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The Chronic Accrual and
Recurring Fatigue Syndrome (CARFS)
Chronic Fatigue
Syndrome Jokes
The Chronic
Query Fever fatigue syndrome
kkk
The most complicated
illness in medical history - The Chronic Fatigue Syndrome
The Chronic Fatigue Syndrome
(The Effort Syndrome)
CFS and exercise
Webpage
A measurable condition where the severity
is related to aerobic capacity and metabolism
By M.A.Banfield
The chronic fatigue
syndrome causes more anxiety, depression, insanity, suicide and
economic incapacity than any other illness. This website provides
information which will be useful in describing, diagnosing, understanding,
measuring, and managing with the condition.
The Chronic Fatigue Syndrome A very
common condition
The development phases of chronic
fatigue in the effort syndrome
|
Return to The Posture Theory homepage The Chronic Accrual and Recurring Fatigue Syndrome (CARFS)
Chronic Fatigue Syndrome Jokes The Chronic Query Fever fatigue syndrome kkk The most complicated illness in medical history - The Chronic Fatigue Syndrome |
The Chronic Fatigue Syndrome(The Effort Syndrome)CFS and exerciseWebpageA measurable condition where the severity is related to aerobic capacity and metabolismBy M.A.Banfield
|
The Chronic Fatigue Syndrome A very common condition
The development phases of chronic fatigue in the effort syndrome |
About the
author of this web page (added on
2-11-05)
I have survived
more than 100 diseases and injuries; this is a brief biography
of my experience with chronic fatigue and exercise
What I did to diagnose the problem
In 1975, after 3 years of health problems
that were becoming relentlessly worse my symptoms became intolerable
but my doctor was unable to diagnose my condition (because "there
was no evidence of organic disease") so I decided to start
reading a few medical books to see what I could find. I soon
found that my symptoms were consistent with Da Costa's Syndrome
(first identified by J.M. DaCosta in 1871)which is nowadays called
The Chronic Fatigue Syndrome.
Why I attempted to treat the condition
with exercise
Many of my symptoms were aggravated
by the slightest exertion, and my general assumption was that
my problems involved a deterioration in my physical condition,
so I decided to treat the problem with some regular exercise
under medical supervision. I made some enquiries and found that
such a service was provided by the South Australian Institute
for Fitness Research and Training so I enrolled in one of their
courses. My immedicate objective was to use exercise safely to
improve my level of fitness to a good standard and regain my
health. After having my fitness assessed I designed my own fitness
programme and proceeded to follow it while training within a
large group of fitter, faster individuals. (I had to ignore the
pressure to conform to the higher levels of training, which was
partly due to the problem of persisting with training while I
was always running last, and partly due to the negative remarks
of some other runners).
My fitness level was scientifically measured
as zero
In the process of training I also found articles
in medical research journals which presented the general opinion
that the condition involved a fear of exercise in people who
had been protected from the vigors of sport as children (I had
to give up my role as gymnastics instructor because of my health
problems, so the idea that the symptoms were due to a fear of
exercise was obviously wrong). I was provided with my own medical
reports which showed that when I started training my fitness
level was zero, compared with a normal healthy level of 900 and
an athletes level of 1200. I was also told that the scores were
determined scientifically using graphs of ergometric load over
pulse rate so that the results were impossible to fake.
(In contrast to my aerobic fitness level of
zero, one of the staff told me that my subcutanious fat level
was that of an athlete. This was measured by applying a caliper
to the skin fold of my abdomen, and I can recall that the teeth
of the calipers were virtually compressing two pieces of skin
together with no fat between).
How I determined that my condition was
chronic
I continued to train for 3 months and
my level rose to 350 so I was becoming quite enthusiastic about
the prospect returning to full health. I therefore trained more
frequently for a further 3 months but at the end of that time
my fitness level was still 350 so I had to consider three things.
That my condition was measurable, and that it was abnormally
low and not related to a lack of exercise, and that it was chronic
and was not continuing to improve to normal levels despite regular,
more frequent, and increasing levels of exercise.
Why I stopped training
I continued to train for a further 3
months when I damaged a knee cartilage and had to stop.
The first effective exercise programme
for CFS
I was therefore the first person in
medical history to design an exercise programme which was achievable
for patients with chronic fatigue, and was the first to provide
scientific evidence that it was a real, physical, and measurable
condition.
I wrote a theory about posture and cfs
Four years later I wrote a theory which
explained how poor posture could cause that type of chronic fatigue
(there are many causes and types)
I co-ordinated a research programme on
exercise and cfs and why all previous medical programmes failed
In 1975 I was invited to coordinate
a research programme for other people with chronic fatigue at
the Fitness Institute, and became the first individual to succeed
in having such patients continue to participate in programmes
(previous programmes which were conducted by doctors who thought
that the ailment was due to a fear of exercise, all ignored the
reality of the symptoms, and all failed. That was because the
patients who followed the doctors instructions and tried to run
at a normal pace would have developed distressing symptoms and
lost confidence in the advice immediately. Most of the other
patients refused to follow instructions or dropped out within
the first few weeks - It was reported in the journals that "they
could not, or would not train".)
Bureaucratic requirements for research
In order to start the programme I had to get
a small government grant and fulfill a few bureaucratic requirements.
I wanted to establish that the condition was measurable so that
other researchers would start trying to cure it (instead of ignoring
it). I was advised to ask for a grant aimed at curing the problem
with an exercise programme rather than measuring it's severity.
(this was because measuring the condition would give proof of
disease and would require doctors and governments to take responsibility
for it, but curing it would solve the patients problems and remove
the governments exposure to the expense of paying for "another
real illness".
I found that many cfs patients had measurable
and abnormally low aerobic capacity
While conducting the programme I found that
some of the other patients with persistent fatigue had abnormally
low scores which were not improving in the normal manner, as
would be expected from healthy people.
The value of scientific evidence???
In the process I had the opportunity to discuss my own
results with a research cardiologist (fitness readings from zero
to 350 and plateauing) and I asked him if that was convincing
scientific evidence of my condition being real and physical.
