with" and "dramein" which means
"to run", where symptoms often run together or characteristically
occur as a collection in the one ailment).
Symptoms related to fatigue include "Effort Intolerance" where mild levels of exertion
are possible but high levels are not, i.e. the ability to walk
at a casual pace for many miles, and to do mild exercise regularly
and often where only moderate improvements in fitness are possible,
and the capacity for normal levels of fitness or to engage in
strenuous exertion is never achieved (also breathing symptoms,
faintness, and dizziness occur, but are more likely to be associated
with exertion). Other fatigue related symptoms include the tendency
for tiredness during the day, the tendency for fatigue to accrue
over a period of weeks or months of sustained normal activity,
and the tendency to develop over fatigue or exhaustion which
is not relieved in the normal way by short periods or rest, such
as hours, weeks, or months. This could be referred to as the Chronic Accruing and Recurring Fatigue Syndrome or
CARFS, and it is most likely that CARFS and Effort Intolerance
are seperate features of the same problem with the same cause.
Other symptoms in the syndrome include lower left and right sided chest pains, sometimes stabbing
or lancing in nature, cramping chest pains occurring on the extreme
left and right side of the chest, a form of breathlessness which
occurs periodically as a brief difficulty breathing in, as if
breathing inwards until a limit is reached so that a full breath
cannot be achieved, faintness (with or whithout actual fainting),
dizziness, upper-abdominal pain, aches in the back in the region
of the kidneys, neck ache and shoulder pain usually occurring
on one side, and lower back ache or pain. Many of those symptoms
are related to postural changes, such as postural hypotension
(orthostatic hypotension - postural low blood pressure) which
causes a sense of faintness and dizziness when moving from the
laying to the standing position. That type of faintness is often
associated with unstable blood pressure (called labile blood
pressure) where there are fluctuations between low and high blood
pressure, and these can be evident as a persons body is moved
up down or sideways on a tilt table where they sometimes report
experiencing very distressing symptoms of faintness or impending
collapse. .
People with the chronic fatigue syndrome are often but not
always characterised by a
particular physique which includes a thin build, a
stooped upper spine, forward arching of the lower spine, sideways
curvature of the spine, and, a long, narrow, or flat chest. M.B.
Effort Intolerance
in The Effort Syndrome;
A real physical
abnormality which has absolutely nothing to do with a fear of
exercise (posted 16-11-05)
Introduction
There has been much presumed and said about effort intolerance
in The Chronic Fatigue Syndrome being a consequence of a fear
of exercise, but this is because doctors have been writing such
stuff based on the absence of laboratory evidence, and their
reluctance to believe what they have been told by patients. To
really understand this problem, in the absence of scientific
proof, would involve doctors actually experiencing this problem
themselves, but when that happens their own colleagues have been
sceptical. In an attempt to redress this misunderstanding I will
give a contrasting account of symptoms related to extreme sport
in healthy people, and the symptoms occurring in CFS exertion
crises.
An example of my
experience with sport.
My father played sport everyday of the week, including
night cricket, snooker, darts, and lawn bowls, and he ultimately
died of a heart attack at age 61 while playing table tennis.
I had a similar enthusiasm for physical activities, and practiced
such sports with my father in the evenings. I was also involved
in school sports and athletics, before school, during recess,
and at lunchtimes, and immediately after school before going
home for tea. I also played a lot of sports outside of school,
on the weekends, and at boy scout meetings, and at a private
gymnastics club, and I attended swimming classes at the beach
during school holidays. I was a patrol leader in the scouts,
captain of a lacrosse team, and an instructor in the gymnastics
club.When I was about 19 years old The National Fitness Council
of Australia offered me a scholarship to study Group Work at
The S.A. Institute of Technology. I turned it down in favour
of another scholarship offered by the state government Department
of Community Welfare, and then turned that down in favour of
a third offer from the Commonwealth Government.
(The sport described below was called
lacrosse, and from memory was played with 10 players per side.
It is a bit like the game of hockey except that it is played
primarily by throwing the ball through the air with a lacrosse
stick which was about 4 foot long, with the first 3 feet being
the handle, and the upper section being a net with a triangular
frame about 10 inches across at the top. The objective was to
scoop up the ball from the ground, or catch it in the air, and
pass it from player to player until eventually throwing it past
a goaly into a large framed netted goal enclosure about 8 feet
high, 8 feet wide, and six feet deep. I often played lacrosse
on cold and rainy mornings in several inches of water and mud,
without wearing my spectacles, and without a helmet. The following account provides a description of one
incident in one game.)
When I was 15 years old I was a member of a lacrosse team.
When the original coach left, another coach took his place, but
was often too busy with other duties to attend training sessions
or matches, and after losing more than a dozen games in a row
one captain after another stopped attending. Ultimately, the
remaining members of the team held a meeting to select an on
field captain. I was late for the meeting and when I walked through
the door I was told that I had been elected unanimously because
I reliably attended games and was the oldest. Despite my protests
at not wanting the job, I was made captain anyway. We lost more
than another 10 games when we came to play the top team in the
high school league.
We rolled up with 6 players (mostly small) against the opposition
of 10 (mostly taller) which had several spare players accompanying
them, and, rather than abandoning the game, they gave us some
of their spare players as substitutes. I won most of the opening
plays against the state centreman by using a trick or two. Nevertheless,
it wasn't long before we were losing by about 20 goals to 1,
so I had a backman take my place in the centre with instructions
to swing the ball in my direction in the outfield. The other
members of the team were instructed to distract the opposition
when I got the ball because I was going to hog it in an attempt
to get a goal on my own, for the hell of it. The ball came in
my direction as planned, and after scraping it from the ground
I was being attacked by 2 opponents so I ran back toward their
goal, and as they were still following me, I ran behind the goal,
and then across the back of the field. I then ran forward and
made a full on charge at the captain, who was much larger than
I was, and although I was not going to ram him I did have him
bluffed. At the last moment, I dug my sprigs into the ground
and angled left, leaving the captain behind. I was then being
attacked from the front by two taller backmen, so I ran to the
outfield and along the boundary, with about 4 players positioning
themselves to stop me getting through to the goals. I then raised
my net and ran directly for the goals. When one of their backmen
came charging toward me I feigned a throw, and turned my back,
and swiveled my head and gave a facial expression as if I was
mystified about where the ball went. This temporarily had all
of the opposition looking in the direction of my throw, and at
that moment I ran straight for the goal again. It was then obvious
to those players that I still had the ball, so one of the backman
brought his heavy stick up and over my head and belted it down.
It bounced off the side of my head and grazed my ear, and rammed
into my shoulder. I then turned my back, and then angled my way
straight toward the goal, with only two backmen pursuing me.
I increased my pace, and left them just far enough behind to
be ineffective at stopping me, I then had only the goaly to deal
with. He was the biggest goaly in the league, and seemed to occupy
the entire frontage of the goal, so I raised my net to aim the
ball straight between his eyes, in a bluff aimed at getting him
out of my way. Of course I didn't want to put him in hospital,
so my next move was to pirouette and swing the ball backwards
with a scooping action under his feet. By that time the goaly
had thrown his stick into the air and had run away laughing.
I assumed that he thought that anyone who had ran through every
member of the best team in the league deserved a goal just for
the joke of it. In any event, the ball rolled slowly across the
unguarded line, making the score about 20 goals to 2. In the
meantime, I was still rotating in the pirouette with a lot of
momentum, and I stumbled forward for about 15 yards before losing
balance and falling to the ground. In the process of evading
all ten members of that team I probably ran, mostly flat out,
a distance of more than 200 yards. My heart was pounding, I was
gasping for breath, and I felt the taste of blood welling up
in my throat, but that wasn't an entirely unusual thing for me
to experience in sport. After about a minute I staggered to my
feet, and could hear a lot of raucous cheering and laughing,
and while still struggling to get enough energy to speak I yelled
out to my other team members, "OK fellas, we've got them
worried, now let's finish them off".It was probably only
two or three minutes before I had made my way back to the centre
to continue play. When the game ended about 20 minutes later
we had been massacred 49 goals to 3.
The point of this description is to give some insight into
the fact that I played a lot of sport, mostly for the fun of
it, and anyone who thinks or says that I am, or was afraid of
exercise, has lost the plot.
An example of my
experience with chronic fatigue and exercise.
About 10 years later I developed the chronic fatigue syndrome,
primarily related to sedentary work, for reasons which are outlined
in The Posture Theory, but eventually the problem also affected
me in sport. At the time I was involved in gymnastics, and for
the first time in my life, exertion was giving me problems. On
one occasion I demonstrated a round off back somersault, and
when my feet thudded to a stab landing, a thousand stars splayed
across my eyes, and I felt dizzy, and faint, as if I might collapse.
A few months later I was getting a pounding heart each time I
lifted my left foot, and then my right foot off the ground, and
I was confined to laying down a lot because of the effort of
walking. Some months later I joined a fitness programme where
my fitness level was medically and scientifically assessed. I
was found to have an aerobic capacity of zero, which was generally
attributed to a lack of exercise stemming from laziness. However,
I also had the skin fat profile of an athlete, which only develops
after years of exercise, such as occurs in gymnastics, where
the activities produce a lot of abdominal muscle with very little
fat between the muscle and skin). When I started the fitness
training I was always jogging last behind, overweight, less athletic
looking, and older men. After about 6 months of training 2 hours
per night, up to 4 times per week, I was occasionally playing
social games of volley ball. I wasn't able to run around vigorously
so I divided the floor into 6 squares, one square for each player
on my team, and I stayed strictly in my one sixth space, only
moving two or three paces whenever the ball came into that small
area. In one particular game I started serving when the score
was nil all, and when I finished it was 14 to nil. My last ball
went outside the opponents boundary, otherwise I would have won
the game without any other player needing to serve. It wasn't
until the other 5 players had been through the rotation, that
I had another opportunity to serve, and ultimately won the game
15 to 3. After that several players approached me to be on their
competition team, and weren't happy, and didn't believe me when
I said that I didn't have enough energy to play competitive sport.
Some time after that I became involved in a relay race as
part of the fitness training. I managed to walk fast enough to
imitate running for the normal relays, but then we were required
to squat down and place a 5 kg medicine ball between our legs
and kangaroo hop to the end of the hall, about 20 yards away,
and back again. Because of peer pressure I started, but after
only 10 yards my heart began to rock violently in my chest and
I collapsed to the ground and rolled about on all fours gasping
for breath in a state of severe hyperactivity. I couldn't stay
still because it made my symptoms worse, so when people crowded
around me to help, I told them to keep out of my way and let
me recover. I crawled and stopped, and crawled again around the
perimeter of the hall, until I had enough strength to lift myself
onto a chair, but after a few seconds of sitting still I felt
quite agitated so I fell to the floor again and crawled around
to ease my extreme restlessness. It took me at least 15 minutes
before I was well enough to explain the situation to the staff,
and then I made my way to my car and drove home. I was not able
to do any significant exercise for at least a week, but then
I knew that the right amount of exercise was the only way I was
ever going to recover, so I returned to training and proceeded
at a more prudent pace, having learned from the experience not
to exceed my very low limits. I kept training for another 2 months
when I threw a knee cartilage while playing another game of volleyball.
Conclusion
As any one who reads these accounts can clearly see, there
is a lot of difference between the physical response to exercise
in healthy people, and the response in people with The Chronic
fatigue syndrome. M.B.
Quotes from other authors
Caughey J.L. Jr. M.D.(April 1939) Cardiovascular Neuroses: A Review. Psychosomatic MedicineVol.1, No.2, p.311-324 . . . The typical patient with the 'effort syndrome' was "''never allowed' to take part in competitive sports" and has felt inferior physically to others of his own age". . . "They never learned to keep on when the going was hard" . . . during the exercise test . . . "the response is no more dependent on the amount of exertion as it is than on the emotional reaction he has, the fear that he has that the test will injure seriously his already weakened heart" (end of quote)
Paul Wood O.B.E. (1950) Diseases of the Heart and Circulation 2nd edition, Eyre & Spottiswood, London p.943 . . . From chapter XX111 about patients with the 'effort syndrome' . . . "They are timid children far too dependent on maternal protection. At school, kindly doctors and soft mothers protect them from the hazards of football, swimming, and the gymnasium. It is probable that predisposition to psychoneurosis is mainly hereditary, but early environmental factors, such as domestic strife, insecurity, suppression, and maternal coddling, play their part . . . Fear of football and fear of swimming are common in childhood, and may precipitate anxiety." (end of quote)
The second reference was by Paul Wood, and it had a major influence on attitudes toward the condition, changing the general view that it was an 'effort syndrome' to an 'anxiety disorder' that has prevailed until today.
To give you some indication of how misleading it is, I can say that you have just read my description of how I participated in sport when I was a teenager. I would play in the cold and the wet, and the rain, on an oval 3 inches deep in water and mud, without my spectacles, and without a helmet, for the fun of it. I also attended swimming classes for several years at the local beaches and was a good swimmer, and would go canoeing in the sea and rowing in rivers, and dive off jetties, and do summersaults down sand hills. I never had a fear of swimming or sport, and I was a gymnastics instructor for five years and a gymnastics leader for an additional five years, and I could easily summersault from springboards over 5 foot high vaulting horses, and I was often the first to arrive at the gym and the last to leave. I have had natural aptitude for some sports and none for others, and have been among the best and worst in teams in some games, and have had all of the cuts and bruises that occur in anyone who plays sport for more than 10 years.
2012
I found an article published on the website of the Hunter-Hopkins Center, P.A. by Charles Lapp, and Laura Black Called "Relapses and Flare: Dealing with relapses and flares" here
The Medical History of The Chronic
Fatigue Syndrome and Stomach Ulcers
1975
In 1975 I was the beneficiary of
the best of medicine, but I was becoming the victim of the worst
of medicine, so I began to study my own health problems, and
I also began to study the medical profession.
In 1975 Many researchers regarded chronic
stomach ulcers and chronic fatigue as psychosomatic disorders
for 'sound scientific reasons'.
They observed that the lining of
the stomach went pink when patients were subjected to stress,
and it was said to be scientifically impossible for bacteria
to cause ulcers because the stomach acid would destroy them.
They could not find any scientific
evidence of organic disease in patients with chronic fatigue,
and claimed that the patients were ill, only because they believed
they were ill.
