https://www.sandiegohealthdirectory.com/kb en-us People with CFS present with different patterns of primary symptoms. Symptom severity can also vary considerably. Clinicians should query patients about which symptoms are most disruptive or disabling and tailor the management plan accordingly. Treatment can be directed toward the most problematic symptoms as prioritized by the patient, but only after underlying conditions applicable to those symptoms have been investigated and excluded. https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=65 Thu, 15 Jun 2006 03:47:23 GMT https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=65 People with CFS present with different patterns of primary symptoms. Symptom severity can also vary considerably. Clinicians should query patients about which symptoms are most disruptive or disabling and tailor the management plan accordingly. Treatment can be directed toward the most problematic symptoms as prioritized by the patient, but only after underlying conditions applicable to those symptoms have been investigated and excluded.

Primary symptoms may include sleep problems, muscle and joint pain, cognitive dysfunction, fatigue, headaches and sore throat. Gastrointestinal complaints, orthostatic instability, depression and allergies are also seen in many patients. Aggressive symptom management for these and other disruptive symptoms is indicated.

Pharmacologic Therapy
Pharmacologic therapy is directed toward the relief of specific symptoms experienced by the individual patient. There are many over-the-counter and prescription drug therapies that can be used to treat sleep difficulties, cognitive problems, pain and other symptoms of CFS.

Many CFS patients are sensitive to medications, particularly sedating medications. Therapeutic benefits can often be achieved at lower than normal dosages, so try prescribing a fraction of the usual recommended dose to start and gradually increase as necessary and as tolerated. All medications can cause side effects, which may lead to new symptoms or exacerbate existing symptoms, so it is important to routinely monitor all prescription drugs, OTC therapies and supplements the patient is taking.

Some drugs act on multiple body systems and symptoms. For instance, tricyclic antidepressants may not only improve mood, but may help with sleep and pain. Prescribing such drugs allows the use of fewer medications to address multiple symptoms with minimal side effects.

Nutritional and Herbal Supplements
Nutritional supplements and vitamins are frequently used by people with CFS for symptom relief. While there have been few clinical trials and many CFS patients report symptom relief with supplements, these products are unregulated, and information on potency and side effects is frequently unknown. The health care professional needs to question patients about supplement use and OTC products to determine safety, efficacy and possible negative interactions with prescribed medications and therapies
.
Patients should be advised to avoid herbal remedies like comfrey, ephedra, kava, germander, chaparral, bitter orange, licorice root, yohimbe and any other supplements that are potentially dangerous.

Nutritional supplements can't take the place of good diet and nutrition and, as such, a well-balanced diet should be encouraged. Some people with CFS report sensitivities to various foods or chemicals, including refined sugar, caffeine, alcohol and tobacco, all of which should be minimized to promote optimum health.

Alternative Therapies
Alternative therapies are often explored by CFS patients to relieve symptoms. Encourage patients to discuss such options with a health care professional to make sure they are safe and effective. Acupuncture, aquatic therapy, gentle massage, meditation, deep breathing, biofeedback, yoga, tai chi and massage therapy have been found to help some patients and are often prescribed for CFS symptom management.

Sleep Disturbances
The majority of CFS patients experience some form of sleep dysfunction. Common sleep complaints include difficulty falling asleep, hypersomnia, frequent awakening, intense and vivid dreaming, restless legs and nocturnal myoclonus. Most CFS patients experience nonrestorative sleep as compared to their pre-illness experience.

Health professionals can help people with CFS adopt good sleep habits. Patients should be advised to practice standard sleep hygiene techniques: establish a regular bedtime routine; avoid napping during the day, incorporate an extended wind-down period; use the bed only for sleep and sex; schedule regular sleep and wake times; control noise, light and temperature; and avoid caffeine, alcohol and tobacco. Light exercise and stretching earlier in the day, at least four hours before bedtime, may also improve sleep.

When sleep hygiene isn't successful, the use of pharmaceuticals may be indicated. Initial medications to consider are simple antihistamines or over-the-counter sleep products. If this isn't beneficial, then start with a prescription sleep medicine in the smallest possible dose and briefest period possible.

Unrefreshing sleep can be present even though medications may help patients achieve requisite hours of sleep. A sleep specialist should evaluate patients whose sleep remains non-restorative following standard interventions.

Primary sleep disorders such as sleep apnea and narcolepsy exclude the diagnosis of CFS, and most people with such disorders respond to therapy. It is imperative to obtain a careful sleep history. The Pittsburgh Sleep Questionnaire, a validated 19-question tool, or a brief sleep survey adapted from the CDC Symptom Inventory can be useful in assessing sleep problems and tracking effectiveness of sleep management interventions.