The exact words in his blunt reply were astonishing and given
in a resentful tone of voice; he said "No! that means nothing!!!"
I got the impression that he was jealous of a non-doctor making
a credible scientific discovery and proving some old theories
wrong, but I wasn't trying to prove anything. My objective was
to solve my own problems, and offending doctors was just creating
more problems.
Also I must say that I had courteous relations with most
of the staff and doctors who were co-operating with me in the
research, and because of my role as co-ordinator, I had access
to the premises on a regular basis. However when I wanted to
access my own file out of curiosity about the medical opinion
given about me, I was advised that it was not standard practice
to give non-doctors permission to read them. Nevertheless, I
made a point of waiting until the staff were out, and went into
the file room and read my own records. Within the text were the
typed words "This man is a hopeless hypochondriac".
This made me furious so I stormed out of the building telling
everyone in sight that they were all useless idiots. After calming
down I apologised for my outburst, as most of them were not responsible
for the remarks. In the meantime I decided that I could only
rely on myself if I wanted to get any useful understanding of
the problem.
(Regarding the doctor who diagnosed "hopeless hypochondriac"
- When I first met him I was suffering from dozens of symptoms,
including breathing difficulties, faintness, and dizziness, and
my heart was pounding violently in response to the slightest
exertion. I vaguely recall having difficulty walking from my
car to the Institute building, and then I found it difficult
to get up the stairs to the medical room on the first floor,
and then the slight effort of riding the ergometric cycle produced
a fitness reading of zero. I was also withdrawing from a high
dose of barbiturates, and decided to study medicine myself because
my doctor was unable to account for my symptoms or treat them
effectively, and I was hopeful of getting better insight from
a research scientist who I presumed would know more than a suburban
general practitioner. I was furious about the diagnosis of hypochondria
because that meant that even research scientists were useless
to me i.e. they did not take my problems seriously and were doing
nothing other than providing a worthless and insulting diagnosis,
and had no intentions of trying to find a cure).
80 patients with cfs were medically assessed
I continued the research programme for
about 2 years but eventually had to stop for health reasons.
During that time more than 80 people with chronic fatigue were
medically assessed and commenced training. Several of them continued
training for 2 hours, twice per week, for 3 training periods
of 3 months each - more than 9 months, and were still training
when I left the programme. One of them participated in a 6 mile
marathon. I have maintained reasonable health for myself since
then by walking 10 - 20 kilometers per week at a casual pace.
What I did about bureaucratic obstacles
About 5 years later I was able to find
another medical opinion about my own health by going through
the difficult task of weaving through bureaucratic obstacles
associated with The Freedom of Information Act, and I found information
which was supposed to be hidden from patients, and the typed
words were "this man is not ill, he only believes he is".
"He is the leader of a self-help group and acknowledging
his condition would have a bad influence on the others".
(I tried to solve some my health problems by establishing several
self help groups for patients with chronic fatigue, and chronic
abdominal pain, essentially because doctors were not providing
any effective treatments). Most of the statements in the report
were misrepresentations of what I said, and some were the exact
opposite, with the obvious intention of discrediting my opinion.
When I discussed my symptoms with him before he prepared the
report I described fatigue in relation to exertion, and abdominal
pain in relation to repetitive bending at the midriff, and he
tried to create the impression that I was an ignorant person
who didn't know his own mind and gave the diagnosis of anxiety
hysteria (that I was converting psychological problems into imaginary
physical symptoms, or that I had an exaggerated fear of trivial
disease). He wrote "There is nothing at all to find on complete
general examination."
I obtained evidence of biochemical abnormalities
in cfs from Newcastle University
About another 5 years passed when I heard
about some researchers in Newcastle University (of New South
Wales) who had found evidence of metabolic abnormalities in chronic
fatigue by examining the chemical profile of urine, so I sent
a sample of my urine to them with the appropriate fee. They returned
two results consistent with the most severe level of chronic
fatigue.
CFS was officially recognised as a medical
condition by the AMA
The Australian Medical Association accepted
that chronic fatigue was an officially recognised medical condition
about 10 years later (in the 1990's).
Modern exercise programmes for cfs
Nowadays there are many exercise programmes
on offer as treatments. All modern exercise programmes use similar
principles to those that I used in 1975 and 1980 when I established
that it was possible for most people to gain a moderate improvement
in health, and in a small number of cases a return to normal
levels of fitness. They involve starting with very mild exercise
(walking)) and progressing slowly.
Current medical attitudes
However, I still see articles which
repeatedly refer to the problem as an anxiety disorder for which
there is no organic evidence, which is not measurable, and simply
involves a fear of exercise, or is just tiredness. M.B.
|
The History of Science and Serendipity
It has been a common enough observation from scientific
history, that the answer to a mystery will be staring thousands
of people in the face, before someone who is looking for it,
sees it, and recognises it's value.
I therefore presume that in 1976, when I saw that my own
fitness reading was scientifically measured as zero, that I was
the first person to recognise it as evidence of a measurable
physical cause of a health problem, because I was looking for
it, and nobody else was.
I can only suppose that thousands of doctors had seen that
data before me, mixed in with data from other types of patient
in fitness programmes, and have routinely assumed that it was
due to lack of exercise resulting from laziness, or due to a
fear of exercise.
It should also be staring any reasonable person in the
face to note that, if I was afraid of exercise I would not have
tried to treat my health problems by deciding, entirely on the
basis of my own considerations, to volunteer for a fitness training
programme, and I would not have continued with it for the best
part of a year, ultimately for 2 hours per day for 6 days of
the week. It is also stating the glaringly obvious, that if I
was a lazy person, I would not have started reading medical books
in order to solve a problem which was, as I was led to believe,
beyond the comprehension of my doctors, or anyone else in the
medical profession for the previous 3000 years. (I didn't think
that it would be an easy thing to do, and the study involved
sitting at a desk, which was causing me a considerable amount
of pain, but the task was, without any doubt of mine, an absolute
necessity - This was because I had been following medical advice
and taking the prescribed medications for several years, yet
my health continued to deteriorate, and there was no evidence
that anything was going to alter that course unless I did something
about it myself).