1995
In 1995 two Australian doctors,
Robin Warren and Barry Marshall, were curing 95% of stomach ulcers
with a 1 week dose of antibiotics, and chronic fatigue was officially
recognised as a real medical condition by the Astralian Medical
Association.
1975-1995
Between 1975 and 1995 patients
were told to ignore their pain and fatigue and continue to work
despite their pain. (Go back to work and work hard or be sacked).
Many were forced to resign without compensation, superannuation
entitlements, or pensions, and lived in poverty on unemployment
benefits. Tens of thousands of them died from medically prescribed
overdoses of Valium or barbiturates, or became depressed, went
mad, or committed suicide.
2005
The Australian doctors who developed
the antibiotic treatment for stomach ulcers were given The Nobel
Prize For Medicine and said that there was a great deal of resistance
from other doctors who refused to believe that it was not a psychosomatic
disorder.
Some doctors still believe (or
pretend to believe) that chronic fatigue is just normal tiredness.
Their science is flawed or false or fake. (All talk and no cure).
The cost of disease to the national
economy is the real hidden reason for blaming patients for disease.
Nobody in authority considers the economic ruin of patients.
Consider this, the Nobel Prize
winning doctors said (jokingly) that it is difficult to study
stomach ulcers nowadays because they have become rare. Consider
the number of ulcer patients who have been cured, and no longer
complain of pain, and what changes that has brought to their
life. Consider what would happen if doctors developed a real
cure for the chronic fatigue syndrome.
M.B.
Posture, pregnancy, corsets, viruses, chemical exposure and
Postural & Mechanical Hypotension
As a cause of tiredness, sleep and exercise disorders, and other related symptoms.
Anyone who still disputes that CFS has a real physical basis has the onus of proof to scientifucally explain the symptoms described on this webpage in some other way.
8-2-2005
Removing The Confusion
>Before discussing this type of
chronic fatigue it is necessary to clear up some confusing aspects
of the subject, otherwise people who have other types of the
condition will be sceptical and argumentative at the outset and
will not even bother to examine the facts, and doctors who do
not understand the difference between normal tiredness and the
most severe types of chronic fatigue will continue to say to
their patients "What are you complaining for; we all get
tired sometimes".
There are
two types of normal fatigue
1.Tiredness (regarding sleep)
Tiredness which results from lack of sleep
2. Physical exhaustion (regarding exertion)
Physical exhaustion and breathlessness which results from
extreme exertion such as completing a marathon
There are
two types of chronic fatigue
1. Sleep Disorders
Tiredness which is unrelated to a lack of sleep and
can occur at any time of the day or night in a manner which is
abnormal, irregular, and, or excessive..
2. Exercise Disorders (Effort Syndromes)
Physical exhaustion, palpitations, breathlessness,
faintness, and dizziness which occurs in response to the slightest
exertion, or is out of proportion to the amount of exercise. e.g excessive symptoms occur in response to sudden efforts,
lifting, running, or climbing.
There are
two other confusing aspects to consider
1.The severity of
each problem varies from person to person so it can be difficult
to distinguish normal fatigue from chronic fatigue (although
in severe case this is obvious to a patient who has formerly
been healthy and athletic and can make the comparison)
2. Some people
with chronic fatigue have a only sleep problems (a sleep disorder)
and some have predominantly a difficulty with exercise (an exertion
disorder) but often there is a mixture and overlap of the
tiredness and the problem with physical exercise.
Two Opposite
Pyschological Possibilities; Is it Cause
or Response
1. Cause? It has been suggested that anxiety
makes the blood pressure rise and the heart beat faster, and
that the abnormal response to exertion is due to a fear of exercise.
It has also been suggested that depressed people get tired. For
these reasons anxiety, fear and depression have been proposed
as causes of CFS symptoms.
The failure to find evidence of cause has it diagnosed as
being "all in the mind" and the failure to measure
it's severity has it diagnosed as "trivial", or as
an abnormal and unwarrented concern about the sort of normal
fatigue which normal people would not complain about.
2. Response? It has been observed that patients
with CFS experience distressing cardiac symptoms during exertion
and refuse to participate in exercise programmes, or are very
reluctant to join in, and when they do most of them quit within
the first week. The patients who may have been former athletes
have to give up their sport. The patients also report that a
variety of symptoms including frequent tiredness during the day,
makes it difficult for them to stay awake and concentrate and
remember, so they have to restrict their employment and social
activities. Their doctors cannot diagnose the problem, measure
it, or cure it , and give the impression that they do not understand
it, so the patients become anxious and depressed about their
health and their future.
The cause of the chronic fatigue, as in some types of sleep
disorder, is sometimes found and the tiredness is cured, and
the patients return to their former lifestyle and cease being
depressed.
Psychological or
Physical
1. Cause: It has been
argued that anxiety, depression, and suicide are so common in
CFS that it must have a psychological cause. (Some doctors believe
that 100% of CFS patients are suffering from anxiety so they
call it Anxiety State, and others believe that 100% are depressed
so they call it a depressive condition. However the medical literature
refers to many CFS patients who are not suffering from anxiety
or depression).
2. Response: If consideration
was given to CFS as being a physical illness, then the the associated
data would make it a greater cause of anxiety, depression, and
suicide that any other 10 illnesses combined.
Three Outcomes
for chronic fatigue
1. Temporary Fatigue; Some people experience an infectious illness where they have
a cough for several weeks. They recover from the cough, but continue
to suffer from fatigue for 2 or 3 more weeks, and then they recover
from the fatigue and return to normal health without any treatment
being necessary.
2. Chronic Fatigue which responds to treatment; Some
people stay out late all night at night clubs or casinos, and
others are shift workers, which makes them tired all day, and
if they change their lifestyle the tiredness is relieved. Other
people have back pain or insomnia which keeps them awake at night
and makes them tired during the day, and if those problems can
be relieved and they get a good nights sleep, the problem is
solved.
Some people have chronic fatigue for many years until one
day a medical test reveals the cause, such as sleep apnea, which
can be treated by surgically removing a flap of skin at the top
of the throat which has been falling back and blocking the airways
when the person lays on their back to sleep at night. After the
surgery, the airways are clear and the person can breath properly
at night, so their sleep is not interrupted, and so they stop
being tired all day and return to normal health.
Some people appear to be afraid of the normal symptoms of
exercise, and if, and when they participate in exercise programmes,
they become accustomed to the symptoms and their fitness improves
and they return to normal health.
3. Chronic Fatigue which does not respond to treatment; Some people have chronic fatigue for many years, and despite
having many medical tests there is no evidence of the cause,
so there is no effective evidence based treatment.
Some people participate in exercise programmes to improve
their fitness, and while they may continue training and improve
their frequency and duration of activity, and while they gain
measurable improvements in their strength and aerobic capacity,
and some relief of symptoms, they do not return to normal levels
of fitness, and continue to have problems with exercise and fatigue.
There are many
different causes of Chronic Fatigue
(Some causes may
produce a common fault - damage to the vena cava? and, or postural
hypotension)
The Vena Cava Syndrome?
Poor posture
When a person with a stooped spine and
a flat chest leans toward a desk they can compress the air in
their chest to produce a pneumatic tournique which blocks blood
flow from the feet to the brain in a way that is similar to a
tournique on the arm which blocks blood flow to the hand and
makes it go numb. Blocking blood flow through the chest also
puts downward pressure on the blood in the main vein of the abdomen
and could stretch its wall and eventually make it weak so that
the person has a chronically impaired upward blood flow. Chronically
weak blood flow to the chambers of the heart would impair a persons
capacity for exercise, and also result in a chronically impaired
blood flow to the brain which gives the person chronic problems
with concentration, memory, faintness, and tiredness. This is
evident from various tests which show an apparent inability of
the body to regulate or maintain normal blood flow. A feature
of this problem is postural hypotension where a person feels
faint if they stand up too suddenly. The sudden and extra weight
of blood in the abdominal vein would make it stretch so that
it takes a few extra seconds for the blood to fill it before
reaching the heart, and hence the slight delay in blood reaching
the brain causes temporary faintness. The main abdominal vein
is the vena cava, but all of the veins below the midriff might
be involved. The chronic fatigue syndrome includes all of those
symptoms, so postural compression of the chest and stretching
of the vena cava, or all of the veins below the chest, may be
the cause of the condition.
Pregnancy
During pregnancy the enlarging womb gets
heavier and compresses the abdominal veins and many pregnant
women experience faintness and fatigue. This usually ceases after
giving birth and the womb returns to its normal size and weight,
but some women continue to suffer post natal fatigue which has
been called post natal depression
Tight
Corsets
Nineteenth century women wore tight waisted
whalebone corsets which compressed their abdominal veins and
they were known to faint in response to the heat, or exertion,
or slight frights. They relieved their faint by unlacing the
corset and laying flat which allowed blood to flow freely to
their brains.
Shock
waves / electrocution
Soldiers exposed to bombing attacks sometimes
develop shellshock because of shockwaves that pass through their
bodies. Sometimes the shockwave makes them temporarily or permanently
deaf or blind and sometimes it leaves them temporarily or permanently
exhaused. That is called battle fatigue which is another name
for chronic fatigue. The shockwaves can sometimes cause the human
abdomen to explode, and it may also have a violent effect on
the blood in the vena cava and weaken the walls of the vein.
Excessive physical exertion, marathons, world record
attempts etc
Some marathon runners, and athletes who
attempt world records develop chronic fatigue. This may be due
to the prolonged and excessive strain on the blood vessels, and
the vena cava.
Overwork
Excessive physical work and long hours
of work without rest can cause chronic fatigue. In the nineteenth
century some coal miners who were required to shovel a particular
tonnage of coal each day developed chronic fatigue so the British
government set up an organisation called The Industrial Fatigue
Board. The excessive strain could damage the vena cava in the
same way as world record attempts (overstraining the human body
makes it permanently weaker, or too much fatigue for too long
causes chronic fatigue)
There are examples of factories or villages
where a severe viral infection spread through most of the individuals.
They recovered from the flu symptoms in a few weeks, but some
of them continued to suffer from fatigue for many years after.
That is an example of post-viral fatigue. Perhaps some viruses
can damage the walls of the vena cava.
Chemical
exposure
Some poisons, or pesticides may be able
to damage the vena cava which may explain why some people report
suffering from chronic fatigue which can be traced back to exposure
to toxic chemicals such as pesticides, or those associated with
factory chemical spills, or the toxic gases of war (mustard gas in WW1, Agent Orange in the Vietnam War, and toxic oil fumes etc in the Gulf War. Glue sniffing
can cause fatigue, and medically prescribed drugs such as barbiturates
can cause or aggravate postural hypotension.
The Severity of
Postural Hypotension and Chronic Fatigue
Many people experience postural hypotension
temporarily and make a full recovery. For example, some teenagers
grow rapidly and their lower spine sways forward as they become
thinner and taller. They generally develop postural hypotension,
probably because the sway back presses on the abdominal veins,
or because the rapid growth of the spine stretches those veins
and impairs the flow of blood to the heart. This gives them a
tendency to feel faint when they rise from the laying to the
standing position, particularly when they get out of bed each
morning. However as they reach adulthood their body fills out
and the feature of postural hypotension ceases to be a problem.
Pregnant women also tend to develop postural hypotension because
the weight of the enlarging womb drags their spine forward, and
also because it sits heavily on the lower abdominal veins. The
tendency to faint varies throughout pregnancy depending on the
weight and position of the womb, and although the symptom usually
ceases after giving birth, sometimes the symptom persists in
a chronic way.
There are various suggestions about the
cause of postural hypotension including the ideas that it is
due to hormonal factors, or a disorder of the nervous system,
and it is a chicken or the egg matter. i.e. Do the hormones or
the nervous system abnormalities cause the weakness in blood
flow, or does the weakness in blood flow put the hormonal or
nervous systems into compensatory action.
Nevertheless there is evidence that mechanical
factors cause impairment to blood flow, and it is likely that
the persistent or repetitive pooling of excessive amounts of
blood in the abdominal veins stretches and damages them. That
would increase their capacity permanently and result in a chronic
tendency to postural hypotension where the responses of the hormonal
and nervous systems would be secondary.
Impairment of blood flow to the heart would
produce firstly, problems during vigourous exertion (effort intolerance
- where the person refuses to exert themselves suddenly or viguourously
because it brings on abnormal and distressing symptoms of rapid
palpitations, faintness, and dizziness), and secondly, problems
with weakness in blood flow to the brain resulting in abnormal
tiredness. Postural hypotension, effort intolerance, and chronic
abnormal tiredness are features of The Chronic Fatigue Syndrome,
but not all people with CFS have evidence of postural hypotension,
so the idea that the hypotension is the cause has been the subject
of debate.
Nevertheless there are differences in the
severity of CFS between individuals, and in the life history
of patients. Sometimes CFS appears to be genetic, and other times
it appears to have a very gradual and insidious origin, but typically
the first bout of fatigue can be traced back to an incident,
such as pregnancy, a viral illness, or chemical exposure. In
such cases the original experience reached a peak of fatigue
which impelled the person to take rest for months or years, during
which time they gradually recovered but remained permanently
impaired to a lesser degree. There are also typical examples
where there were years of minor fatigue, interspersed with brief
periods of more severe fatigue. It is therefore likely that the
postural hypotension is a chronic latent feature which is only
evident during severe cases or with the relapses.
In severe cases of CFS the symptoms tend
to be worse and more numerous and varied. One of the prominent
symptoms is postural hypotension and the obvious indication of
weakness in blood flow is the tendency to feel faint when moving
from the laying to standing position, especially when getting
out of bed in the morning when patients report the they have
to stand up very slowly to avoid feeling faint. Other less common
observations are the sense of faintness which patients report
when they lean toward a desk to write, or when they lean toward
the washing machine to drag clothes out, or when they lean toward
an ironing board to iron clothes, or when they lean toward the
kitchen sink to wash dishes. They may also feel faint and dizzy
if they squat down and lean forward to clean low windows, or
when they apply the brakes suddenly while driving a car and their
body is thrown forward, or when they are a passenger in a car
which speeds around a curve in a country road and throws their
body sideways, or when they are sitting in the chair of a rotating
amusement ride at a carnival. Many patients report feeling an
extremely distressing form of faintness when their body is being
moved up and down and sideways at all angles on a tilt table
while having some types of x-ray. All of those factors have a
mechanical effect on the body, and the response is often immediate,
so the condition is clearly mechanical hypotension.
