The tiresome pain of chronic fatigue

This is a condition that is made by a diagnosis of exclusion. Chronic fatigue syndrome also known as myalgic encephalomyelitis or ME.

This diagnosis is usually arrived at where there is no demonstrable problem found but the clinical picture fits a recognised pattern.

This has had the reputation of "yuppie flu" and many doctors felt it was an unusual presentation of a psychiatric problem such as depression and not a discrete clinical entity.

Recent evidence demonstrated people with ME have abnormal brain wave activity. Coupled with better recognition of the classic symptoms associated with ME means it is now a much less controversial diagnosis.

ME is a pathological fatigue state affecting both physical and cognitive performance.

The symptoms are a definite change in the patient's usual presentation.

The symptoms are marked and have to have been present for at least six months.

The usual presentation will include muscle pains, recurrent sore throats, recurrent glandular enlargement, mood disturbances, sleep disturbances and headaches.

Patients will complain of physical exhaustion, poor concentration and an inability to recover from physical effort even when rested.

Patients often have predisposing factors including eczema, asthma, hay fever and symptoms of irritable bowel.

Patients may have had a previous history of low mood, depression or other psychological problems.

The trigger for most ME sufferers is a viral infection, such as Epstein Barr causing glandular fever.

As a chiropractor I fully appreciate ME patients need a very different approach to that of a regular acute low back pain or headache sufferer.

These patients can barely get to the clinic, let alone go home after a treatment and get on with a days work or look after children.

Two particular patients stand out in my memory. One was a lovely youngster who was 17 when she developed ME.

I treated her biomechanical problems which developed from her inactivity. This girl was pale, with very fine thinning hair.

It was usually a little greasy as she had to muster up the energy to wash it with her mum's help about once a week. If you have suffered real flu you will appreciate the exhaustion caused by just having a shower or bath.

She also didn't like washing her hair as she would see how much fell out when she looked in the plug.

Her complexion was pale and almost ashen. Her eyes were dark and she moved like someone who was in the throws of a flu attack.

Slow, uncomfortable and laboured. It was a sense of achievement when we got her comfortable on the bench and she could finally relax. She didn't venture out too often.

One day I remembered commenting on her nails. She had pretty bright pink nail varnish on her fingers. She was quick to tell me not to look too closely because they were so poorly painted.

It had taken her all morning to paint them. She started just after 9am and as it required so much concentration and accuracy she had to rest between each nail.

This illustrates the kind of fatigue that severe ME can create. Another lady that I treated with ME couldn't make it to the clinic.

It was whilst I was working in Wimborne, Dorset. This lady was an existing patient of the clinic I was at and she had telephoned to see if someone could go round, as she had an acute low back pain.

She had not been to the clinic for about a year and lived about two streets away. I was instructed to arrive at the front door and ring the bell. This would tell the patient I had arrived.

She was then going to call her dog to her and I was to walk around to the back door and let myself in. She said she would be easy to find once I was in the house and the dog hadn't eaten me alive.

I followed my instructions and entered the back door. I followed her voice through the kitchen and into what would have been the dining room.

I wasn't ready for what I saw. This lady was 51 years old and living like her dog. She was on a mattress on the floor.

She was wearing grubby underwear and had clearly not washed herself or the bedding recently.

She had a bottle of water by her bed with a packet of biscuits. The dog's food bowl was not far away and was clearly her only companion.

The room was full of stacked up magazines and newspapers, which I later learned was her main contact with the outside world.

This woman had been sleeping on this mattress for nine months since the effort to climb the stairs had become too much for her.

She had recently been diagnosed with ME following a progression of her symptoms over the previous year.

This lady's life had been encased in this one room for almost 12 months.

She had an unsympathetic daughter who was only prepared to bring food to her twice a week.

It was her daughter's belief that she could just snap out of it if she wished and that her mother was attention seeking.

I found this ironic as she clearly had no ones attention. I treated her low back problem successfully over several weeks but was left feeling inadequate that it made little difference to her severe limitations.

Severe forms of ME like this one are not common and patients usually have far more supportive families.

So, the next time you yawn and think how exhausted you feel, think againWhen did you last eat, rehydrate and exercise?

Next time we are going to look at another specific cause of feeling TATT, the thyroid, as it has been requested by several readers. You can email me on ilkleychiro@tiscali.co.uk with any questions or suggestions or call Ilkley Chiropractic Clinic on 605060.