Unfortunately there is a strategy called spin, which enables
data and evidence to be dismissed, trivialised or ignored entirely,
and will only ever be found by those who look for it.
When Galileo found evidence that the sun was the
centre of the universe rather than the earth, his book was confiscated
and he was put under house arrest, because his ideas contradicted
those of the church. The church authorities new of the truth,
but did everything they could to stop the public from finding
it, or believing it.
Semmelweis discovered that women were dying of
child bed fever because surgeons were using the same instruments
that had been used and contaminated in autopsy studies. However
this offended other surgeons who blocked his promotion to the
position of clinical professor. They also refused to cooperate
with his methods of disinfecting their hands and instruments
with chloride of lime, and as a result, many women continued
to die unnecessarily. Such frustrations eventually sent Semmelweis
mad, presumably because he didn't know enough about history.
M.B
|
It has been a common enough observation from scientific history, that the answer to a mystery will be staring thousands of people in the face, before someone who is looking for it, sees it, and recognises it's value. I therefore presume that in 1976, when I saw that my own fitness reading was scientifically measured as zero, that I was the first person to recognise it as evidence of a measurable physical cause of a health problem, because I was looking for it, and nobody else was. I can only suppose that thousands of doctors had seen that data before me, mixed in with data from other types of patient in fitness programmes, and have routinely assumed that it was due to lack of exercise resulting from laziness, or due to a fear of exercise. It should also be staring any reasonable person in the face to note that, if I was afraid of exercise I would not have tried to treat my health problems by deciding, entirely on the basis of my own considerations, to volunteer for a fitness training programme, and I would not have continued with it for the best part of a year, ultimately for 2 hours per day for 6 days of the week. It is also stating the glaringly obvious, that if I was a lazy person, I would not have started reading medical books in order to solve a problem which was, as I was led to believe, beyond the comprehension of my doctors, or anyone else in the medical profession for the previous 3000 years. (I didn't think that it would be an easy thing to do, and the study involved sitting at a desk, which was causing me a considerable amount of pain, but the task was, without any doubt of mine, an absolute necessity - This was because I had been following medical advice and taking the prescribed medications for several years, yet my health continued to deteriorate, and there was no evidence that anything was going to alter that course unless I did something about it myself). Unfortunately there is a strategy called spin, which enables data and evidence to be dismissed, trivialised or ignored entirely, and will only ever be found by those who look for it. |
References relating to The Chronic Fatigue Syndrome
A very common illnesswhich has been
well known to the medical profession for several centuries
Many doctors and
medical experts continue their attempt to create the public impression
in their journals, and in newspapers, and on their websites that
CHRONIC FATIGUE is a very new and quite rare condition. They
imply that there has never been any scientific evidence of it
having a real or measurable physical basis, and that therefore
there is a great deal of doubt about whether it actually exists
or not. It is still widely reported that the condition is just
normal tiredness which some patients complain excessively about,
or that it is "all in their mind". Many doctors also
persist with their disproven suggestions that the condition can
be cured simply by thinking positively and doing some sort of
exercise or another. I do not wish to comment on why they try
to create this false, and insidious, and pernicious impression
but I will present some quotes from medical publications of the
past to discredit that deceit.
The chronic fatigue
syndrome is one of the most common diseases of modern life but
it is not a new condition. In the past it has been given many
different names which include DaCosta's syndrome, neurasthenia,
neurocirculatory asthenia, vasoregulatory asthenia, and the effort
syndrome etc. Here is some information from the past which has
been extracted from the 11th edition of The Posture Theory.
"The patient's voice falters. 'Doctor,
I'm so tired. What's wrong, what shall I do'.
Every hour, every day, in
almost every doctor's consulting room, at least half the visitors
voice this complaint. Of all ages, of either sex,
rich or poor, they make up the vast throng of fatigued human
beings who get little comfort from the pills, shots and examinations
they solicit from baffled physicians"
From: Our Human Body, It's Wonder and It's Care (1962) p. 410
"Neurasthenia":
This diagnosis "had wide popularity in the nineteenth century
and is now obsolete. It referred to a state in which the major
symptoms were chronic fatiguability, lack of endurance, backache,
and headache".
From: Harrison's Principles of Internal Medicine 6th Edition
(1970) p.1863
"Neurasthenia is a term which,
in the past, was used more commonly as a diagnosis than almost
any other". Now it is used only for cases of "excessive
persistent fatigue" where is no evidence of pathological
cause.
Reference: The British Encyclopaedia of Medical Practice (1950)
Vol.10, p.32.
Neurasthenia . . . The classic neurasthenia
patient is thin and underweight and "wanders from one physician
to another seeking relief from various complaints and may undergo
unnecessary surgery or extensive medical treatment on insufficient
or vague indications .... Changes in lifestyle ... and 'rest
cures' along the lines of old-time spa therapy are of value in
some cases."
Reference: Current Diagnosis And Treatment (1973) p.574.
"Neurasthenia
is a state of chronic mental and physical weariness for which
there is no obvious cause." They feel tired "as soon
as they attempt to undertake the ordinary tasks of life"
and when they do manage to work it is below their previous standards.
They awake "tired and unrefreshed" and are at their
worst in the morning except when "they have to work hard,
in which case the amount of tiredness is out of proportion to
the amount of work performed."
There are many accompanying symptoms including headaches, palpitations,
and indigestion, and . . . "Reading makes their eyes ache
or produces the sensation of spots in front of their eyes."
Reference: The Universal Home Doctor (no date) p.531.
In the 19th
and early 20th centuries people who suffered from pain and fatigue
or paralysis were diagnosed as having 'nervous spine', 'neurasthenia'
or 'fits'.
Edward Shorter called such people "somatizers" and
described them as suffering from "pain and fatigue that
have no physical cause", and suggested that they were playing
sick as a means of consciously or sub-consciously seeking solace,
attention, or social excuses.
"Such somatizers have produced a fascinating succession
of phantom diseases" and the "Archetypal Victorian
ladies" collapsed on their beds, or had fits, convulsions,
or paralysis, but, "By 1900 such operatic displays softened
into a symptomatological chamber music", of less dramatic
symptoms of neuralgia, headache, and fatigue.