If the veins below the midriff, or all
veins leading to the heart, i.e. all of the venous system was
stretched and had greater capacity, then there would be a tendency
for blood to pool excessively in response to any obstruction
to blood flow. Therefore if a person stood up suddenly the blood
would pool below the waist in response to gravity increasing
the weight of the blood, and it would tend to pool below the
midriff if the person leaned forward and compressed the air in
their chest, and it would pool in the legs if a woman was pregnant
and the heavy womb was compressing the abdominal veins behind
or the pelvic veins below, and it would pool in the extreme outer
parts of the venous system if the body was subjected to any type
of centrifugal force.
Therefore there is evidence that mechanical
factors can cause damage to the walls of the veins to produce
postural hypotension which is in turn responsible for the symptoms
of chronic fatigue (effort intolerance and tiredness), However,
those veins would have some resilience, and therefore some ability
to recover, which would explain variations in the severity of
the condition at its onset, and variations in the severity between
individuals, and variations in the recovery times, and it would
also explain the chronic nature of some cases, and the fluctuations
in the course of the condition in others.
Putting the Mechanical
Hypotension Theory for CFS to the Test
(for those who
wish to confirm or dispute it)
Posted 5-8-05
Any medical research group or patient organisation
could easily test this theory and determine the presence or not
of proof of a physical basis for CFS by using the following methodology.
1. Gathering 200 patients who report the
symptoms of CFS
2. Testing the aerobic capacity of those
patients using ergometric cycles and cardiographs
3. Selecting the 100 patients with the
lowest aerobic capacity
4. Attaching blood pressure monitoring
equipment and cardiograph leads to the patients.
5. Measuring the resulting data while the
patient is being tilted up and down at various angles and rotated
at various speeds on a tilt table.
6. Documenting the results for public review.
Proof is in establishing
that an experiment
1. can be replicated
2. That the results
are predictable
3. That the results
are consistent
4. That the experiment
is performed independently by several investigators
5. That the results
are different from those of a control group (of healthy patients)
Some Notes on the
Matter of Proof
1. When some people refer to the chronic fatigue syndrome
as trivial they are not basing their statement on a scientific
measurement but are merely giving an opinion (a reckless and
irresponsible guess)
2. When people say that the condition has a psychological
cause they are not suggesting that every patient with CFS is
anxious or depressed because that is simply not true. They are
basing the idea on the absence of absolute proof of physical
cause and typically arguing "if it is not evident on physical
tests it must be psychological, otherwise there is no other explanation".
Of course they are not looking very hard for other explanations
or they would have found countless possibilities.
3. The suggestions on this web page can be tested by anyone
who wishes to do so and some matters are worth considering in
relation to postural hypotension (a type of faintness which is
brought about by standing up too suddenly or by other similar
acts which are entirely physical and mechanical).
(a) If pregnant women feel faint because of a fear of pregnancy
and childbirth then why do they only feel faint at particular
periods of the pregnancy, and if it is not due to the weight
of the womb pressing on abdominal veins then why is it aggravated
when they lay on their back and relieved when they lay on their
side.
(b) Why so some women during and after pregnancy, feel faint
and giddy and get exhausted when they lean toward a sink, or
an ironing board, and why does their heart pound when they lay
on their back at night when they go to bed.
(c) If nineteenth century women felt faint because of multiple
fears then why did their symptoms ease when they loosened the
laces of their corsets and layed down on a chaise lounge.
(d) If patients are afraid of having their x-ray taken on
a tilt table then whey aren't they afraid of having a plain chest
x-ray while standing, and if they are afraid of tilt tables then
why do they only feel faint when the tilt table is moving, and
why does the faintness vary in intensity with the angle of the
table, and the speed of the movement, and why do they stop feeling
faint when the tilt table stops moving.
(e) If patients feel faint during some postural movements
then why do they feel faint when slumping and leaning forwards
and not when leaning backwards
(f) If the faintness is not due to mechanical factors and,
or, weakness in the walls of veins, then what is the cause.
4. If the patients are afraid of exercise, why aren't they
afraid to walk, and if they can move at a measured or gradual
pace why do they have problems with sprinting, and if they can
walk on flat land or up slight hills slowly, why can't they walk
up steep slopes, and why is it that some of them were former
athletes who never had any problems with any type of exertion,
and why do some of them voluntarily participate in experimental
exercise programmes and attempt to cure their health problems
by improving their fitness.
5. Why do their hearts pump less blood during and after exercise
compared with healthy people (do their veins stretch excessively
in response to exercise and reduce the volume of blood returning
to the heart chambers, and does that make the heart beat faster
and more powerfully than normal in order to draw the same amount
of blood up to its chambers each minute during vigorous exertion?).
6. Why do CFS patients have a measurably low earobic capacity
and why does it remain low despite participating in exercise
programmes.
7. If the cause of CFS is not physical then why do patients
have abnormal breathing patterns during exertion (breathing becomes
shallower, oxygen consumption is lower, and blood lactate concentration
is higher), and why do they experience an elevated pulse rate
for a prolonged period after exertio.
8. Why do they have poor breath holding capacity and an intolerance
for CO2 and to wearing gas masks.
9. Why do they complain of aerobic distress when a cardiograph
belt is strapped tightly to their chest but not when it is loosely
strapped
10. If the symptoms above are not more likely to affect people
with thin and stooped physiques who have long, narrow and flat
chests then why was a life sized portrait of such a person painted
by Ian Tillard and put on permanent display in the museum of
the Post-Graduate Medical School of London (with reference to
the Effort Syndrome). A photo of this portrait can be seen on
page 941 of the book entitled Diseases of the Heart and Circulation
by Paul Wood, published by Eyre & Spottiswoode in London
1956.
11.If the problem only effects timid softly spoken patients
who are anxious, afraid of exercise, and depressed, then how
can it be explained that some of the patients have formerly been
confident athletes, and show no signs of anxiety or depression,
and may be confident public speakers, while others show anger
and hostility toward their own doctors (as reported in the medical
literature).
Scientific proof of the tilt table method
Regarding my suggestions that tilt table test could be used as a means of testing for CFS, one of the main symptoms is faintness when standing up suddenly, which is also called orthostatic intolerance. The tilt table test is now being used as a method of testing for orthostaitic intolerance, so the method has been scientifically confirmed as correct. See here http://www.dizziness-and-balance.com/testing/tilttabletest.html
I was also referring to postural Valsalva's maneuvre as a cause, and the laboratory use as a diagnosis which is now verified in the same website article.
Note that all of the references are recent from 1999 to 2009, compared to my suggestions of the relevance of tilt tables and symptoms from the 1970's.This is one of the modern references; Kurbaan, A. S., A. C. Franzen, et al. (1999). "Usefulness of tilt test-induced patterns of heart rate and blood pressure using a two-stage protocol with glyceryl trinitrate provocation in patients with syncope of unknown origin." Am J Cardiol 84(6): 665-70.
When making a decision about the nature of an ailment it is
not just a matter of accepting the only explanation available
but of considering various possibilities and deciding the best
for now.
In that regard the ideas of a psychological cause are based
on a medical theory rather than objective fact
For example when consulting a doctor the patient may be told
that there is no evidence of disease on an x-ray so the condition
cannot be phyically based and must therefore be due to anxiety,
and then, when the patient says that they are not anxious the
doctor may believe that he is lying, or faking, or is suffering
from sub-conscious anxiety, or does not know their own mind,
or is out of touch with reality or is denying the presence of
a psychological cause because of some presumed shame which the
patient feels in relation to admitting to having a mental rather
than a physical illness. All of those ideas seem plausible but
are simply not valid for the following good reasons.
1. Many patients say that their symptoms could not be caused
by anxiety simply because they are not anxious and the symptoms
often exist in the complete absence of anxiety, and when other
people suggest the presence of sub-conscious anxiety they are
regarded as being disrespectful and annoying. Nobody likes being
accused of being a liar or of not knowing their own mind and
hostility toward such suggestions is perfectly normal
2. The reason patients say that their symptoms must have a
physical basis is because they occur in response to physical,
rather than emotional events. For example the symptoms are made
worse by physical exertion, and higher levels of exertion are
almost exclusively likely to bring on symptoms which are not
evident at rest, or with mild exertion. Secondly the symptoms
such as fainting are brought on by physical, not mental activities
such as leaning or stooping or squatting, and by participating
in activities which involve centrifugal forces, such as riding
on swirling carnival wheels. Patients are not going to believe
that those symptoms have a psychological cause no matter how
many slick arguments are presented to convince them, simply because
nobody is that gullible.
When deciding whether the symptoms of CFS are real or not,
or physical or not, it is necessary to consider all the facts,
not just opinions.
I would not be so arrogant as to expect anyone to believe
what I said about this condition simply on the basis of my opinion,
and no-one else should expect the public to be that mindless
and gullible. It is a matter of making a decision on the basis
of the facts, and that can only be done when all possibilities
are explored, not just one.
The Myths of Chronic
Fatigue
There are many false beliefs about the nature of CFS
that continue to be mentioned in medicine and the media despite
the fact that they are ridiculous and have been discredited many
times over the past century.
1. That people with chronic fatigue are complaining about
the sort of normal fatigue which an ordinary person would not
be bothered by.
2. That chronic fatigue is a brand new condition of modern
times
3. That the chronic fatigue syndrome is a rare condition
4. That people with CFS refuse to participate in exercise
programmes because they are afraid of exercise, and that they
could cure their condition if only they could overcome their
fear of exercise and improve their fitness.
4a. That people with CFS are tired because of a lack of exercise
and poor physical fitness.
4b. That if they simply forced themselves to ignore the symptoms
they could exercise like everyone else
5. That people with CFS did not play sport as children or
teenagers and are afraid of competitive sport.
6. That people with CFS are afraid of heart disease, and don't
know the difference between CFS and heart disease
7. That people with CFS are anxious or depressed about something
obvious or subconscious.
8. That thinking positive and ignoring fatigue will enable
the person to continue with the same normal lifestyle as anyone
else.
9. That people with CFS are abnormally introspective and pay
too much notice to the bodies normal function and misinterpret
the normal beating of the pulse and normal functions of breathing
and digestion as abnormal, and that they don't know enough about
medicine to recognise the difference between normal and abnormal
body processes.
Learning From History
Comparing 19th
century Antwerp Fever with 20th century Chronic Fatigue Syndrome
In the nineteenth century the diagnosis of Fever was
given to anyone who had an elevated body temperature, and as
the thermometer had not been invented then, the diagnosis was
made when the physician placed his hand on the patients forehead
and noticed that it was abnormally hot. Infectious illnesses
raise body temperature, but in those days there were no microscopes
so doctors could not see the microbes responsible, or tell one
infection from another, . Therefore, for example, any and every
illness which caused a rise in body temperature in the city of
Antwerp came to be diagnosed as Antwerp Fever, and some
medical historians have estimated that they included typhoid,
typhus, malaria, pneumonia, and tuberculosis, Those illnesses
often presented themselves to doctors without any obvious identifying
signs of spots or rashes etc. Furthermore there were no treatments
available because antibiotics had not been invented so the infections
of the liver, stomach, kidneys, or lungs often spread to the
brain causing meningitis or encephalitis. The inflammation of
the brain caused delirium which involved nightmares and sometimes
bizarre or violent behavior. For this reason it was common to
diagnose on the basis of survival. If the patient died they were
diagnosed as having the fever, and if they lived they were told
that they must have been complaining of something trivial, or
that it was caused by their mind, or evil spirits. Furthermore
many plagues occurred in the nineteenth century and if patients
contracted several of them over a period of years, and survived
the illnesses which ended in delirium, they were diagnosed as
having a life history of mental illness.
Many doctors of that time in history did not accept
the germ theories even when they were first proposed because
they couldn't believe that something so small could kill humans,
and they were not going to believe it until they could see for
themselves, only after microscopes came into common use. In the
meantime they would visit one patient after another without washing
their hands or instruments, and would go coughing and sneezing,
and spreading the plagues that they were trying to cure.
Since then the inventions such as thermometers can
measure the severity of body temperature accurately, and microscopes
can reveal microbes and identify the types, and immunisation
techniques can prevent the ailments, and antibiotics can cure
the problem before it spreads to the brain to cause bizarre delirium
or death, and such patients do not have their sanity questioned.
However, in the 20th and the current 21st centuries
there are many people who persistently complain of a different
group of problems which feature fatigue, but there is still no
established way of measuring it's severity, or of identifying
the different causes, or of reliably treating it. The problem
is referred to vaguely with the same words The Chronic Fatigue
Syndrome. Despite this, quite often patients can't get a
diagnosis, because doctors don't accept the existance of the
condition, and even then, the patients can't get an explanation,
a diagnosis, or a cure, so many of them worry or get depressed
by their predicament which is often diagnosed as psychosomatic,
and when recurring bouts of fatigue occur throughout the persons
life they are generally described as having a medical history
of mental breakdowns.
The purpose of this web page is to identify different
types of fatigue, and different causes, and possible common causes,
and various effective treatments for some of the symptoms, and
to suggest ways in which the condition may be further investigated
so that in 10 years or 100 years from now the ailments will be
clearly understood and diagnosed and treated, and will cease
to be a problem, in much the same way as highly contagious plagues
or Fevers are now less of a problem for patients, doctors and
society.
In the meantime:
People who don't learn from history repeat the mistakes
of history.
Exercise Training in The Chronic Fatigue Syndrome
Exercise Training in The Chronic Fatigue Syndrome - A Biography
I played a lot of sport as a teenager, sometimes on cold and rainy mornings on ovals that were 3 inches deep in mud and water, and I ran in hurdle events and the mile, and up and down hills and valleys in cross country races. I was also involved in a private gymnastics club where, on a typical night I would arrive at 7 p.m. and assist with moving heavy wooden springboards and vaulting horses from their storage shed into the hall. The next 4 hours would involve warm up sessions, which sometimes included tossing a 5 kg medicine ball back and forth 50 times, followed by training sessions which included 50 or more somersaults off the floor, or off springboards, or teeterboards, or over the 4 and 5 foot vaulting horses, and the evening would end with team relays, or a game of indoor soccer or volley ball, after which the equipment would be carried back to the shed, finishing at 11 p.m. On summer weekends we would often go down to the beach and somersault down sand hills and go swimming, and diving or somersaulting off jetties.