Pain
CFS pain occurs both in muscles (sometimes described as "deep pain") and joints (arthralgias). Patients may also complain of headaches (typically pressure-like) and allodynia, which is generalized hyperalgesia or soreness of the skin to touch.

Most pain therapy begins with simple analgesics like acetaminophen, aspirin or NSAIDS..Additional therapy can be managed by a pain specialist. Counseling for pain management techniques is advisable for patients with this kind of unremitting pain.

Pain management should include nonpharmacological modalities and alternative therapies. Stretching and movement therapies, gentle massage, heat, toning exercises, hydrotherapy and relaxation techniques can be helpful for CFS care. Acupuncture, when administered by a qualified practitioner who is knowledgeable about CFS, may be effective for pain management in some patients.

Orthostatic Instability
Some patients with CFS may also exhibit symptoms of orthostatic instability, in particular frequent dizziness and light-headedness.

Depending on severity and clinical judgment, these patients should be referred for evaluation by a cardiologist or neurologist. Specific treatment for orthostatic instability should only be initiated following confirmed diagnosis and by clinicians experienced in evaluating therapeutic results and managing possible complications.

Treatments for orthostatic problems include volume expansion for CFS patients who don't have heart or blood vessel disease. If symptoms don't improve with increased fluid and salt intake, prescription medications and support hose can be prescribed.

During office visits, provide a place for CFS patients to recline if they have difficulty staying upright for more than a few minutes at a time.

Depression
Research shows that CFS is not a form of psychiatric illness or depression. However, many people with chronic illnesses, including those with CFS, may suffer from secondary depression as the patient makes the multiple adjustments to having a debilitating, chronic illness.

As many as half of CFS patients develop depression sometime during the course of the illness. When it's present, it needs to be treated. Although treating depression can reduce anxiety and stress, it's not a cure for CFS.

Professionals are advised to use caution in prescribing antidepressants. Antidepressant drugs of various classes have other effects that may act on other CFS symptoms and/or cause side effects.

There are brief psychiatric screening tools available that can be administered and scored in the primary care setting, such as the Beck Depression Inventory and the PHQ9. Results of these screening tools that point to a possible underlying depression or other psychological disorder necessitate a referral to a mental health professional.
.
Cognitive Dysfunction
Memory and concentration complaints are two of the more distressing symptoms reported by people with CFS. Relaxation and meditation training and memory aids, such as organizers, schedulers and written resource manuals, can be helpful in addressing cognitive problems. Stimulating the mind with puzzles, word games, card games and other activities may also be beneficial for some patients.

Clinicians may want to refer some CFS patients to behavioral health professionals to help them problem-solve and develop specific techniques for conducting activities of daily living that have become difficult. Referral to a neuropsychologist, neurologist or psychiatrist for evaluation and testing may be necessary in severe cases to determine whether other underlying conditions may be involved. It should be noted that training to improve cognition is a highly specialized therapy and requires input of trained behavioral health clinicians.

Use caution in prescribing stimulants for cognitive problems. Mild stimulants may be helpful for some patients, but stronger stimulants can precipitate the push-crash cycle and cause relapse.

Managing Patients with CFS
While symptom management is critical to the care of patients with chronic fatigue syndrome, it is also important for clinicians to address the emotional and psychosocial consequences of CFS. Like other debilitating chronic illnesses, CFS can have a profound impact on daily life, requiring patients to make therapeutic lifestyle changes including adaptation to prevent life-altering limitations.

The overall treatment plan should acknowledge the limitations of this illness, and the patient’s emotional reactions to them. While patients are justified in their emotional response to such a devastating illness, educating them about the link between stress and symptom exacerbation is an important adjunct to validating their feelings and subsequent clinical improvement.]]> As the name chronic fatigue syndrome suggests, this illness is accompanied by fatigue. However, it's not the kind of fatigue patients experience after a particularly busy day or week, after a sleepless night or after a stressful event. https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=64 Thu, 15 Jun 2006 03:41:23 GMT https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=64 Chronic fatigue syndrome shares symptoms with many other disorders. Fatigue, for instance, is found in hundreds of illnesses, and 10% to 25% of all patients who visit general practitioners complain of prolonged fatigue. The nature of the symptoms, however, can help clinicians differentiate CFS from other illnesses.

Primary Symptoms
As the name chronic fatigue syndrome suggests, this illness is accompanied by fatigue. However, it's not the kind of fatigue patients experience after a particularly busy day or week, after a sleepless night or after a stressful event. It's a severe, incapacitating fatigue that isn't improved by bed rest and that may be exacerbated by physical or mental activity. It's an all-encompassing fatigue that results in a dramatic decline in both activity level and stamina.