Such patients were "frustrating to no-nonsense physicians
such as the early twentieth century Kentucky doctor" who
believed that "a good
spanking", or sometimes even a "good cussing"
was the best treatment for such "evident hypochondriacs".
Nowadays the condition
is called "myalgic encephalomyelitis or ME (also called
'yuppie flu' or chronic fatigue syndrome)".
Reference: The Cambridge Illustrated History of Medicine (1996)
p.111-112
"The neurologist calls the disease,
in technical phrase, neurasthenia; the gynaecologist is too likely
to look no farther than the womb and ovaries; and the general
practitioner is apt to imagine spinal disease, dyspepsia, "liver
complaint" or "malaria" to be at the bottom of
all the trouble. Each treats the patient from his partial stand-point,
and is disappointed that recovery does not result."
From: The Ladies Guide (1904) p.588-589
The psychiatrist
divides these individuals into groups of "anxiety states,
obsessional neuroses and conversion hysterias."
These conditions include the effort syndrome (chronic fatigue)
and may occur "in the convalescent period after such acute
illnesses as influenza, pneumonia or even tonsillitis, particularly
in young adults."
A hasty convalescence predisposes to this condition so "special
care" should be taken in determining the appropriate time
for returning to work.
The condition causes "distress,
disability and economic incapacity" and has an intractable
nature.
"Drugs are of little or no value."
Reference: Textbook Of Medical Treatment, 4th edition, (1946)
p.604-606.
The most common symptom in neurasthenia is ready fatigueability,
but there can also be headaches, dizziness, ringing in the ears,
palpitations, chest discomfort, cold feet and hands, digestive
disturbances, constipation, sleeplessness, and "pains in
the neck, between the shoulders, or in the back and the limbs,
with tender spots along the spine". "In fact the symptoms
are so many and so varied that it is common for a neurasthenic
to imagine that he has any or every disease that he happens to
read about."
Reference: Modern Medical Counsellor Revised Edition (1957) p.
554
The Chronic Fatigue Syndrome
has previously been called many things, including the Effort
Syndrome because it often involves "effort intolerance"
and "is characterised
by a group of symptoms which unduly limit the subject's capacity
for effort". Breathlessness 93%, palpitations
89%, fatigue 88%, left inframammary pain 78%, dizziness 78% and
or faintness 35%.
Reference: Diseases of the Heart & Circulation 2nd Edition
(1956) p.937-944
"The pulse is always greatly
and rapidly influenced by position . . . Dizziness was often
complained of". It was increased by stooping (case 44);
by exercise (case 57) or by laying on the left side in some cases
or on the right side or the back in others. For treatment . .
. "Their equipments be such as will not unnecessarily constrict
and thus retard or prevent recovery".
Reference: Da Costa J.M. (January 1871), On Irritable Heart,
The American Journal of the Medical Sciences p.18-52
Erben's phenomenon . . . temporary
slowness of the pulse on stooping or sitting down; said to characterize
certain cases of neurasthenia."
Reference: Dorland's Illustrated Medical Dictionary 25th edition
(1974) p.1179.
Neurocirculatory asthenia, Da Costa's
Syndrome is less adequately called "the soldiers heart",
the "effort syndrome" and "anxiety neurosis",
and involves instability and abnormal irritability of the nervous
and circulatory system of unknown cause. It tends to be precipitated
by physical exhaustion, nervous strains and infections.
Symptoms occur as a syndrome of breathlessness with sighing respiration,
palpitation, exhaustion, precordial pain, (or ache), dizziness,
nervousness, tremor, sweating, headache and faintness aggravated
by effort or excitement. In some cases the condition is more
or less constant with little or no provocation. "That such a state of ill-health exists there
can be no doubt". It is not just fatigue, or
infection or nervous strain or psychoneurosis, but may attend
or follow such conditions "or even frequently stand alone".
The effort syndrome is sometimes
considered unworthy of discussion because "so
far as we know, it is not an organic disease, and since it may
occur in perfectly normal persons," but it is important
because "it is often a partially or completely incapacitating
condition", and treatment is important but often neglected,
and it is essential to distinguish it from organic heart disease.
. .
It is a real and not an imaginary
incapacity, even though at first glance it may have
appeared imaginary during World War I (1914-1918) when it was sometimes labeled "malingering",
and even though in civilian practice it has frequently been diagnosed as "mere nervousness".
The cause remains obscure, where there are no pathologic changes
and the heart is usually structurally normal, and there are no
lesions of the nerves or glands, although "Abnormalities
of central nerve cells induced by fatigue in experimental animals
have been noted and may be possible factors". . .
Blood pressure may be a little elevated and variable, strength
and endurance tests and vital capacity are low, in some cases
extremely low. There is an
easily induced oxygen debt on exercise with an excess accumulation
of lactic acid.
Reference: Heart Disease 4th edition (1951) p. 579-585
DaCosta's
syndrome . . . "Lewis
commented 'it is because these symptoms and signs are largely,
in some cases wholly, the exaggerated physiological responses
to exercise . . . that I term the whole the 'effort syndrome'
'. . . 'a proportion of the patients whom I include
in the group effort syndrome sooner or later acquires the diagnosis
of neurasthenia.'"
In some cases "the chest is long and narrow or flattened
and associated with a kyphotic curve" or the person is slight
in build or has chest wall deformities. The pulse shows an exaggerated reaction to posture.
The condition can effect soldiers particularly those who came
from sedentary occupations and who had signs of the condition
in civil life many years before joining the army. It affects
sedentary town dwellers and is commoner in women".
From: Wooley C.F. (May 1976) Where are the Diseases of Yesteryear,
Circulation p. 749-751
DaCosta's syndrome . . .
After exercise the pulse rate
deceleration time is abnormal.
Reference: Diseases of the Heart & Circulation 2nd edition
(1956) p. 940-942
During exercise the breathing
rate increases for all people including those with neurocirculatory
asthenia, but in those with neurocirculatory asthenia the "breathing
becomes disproportionately shallow." "During exhausting
work, such as running, patients developed significantly high
blood lactate concentration" indicating "that aerobic metabolism was defective in these
patients."