In my late teens I obtained 3 scholarships to study Group Work at The Institute of Technology. The first was from The National Fitness Council, the second was from the State Government Department of Community Welfare, and the third, which I accepted, was from the Commonwealth Government. I completed the course of subjects which included individual, group, and social psychology, and politics, and I had interests in leadership methods, creativity, and conformity.
Later, in my role as leader of the gymnastics club, I would typically stand in front and demonstrate 20 push ups, 30 toe touches, and 40 side stretches etc, for the class to follow. However, there were occasions when parents would advise me that their child had a health problem such as asthma, which could benefit from exercise, but they would show concern that too much strain could be a problem for them. I dealt with this by advising the child to do the same exercises, but not to worry about trying to keep up the same pace. I also instructed the group not to criticise him, as that would prompt him to try too hard for his own good and would discourage him from continuing.
When I was about 22 I had a very large steak and vegetable meal for tea, and 10 minutes later walked into the gym and flipped into a hand spring, and felt something rip inside my belly. The incident seemed uneventful but about 2 months later I started getting an ache in my belly whenever I leaned toward my desk in my job as a clerk. This ache gradually became worse and was eventually accompanied by various other problems such a faintness, breathlessness, or dizziness whenever I leaned toward the desk, and eventually I also started to get distressing symptoms of faintness and dizziness when doing just one somersault in the gym.
My doctor was unable to explain these symptoms and they were getting progressively worse so I resigned from the gymnastics club, and soon after that I resigned from work and began reading a medical dictionary at the rate of one or two words a day until I found that my symptoms were consistent with Da Costa's Syndrome.
As my health had deteriorated gradually over a period of about 3 years, I decided to participate in a fitness programme with the view to gradually improving my fitness and recovering full health in a year or two. I therefore enrolled in a course at The South Australian Institute For Fitness Research and Training.
My initial fitness was measured and found to be zero, as compared to a friend of mine who had an average fitness of 900, and an athlete level of 1200. Part of the programme involved jogging, and typically I could only jog slowly for about 20 yards before struggling for breath and having to rest. For example in a group of 50 people I would be running last around an oval, and for a while I had a companion. He was 40 years old, overweight and asthmatic and I told him not to worry about leaving me at the back alone, and that he should run ahead and catch up with the group which he did. As the group outleaped me two 50 year old men ran together and one said, in a voice loud enough for me to hear, "we have an excuse for being unfit because we are 50 and have spent years smoking; we are not like the youth of today (meaning me) who are unfit because of laziness".
After 3 months training my fitness level rose to 350 so I increased the number of days I trained to 4 per week. On one occasion the instructor ran some relay races and I ran as fast as I could, but was not much help to the team, and then we were required to squat down and place a 5 kg medicine ball between our knees and frog hop to the end of the hall and back. After 10 yards my heart began to beat violently and I fell to the floor and crawled around on all fours feeling faint and dizzy and on the verge of collapse for about 10 minutes. It took me a week to recover from that 10 yard run. On another occasion we left the hall and ran through the streets for a change. After about 300 yards all the other runners were so far ahead that they had gone around street corners and were out of sight so I ran alone for about 20 minutes until returning to the hall 10 minutes behind everyone else. After 6 months my fitness was measured again but it was still 350 despite improvements in my speed, strength, and endurance on the ergometric cycle. (fitness level was measured by graphing pulse rate over load). During the ninth month I was training 6 nights per week but I threw knee cartilage and had to stop.
About 4 years later I wrote The Posture Theory about a postural cause of various symptoms which included fatigue. The fatigue was due to postural pressure on the air in the chest which blocked blood flow and stretched the veins below, similar to the way in which a garter blocks blood flow in the leg and causes varicose veins below the garter line. However unlike varicose veins which show up on the legs, the enlargement of the main veins in the abdomen, or the whole system may not be visibly evident, but something was impairing the normal blood flow through the body and that was my estimate of the causes of exercise problems and fatigue.
Shortly after that I discussed my ideas with the head of the Fitness Institute and he suggested that I run a research programme to study the problem in more detail. I was aware from the medical literature that the general view was that these patients could not or would no train and that their reluctance to participate in exercise programmes was generally attributed to a fear of exercise. Other researchers were treating the patients as if they were physically sound and expecting them to train in normal programmes with healthy people. However, I knew that the pressure to conform would make the fatigued patients run faster than their limits and cause problems, so it did not surprise me that all of them refused to run, or dropped out of the courses before results could be achieved.
Therefore in order for a programme to succeed and provide improvements in health and meaningful data it would need to be designed so that fatigued patients were in a group of their own under instructions to walk or run at their own pace within their own limits, and not to be concerned about how fast others were going.
The first 3 month course involved about 20 people with 6 remaining at the end. By the end of the third course about 80 people had been medically assessed and more than 12 were still training with some continuing for the entire 9 months, and one person participated in a 6 mile marathon. The fitness levels at the outset had examples at the level of 100 and 300, but there were also some at 700 or 1100 and that data confused me until some years later when I suddenly realised that there were different types of chronic fatigue syndrome (for example the low measurements would relate to exercise disorders, and the high measurements to sleep disorders)
Unfortunately the writing of the data involved desk work which was aggravating my abdominal pain so when I was asked to increase the programme to include 200 participants I stopped.
My health returned to tolerable levels after about 10 years but I never fully recovered.
For example, every summer I would go to the beach and run about 10 paces along the sand and then hop step into a hand spring, and when I landed abruptly with my back arched and my arms outstretched I felt a rip followed by a caustic ache in my belly. I did that once every summer for at least 5 years, always with the same response and have never had a medical explanation for it. Similarly, one day I was digging in the garden and the spade struck a rock under the dirt. The sudden jolt caused a pain in my midriff which persisted for 3 months and was accompanied by severe constipation for that time. Also whenever doctors prodded my belly with their finger during medical investigations I have always felt pain when that same spot is struck, and on some occasions it has persisted for a week after.
In those early years I decided to build a carport and pergola around my house. I would start digging with a post hole digger at 9.a.m. After 10 minutes the hole would be 1 foot deep but I would be breathless and dizzy and have to stop and rest for half an hour. At 11 a.m. I would start again and 10 minutes later when the hole was 18 inches deep I would have to stop and rest again. By mid afternoon through several diggiing sessions I was able to complete 1 and a half holes 3 feet deep. At 4 p.m. my neighbour would return from his full days work and dig 3 or 4 holes in an hour without having to stop and rest.
Also there were times when I would go to town by bus, and sometimes I would be late so I would have to walk fast or jog to get to the bus stop on time. On one occasion I had to walk briskly, and was at my limit when I saw the bus passing across the end of the street. I then walked faster until I got around the corner and could see the last passenger getting on, so I ran, and my heart began to pound violently so I had to stop. I watched the bus driver looking at me as if I was too lazy to run and then he drove off in disgust and I had to wait in the cold and rain for the next bus.
I kept feeling generally healthier as time passed so from time to time I would try to run and could go quite fast for short periods of time but there was always a problem with symptoms if I didn't keep within reasonable limits. However sometimes I got caught in situations where I was motivated to ignore those limits. For example I often go walking, sometimes up and down hills, but on one occasion I was asked to join some bush walkers. It was difficult enough to keep up the pace in the early stages but then the leader turned left up a steep hill. I puffed and panted to get to the first tree about 10 yards up and after reaching the second tree little old ladies and old men with walking sticks started to stream past me. By the time I got to the top of the hill every one else was relaxing and chatting and eating their sandwiches or having a cup of tea, and I was trying to hide my breathlessness and look as if If had gone slow because of loose shoelaces.
A few years later I was able to walk quite briskly up several flights of stairs so I would do so as a form of regular exercise, instead of getting the lift.
Some time after that I was walking up and down hills for exercise when I met a friend who asked me to follow him down a track to see some native flowers. When we got to the bottom there was only one way out - up - and it was steep. He kept his normal pace on the way up but after about 10 yards I was puffing and panting and my heart was pounding so I had to grab hold of a tree trunk for support. My friend looked at me from 50 yards ahead and his dog came bounding down and licked me in the face as if in a reassuring manner and then went bounding up again. The dog would disappear and come bounding back several times before I reached the top gasping for breath.
In summary, the condition that I have been discussing is nowadays called The Chronic Fatigue Syndrome. I believe that the term was first used overseas in 1975, but I cannot recall when it came into general use in Australia, or when I first became aware of it. However I have been able to establish that it is measurable, that its severity varies from person to person, that it involves an exercise disorder and, or a sleep disorder, and that the condition generally responds favorably to appropriately designed exercise programmes and may even be cured. However in other cases, despite participating in exercise programmes which would make an average person extremely fit, and despite improvements in the general feeling of well being, there will remain a persistent limitation until the exact anatomical cause can be confirmed and cured. M.A.Banfield
See the
Banfield Principles for Exercise Training, and symptom management
in a type of Chronic Fatigue Syndrome called the Effort Syndrome here
About My Personality
When I attempted to learn about the cause of the health problems
of Robert Louis Stevenson I found that some biographers described
him as an heroic adventurer who sailed the high and stormy seas
and toured the world despite suffering from the plagues of tuberculosis,
pneumonia, typhoid, and malaria which killed millions of his
contemporaries. Other biographers described him as a whinging,
sympathy seeking hypochondriac who was troubled by deep seated
psychological problems and emotional insecurities that dated
back to his early childhood.
That is an example of how a personality is determined by the
individual but an interpretation is determined by others.
I have no particular interest in talking about my own personality
other than to say that it compares favourably according to my
observations of the world. The comments are made on this webpage
because it is popularly believed that all people with chronic
fatigue have anxious and troubled minds where anxiety is the
cause of their symptoms, and that their reluctance to exercise
is due to a fear of exercise, and that they complain excessively
about trivial illness in an attempt to get sympathy, and that
they would not know how to cope with a serious illness if they
had one, and I do not believe that to be true.
I have survived more than 100 illnesses and injuries. For
example 10 years ago I had bladder surgery and complications
included several bouts of bladder blockage which was more painful
than the pain of kidney stones, and that was followed by the
cystitis of urinary infections. A specialist told me that blood
tests and a CAT scan revealed that my body was riddled with incurable
cancer and that I would probably be dead in 2 months. I walked
about with post operative bladder ache for 8 months. About a
year later I had further bladder surgery during a hospital staff
strike. I underwent surgery while suffering from untreated high
blood pressure and came out diagnosed by ultrasound as having
a strained and enlarged heart and incurable high blood pressure
and was advised to avoid strenuous exercise and take anti hypertensive
drugs for the rest of my life. After learning about post-operative
procedures during the previous surgery I recovered from the second
bladder operation in a month. Since then I have had several other
major problems including angina symptoms which I treated with
a disciplined vegetarian diet rather than having bypass surgery.
The symptoms subsided gradually over a 6 month period but I did
not recover fully until another 18 months had passed. I also
tried to cure the cancer with a 6 week fruit juice only diet.
After 4 weeks I became exhausted so I ate some food but that
gave me food poisoning and I was unable to eat for another week
because of severe nausea and vomiting. Some time after that I
had surgery to remove a 5 cm cancerous tumour from my neck, and
the following day I walked for 2 kilometers. Shortly after that
I started CHOP chemotherapy where I lived like a hermit for 6
months to avoid contagious infections as my immune system was
depleted. 18 months later I had more surgery to remove a 10 cm
cancerous tumour which was partially blocking my left kidney.
That surgery left a 12 cm scar across the left side of my abdomen,
and 5 days later I walked at least 5 kilometers down the beach.
About a month later I started DHAP chemotherapy and that was
followed by a stem cell transplant. Three doctors tried to convince
me to use a self administering morphine machine to control pain
and advised me that 90% of patients did so for a fortnight. I
only had one morphine injection on the first day and declined
the offer of the machine. Some other patients had very little
nausea but the surgery and chemo left me ill and nauseas for
10 months, followed by another year of poor appetite. I then
contracted a coughing virus which lasted for 6 weeks during which
time I was bedridden for a month and my doctor advised me to
get an ambulance and go to hospital where I spent a week with
recurrent fevers and sweats, and was on tablets and a drip to
offset the effects of dehydration, and oxygen to help me breath.
The virus could not be detected or identified by blood tests.
By contrast I have met a 70 year old man who told me that
he never had a sick day in his life, and I know of at least two
people who have not had a days sickness of any significance in
20 years.
I am not afraid of spiders or snakes, and I am not afraid
of sharks but am sensible enough to avoid the ocean and swim
in pools and sometimes do so in those which are 20 feet deep.
I am not afraid of public speaking which is reported as being
the commonest fear which affects 90% of the population. I am
not afraid of exercise and I am not afraid of disease, or death.
I find it difficult to take life seriously and I often tell jokes
and laugh a lot.
However, I have seen billionaire corporate criminals who live
in mansions and float about on multi-million dollar yachts and
cry and beg for sympathy on public television, and others who
carry worry beads and look miserable and spend time in psychiatric
hospitals and ultimately commit suicide after being charged with
corporate crimes, and I have seen media personalities and politicians
succumb to severe depression after their promising and prosperous
careers were stifled, sometimes by their own folly, and I have
seen movie stars who have had leading roles in 100 movies or
plays who say that they had stage fright when they were young
and still get stage fright every time they walk on stage 50 years
later. I have seen sporting champions, Olympic athletes and mountain
climbing adventurers talk about how they had one illness which
threatened their activity and their life, and they have described
it as the greatest challenge that they have ever had to deal
with. M.B.
The Chronic Post
- Q Fever Fatigue Syndrome
Query-fever on
ABC TV
About 30 years ago I had health
problems which were becoming progressively worse until they were
seriously interfering with my capacity to do anything, including
work. My doctor was unable to find evidence of disease regardless
how bad the symptoms became, and the treatment was ineffective,
so I eventually applied for sick leave, followed by recreation
leave, but the symptoms weren't relieved despite the rest, so
I then applied for 12 months leave without pay in the hope of
recovering. Ultimately I was left with no choice but to get more
leave, or to resign and go on a pension, which would have amounted
to 40% of my salary. However, I was then referred to a psychiatrist
who asked me a lot of irrelevant questions, and then an administrative
officer said that I would have to go back to work and work hard
or be sacked.
