Fatigue that does not improve even after sleeping at night, restlessness after physical or mental exertion, difficulty organizing thoughts and even standing. These are symptoms that, if they persist for more than six months, indicate an unknown disease that some people suffer from after pregnancy. COVID-19CFS (chronic fatigue syndrome), also called encephalomyelitis.
Far from being simply laziness, the disease imposes limitations that can be severe, as well as having symptoms that can easily be confused with other conditions, such as depression, fatigue, hypothyroidism, anemia and vitamin D deficiency, for example.
Dr. Roberto Heymann, member of the Fibromyalgia Committee of the SBR (Brazilian Society of Rheumatology), explains that there are only theories about the causes of CFS, one of which is infectious diseases.
At one time there were many cases of mononucleosis [doença causada pelo vírus Epstein-Barr] That the person subsequently developed chronic fatigue. Now, with Covid-19, there is post-Covid, one of the symptoms being significant fatigue and cognitive disturbance…”
Cytomegalovirus, the bacteria that causes Lyme disease, and the fungus Candida albicans (which causes candidiasis) have also been mentioned in CFS studies, according to the MSD Guide to Diagnosis and Treatment, although the relationship has not been fully demonstrated.
The expert raises the question of whether infection by the pathogen is the cause itself or whether it is a trigger in people prone to developing chronic fatigue, something that still needs a scientific answer.
“Chronic fatigue syndrome is also described after long periods of stress at work. In the past, there was a lot of talk about chronic fatigue in very idealistic people, great workers, people in senior positions in companies, with great stress. It is like burnout. Now , if you ask yourself: What is the difference between Chronic Fatigue Syndrome and Fatigue? It’s hard to say,” he embodies.
Another factor that Heymann draws attention to is the overlap of diseases. According to him, it is also common for CFS patients to develop depression, which makes the diagnosis more complicated.
“A very active person who suddenly began to experience fatigue and developed a state of depression, we can call it chronic fatigue syndrome,” he adds, stressing the importance of treating the condition of depression.
In depression, there is negative thinking, a lack of perspective, and a lack of motivation. In chronic fatigue syndrome, a person may want to do tasks, but cannot perform tasks, as there are deficits in thinking and memory, described as ‘brain fog’.
Although the diagnosis of chronic stress syndrome is made by exclusion – the doctor will rule out a number of other possible diseases through tests or clinical evaluation – certain criteria are taken into account when this syndrome is suspected. They are as follows:
• Extreme tiredness that lasts for at least six months in a person who has not had this complaint before.
• Feeling tired most of the day.
• Fatigue that is exacerbated by physical activity or mental exertion.
• Difficulty concentrating, learning, thinking or memory.
Dizziness when standing up.
• Trouble sleeping and waking up and feeling tired (unresolved sleep).
“Although up to 25% of people have chronic fatigue, only 0.5% of people (1 in 200) have CFS,” adds the MSD handbook, citing North American data.
In the United States, the CDC (Centers for Disease Control and Prevention) estimates that between 1 and 2.5 million people have chronic fatigue syndrome, but notes that “a lot of people go undiagnosed.”
Among the reasons for this, the agency cites limited access to health services and even a lack of knowledge of professionals in the area about chronic fatigue syndrome.
“The disease is often misunderstood and may not be taken seriously by some healthcare professionals,” the CDC says on its website.
Because it is a disease that affects several areas of the body, the treatment of chronic fatigue syndrome also involves several specialties. There are no specific treatments.
A 2011 study reports that CBT (cognitive behavioral therapy) and TEG (graded exercise therapy) are beneficial for patients diagnosed with the syndrome, compared to those who received only medical care.
“The primary treatment is to try to put the person into some sort of progressive exercise program, ie gradually increasing the intensity of the exercises. This is not easy for an individual whose illness is specifically marked by extreme fatigue,” Heymann adds.
In addition, the doctor will treat other symptoms individually, such as changes in sleep, and possibly orthostatic hypotension, causing dizziness when standing, among others.
The most important thing, according to the SBR specialist, is to know that there is a possibility to resume normal life after a diagnosis of chronic fatigue syndrome, but it takes effort and time.
“Sometimes this disease can go away the same way it came or it can last for the rest of your life. Treatment is often difficult, but it can go away. In some people, there are periods of improvement and periods of deterioration.”
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