These patients were generally thin and "were poor athletes"
and were especially poor swimmers". . . and their symptoms "are not mentally determined or
removable by analysis."
Reference: Neurocirculatory Asthenia: 1972 Concept, Journal of
Military Medicine (April 1972) p. 142-144
Since
World War I it has been known that high concentrations of C02
can trigger a so-called 'anxiety attack' in patients with neurasthenia.
Reference: Neurocirorlatory Asthenia: 1972 Concept, Journal of
Military Medicine (April 1972) p. 142-
The concept
of ME (the Chronic Fatigue Syndrome) has deeply divided the medical
profession and provoked bitter arguments between those who believe
it is "entirely imaginary" and those who think "it
has an organic basis".
Some doctors belittle the
condition and regard the patients as malingerers and manipulators.
The condition mainly affects
women, but some men also suffer from it, including "both
male and female members of the medical profession", and
it features severe fatigue which can "be made worse by exercise,
a single act of which may cause fatigue for weeks."
Reference: Symptoms (1996) p. 300-304
Researchers
at the Harvard Fatigue Laboratory in America have " learned
that physical fatigue is caused by a complex chain of chemical
reactions" where prolonged muscular effort causes lactic
acid, carbon dioxide and other by-products to seep into the bloodstream
. . . "So acute is the chemical change that injections of
the blood of a fatigued animal into a rested animal will produce
fatigue."
Reference: Our Human Body Its Wonders and Its Care (1962) p.413.
It may be useful to inject the blood of people with chronic
fatigue into healthy experimental subjects to determine if they
too become fatigued. M.B.
Treatment: "The plan of life of the patient
is to be worked out with care. Usually normal but quiet work
and play are to be advised, with avoidance of late hours, coffee,
tea, over-indulgence in alcohol and tobacco, strenuous vacations,
excitement in general, too many hours at work, and new or burdensome
tasks or duties. Often the patient himself is aware of this necessity,
but he has perhaps disliked to humor his symptoms or to fall
behind his fellows in strenuous living in the business, professional,
and social world. With clear medical advice, however, he realizes
the wisdom of doing so, and gradually he adjusts himself to suit
his symptoms, and is surprised at recapturing a feeling of well
being."
Reference: White P.D. (1951) Heart Disease 4th edition, Mcmillan
& Co., New York, Ch. 22 (neurocirculatory asthenia) p.587.
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A very common illness "The patient's voice falters. 'Doctor, I'm so tired. What's wrong, what shall I do'. Every hour, every day, in almost every doctor's consulting room, at least half the visitors voice this complaint. Of all ages, of either sex, rich or poor, they make up the vast throng of fatigued human beings who get little comfort from the pills, shots and examinations they solicit from baffled physicians" From: Our Human Body, It's Wonder and It's Care (1962) p. 410 "Neurasthenia": This diagnosis "had wide popularity in the nineteenth century and is now obsolete. It referred to a state in which the major symptoms were chronic fatiguability, lack of endurance, backache, and headache". From: Harrison's Principles of Internal Medicine 6th Edition (1970) p.1863 "Neurasthenia is a term which, in the past, was used more commonly as a diagnosis than almost any other". Now it is used only for cases of "excessive persistent fatigue" where is no evidence of pathological cause. Reference: The British Encyclopaedia of Medical Practice (1950) Vol.10, p.32. Neurasthenia . . . The classic neurasthenia patient is thin and underweight and "wanders from one physician to another seeking relief from various complaints and may undergo unnecessary surgery or extensive medical treatment on insufficient or vague indications .... Changes in lifestyle ... and 'rest cures' along the lines of old-time spa therapy are of value in some cases." Reference: Current Diagnosis And Treatment (1973) p.574. "Neurasthenia is a state of chronic mental and physical weariness for which there is no obvious cause." They feel tired "as soon as they attempt to undertake the ordinary tasks of life" and when they do manage to work it is below their previous standards. They awake "tired and unrefreshed" and are at their worst in the morning except when "they have to work hard, in which case the amount of tiredness is out of proportion to the amount of work performed." There are many accompanying symptoms including headaches, palpitations, and indigestion, and . . . "Reading makes their eyes ache or produces the sensation of spots in front of their eyes." Reference: The Universal Home Doctor (no date) p.531. In the 19th and early 20th centuries people who suffered from pain and fatigue or paralysis were diagnosed as having 'nervous spine', 'neurasthenia' or 'fits'. Edward Shorter called such people "somatizers" and described them as suffering from "pain and fatigue that have no physical cause", and suggested that they were playing sick as a means of consciously or sub-consciously seeking solace, attention, or social excuses. "Such somatizers have produced a fascinating succession of phantom diseases" and the "Archetypal Victorian ladies" collapsed on their beds, or had fits, convulsions, or paralysis, but, "By 1900 such operatic displays softened into a symptomatological chamber music", of less dramatic symptoms of neuralgia, headache, and fatigue. Such patients were "frustrating to no-nonsense physicians such as the early twentieth century Kentucky doctor" who believed that "a good spanking", or sometimes even a "good cussing" was the best treatment for such "evident hypochondriacs". Nowadays the condition is called "myalgic encephalomyelitis or ME (also called 'yuppie flu' or chronic fatigue syndrome)". Reference: The Cambridge Illustrated History of Medicine (1996) p.111-112 "The neurologist calls the disease, in technical phrase, neurasthenia; the gynaecologist is too likely to look no farther than the womb and ovaries; and the general practitioner is apt to imagine spinal disease, dyspepsia, "liver complaint" or "malaria" to be at the bottom of all the trouble. Each treats the patient from his partial stand-point, and is disappointed that recovery does not result." From: The Ladies Guide (1904) p.588-589 The psychiatrist divides these individuals into groups of "anxiety states, obsessional neuroses and conversion hysterias." These conditions include the effort syndrome (chronic fatigue) and may occur "in the convalescent period after such acute illnesses as influenza, pneumonia or even tonsillitis, particularly in young adults." A hasty convalescence predisposes to this condition so "special care" should be taken in determining the appropriate time for returning to work. The condition causes "distress, disability and economic incapacity" and has an intractable nature. "Drugs are of little or no value." Reference: Textbook Of Medical Treatment, 4th edition, (1946) p.604-606. The most common symptom in neurasthenia is ready fatigueability, but there can also be headaches, dizziness, ringing in the ears, palpitations, chest discomfort, cold feet and hands, digestive disturbances, constipation, sleeplessness, and "pains in the neck, between the shoulders, or in the back and the limbs, with tender spots along the spine". "In fact the symptoms are so many and so varied that it is common for a neurasthenic to imagine that he has any or every disease that he happens to read about." Reference: Modern Medical Counsellor Revised Edition (1957) p. 554 The Chronic Fatigue Syndrome has previously