I was advised by a Trade Union
official to challenge the position but my health was so poor
that I decided to resign, rather than go through the harassment
of trying to convince any one that I had health problems when
I had no medical evidence to support my claim.
My objective was to continue
resting in the hope of gradually returning to normal health and
then find some other form of occupation.
In the early stages I began
reading medical books to solve the mystery for myself, and I
discovered that my symptoms corresponded to DaCosta's syndrome.
One of the main symptoms was a complex form of fatigue which
is nowadays called The Chronic Fatigue Syndrome.
I tried to solve those health
problems by reading a paragraph of medical text for 5 minutes
in the morning and then laying on my back on the carpet and staring
at the ceiling for the remainder of the day, trying to identify
and understand the aggravating and relieving factors with the
simple objective of removing the aggravating factors and including
the relieving factors until I could make a steady improvement
in my condition.
During those early stages I
also overcame boredom by listening to radio, and then turned
to ABC radio because of their reputed attitude about proper use
of the English Language, which might improve my ability to understand
medical text. I heard a lot of doctors making statements in the
name of medical science which were rash assumptions, tripe, or
lies, so I became a talk back caller.
I frequently criticized doctors
with ranting tirades, but the announcers had a discriminatory
attitude toward doctors and treated their statements as the infallible
truths of educated men, and treated people like me as ignorant
uneducated people who weren't qualified enough to give credible
criticism, and who had trivial and mental rather than real problems,
and didn't know their own minds, or were simpletons who didn't
understand the complexities of disease.
I was often restricted in the
number of times I could speak on radio ( to once per fortnight
for two minutes under rigorous and almost vindictive cross examination),
yet doctors would talk on radio for 15 minutes three times a
week and be free to speak any ridiculous tripe they wanted to
without question.
I adopted the tactic of using
false names and addresses to get on radio more frequently.
Nowadays most of those doctors
and radio announcers have died or have retired early with very
healthy bank accounts.
It therefore entertained me
to watch the ABC TV show Landline, on Sunday 27-11-05 when an
ABC radio announcer - Kendall Jackson, from Port Pirie, reported
her experience with Q-fever.
After suffering from some headaches,
and thinking that they might be migraines, and then having really
severe night sweats which saturated her nightwear, and then hot
and cold spells, she thought that "something was majorly
wrong" with her and that she was going "insane"
so she consulted her doctor who diagnosed the flu.
Some time later she was doing
a report about Q-fever in the local community and noticed that
the people who she interviewed were describing similar symptoms
to those that she had experienced
She then reconsulted her doctor
and he confirmed that it was highly possible that her problem
had been Q-fever.
The diagnosis of Q-fever is
an abbreviation of "Query Fever", because, when it
was first discovered in Australia in the 1930's its nature was
a complete mystery - there was a query, or doubt about it, but
since then it has been found to be present in almost every county
in the world
Kendall Jackson was later interviewed
on ABC TV show Landline, and as part of their investigation into
Q-fever they contacted.
the Australian expert on the disease, Professor Barrie Marmion,
who said that Q-fever is contracted from the droplets of moisture
which enter the air from the placenta of infected cows during
the birth process, and Kendall Jackson had been to a cattle yard
just prior to her illness, for only 20 minutes. The condition
can also be contracted from contact with infected sheep or goats,
and typically affects people involved in the meat industry such
as auctioneers, shearers, truckies, farmers, and of course "even
rural journalists".
Kendall Jackson also learned
that there is sometimes a relapse of symptoms during pregnancy,
and as a woman who had been pregnant, and who intended to have
two more children that is an important thing to know.
Included in the Landline report
were aspects of the money, and politics, and intrigue of the
problem
Q-fever involves flu like symptoms
such as headaches, and joint pains - hence the common misdiagnosis
of the flu. The condition is usually temporary - just like the
flu is usually temporary and over in a few weeks, but it has
been only recently discovered that in 8-10% of cases the condition
leaves a state of chronic fatigue. In particular, in the 1980's
while doing vaccine trials in Adelaide abattoirs, Professor Marmion
found people who had previously contracted the condition "and
they hadn't got over it and they were lethargic and they really
couldn't cope with exercise which they normally achieved easily,
and so on, and there were very few localising physical signs,
except this general disturbance of various body systems".
>
One patient reported that he
contracted the ailment while working on the slaughter floor as
a meat inspector. He initially felt unwell and dizzy when one
of his co-workers suggested that he see the factory nurse who
told him that his blood pressure was extremely low. Since then
he has had headaches and joint pains, and memory problems which
were so bad that sometimes he couldn't remember his own phone
number. He also had sleep problems. During the first year of
his ailment he would suddenly feel as if he was melting into
the earth as he fell into a deep sleep at any unpredictable time.
His wife said that his sleeps were so deep that she was scared
that he was dead, or would never wake up. He felt that eventually
he would get over it. but the problem persisted and he had to
leave work. Eventually, After a battle with an insurance company
he managed to get compensation payments equivalent to 75% of
his former salary.
Of course that is where the
politics of medical opinion arises - in the cost of disease to
the meat industry.
The meat industry has a liability
to pay for the cost of occupational illness, and Q-fever is a
clear case of that.
They deal with this liability
by having a policy of providing free Q-fever immunisation injection
to all employees, to prevent the problem, with their policy summed
up as "no jab, no job". More than 85,000 doses of vaccine
were given in a five year period.
Such a policy keeps the employees
healthy, and saves the employer money - it suits everyone.
However, the 300 or more cases
per year of temporary Q-fever cost the industry 1.3 million dollars
per annum, but the cost of the chronic cases can be up to one
million dollars per worker.
For that reason representatives
of the meat industry are "nervous about discussing it"
(it might create a rush of costly compensation claims), and reporter
Prue Adams found that all attempts to interview the meat industry
officials was met with refusal. They said that they didn't want
to because they might "become the target of common law claims".
. ."And compensation for Q-fever certainly has the potential
to blow out ". . . "It's big money".
I would like to congratulate
the Landline TV show for their informative programme.
The ABC Landline programme has
given a good account of the cause, nature, prognosis, economics,
politics, and intrigue of a "Previously Undetectable and
Unknown Illness" - The Chronic Q-Fever Fatigue Syndrome,
which is stereotypical of other types of Chronic Fatigue Syndrome,
which has multiple causes, including Post Viral Chronic Fatigue
Syndrome - i.e. conditions which are still the subject of much
query, question, doubt, debate, politics, and intrigue - with
suggestions that the conditions do not exist.
As Professor Barrie Marmion
stated "I think that we badly need, for instance a decent
diagnostic test for post-Q fever fatigue syndrome".
Nowadays Q fever is known to be caused by a bacterium called
Coxiella Burnetti. It is highly infectious and can survive in
dust or soil for a year or more. Animals which breath in the
dust become infected and although they show no symptoms they
become carriers of the disease.
The infected animals spread the disease to humans who come
in contact with their urine, feces, milk, or blood, or who breath
in the dust etc.
It has an incubation period of 4 weeks and usually lasts for
10 days. The symptoms include fever, muscle pain, headaches,
sweats, coughing, and fatigue.
It's antibodies are evident in blood tests and it is now treated
with antibiotics such as tetracycline, but a small percentage
of cases become chronic and are difficult to cure.
Are These The Hallmarks
of Hypochondria and Cyberchondria
When Q-fever was common in almost
every country in the world 80 years ago, none of the Australian
doctors knew about it, and when it was first discovered in Australia
only one doctor knew about it. When Kendall Jackson developed
it in 2005 her own doctor misdiagnosed it as the flu, and she
later self-diagnosed it by remembering her symptoms and noting,
during a conversation with other patients, that she had the same
condition which had been correctly diagnosed as Q-fever by another
doctor. Ms. Kendall then started making enquiries about the problem
and ABC Landline later interviewed her about her personal experience
with the illness.
Q-fever can be temporary or
chronic, and even nowadays it is still not possible to find scientific
laboratory evidence of the chronic form which involves fatigue,
and a reduced capacity for exertion, and can be aggravated by
pregnancy. The chronic form can be economically incapacitating
and there is no known cure, so if the patient does not obtain
compensation they are likely to lead lives of poverty and deprivation.
It is an occupational illness
well known to industry officials, but, in an attempt to evade
their liabilities they use every trick in the book, and do everything
they can to hide the truth of the condition from patients who
suffer from the chronic incurable form.
If many of the patients with
chronic Q-fever did not self-diagnose and study the condition
for themselves their predicament would be absolutely hopeless.
About the
author of this web page
(added on
2-11-05)
This section contains a brief biography
of my experience with chronic fatigue and exercise
What I did to diagnose the problem
In 1975, after 3 years of health problems
that were becoming relentlessly worse my symptoms became intolerable
but my doctor was unable to diagnose my condition (because "there
was no evidence of organic disease") so I decided to start
reading a few medical books to see what I could find. I soon
found that my symptoms were consistent with Da Costa's Syndrome
(first identified by J.M. DaCosta in 1871)which is nowadays called
The Chronic Fatigue Syndrome.
Why I attempted to treat the condition
with exercise
Many of my symptoms were aggravated
by the slightest exertion, and my general assumption was that
my problems involved a deterioration in my physical condition,
so I decided to treat the problem with some regular exercise
under medical supervision. I made some enquiries and found that
such a service was provided by the South Australian Institute
for Fitness Research and Training so I enrolled in one of their
courses. My immedicate objective was to use exercise safely to
improve my level of fitness to a good standard and regain my
health. After having my fitness assessed I designed my own fitness
programme and proceeded to follow it while training within a
large group of fitter, faster individuals. (I had to ignore the
pressure to conform to the higher levels of training, which was
partly due to the problem of persisting with training while I
was always running last, and partly due to the negative remarks
of some other runners).
My fitness level was scientifically measured
as zero
In the process of training I also found articles
in medical research journals which presented the general opinion
that the condition involved a fear of exercise in people who
had been protected from the vigors of sport as children (I had
to give up my role as gymnastics instructor because of my health
problems, so the idea that the symptoms were due to a fear of
exercise was obviously wrong). I was provided with my own medical
reports which showed that when I started training my fitness
level was zero, compared with a normal healthy level of 900 and
an athletes level of 1200. I was also told that the scores were
determined scientifically using graphs of ergometric load over
pulse rate so that the results were impossible to fake.
(In contrast to my aerobic fitness level of
zero, one of the staff told me that my subcutanious fat level
was that of an athlete. This was measured by applying a caliper
to the skin fold of my abdomen, and I can recall that the teeth
of the calipers were virtually compressing two pieces of skin
together with no fat between).
How I determined that my condition was
chronic
I continued to train for 3 months and
my level rose to 350 so I was becoming quite enthusiastic about
the prospect returning to full health. I therefore trained more
frequently for a further 3 months but at the end of that time
my fitness level was still 350 so I had to consider three things.
That my condition was measurable, and that it was abnormally
low and not related to a lack of exercise, and that it was chronic
and was not continuing to improve to normal levels despite regular,
more frequent, and increasing levels of exercise.
Why I stopped training
I continued to train for a further 3
months when I damaged a knee cartilage and had to stop.
The first effective exercise programme
for CFS
I was therefore the first person in
medical history to design an exercise programme which was achievable
for patients with chronic fatigue, and was the first to provide
scientific evidence that it was a real, physical, and measurable
condition.
I wrote a theory about posture and cfs
Four years later I wrote a theory which
explained how poor posture could cause that type of chronic fatigue
(there are many causes and types)
I co-ordinated a research programme on
exercise and cfs and why all previous medical programmes failed
In 1975 I was invited to coordinate
a research programme for other people with chronic fatigue at
the Fitness Institute, and became the first individual to succeed
in having such patients continue to participate in programmes
(previous programmes which were conducted by doctors who thought
that the ailment was due to a fear of exercise, all ignored the
reality of the symptoms, and all failed. That was because the
patients who followed the doctors instructions and tried to run
at a normal pace would have developed distressing symptoms and
lost confidence in the advice immediately. Most of the other
patients refused to follow instructions or dropped out within
the first few weeks - It was reported in the journals that "they
could not, or would not train".)
Bureaucratic requirements for research
In order to start the programme I had to get
a small government grant and fulfill a few bureaucratic requirements.
I wanted to establish that the condition was measurable so that
other researchers would start trying to cure it (instead of ignoring
it). I was advised to ask for a grant aimed at curing the problem
with an exercise programme rather than measuring it's severity.
(this was because measuring the condition would give proof of
disease and would require doctors and governments to take responsibility
for it, but curing it would solve the patients problems and remove
the governments exposure to the expense of paying for "another
real illness".
I found that many cfs patients had measurable
and abnormally low aerobic capacity
While conducting the programme I found that
some of the other patients with persistent fatigue had abnormally
low scores which were not improving in the normal manner, as
would be expected from healthy people
The value of scientific evidence???
In the process I had the opportunity to discuss my own results with a research cardiologist (fitness readings from zero to 350 and plateauing) and I asked him if that was convincing scientific evidence of my condition being real and physical. The exact words in his blunt reply were astonishing and given in a resentful tone of voice; he said "No! that means nothing!!!" I got the impression that he was jealous of a non-doctor making a credible scientific discovery and proving some old theories wrong, but I wasn't trying to prove anything. My objective was to solve my own problems, and offending doctors was just creating more problems.
Also I must say that I had courteous relations with most of the staff and doctors who were co-operating with me in the research, and because of my role as co-ordinator, I had access to the premises on a regular basis. However when I wanted to access my own file out of curiosity about the medical opinion given about me, I was advised that it was not standard practice to give non-doctors permission to read them. Nevertheless, I made a point of waiting until the staff were out, and went into the file room and read my own records. Within the text were the typed words "This man is a hopeless hypochondriac". This made me furious so I stormed out of the building telling everyone in sight that they were all useless idiots. After calming down I apologised for my outburst, as most of them were not responsible for the remarks. In the meantime I decided that I could only rely on myself if I wanted to get any useful understanding of the problem.
