CFIDS: Chronic Fatigue and Immune Dysfunction Syndrome
In general, the physical examination shows only subtle abnormalities, such as throat inflammation or muscle and lymph node tenderness. It is truly remarkable that a patient can feel so bad yet look relatively well. The routine laboratory evaluation, like the physical examination, shows only minimal, if any, abnormalities. Although sophisticated laboratory testing may reveal abnormal results, they are difficult for most physicians to interpret and have been largely ignored. The combination of numerous severe somatic complaints and only minor abnormalities on physical exam and routine laboratory testing is the reason many physicians have dismissed this illness as hypochondriasis.
In the past fifty years, the emphasis in medicine has been to divide illnesses into categories by the nature of the symptoms. Therefore, a joint specialist would see CFIDS as a form of arthritis, a psychiatrist would see it as mental illness, and an allergist would see it as a manifestation of allergies. It is ironic that in this day of specialists, the generalists have been the only group of physicians able to recognize the spectrum of symptoms in CFIDS as a specific syndrome. But in our era of technology, it is rare for specialists to listen to generalists.
And specialists have been unable to make much progress in studying this illness, primarily because of the lack of "disease" in the organs in which they specialize. That is to say, although the muscles hurt, muscle biopsies are normal or show minimal changes only. Although there are headaches, CT scans of the brain are normal. Specialists are interested in diseases originating in their area of specialty. In these days of specialty medicine, a patient with CFIDS might see more than ten different specialists, and none will be able to find the cause of the complaints. In CFIDS, whatever causes the symptoms is outside of the limited specialties. We are witnessing a disease so fundamental in its origin that it affects all body systems but causes little damage.
Following is a list of the myriad symptoms seen in CFIDS.
Fatigue or exhaustion
Headache
Malaise
Short-term memory loss
Muscle pain
Difficulty concentrating
Joint pain
Depression
Abdominal pain
Lymph node pain
Sore throat
Lack of restful sleep
Muscle weakness
Bitter or metallic taste
Balance disturbance
Diarrhea
Constipation
Bloating
Panic attacks
Eye pain
Scratchiness in eyes
Blurring of vision
Double vision
Sensitivity to bright lights
Numbness and/or tingling in extremities
Fainting spells
Light-headedness
Dizziness
Clumsiness
Insomnia
Fever or sensation of fever
Chills
Night sweats
Severe weight loss and gain
Allergies
Chemical sensitivities
Palpitations
Shortness of breath
Flushing rash of the face and cheeks
Swelling of the extremities or eyelids
Burning on urination
Sexual dysfunction
Hair loss
A list of CFIDS symptoms is misleading. At first glance it appears that almost every symptom possible is part of the list. This is another reason many physicians have not accepted the reality of CFIDS-there are simply too many symptoms. But a patient relating these symptoms does not list them in a random manner. They fit a precise pattern that is nearly identical from one patient to the next. The pattern of symptoms is so reproducible in the usual case that patients are able to diagnose CFIDS in others in an instant.
(From the book by David S. Bell, M.D., The Disease of a Thousand Names [Lyndonville, Pollard Publications, 1991]. Reproduced here with the permission of the author. )
:also, so many of these symptoms sound mild and aren't imagined as not only chronic (not just recurring) but also acute and happening all at the same time!