been called many things, including the Effort Syndrome because it often involves "effort intolerance" and "is characterised by a group of symptoms which unduly limit the subject's capacity for effort". Breathlessness 93%, palpitations 89%, fatigue 88%, left inframammary pain 78%, dizziness 78% and or faintness 35%. Reference: Diseases of the Heart & Circulation 2nd Edition (1956) p.937-944 "The pulse is always greatly and rapidly influenced by position . . . Dizziness was often complained of". It was increased by stooping (case 44); by exercise (case 57) or by laying on the left side in some cases or on the right side or the back in others. For treatment . . . "Their equipments be such as will not unnecessarily constrict and thus retard or prevent recovery". Reference: Da Costa J.M. (January 1871), On Irritable Heart, The American Journal of the Medical Sciences p.18-52 Erben's phenomenon . . . temporary slowness of the pulse on stooping or sitting down; said to characterize certain cases of neurasthenia." Reference: Dorland's Illustrated Medical Dictionary 25th edition (1974) p.1179. Neurocirculatory asthenia, Da Costa's Syndrome is less adequately called "the soldiers heart", the "effort syndrome" and "anxiety neurosis", and involves instability and abnormal irritability of the nervous and circulatory system of unknown cause. It tends to be precipitated by physical exhaustion, nervous strains and infections. Symptoms occur as a syndrome of breathlessness with sighing respiration, palpitation, exhaustion, precordial pain, (or ache), dizziness, nervousness, tremor, sweating, headache and faintness aggravated by effort or excitement. In some cases the condition is more or less constant with little or no provocation. "That such a state of ill-health exists there can be no doubt". It is not just fatigue, or infection or nervous strain or psychoneurosis, but may attend or follow such conditions "or even frequently stand alone". The effort syndrome is sometimes considered unworthy of discussion because "so far as we know, it is not an organic disease, and since it may occur in perfectly normal persons," but it is important because "it is often a partially or completely incapacitating condition", and treatment is important but often neglected, and it is essential to distinguish it from organic heart disease. . . It is a real and not an imaginary incapacity, even though at first glance it may have appeared imaginary during World War I (1914-1918) when it was sometimes labeled "malingering", and even though in civilian practice it has frequently been diagnosed as "mere nervousness". The cause remains obscure, where there are no pathologic changes and the heart is usually structurally normal, and there are no lesions of the nerves or glands, although "Abnormalities of central nerve cells induced by fatigue in experimental animals have been noted and may be possible factors". . . Blood pressure may be a little elevated and variable, strength and endurance tests and vital capacity are low, in some cases extremely low. There is an easily induced oxygen debt on exercise with an excess accumulation of lactic acid. Reference: Heart Disease 4th edition (1951) p. 579-585 DaCosta's syndrome . . . "Lewis commented 'it is because these symptoms and signs are largely, in some cases wholly, the exaggerated physiological responses to exercise . . . that I term the whole the 'effort syndrome' '. . . 'a proportion of the patients whom I include in the group effort syndrome sooner or later acquires the diagnosis of neurasthenia.'" In some cases "the chest is long and narrow or flattened and associated with a kyphotic curve" or the person is slight in build or has chest wall deformities. The pulse shows an exaggerated reaction to posture. The condition can effect soldiers particularly those who came from sedentary occupations and who had signs of the condition in civil life many years before joining the army. It affects sedentary town dwellers and is commoner in women". From: Wooley C.F. (May 1976) Where are the Diseases of Yesteryear, Circulation p. 749-751 DaCosta's syndrome . . . After exercise the pulse rate deceleration time is abnormal. Reference: Diseases of the Heart & Circulation 2nd edition (1956) p. 940-942 During exercise the breathing rate increases for all people including those with neurocirculatory asthenia, but in those with neurocirculatory asthenia the "breathing becomes disproportionately shallow." "During exhausting work, such as running, patients developed significantly high blood lactate concentration" indicating "that aerobic metabolism was defective in these patients." These patients were generally thin and "were poor athletes" and were especially poor swimmers". . . and their symptoms "are not mentally determined or removable by analysis." Reference: Neurocirculatory Asthenia: 1972 Concept, Journal of Military Medicine (April 1972) p. 142-144 Since World War I it has been known that high concentrations of C02 can trigger a so-called 'anxiety attack' in patients with neurasthenia. Reference: Neurocirorlatory Asthenia: 1972 Concept, Journal of Military Medicine (April 1972) p. 142- The concept of ME (the Chronic Fatigue Syndrome) has deeply divided the medical profession and provoked bitter arguments between those who believe it is "entirely imaginary" and those who think "it has an organic basis". Some doctors belittle the condition and regard the patients as malingerers and manipulators. The condition mainly affects women, but some men also suffer from it, including "both male and female members of the medical profession", and it features severe fatigue which can "be made worse by exercise, a single act of which may cause fatigue for weeks." Reference: Symptoms (1996) p. 300-304 Researchers at the Harvard Fatigue Laboratory in America have " learned that physical fatigue is caused by a complex chain of chemical reactions" where prolonged muscular effort causes lactic acid, carbon dioxide and other by-products to seep into the bloodstream . . . "So acute is the chemical change that injections of the blood of a fatigued animal into a rested animal will produce fatigue." Reference: Our Human Body Its Wonders and Its Care (1962) p.413. It may be useful to inject the blood of people with chronic fatigue into healthy experimental subjects to determine if they too become fatigued. M.B. Treatment: "The plan of life of the patient is to be worked out with care. Usually normal but quiet work and play are to be advised, with avoidance of late hours, coffee, tea, over-indulgence in alcohol and tobacco, strenuous vacations, excitement in general, too many hours at work, and new or burdensome tasks or duties. Often the patient himself is aware of this necessity, but he has perhaps disliked to humor his symptoms or to fall behind his fellows in strenuous living in the business, professional, and social world. With clear medical advice, however, he realizes the wisdom of doing so, and gradually he adjusts himself to suit his symptoms, and is surprised at recapturing a feeling of well being." Reference: White P.D. (1951) Heart Disease 4th edition, Mcmillan & Co., New York, Ch. 22 (neurocirculatory asthenia) p.587. |
The origin of ideas
about posture and fatigue
When I first became interested in
the study of medicine one of the primary symptoms that I was
considering was a form of fatigue. Four years later I was able
to recognise that it came on more readily and persisted longer
than ordinary fatigue. I likened this to the way one end of a
seesaw rose too fast and fell too slowly if the people on each
end were of unequal weight. I therefore referred to the fatigue
as a disorder of equilibrium, and began writing an essay to summarise
that conclusion.