(Regarding the doctor who diagnosed "hopeless hypochondriac" - When I first met him I was suffering from dozens of symptoms, including breathing difficulties, faintness, and dizziness, and my heart was pounding violently in response to the slightest exertion. I vaguely recall having difficulty walking from my car to the Institute building, and then I found it difficult to get up the stairs to the medical room on the first floor, and then the slight effort of riding the ergometric cycle produced a fitness reading of zero. I was also withdrawing from a high dose of barbiturates, and decided to study medicine myself because my doctor was unable to account for my symptoms or treat them effectively, and I was hopeful of getting better insight from a research scientist who I presumed would know more than a suburban general practitioner. I was furious about the diagnosis of hypochondria because that meant that even research scientists were useless to me i.e. they did not take my problems seriously and were doing nothing other than providing a worthless and insulting diagnosis, and had no intentions of trying to find a cure).
In the process I had the opportunity to discuss my own
results with a research cardiologist (fitness readings from zero
to 350 and plateauing) and I asked him if that was convincing
scientific evidence of my condition being real and physical.
The exact words in his blunt reply were astonishing and given
in a resentful tone of voice; he said "No! that means nothing!!!"
I got the impression that he was jealous of a non-doctor making
a credible scientific discovery and proving some old theories
wrong, but I wasn't trying to prove anything. My objective was
to solve my own problems, and offending doctors was just creating
more problems.
Also I must say that I had courteous relations with most
of the staff and doctors who were co-operating with me in the
research, and because of my role as co-ordinator, I had access
to the premises on a regular basis. However when I wanted to
access my own file out of curiosity about the medical opinion
given about me, I was advised that it was not standard practice
to give non-doctors permission to read them. Nevertheless, I
made a point of waiting until the staff were out, and went into
the file room and read my own records. Within the text were the
typed words "This man is a hopeless hypochondriac".
This made me furious so I stormed out of the building telling
everyone in sight that they were all useless idiots. After calming
down I apologised for my outburst, as most of them were not responsible
for the remarks. In the meantime I decided that I could only
rely on myself if I wanted to get any useful understanding of
the problem.
(Regarding the doctor who diagnosed "hopeless hypochondriac"
- When I first met him I was suffering from dozens of symptoms,
including breathing difficulties, faintness, and dizziness, and
my heart was pounding violently in response to the slightest
exertion. I vaguely recall having difficulty walking from my
car to the Institute building, and then I found it difficult
to get up the stairs to the medical room on the first floor,
and then the slight effort of riding the ergometric cycle produced
a fitness reading of zero. I was also withdrawing from a high
dose of barbiturates, and decided to study medicine myself because
my doctor was unable to account for my symptoms or treat them
effectively, and I was hopeful of getting better insight from
a research scientist who I presumed would know more than a suburban
general practitioner. I was furious about the diagnosis of hypochondria
because that meant that even research scientists were useless
to me i.e. they did not take my problems seriously and were doing
nothing other than providing a worthless and insulting diagnosis,
and had no intentions of trying to find a cure).
80 patients with cfs were medically assessed
I continued the research programme for
about 2 years but eventually had to stop for health reasons.
During that time more than 80 people with chronic fatigue were
medically assessed and commenced training. Several of them continued
training for 2 hours, twice per week, for 3 training periods
of 3 months each - more than 9 months, and were still training
when I left the programme. One of them participated in a 6 mile
marathon. I have maintained reasonable health for myself since
then by walking 10 - 20 kilometers per week at a casual pace.
What I did about bureaucratic obstacles
About 5 years later I was able to find
another medical opinion about my own health by going through
the difficult task of weaving through bureaucratic obstacles
associated with The Freedom of Information Act, and I found information
which was supposed to be hidden from patients, and the typed
words were "this man is not ill, he only believes he is".
"He is the leader of a self-help group and acknowledging
his condition would have a bad influence on the others".
(I tried to solve some my health problems by establishing several
self help groups for patients with chronic fatigue, and chronic
abdominal pain, essentially because doctors were not providing
any effective treatments). Most of the statements in the report
were misrepresentations of what I said, and some were the exact
opposite, with the obvious intention of discrediting my opinion.
When I discussed my symptoms with him before he prepared the
report I described fatigue in relation to exertion, and abdominal
pain in relation to repetitive bending at the midriff, and he
tried to create the impression that I was an ignorant person
who didn't know his own mind and gave the diagnosis of anxiety
hysteria (that I was converting psychological problems into imaginary
physical symptoms, or that I had an exaggerated fear of trivial
disease). He wrote "There is nothing at all to find on complete
general examination."
I obtained evidence of biochemical abnormalities
in cfs from Newcastle University
About another 5 years passed when I heard
about some researchers in Newcastle University (of New South
Wales) who had found evidence of metabolic abnormalities in chronic
fatigue by examining the chemical profile of urine, so I sent
a sample of my urine to them with the appropriate fee. They returned
two results consistent with the most severe level of chronic
fatigue.
CFS was officially recognised as a medical
condition by the AMA
The Australian Medical Association accepted
that chronic fatigue was an officially recognised medical condition
about 10 years later (in the 1990's).
Modern exercise programmes for cfs
Nowadays there are many exercise programmes
on offer as treatments. All modern exercise programmes use similar
principles to those that I used in 1975 and 1980 when I established
that it was possible for most people to gain a moderate improvement
in health, and in a small number of cases a return to normal
levels of fitness. They involve starting with very mild exercise
(walking)) and progressing slowly.
Current medical attitudes
However, I still see articles which
repeatedly refer to the problem as an anxiety disorder for which
there is no organic evidence, which is not measurable, and simply
involves a fear of exercise, or is just tiredness. M.B.
The History of Science and Serendipity
It has been a common enough observation from scientific history, that the answer to a mystery will be staring thousands of people in the face, before someone who is looking for it, sees it, and recognises it's value.
I therefore presume that in 1976, when I saw that my own fitness reading was scientifically measured as zero, that I was the first person to recognise it as evidence of a measurable physical cause of a health problem, because I was looking for it, and nobody else was.
I can only suppose that thousands of doctors had seen that data before me, mixed in with data from other types of patient in fitness programmes, and have routinely assumed that it was due to lack of exercise resulting from laziness, or due to a fear of exercise.
It should also be staring any reasonable person in the face to note that, if I was afraid of exercise I would not have tried to treat my health problems by deciding, entirely on the basis of my own considerations, to volunteer for a fitness training programme, and I would not have continued with it for the best part of a year, ultimately for 2 hours per day for 6 days of the week. It is also stating the glaringly obvious, that if I was a lazy person, I would not have started reading medical books in order to solve a problem which was, as I was led to believe, beyond the comprehension of my doctors, or anyone else in the medical profession for the previous 3000 years. (I didn't think that it would be an easy thing to do, and the study involved sitting at a desk, which was causing me a considerable amount of pain, but the task was, without any doubt of mine, an absolute necessity - This was because I had been following medical advice and taking the prescribed medications for several years, yet my health continued to deteriorate, and there was no evidence that anything was going to alter that course unless I did something about it myself).
Unfortunately there is a strategy called spin, which enables data and evidence to be dismissed, trivialised or ignored entirely, and will only ever be found by those who look for it.
When Galileo found evidence that the sun was the centre of the universe rather than the earth, his book was confiscated and he was put under house arrest, because his ideas contradicted those of the church. The church authorities new of the truth, but did everything they could to stop the public from finding it, or believing it.
Semmelweis discovered that women were dying of child bed fever because surgeons were using the same instruments that had been used and contaminated in autopsy studies. However this offended other surgeons who blocked his promotion to the position of clinical professor. They also refused to cooperate with his methods of disinfecting their hands and instruments with chloride of lime, and as a result, many women continued to die unnecessarily. Such frustrations eventually sent Semmelweis mad, presumably because he didn't know enough about history. M.B
A Useful link on the politics of CFS
One of the objectives of my exercise research programme was to scientifically prove that chronic fatigue was due to a real measurable ailment and that it was not just imaginary, and not just normal tiredness, and the programme was entirely successful. A second objective was to determine if continued participation in that programme was effective in relieving symptoms and improving stamina, or curing the problem. The results clearly indicated that most of the individuals who participated did improve their fitness, but reached a level that was still below normal, and stayed that way regardless of continuing to exercise, and only one appeared to have returned to normal levels.
In other words the success of that programme scientifically proved that people who were persistently troubled by fatigue had a real physical condition, and that it responded favorably to three to nine months of training, and that it was, in most cases, not a cure. It was useful to some patients but only those who wanted to try it, and, obviously no person should be forced to do it, or to increase at a rate that aggravated their symptoms. The fact that they reached a degree of fitness that would not continue to improve even if they exercised also proved that they were not lazy, and that the fatigue was chronic.
I had also read the psychiatric literature and found an idea that might be useful called Cognitive Behavioural Therapy, which simply means 'changing the information that a person has to relieve a problem'. In particular, if a person has chest pain and think it is due to their hearts, and a doctor tells them that they don't, they won't believe it, and will worry. However if you change the information that they have, by explaining that the chest pain is in muscles to the left of the chest, and the heart is in the centre of the chest, they may stop worrying unnecessarily about their hearts. The problem is, of course, a bit more complicated than that, but the general principle is appropriate.
I did my research in the early 1980's and since then the term 'chronic fatigue syndrome' has become popular, and many research programmes have been conducted under the name of GET or PACING which means, in plain English - Graduated Exercise Training, or, walking or running at a pace that is that is within your own limits i.e. exercising within your own personal limits - and by extension - keeping within your own limits in terms of general lifestyle. Also Cognitive Behavioural Therapy has been abbreviated to CBT, and both methods have become the most popular forms of treatment.
However, some people have been deliberately trying to misrepresent those ideas, and the disinformation has become so effective that those methods have been disputed by people who actually study CFS, or run CFS societies, or actually have CFS.
The types of disinformation include . . .
The false claim that GET is a useless treatment because it doesn't cure the problem.
Here is the facts . . . 'You can't cure every case of CFS, but it is still a useful method for improving the stamina for some patients, and it is still a useful reproducible method for scientifically proving that it is a real physical illness.
The following quotes come from a website that has some very useful information about the politics of CFS, but I was reluctant to use it because it is critical of Graduated Exercise Training, and Cognitive Behavioural Therapy.
"There can be no doubt that, for patients with ME/CFS as distinct from those suffering from chronic “fatigue”, neither CBT nor GET is effective, otherwise everyone would by now be cured . . . The apparent intention of the PACE Trial Principal Investigators to remove people with ME/CFS from receipt of state and insurance benefits raises a larger question than just welfare reform. It is also about the way illness is being redefined and reclassified and about why this is happening and about what forces are at work in this process of redefinition".
See here http://www.meactionuk.org.uk/Can-the-MRC-PACE-Trial-be-justified.htm
My main point here is to say that people with CFS need all of the scientific evidence that they can find, and shouldn't be dismissing good studies, and should look toward a co-operative approach to other people who are trying to solve the same, or similar problems.
The people who want to discredit the reality of CFS are deliberately spreading disinformation to create confusion, and they want nothing better than to have CFS groups arguing with each other.
***
While I was contributing to the Da Costa's syndrome topic in Wikipedia I had two critics named WhatamIdoing and Gordonofcartoon who were essentially doing as much as they could to delete the information and ban me and steal the information, but also misrepresent it and spread disinformation about the symptom of chronic fatigue. Their choice of wording on many topic pages before and since has been aimed at confusing normal fatigue with chronic fatigue to create the impression that they are the same. One of them has won a "prize" for writing an essay on ordinary fatigue caused by work, and is obviously raging with jealousy about me, because I have done real research, in a real research institute about a serious disabling condition of chronic fatigue.
That individual has recently written an article called "Cancer-related fatigue" which includes this statement at 1:33 on 7-10-10
"Cancer-related fatigue is a chronic fatigue (persistent fatigue not relieved by rest), but it is not related to chronic fatigue syndrome.[2] See here http://en.wikipedia.org/w/index.php?title=Cancer-related_fatigue&diff=prev&oldid=389218805
Since then that editor has found a reference for that, but I have actually had the chronic fatigue syndrome for 35 years from 1975 to 1010, and cancer and chemotherapy for 8 years from 1994 to 2000, so I actually know the difference, and yet that contemptible fool has made snide remarks about 'anecdotal evidence' being 'unreliable'.
Most other editors will never notice that the 'Cancer-related fatigue' page was started by the same individual who is linking many other topic pages back to it.
That self-proclaimed 'instant expert', who has the impressive memory of a parrot, but only the brain power of a flea, and the ethical standards of a fork-tongued rattlesnake, has stolen that general information from me.
Nobody could say with any authority that they were different unless they actually had both illnesses, because there is no "officialy" "acceptable" scientific way of measuring either of them. I have said that the chronic fatigue syndrome was not made any worse or any better by the 8 years of 'non-Hodgkin's lymphoma, or by the two years of side effects of chemotherapy, and that a different type of fatigue only occurred occasionally for short periods of time about 2 weeks after each of five sessions of the CHOP type of chemo. The temporary nature of that fatigue made it trivial compared to the chronic fatigue syndrome. Since recovering from the chemo side effects the chronic fatigue syndrome is no better or worse than it was before I had the chemo. For more information see here http://users.chariot.net.au/~posture/AboutTheAuthor.html#anchor260609
People with the chronic fatigue syndrome are attempting, under difficult circumstances, to do the right thing by finding scientific proof to confirm the reality of the problem, and that editor is doing everything to hide and discredit it, so CFS patients should do everything they can to get rid of the toxic influence of that individual who is an insidious pest.
An organisation, such as an insurance corporation, is either paying them to confuse the issue of chronic fatigue, or that editor is ingratiating themselves by doing the type of dirty work that will get them some sort of social or financial gain in the future.
Essentially, insurance companies are making profits by claiming that if you make weekly payments into their funds, they will make payouts to individuals if they later develop 'medically diagnosabel' illnesses' called MDI's, but what they don't tell you is that only 50% of illnesses are "medically diagnosable" to the extent of "official recognition", so 50% of people who pay premiums and become chronically ill, don't get payouts. i.e. the insurance companies make profits from 100% of premiums, but only honor 50% of their contracts.