People with CFS function at a significantly lower level of activity than they were capable of prior to becoming ill. The illness results in a substantial reduction in occupational, personal, social or educational activities.

A CFS diagnosis should be considered in patients who present with six months or more of unexplained fatigue accompanied by other characteristic symptoms. These symptoms include:
1. cognitive dysfunction, including impaired memory or concentration
2. postexertional malaise lasting more than 24 hours (exhaustion and increased symptoms) following physical or mental exercise
3. unrefreshing sleep
4. joint pain (without redness or swelling)
5. persistent muscle pain
6. headaches of a new type or severity
7. tender cervical or axillary lymph nodes
8. sore throat

Other Common Symptoms
In addition to the eight primary defining symptoms of CFS, a number of other symptoms have been reported by some CFS patients. The frequency of occurrence of these symptoms varies among patients. These symptoms include:
1. irritable bowel, abdominal pain, nausea, diarrhea or bloating
2. chills and night sweats
3. brain fog
4. chest pain
5.shortness of breath
6. chronic cough
7. visual disturbances (blurring, sensitivity to light, eye pain or dry eyes)
8. allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise
9. difficulty maintaining upright position (orthostatic instability, irregular heartbeat,
10. dizziness, balance problems or fainting)
11. psychological problems (depression, irritability, mood swings, anxiety, panic attacks)
12. jaw pain
13. weight loss or gain

Clinicians will need to consider whether such symptoms relate to a comorbid or an exclusionary condition; they should not be considered as part of CFS other than they can contribute to impaired functioning.

Clinical Course
The severity of CFS varies from patient to patient, with some people able to maintain fairly active lives. By definiton, however, CFS significantly limits work, school and family activities.

While symptoms vary from person to person in number, type and severity, all CFS patients are functionally impaired to some degree. CDC studies show that CFS can be as disabling as multiple sclerosis, lupus, rheumatoid arthritis, heart disease, end-stage renal disease, chronic obstructive pulmonary disease (COPD) and similar chronic conditions.

CFS often follows a cyclical course, alternating between periods of illness and relative well-being. Some patients experience partial or complete remission of symptoms during the course of the illness, but symptoms often reoccur. This pattern of remission and relapse makes CFS especially hard for patients and their health care professionals to manage. Patients who are in remission may be tempted to overdo activities when they're feeling better, which can exacerbate symptoms and fatigue and cause a relapse. In fact, postexertional malaise is a hallmark of the illness.

The percentage of CFS patients who recover is unknown, but there is some evidence to indicate that the sooner symptom management begins, the better the chance of a positive therapeutic outcome. This means early detection and treatment are of utmost importance. CDC research indicates that delays in diagnosis and treatment may complicate and prolong the clinical course of the illness.]]> Fibromyalgia is a disorder that causes muscle pain and fatigue (feeling tired). People with fibromyalgia have "tender points" on the body. Tender points are specific places on the neck, shoulders, back, hips, arms, and legs https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=56 Wed, 14 Jun 2006 05:39:38 GMT https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=56
People with fibromyalgia may also have other symptoms, such as:
1. Trouble sleeping
2. Morning stiffness
3. Headaches
4. Painful menstrual periods
5. Tingling or numbness in hands and feet
6. Problems with thinking and memory (sometimes called "fibro fog").

What Causes Fibromyalgia?
The causes of fibromyalgia are unknown. There may be a number of factors involved.
Fibromyalgia has been linked to:
1. Stressful or traumatic events, such as car accidents
2. Repetitive injuries
3. Illness
4. Certain diseases.

Fibromyalgia can also occur on its own.
Some scientists think that a gene or genes might be involved in fibromyalgia. The genes could make a person react strongly to things that other people would not find painful.

Who Is Affected by Fibromyalgia?
Fibromyalgia affects as many as 1 in 50 Americans. Most people with fibromyalgia are women. However, men and children also can have the disorder. Most people are diagnosed during middle age.

People with certain other diseases may be more likely to have fibromyalgia. These diseases include:
1. Rheumatoid arthritis
2. Systemic lupus erythematosus (commonly called lupus)
3. Ankylosing spondylitis (spinal arthritis).

Women who have a family member with fibromyalgia may be more likely to have fibromyalgia themselves.

How Is Fibromyalgia Treated?
Fibromyalgia can be hard to treat. It's important to find a doctor who is familiar with the disorder and its treatment. Many family physicians, general internists, or rheumatologists can treat fibromyalgia. Rheumatologists are doctors who specialize in arthritis and other conditions that affect the joints or soft tissues.