At that time I was also writing an essay on a postural cause
of backache, chest pains, breathlessness, stomach pain, and kidney
pain. As the fatigue occurred together with this set of symptoms
I suspected that there may have been a postural cause for the
fatigue as well, but did not have the evidence to establish that
fact. I therefore started a third essay in which I brought all
of this information together in an attempt to integrate it.
While looking for clues I came upon
a word in a Medical Dictionary called Valsalva's maneuver which
referred to an experimental method for stimulating the nervous
system. It then occurred to me that overstimulating the nervous
system might damage it and cause it to malfunction, resulting
in chronic fatigue, so I sought a more detailed explanation of
the maneuver at the Barr Smith medical library. I then determined
that Valsalva's maneuver involves holding the mouth and nose
shut and breathing out forcefully to increase the pressure in
the lungs. This impairs blood flow through the chest and stimulates
the nervous system to increase the blood pressure in the arms
and legs, which in turn forces the blood through the pressurised
chest.
I was aware that the fatigue symptom was common in sedentary
workers and rare in manual labourers so I assumed that repeatedly
leaning toward a desk hundreds of times a day for many years
might be repeatedly pressurising the chest and eventually causing
the nervous system to malfunction.
I then discarded the three other essays and started writing one
new essay describing how all of the symptoms had a common postural
cause. When I was considering several titles I realised that
I was writing a framework of ideas to link a framework of symptoms,
and I noted that these were related to the framework of the human
body, so I eventually decided that one of the best of the title
options was The Matter Of Framework, so that is what it was called,
and that essay was the original Posture Theory.
I later attended a meeting of a group of people who suffered
from chronic fatigue, and they were basing their discussion on
the possibility that the condition was caused by a virus.
Since then I have concluded that there are different causes,
types, and degrees of severity of the condition. Most, if not
all of these conditions involve excessive tiredness, which is
a disorder of sleep metabolism, and one type involves abnormal
responses to physical exertion, which is a disorder of exercise
or energy metabolism. M.B.
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When I first became interested in
the study of medicine one of the primary symptoms that I was
considering was a form of fatigue. Four years later I was able
to recognise that it came on more readily and persisted longer
than ordinary fatigue. I likened this to the way one end of a
seesaw rose too fast and fell too slowly if the people on each
end were of unequal weight. I therefore referred to the fatigue
as a disorder of equilibrium, and began writing an essay to summarise
that conclusion. While looking for clues I came upon
a word in a Medical Dictionary called Valsalva's maneuver which
referred to an experimental method for stimulating the nervous
system. It then occurred to me that overstimulating the nervous
system might damage it and cause it to malfunction, resulting
in chronic fatigue, so I sought a more detailed explanation of
the maneuver at the Barr Smith medical library. I then determined
that Valsalva's maneuver involves holding the mouth and nose
shut and breathing out forcefully to increase the pressure in
the lungs. This impairs blood flow through the chest and stimulates
the nervous system to increase the blood pressure in the arms
and legs, which in turn forces the blood through the pressurised
chest. |
Any written permission
which has been granted to publish information from this webpage
relates to the information above this line. The information below
this line is new to this page and may be referred to or linked
to, but not published. M.B.
| Any written permission which has been granted to publish information from this webpage relates to the information above this line. The information below this line is new to this page and may be referred to or linked to, but not published. M.B. |
The Posture Theory:
in progress from 8-3-02
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The
nature, measurement, and management of The Effort Syndrome
The confusing aspects
The possibility that many different problems have been lumped
together under the same general fatigue category, which has previously
been labeled by hundreds of different titles, has long been recognised,
and there have been many attempts to distinguish the sub-groups.
This category has included several main groups which include
those relating to the function of the circulatory system, the
post-viral category, and the psychological possibilities. Hence
the same broad group of syndromes has been labeled as neurocirculatory
asthenia, myalgic encephalomyelitis, or anxiety state, and there
has been a general tendency to lump all people with fatigue in
the same way (to fit square pegs into round holes). Hence they
have all been deemed by some to have circulatory problems, or
by others to all have a post-viral condition, and of course there
have been suggestions that they are all anxiety states, or depressives,
or are complaining excessively about normal fatigue
It is worth noting that all people experience fatigue after
strenuous or prolonged exertion, but they usually recover in
a few minutes or hours, or by the next day. It is also common
to have fatigue during an infectious illness but this usually
only persists in the course of that illness, and or in the convalescent
period, but in some cases it persists chronically for months
or years afterwards. Others notice that when they are anxious
they get fatigued, and when the are depressed they may be too
apathetic or too tired to get out of the bed in the morning.