There are now clear warnings on cigarette packets which say 'Smoking causes lung cancer', and there should be consumer warning's on the front page of insurance or superannuation contracts . . . 'Only 50% who become become chronically ill will get payouts'. The percentage might not be accurate, but the concept of the problem is.
Another problem that you will need to deal with if you develop CFS is that you may find yourself in a court room where the burden of proof will be foisted onto you, and your opponents will be a highly paid team of scientists, doctors, psychiatrists and lawyers. Such imbalances need to be corrected.
A comment on research news about exercise and CFS in The Weekend Australian 26-3-2011
I provided some comprehensive information about the IRFT programme to a freelance journalist in 1983. He sent items to several newspapers including The West Australian Newspaper, which was published on August 22 1983 page 34.
He mentions that physical or emotional traumas and viral infections can sometimes be followed by fatigue which persists long after those events occurred, and that the study found that many of those patients gained a benefit from the fitness programme.
The success was due to the fact that I designed it to include the specifications that no-one had to train if they didn't want to, and that those who did were requested to determine and keep within their own limits.
An article in the Australian by journalist Tony Kirby presents some information about modern research into the topic of PACING and whether or not it is useful as a treatment. There were some discussions about how to select patients and complaints that the exercise often resulted in problems.
I can give some information form my own experience to clarify some of those confusing issues.
First of all I was a gymnastics instructor who had been keen on sports for ten years prior to developing the problem of fatigue, so it was not due to laziness or the lack of exercise (which is also called 'deconditioning')
Secondly when I stayed within my exercise limits (which was slow walking at first, and some slow jogging later) then I was able to continue to improve without problems. However, when i participated in a relay, and squatted down with a medicine ball between my knees and hopped for about ten yards, my heart began to pound violently, and I fell to the ground gasping for breath. It took me about 20 minutes to recover, and i didn't resume exercises again until a week later. I know from a matter of pure sense that most people who had that experience would leave such a course and never go back.
My fitness levels were measured at the start, and after three months of regular training, and at six months, and were based on scientific graphs of pulse rate over effort, so cannot be faked. The level went from minus 10 to plus 350kpm's after three months and did not improve despite increasing the frequency and pace of exercise, so I had a physical limitation that was not going to get any better, and was still less than half normal.
The initial reading of minus 10 was because of the severity of my fatigue, and because the graph was drawn as a straight line instead of a curve at the base. Therefore my actual level was estimated at somewhat higher than that, as plus 10.
The plain fact was that it was obvious to me that I had physical limitations and didn't need to get 'scientific' evidence of it. That is just what other people need to verify it.
The physical limitations meant that it was possible for me to exercise at a slow pace, and impossible to exceed my limits, which meant that I didn't sprint or lift heavy weights.
I did the training purely because I thought it was a good idea, and not because doctors or anyone else suggested it, and my sole purpose was to get back to normal health, but it turned out that it was not possible.
Consequently I didn't know that, according to some opinions, I was supposed to have a fear of exercise (nobody told me that), and I didn't have a fear of exercise, and I didn't have anyone else telling me what I 'should' or 'should not' be able to do, or force me to exercise past those limits. I just did what was sensible, practical, and possible.
It was obvious to me that I had a type of chronic fatigue which was directly related to a physical impairment which also reduced my capacity for exertion.
Five years later I was asked by the head of the research institute to design a fitness programme to scientifically study the effect of exercise on other people with chronic fatigue. The results from about a dozen people who continued to train, confirmed that other individuals had similar limitations in exercise capacity, and that they could participate in an exercise programme if it specified that they stayed within their own limits.
The fact that such limitations exist is also evident from a thorough search of the history of medical literature.
It surprises me that modern researchers don't set exercise capacity as a specific criteria for one type of CFS and separate it from the other types, such as anxiety or depression etc.
Also some researchers expect that the exercise programme will cure every patient, but that is simply not possible. Nevertheless some improvement is beneficial.
They also may not be aware of the history of such research which shows that patients develop adverse symptoms as a result strenuous exertion, and that programs which are designed to encourage or force them to increase their level of fitness have failed repeatedly and had to be abandoned.
The people who designed such programs were at fault, because they didn't understand the problem, and used the wrong exercise principles, and sometimes, rather than admit to it being due to that factor, they blamed the patient by referring to them dropping out and becoming "therapeutic failures". (a clear case of victim blaming)
I also suspect that some researchers are deliberately organising the wrong types of exercise programs in order to create confusion.
This is a quote from another source which is relevant the process of producing research results that are deliberately rigged from the start . . . 'the manufacture of scientific doubt'.
Note also that I gave the freelance newspaper reporter an account of many different causes of the ailment including excessive and prolonged exertion, viral infections, emotional factors, and unknown causes etc, and he, or the editors in charge of each newspaper picked which examples to use, and they generally focused on the 'emotional factors' rather than the others.
One of many newspaper reports about my research can be seen at the top of this essay.
A copy of a newspaper article about a different study can be seen here
See another report on these issues in The West Australian Newspaper's internet page called "the west" at 12:05 p.m. on February 18th 2011 here http://au.news.yahoo.com/thewest/lifestyle/a/-/lifestyle/8868468/chronic-fatigue-treatment-questioned
The following words are quotes from The Australian newspaper about another more recent study
"ME-CFS is generally defined by persistent fatigue unrelated to, but often worsened by exertion, with other possible symptoms, for at least six months. The condition has long been controversial, in part because of disputes over whether its cause is physiological, psychological or both."
"They then received one of three treatments on top of this.
The first, adaptive pacing therapy, generally preferred by ME-CFS patients groups, encourages patients to fit their activity level to their energy limits, identifying and so avoiding activities that worsen their symptoms."
"Some patients fear the $8 million PACE trial, published in British medical journal The Lancet earlier this year, will put pressure on sufferers to be more physically active than is good for them, possibly causing relapse."
"Critics warn that the PACE findings cannot be applied to all patients because they excluded severely affected housebound patients, and children."
"Lloyd believes any harm comes from patients not sticking to their agreed plan."
My comment - Useful information about the effects of exercise in chronic fatigue can be found in a book by Sir Thomas Lewis, which was published in 1919.
References:
Lewis, Sir Thomas] (1919). The Soldier's Heart And The Effort Syndrome 2nd. edition. New York U.S.A.: Paul B. Hoebe
Lewis, T. (1918). "Observations upon prognosis, with special reference to a condition described as the "irritable heart of soldiers"". Lancet i (181-3)
and here Osler, Sir William (1918). "Graduated exercise in prognosis. Letter.". Lancet (1): 231.
and by reading other references that I provided at the end of the article here
For more information on the history of CFS see here
Based on my book called The Posture Theory and first published on this website on 4-6-11
There is a characteristic type of breathing in CFS that is so typical that it's observation has been used as a means of diagnosing the ailment.
If you watch the person for awhile you will see them occasionally take a more forceful and deeper breath that ends with a sudden stop and be followed with normal breathing. There is sometimes the sound of air rushing into their mouth and a heave of their chest as they do so.
The patient will say that they felt as if they needed extra air, and that they couldn't get as much as they wanted because it felt as if they had met some type of obstruction.
To understand that symptom it is necessary to know how normal breathing occurs. Essentially the body has two major cavities or spaces. The upper one is called the chest which contains the heart in the middle, and the lungs on each side. The lower cavity contains the stomach and liver etc.
The two spaces are separated by a large broad muscle which includes several holes such as the one which allows the food pipe to pass through to the stomach below. It is called the thoracic diaphragm and is dome shaped, and as it contracts the central part descends and drags the lungs downwards and creates a bigger space in the chest, and hence a vacuum which draws air in through the nose and down the throat to the lungs. The lungs are elastic like rubber bands, and are attached to that muscle, so when they are dragged down they are stretched. Therefore, when the muscle relaxes the lungs draw it up again. As it rises it pushes air out of the lungs, up through the throat, and out through the nose.
Hence breathing occurs because the contraction and expansion of that muscle draws air in and pushes air out of the lungs.
When the person with CFS feels as if they haven't got enough air, they try to contract that muscle as tightly as possible. but it can only draw in a small amount extra, and won't contract any further, which is why they sometimes feel as if they are "breathing in as if against an obstruction", and why they say that they feel as if "they can't get enough air".
That individual may breath normally for an hour or two and then take such a breath, and continue to breath normally but take such breaths periodically throughout the day. The frequency depends on how much energy has been expended and how much oxygen is required to cover the requirements of such things as sitting, standing, or walking etc.
Healthy people have biological monitoring mechanisms which ensure that as the level of exercise increases the level of oxygen use increases to cover the energy needs precisely. However, in CFS, the breathing process is inefficient, and at rest there is not much difference to normal, so the symptoms only occur occasionally. Nevertheless, during exercise the abnormalities and inefficiency of breathing increases out of proportion as the level of exertion increases.
In practice that is evident by the fact that, at rest, the person may take occasional forced and deeper breaths, and when walking they may take such breaths more often. When the level of exertion is increased by jogging the person may actually have to stop after fifty yards and take two or three forced deep breaths, and then continue. Generally speaking, based on my experience, if I haven't gained enough extra air in that process I will continue anyway and sometimes stop again in another ten yards and take another forced breath. and then proceed for another 50 yards. When jogging for a mile I may have to stop many times, usually taking from one to three breaths before continuing, and occasionally have to walk for fifty yards, and then stop, take some deep breaths, and continue jogging again.
Exercise at higher levels may in some cases be impossible because the difference between the energy being expended and the oxygen being usefully supplied is too great, and it can result in more significant gasping which is unpleasant and draining and takes excessive amounts of time to recover from.
That is why most patients will refuse to participate in exercise programs where they are required to keep on increasing their levels of exertion every week. Sooner or later they will reach their limit, and leave the course.
At rest the feature is just a forced breath, but sometimes I will need to place my hands on my hips to gain extra leverage and force the breath deeper. However. when I am jogging I will generally stop, and then bend at the hips and put my hands on my knees, straighten my back, and get even more leverage to gain the maximum depth of breath possible. It seems to be more effective in supplying the extra air I need.
The frequency of the extra breaths may also increase while talking if the amount of air exhaled in producing voice sounds is reducing the air available to the lungs.
That breathing abnormality is different to normal sighing or yawning, and different to asthma, and is different to the general concepts of hyperventilation where the person will be described as panicking and then breathing rapidly for several minutes until they become dizzy. It is not due to lack of exercise.
The CFS anomaly can and does happen any time of the day or night when the person is resting comfortably or when they are watching TV comedies, dramas, or sports. The only factor which seems to influence the symptom in my experience is the level of exercise.
To view some 3D video's on the normal breathing process see here and here
For my YouTube video on this topic see here http://www.youtube.com/watch?v=iGts2nfGtY0
The benefit of experience
If you read the medical literature about patients with chronic fatigue you will get the general impression that the difficulties they have with exercise as adults are the result of not having any experience with normal exericise during childhood. The following words are extracted from a 1956 book . . . " At school kindly doctors and soft mothers protected them from the hazards of football, swimming and the gymnasium . . . and . . . Fear of football, and fear of swimming are common in childhood." (end of quote).
However, I played a lot of sport when I was young and was a good swimmer and a gymnastics instructor, so when I developed the chronic fatigue syndrome and read that opinion I was able to see that it was 'plausible but not factual'. I was also able to notice and describe the differences in the response to exercise, and was invited to design and co-ordonated a research program to scientifically measure and evaluate those differences.
One of the features of good health is often described by marathon runners who will say that they were able to run the first few miles with relative ease, but would become fatigued later in the race. They typically ignored that fatigue and persevered until they got their 'second wind' and could continue to finish the race without any further problems.
That aspect of exercise is common knowledge and well known to runners, or anyone who has played a lot of sport, so it tends to be taken for granted as a characteristic of all types of fatigue.
However, with chronic fatigue that 'second wind' generally doesn't come, and in fact, persevering despite the fatigue can make the problem much worse. The fatigue tends to continue getting worse until the person can't keep going any more, and then, instead of recovering within a few minutes, it may take days or weeks.
Consequently if the person does actually have an exercise related fatigue problem then it is not appropriate to give them a 'graded' set of exercises to do where they have to increase the level each week, every week, until they recover to normal health, because as soon as they reach their limit they will start having more problems than benefits, and will almost certainly refuse to continue.
To conclude, I can say that telling a person who is healthy to ignore their fatigue, think positively, and get through the fatigue barrier may be an appropriate and effective way of getting them to improve their fitness. However, giving that advice to someone with exercise related chronic fatigue is the worst thing that you can do, which is evident from the reports from 100 years of graded exercise programs. It is also not sensible to argue that other patients with fatigue regained their fitness, therefore eveyone should be able to, and it is not aceptable to 'blame the victim' for the failure of the inappropriate program design.
The individual needs to recognise that their physiological response to exercise, fatigue and perseverance is different, and they need to learn their limits and stay within them. The reduced levels of exercise can still improve the tone of the cardiovascular system and their physical fitness to whatever level is practical and possible.
It is apparent from the different responses, that each individual needs to be assessed before they start training to determine what type of fatigue they have, and what type of programme is most appropriate to their requirements.
An article by Andrew R Lloyd in the Medical Journal of Australia in 2004; 180 (9) p.437-438 (which confirms the effectiveness of a fitness programme which has exactly the same principles as the program that I designed 22 years earlier) here
Some newspaper reports on the controversies about CFS exercise programs in 2011 here
The Most Common, Complicated, and Confusing Illness in Medical History
The chronic fatigue syndrome is
the most common illness in medical history and has been particularly
common in the Western World since the seventeenth century when
it was recognised as being a disorder of sedentary workers that
was rare in farm laborers and non-existent in primitive tribes
people.
Nowadays it is commonly encountered
amongst patients in every medical clinic and is well known and
recognised by all doctors, but there is no generally accepted
blood test or x-ray evidence of the cause, and no officially
endorsed reliable way of diagnosing the condition, and no consistently
effective treatment, and no known cure.
The condition is so complicated
and confusing that there are more than 100 diffferent labels for it which vary from one doctor or specialist to another, and from year to year, decade to decade, and century to century, and has often been used as the subject of classroom
debates for first year medical students, and sometimes produces
heated arguments at medical conferences.
