The Cause of Chronic Fatigue Syndrome; Mechanical Hypotension Webpage

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The Posture Theory And The Chronic Fatigue Syndrome (The Effort Syndrome) Webpage: a measureable condition related to aerobic capacity and metabolism.

The Chronic and Recurring Fatigue Syndrome CARFS

A Joke about chronic fatigue

The Banfield Principles for Exercise Training, and symptom management in a type of Chronic Fatigue Syndrome called the Effort Syndrome

Chronic Fatigue Syndrome

The Banfield Proof

of Physical Cause ©

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 scientifically explain the symptoms described on this webpage in some other way.

8-8-2005

The different types of CFS

8 different causes of CFS

A theory linking differrent causes to postural & mechanical hypotension

About the author; A biography of CFS

The tiredness of former Australian Deputy Prime Minister John Anderson

The Chronic Q Fever Fatigue Syndrome

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)
Viruses see also Chronic Q-Fever Fatigue Syndrome	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. 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

as a basis for a theory on mechanical hypotension as the cause. © 5-8-05

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).

Choosing the Best Explanation

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 - 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

Another brief biography describing the difference between the symptoms of the Effort Crisis in the Effort Syndrome, and the normal response to effort in sport

The Banfield Principles for Exercise Training, and symptom management in a type of Chronic Fatigue Syndrome called the Effort Syndrome

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.

Vaccines can prevent the problem.

Reference - http://www.abc.net.au/health/library/qfever_ff.htm

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.

Return to The Posture Theory homepage

The Posture Theory And The Chronic Fatigue Syndrome (The Effort Syndrome) Webpage

For more information and evidence on the physical basis for the exertion symptoms in The Effort Syndrome

see Tricky Heart may cause chronic fatigue

http://my.webmd.com/content/article/63/72082.htm