Fibromyalgia treatment often requires a team approach. The team may include your doctor, a physical therapist, and possibly other health care providers. A pain or rheumatology clinic can be a good place to get treatment.

The U.S. Food and Drug Administration (FDA) has not yet approved any medicines to treat fibromyalgia. Doctors treat fibromyalgia with medicines approved for other purposes. Pain medicines and antidepressants are often used in treatment.

What Can I Do to Try to Feel Better?
There are many things you can do to feel better, including:
1. Taking medicines as prescribed
2. Getting enough sleep
3. Exercising
4. Eating well
5. Making work changes if necessary.

What Research Is Being Done on Fibromyalgia?
The NIAMS sponsors research to help understand fibromyalgia and find better ways to diagnose, treat, and prevent it. Researchers are studying:
1. Why people with fibromyalgia have increased sensitivity to pain
2. The role of stress hormones in the body
3. Medicines and behavioral treatments
4. Whether there is a gene or genes that make a person more likely to have fibromyalgia.

For More Information on Fibromyalgia and Other Related Conditions:
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health ]]> Lead poisoning is one of the most common and preventable public health problems among young children. Many are now aware that even small amounts of lead can have disastrous effects. https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=22 Mon, 05 Jun 2006 06:28:06 GMT https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=22
There is no safe blood lead level. Chronic exposure to high levels of lead can cause brain damage, affect a child’s growth, damage kidneys, and impair hearing, as well as cause vomiting and headaches. It can cause learning and behavioral problems for children. In adults, lead can increase blood pressure and can cause digestive problems, nerve disorders, sleep problems and mood changes.

Fetuses, infants and children are more vulnerable to lead exposure than adults since lead is more easily absorbed into growing bodies. Another reason is that small children are more sensitive to the damaging effects of lead. This is especially the case with children from infancy to six years of age because their brains and nervous system are not yet fully developed.

Children who are lead toxic may have no outward appearance of illness. A child’s behavior may be the only indication that he or she is accumulating toxic amounts of lead. There are now recorded cases where a child’s unruly behavior like bullying and poor performance in school are directly linked to high lead exposure. Lead toxic children are normally identified as being "difficult to manage."

Studies with children show a seven times higher chance of dropping out of high school with lead exposure in early childhood and a higher rate of delinquent behavior in later adolescence.
Lead is a sweet-tasting highly toxic metal that produces various damaging effects on health especially young children.

The major cause of lead poisoning is deteriorating lead-based paint and the interior and exterior dust caused by such paint. Other sources could be air, drinking water, food and contaminated soil. Airborne lead enters the body when you breathe or swallow lead particles or dust once it has settled. Lead can leach into drinking water from certain types of plumbing materials, such as lead pipes, copper pipes with lead solder and brass faucets.

It can also be found on walls, woodwork and the exterior of homes in the form of lead-based paint. Lead can be deposited on floors, windowsills, eating and playing surfaces, or in the soil outside the home.

Most homes built before 1940 and half of homes built from 1940 to 1960 contain lead-based paint. Lead paint was banned from residential use in 1978. As a rule, the older the house, the more likely it is to contain lead-based paint and a higher concentration of lead in the paint.

Past emissions of leaded gasoline now account for the high level of lead found in soil. This is why it is unsafe for children to play in the dirt or in dusty areas, even indoors. They then put their fingers, clothes, or toys in their mouths, or if they eat without first washing their hands.

What steps are being done? For starters, the United States is spending $147 million to address the problem of lead exposure from housing sources. They have established a system that considers the health of occupants and the physical condition of houses. They require blood lead screenings done on children especially in high-risk areas that are determined by the age of the housing, the number of poor families and the prevalence of children previously found to have elevated blood lead levels.

Certified lead inspectors and accredited lead removal contractors are helping many people in both poor and affluent sectors of their communities.

Canada is following suit. They are now fully aware of the problem and are actively enacting laws to address the problem of lead exposure.
If your home was built before 1978, chances are it contains lead-based paint. If you had a child under age six who may have been exposed to it, he or she should have a blood lead test. In children any blood lead level greater than 10 micrograms per deciliter is considered elevated blood lead level; for adults it is any blood lead level greater than 25 (æg/dl).

Some even encourage the use of hair elemental analysis as an adjunct to blood screening in detecting chronic exposure to metals such as lead and mercury.

Check your house for peeling and chipping paint. Clean it up and prevent your children from touching those areas. Cover these areas with contact paper and block them off with furniture. Cover old carpets. They can be full of lead dust. Let your children play elsewhere.