Chronic fatigue was the most common
ailment in the nineteenth century when it was called Neurasthenia
due to the belief that it was caused by a weakness of the nervous
system. That label was the most commonly used diagnosis in medical
clinics where the condition came to be regarded as an imaginary,
trivial, or psychological disorder. Some researchers thought
it was caused by tight corsets which compressed the chest, heart,
and lungs. It was therefore known as a women's ailment but it
also affected some men, especially those who wore male corsets,
which were common at the time.
During the American Civil War a physician named J.M.DaCost observed the extreme faintness and fatigue in soldiers
who had marched into battle with heavy
fully laden knapsacks at double quick pace for 16 hours at a
time in cold wet conditions, while suffering from an infection. He also noted that the symptoms were 'undoubtedly' aggravated by their tight waistbelts, and, as the result of his studies the condition became widely known as Da Costa's syndrome.
In the early twentieth century
when time and motion studies were introduced to improve productivity
in coal mines, the condition became common amongst men
who were required to increase the tonnage of coal that they shoveled
each day to achieve the new and gradually increasing average
worker requirements. The illness was then called Industrial Fatigue.
However, there was no medical test to confirm the existence
of the ailment and that created two problems. Firstly the number
of individuals developing the ailment was posing a great cost to industry, and
secondly, healthy workers could start faking the condition to
avoid their occupational responsibilities, so industrialists
socially engineered the idea that it was a psychological disorder,
and in Britain the name of The Industrial Fatigue Boardwas changed
toThe Industrial Psychology Board. Thereafter healthy workers
refrained from faking the condition to avoid being branded as
mental cases, and genuinely fatigued patients had to endure the
shame and psychological distress imposed on them by the fraudulent
defamation of their characters.
In World War 1 the condition affected
soldiers who were exposed to round the clock cannon fire in the
trenches of the Western Front, where the constant noise made
it difficult for them to sleep for months at a time. It also
affected soldiers who were exposed to the shockwaves from exploding
bombs, but were not hit by shrapnel, so it became known as Shell shock. The undetectable nature of the fatigue again posed several
problems for army administrators. Firstly, the large number of cases was reducing the manpower available to do the fighting. Secondly, large numbers of healthy soldiers
could start faking the condition to avoid the risk of death on
the front line, and the combined loss of manpower could make it difficult
to win the war. Thirdly, the cost of military pensions was making it
uneconomic to continue the war. The armies therefore started discrediting the
idea that the condition was a real physical ailment and reinforced
the psychological theories by attributing it to fear, with emphasis
on the label of cowardice. Thereafter healthy soldiers would
choose to face death in battle rather than fake the fatigue and
be branded as cowards, and the genuinely fatigued patients had
to endure the shame of the devious defamation. The army chose
to conveniently overlook the fact that some soldiers were being
granted bravery awards at their bedside while they were being
treated in shell shock hospitals. The awards were given to soldiers
who demonstrated courage in battle above and beyond the call
of duty.
During the Iraqi War the U.S.
planes were reported as carrying bombs which were specifically
designed to produce the type of shock waves that were most effective in causing the symptoms of shell shock, and many enemy soldiers were reported as being too exhausted to pull the triggers of their guns and were easily captured.
In civilian life some scientists observed
that most patients with chronic fatigue spoke of intolerably
distressing cardiac symptoms during physical exertion so the
ailment was called "The Effort Syndrome". Others noted the similarity to the normal symptoms of fear and exertion, and therefore concluded that the symptoms may have been due more to the fear of exercise, rather than the exertion itself. However,
many of the patients had thin physiques so there was the suggestion
that it was due to poor physical fitness resulting from a lack
of exercise (some researchers call that 'deconditioning' i.e. gradually becoming less and less fit due to the lack of exercise). There were also suggestions that it was due to the fear of competitive sport, or laziness. When the condition affected factory
workers who were accidentally electrocuted at work it was called
Industrial Shell shock.
Follow up studies from World War 1 showed that the condition was more common amongst
lightly built sedentary workers who were sent off to war without
the proper amount of physical training, and they were expected
to keep up with the marching pace of solidly built soldiers recruited
from farm laboring communities. Consequently, by the start of the second World War, volunteers with such physiques were rejected on medical grounds. However, even the fittest of recruits could develop the fatigue if the conditions of war were severe enough. Their condition was called Battle
Fatigue. Prisoners of War who lost more than one third of their
body weight due to starvation developed chronic fatigue and many
of them were still troubled by abnormal fatigue thirty years
later.
Some psychiatrists continued to
believe, or promote the idea that the absence of blood test or x-ray evidence of disease
was an indication that there was nothing physically wrong with
the patients, so they diagnosed the condition as Anxiety State,
and other psychiatrists noted that many of the patients with
chronic fatigue were depressed so they called it a Depressive
Disorder, but most doctors reported that there were patients
in almost every clinic who had the condition but appeared to
be as anxiety free and as well adjusted as any of their other
patients. When the condition affected a soldier at war some psychiatrists
continued to attribute it to the fear of battle and called it
Battle or War Neurosis, and if it affected a person at work they
attributed it to laziness or psychological stress so they called
it an Occupational Neurosis, and if the person claimed workers
compensation for the ailment they believed that the motive was
subconscious greed so they called it Compensation Neurosis, and
they believed that after the workers left their employment or
received a large financial payout from an insurance company they
would make a rapid recovery. Those psychiatrists did not do proper
follow up studies, because they were not aware that many patients were forced to resign without
the benefit of workers compensation or other entitlements and
spent the remainder of their lives in poverty.
Furthermore, by not informing workers
of the consequences of continuing to work while in a state of
fatigue they were neglecting their responsibility to provide
preventive advice, and contributing to the development of the
chronic condition, and hence were contributing to economic costs
to the patients and society.
(It has been a feature of medical
history that obscure illnesses have been prejudically attributed
to negative, rather than positive personality traits, such as
evilness, sinfulness, laziness, cowardice, or greed.)
After more than 100 years of the
condition being popularly attributed to laziness or a fear of
exercise, it became widely known to affect Olympic athletes,
Sports Champions, Football stars, Marathon runners, and World
Record holders. The new profession of sports physicians attributed
it to excessive physical strain without adequate rest breaks,
and began calling it the Overtraining Syndrome. For example,
if poorly prepared athletes participated in too many marathons
in the one year they were likely to develop chronic fatigue.
They didn't have sufficient time between marathons to fully recover,
so when running each additional marathon they just compounded
the fatigue which permanently impaired their fitness capacity
until they could no longer compete at the elite level, and in
the worst cases could not continue with normal employment or
lead normal lives. (i.e. it was caused by overwork amongst athletes
who were enthusiastic about exercise). The sports doctors recognised
its chronic nature and the fact that it could ruin the careers of
professional athletes, so they began recommending graduated and regulated
physical training programmes as important methods of preventing
and treating the problem.
Some observers have noted that
overwork can cause chronic fatigue so it could be called the
Overwork Syndrome which affected workers who worked too hard
for too long without adequate rest breaks. The workers who became fatigued and took rest breaks
recovered but those who ignored the symptom of fatigue and kept
working became over-exhausted and stayed exhausted.
The condition is also common in
pregnancy and in other cases it persists or starts after childbirth
when the post-natal fatigue has been called Post-Natal Depression,
due to the belief that it is the result of the psychological
stresses of motherhood. Some women with chronic fatigue can trace
their first experience of fatigue back to a pregnancy which may
have occurred twenty years earlier, and that prior to the pregnancy
they were fit and healthy and had a lot of energy and played
a lot of sport.
Other patients report that they
can trace the condition back to a traumatic experience in their
past, such as the death of a spouse, or the break up of a relationship.
Throughout history there are many
examples of epidemics of chronic fatigue of unknown cause which
have occurred amongst localised communities such as an outbreak
in Akureyri in Iceland in 1948. The symptoms included headaches,
sore throat, muscle pain, spasms, paralysis, tiredness, and emotional
instability. This set of symptoms was called Icelandic Disease
to identify it's locality, with a medical diagnosis of Myalgic
Encephalomyelitis, and it was thought to be due to a contagious
viral infection. In some cases the fatigue persisted for weeks
or months or even years afterwards, and the duration was related
to the extent of the paralysis during the original phase. It
has been proposed that the persistence of fatigue was due to
a post-viral condition where the virus became dormant or hidden
and produced long term strain on the immune system. In 1955 there
was an outbreak of the ailment affecting 300 of the male and
female staff of the Royal Free Group of hospitals in Great Britain
where it became known as The Royal Free Disease. Also, after a flu epidemic in Tapanui,
New Zealand, many patients were left with persistent fatigue
which became known as The Tapanui Flu.
In World War 1 60,000 British soldiers
returned from the trenches of the Western Front where they were
exposed to the cold and wet, poor nutrition, blood, pus, rotting
corpses, bed lice, contaminated food, food poisoning, dysentery,
and wound infections, and the war was finally brought to an end
by the Spanish flu which killed millions of soldiers and civilians
and was the most severe influenza epidemic in history. After
recovering in hospital from months of dysentery and flu the fatigue
persisted and many veterans continued to suffer from fatigue
for the remainder of their lives.
There are also many cases where
patients who have had chronic fatigue for many years, can trace
the onset of their condition back to a viral infection of some
sort, such as Glandular Fever. Prior to that infection they were
fit and healthy and lead normal lives, and since then
their lifestyle has been restricted by the fatigue.
Other patients report that they
can trace the start of the fatigue back to a period of exposure
to farm insecticides, or factory chemicals.
Some patients report that is has
been a problem since they were born because they cannot remember
a time in their lives when they were not easily fatigued, and
others cannot recall any particular starting point or incident,
and some say that the condition seemed to start incidiously
for no identifiable reason and that it gradually got worse until
it affected their sport, and then their social life, and ultimately
their employment.
There is evidence of a disorder
of blood flow throughout the body so North American medical researchers
called it Neurocirculatory Asthenia, and Russian researchers
called it Vasoregulatory Asthenia based on the idea that it is due to a disorder that affects the regulation of blood flow.
Apart from the fact that the actual
physical or organic cause of this ailment has not yet been found,
the other reason for the condition being confusing is that there
are probably several different disorders being diagnosed as one.
For example, some of the conditions may be sleep disorders (related
to tiredness) and some may be exercise disorders (related to
physical fatigue), and others may be a combination of sleep and
exercise disorder. There may also be several different causes
for each type which have the same ultimate affect on the body.
In the nineteenth century the condition
was commonly seen in women who wore tight waisted corsets which
compressed the chest, heart, and lungs and impaired blood circulation
from the feet to the chest and brain.
According to The Posture Theory,
poor posture compresses the chest and abdomen, and sedentary
work involves repeated or constant leaning toward a desk, and
when both of those factors are combined the heart, lungs, and
abdomen are being repeatedly compressed, and if that process
is continued for many years it can eventually and permanently
affect the the blood flow from the feet to the chest and brain,
and the regulation of physical responses to exertion, and sleep
patterns, which is characteristic of The Chronic Fatigue Syndrome.
Multiple factors need to be considered when assessing the cause, and the type of CFS. M.B.
The possibility of many causes
Some people have argued that coronary heart disease is due to genetics, cholesterol, smoking, alcohol, stress, or worry, and or combinations of those factors. All of those suggestions may be correct.
Some people have argued that the chronic fatigue syndrome is due to genetics, excessive and prolonged exertion, overwork, viral infections, disorders of the immune system, or the autonomic nervous system, exposure to toxic chemicals, postural problems, stress, or worry. Probably all of those factors are correct.
Unfortunately, people who favor one idea, generally try to argue that everything else is wrong, regardless of the fact that they can't prove their own idea, or prove that the others are wrong.
Eliminating criticism of Diagnostic Criteria for CFS
One of the problems in research is getting specific results which are confused with other factors, where it is argued that the symptoms could simply be due to a lack of exercise, or a due to depression etc. Hence, if I was to do a fitness study again, I would ensure that the selection criteria eliminated that confusion in the following manner.
1. The patients should have a type of fatigue which restricts their capacity for strenuous exertion and involves measurable abnormal physiology which is evident as the level of exercise increases, or afterwards.
2. The individuals should report that they have to occasionally take forced deep breaths where they often feel as if they cannot get as deep a breath as they need, and hence may take a series of two or three forced breaths. This is due to inefficient respiratory function, and is more likely to occur with greater frequency during exertion.
3.The individual should have a history of being physically fit and involved in strenuous sport in the years prior to developing CFS.
4. The individual should not show any signs of sadness, gloominess, or despondency, or any other psychological evidence of depressed mood. The history of research clearly shows that such individuals do exist and are not particularly difficult to find.
Once the data of the fatigue has been clearly determined, then it can be reassessed in relation to mixed groups later.
What not to do - Don't mix the study with people who have never exercised or played sport in their life, or individuals who look and act miserable and despondent, or you will get mixed results, and your critics will argue that they are all just unfit due to a lack of exercise, or are all depressed, and that your results and conclusions mean nothing.
I considered all individuals with chronic fatigue. Modern definitions tend to focus on a narrow range of symptoms and call it 'The Chronic Fatigue Syndrome' which gives the advantage of gaining consistent data, but creates the problem of excluding all other types from being called by that name. They are all different types of 'chronic fatigue syndrome', and all need to be identified and studied. The common problem is fatigue which restricts activity and lifestyle. Consider this reference from 1950 before that label was used . . .
Wheeler E.O. (1950), Neurocirculatory Asthenia et.al. - A Twenty Year Follow-Up Study of One Hundred and Seventy-Three Patients., Journal of the American Medical Association, 25th March 1950, p.870-889 (Contributors to the study: Edwin O.Wheeler, M.D., Paul Dudley White, M.D., Eleanor W.Reed, and Mandel E.Cohen, M.D.)
Email contact: posture@chariot.net.au
For more information about the chronic fatigue syndrome:
The South Australian Chronic Fatigue Society- ME/CFS Australia (SA) Inc.here http://www.sacfs.asn.au
The National Alliance for Myalgic Encephalomyelites here http://www.name-us.org/index.html
An article from the National Alliance for exercise testing
here http://www.name-us.org/MECFSExplainPages/TestAbnormalities.htm
A website called Doctors CFS page - Chronic fatigue syndrome information for medical doctors here http://www.cfs-news.org/doctors.html