When cleaning, wet mop floors at least twice a week. Add detergent to the wash water and rinse. Wash windowsills weekly. Do not rinse used paper towels. Just throw them away. The windowsill is the part of the house that is normally in direct contact with young children. Some of them even chew on the paint found in windowsills.

Put a washable floor mat outside your front and back service doors. Wash them weekly.

To prevent lead dust from getting to your child’s mouth, wash his or her hands before eating. It also helps to keep your child’s fingernails clean and trimmed.

It is also important to stress the need to make sure that the children are fed nutritious food. Lead latches on to children’s bones, like nutrient such as calcium. Experts agree that poisoning is more severe when a child’s diet is poor.

Next time your child becomes unruly and difficult to manage, don’t blame it on his genes or his nutrition; he just might be suffering from toxic lead poisoning.
]]> Study finds nerve damage in previously mysterious chronic pain syndrome Reduction in small-fiber nerves may underlie complex regional pain syndrome-I (reflex sympathetic dystrophy) https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=8 Fri, 03 Feb 2006 14:49:23 GMT https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=8
"This sort of small-fiber degeneration has been found in every nerve pain condition ever studied, including postherpetic neuralgia and neuropathies associated with diabetes and HIV infection," says Anne Louise Oaklander, MD, PhD, director of the MGH Nerve Injury Unit, who led the study. "The nerve damage in those conditions has been much more severe, which may be why it's been so hard to detect CRPS-I-related nerve damage."

Complex regional pain syndrome is the current name for a baffling condition first described in the 19th century in which some patients are left with severe chronic pain and other symptoms - swelling, excess sweating, change in skin color and temperature - after what may be a fairly minor injury. The fact that patients' pain severity is out of proportion to the original injury is a hallmark of the syndrome, and has led many to doubt whether patients' symptoms are caused by physical damage or by a psychological disorder. Pain not associated with a known nerve injury has been called CRPS-I, while symptoms following damage to a major nerve has been called CRPS-II.

Because small-fiber nerve endings transmit pain messages and control skin color and temperature and because damage to those fibers is associated with other painful disorders, the MGH research team hypothesized that those fibers might also be involved with CRPS-I. To investigate their theory they studied 18 CRPS-I patients and 7 control patients with similar chronic symptoms known to be caused by arthritis. Small skin biopsies were taken under anesthesia from the most painful area, from a pain-free area on the same limb and from a corresponding unaffected area on the other side of the body.

The skin biopsies showed that, the density of small-fiber nerve endings in CRPS-I patients was reduced from 25 to 30 percent in the affected areas compared with unaffected areas. No nerve losses were seen in samples from the control participants, suggesting that the damage was specific to CRPS-I, not to pain in general. Tests of sensory function performed in the same areas found that a light touch or slight heat was more likely to be perceived as painful in the affected areas of CRPS-I patients than in the unaffected areas, also indicating abnormal neural function.

"The fact that CRPS-I now has an identified cause takes it out of the realm of so-called 'psychosomatic illness.' One of the great frustrations facing CRPS-I patients has been the lack of an explanation for their symptoms. Many people are skeptical of their motivations, and some physicians are reluctant to prescribe pain medications when the cause of pain is unknown," says Oaklander. "Our results suggest that CRPS-I patients should be evaluated by neurologists who specialize in nerve injury and be treated with medications or procedures that have proven effective for other nerve-injury pain syndromes." She adds that the next research steps should investigate why some people are left with CRPS after injuries that do not cause long-term problems for most patients, determine the best way of diagnosing the syndrome and evaluate potential treatments.

"Investigations that identify the causes of disease are only possible if patients are willing to come to the lab and allow researchers to study them," she adds. "We are tremendously grateful to these CRPS patients, whose willingness to let us study them - despite their chronic pain - allowed us to make an important step in helping those who suffer from this condition." Oaklander is an assistant professor of Anaesthesia and Neurology at Harvard Medical School.

The study was supported by grants from The Mayday Fund, the National Institute for Neurological Disorders and Stroke, and the American Federation for Aging Research. Coauthors are Julia Rissmiller, Lisa Gelman, Li Zheng, MD, PhD; Yuchiao Chang, PhD; and Ralph Gott, all of the MGH.


Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of nearly $500 million and major research centers in AIDS, cardiovascular research, cancer, cutaneous biology, medical imaging, neurodegenerative disorders, transplantation biology and photomedicine. In 1994, MGH and Brigham and Women's Hospital joined to form Partners HealthCare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups, and nonacute and home health services.

]]>