However, regardless of the number of different conditions
which are involved, there is a group of people who have chronic
persistent problems with fatigue, and who also experience a set of symptoms in relation to exertion,
yet they are not anxious, nor depressed, and some have been former
athletes or sportsmen, so the idea that their symptoms are due
to a fear of exercise is unlikely.
When examining the aerobic capacity of any 100 people with
chronic fatigue there are usually a small percentage who have
very low aerobic capacity, and this has been customarily regarded
as proof that the fatigue does not have a physical basis, otherwise,
it has been said, they would all have low aerobic capacity.
However, if all the individuals with low aerobic capacity
were considered separately as having a specific problem, for
which the term "the effort syndrome" is apt, they could probably be identified,
not as being contradictory, but as having some consistencies,
and some of the confusing aspects of these problems would be
solved.
Those aspects which are particularly relevant to an effort
syndrome are included in the accompanying list.
The distinguishing features of The Effort Syndrome
1. low aerobic capacity
2. defective aerobic metabolism
3. poor breath holding ability
4. reduced capacity for exertion
5. disproportional shallow breathing during exertion
6. readily induced oxygen debt in response to exertion
7. high blood lactate production during exertion
8. sensitivity to high concentrations of CO2
9. ready fatigability
10. fatigue accruing out of proportion to particular
types and levels of exertion or strain
11. poor stamina for high levels of exercise
12 inability to sprint for short distances with,
in some cases, a concurrent average stamina for low levels of
exercise
13. reduced capacity for anaerobic exercise
14. exaggerated response of pulse rate in proportion
to effort
15. Slow deceleration of pulse rate after exertion
16. abnormalities to pulse rate in relation to
stooping or squatting, or to changes in posture such as standing
suddenly
17. abnormalities in the circulation of blood in
response to sudden loud noise
18 abnormailities in the circulation of blood in
response to sudden or intense changes in gravitational or centrifugal
forces
19 labile blood pressure
The Banfield Principles
for Exercise Training
and symptom management in the Chronic Fatigue Syndrome (the Effort
Syndrome)
First devised in
1976, and later modified between 1980-1983
1. Many people
with the Effort syndrome have participated in exercise programs
in the past and have proceeded on the basis of the idea that
they can return to normal levels of fitness with the purpose
of curing the problem. These programs have often been promoted
with enthusiastic expectation of success with the instructors
encouraging the individuals to keep trying, and keep improving,
and forcing themselves to get past any perceived limits or presumed
fears of exercise. However such programs have invariably failed
because it can result in the types of symptoms that convince
the person to stop. That individual then loses confidence in
the advice given by the supposed expert, and they are unlikely
to participate in any exercise program again.
The expectation of success comes from the observation that some
people with Chronic Fatigue do return to normal levels, so therefore
all people should be able to. However the successful cases probably
had a different type of Chronic Fatigue involving a disorder
of sleep metabolism which did not influence their aerobic capacity
and the person was simply unfit. Others may have had a fear of
the palpitations which accompanies exertion, and after the progressive
exercise has removed that fear they are essentially cured of
their particular problem.
The following suggestions are for individuals who have abnormally
low levels of aerobic capacity and who have difficulty improving
their condition, but because of the confusing aspects the suggestions
are not strict rules but are guidelines. Furthermore the ailment
involves a disordered regulation of aerobic metabolism and is
unstable and therefore the implementation needs to be flexible.
Most individuals should be able to gain some degree of improvement
in their aerobic capacity which is accompanied by more stable
health, and others may eventually achieve completed recovery.
2. Some individuals
may be too readily exhausted to exercise, and if they benefit
from rest, they should rest. If they are able to exercise the
exertion should be faster than standing still and slower than
sprinting, and the level of starting should be determined by
the indivudual, and the rate of improvement should be gradual.
3.
If the individual is walking or training with other people they
may be always passed by other paticipants or walking at the back
of the pack. This should not be a deterrent but if it is then
people with this ailment should train in groups where all participants
are aware of the nature of the problem and the programme. (Exercise
ability is proportional to aerobic capacity and the Effort syndrome
involves an abnormally low aerobic capacity which varies from
person to person).
4.
Healthy people recognise that when they train fast they can often
force themselves past any perceived limits of endurance with
the expectation of getting a second wind that enables them to
proceed in comfort. This is a common observation amongst marathon
runners, but it may be non-existant or ineffective in The Effort
Syndrome and should not be relied upon.
5.
While walking or jogging a sense of breathlessness can
occur at irregular distances, sometimes after twenty yards, and
then after the next fifty yards, and then again thirty yards
further. This symptom can be relieved by taking two or three
forced breaths each time without causing any problems. If these
do not relieve the symptom, slow your pace, or stop if necessary,
but sometimes these forced breathes may be occasionally necessary,
even at rest. The breathlessness is probably due to inefficient
function of the diaphragm (the main breathing muscle), and a
forced inhalation expands the chest sideways and improves the
oxygenation of the lungs which is deficient because of less downward
movement of the diaphragm.
6.
If distressing symptoms of palpitations, faintness, or dizziness
occur at improved levels of exercise then return to a lower level,
and improve gradually again later.
7.
Faintness can be due to any factor which traps blood below the
waist, especially if the blood vessels have been strained by
many years of stooping which can result in a tendency of blood
to pool in the blood vessels below the waist and reduce the efficiency
of circulation. Therefore faintness may be induced by stooping,
or leaning forwards, or by any factor which constricts the waist
such as tight belts and girdles. Hence to prevent faintness those
factors should be avoided. It is worth noting that 19th century
women tended to faint because they wore very tight wasp-waisted
whalebone corsets. They relieved the faint by loosening their
corset laces, and by laying in a chaise-lounge, with their body
horizontal, and their head and shoulders slightly elevated on
the arm of the lounge. The faintness was relieved partly because
the waist constriction was released, and partly because the gravitational
load on the blood vessels was removed, and blood could therefore
flow toward the head unimpeded. In fact fainting results in falling
to the floor, and this is natures way of getting the body into
the horizontal position so that blood can flow to the head and
the person can recover.
Additional notes on faintness: 1. Even snug
fitting belts can cause problems because they restrict the free
expansion and contraction of the abdomen which accompanies breathing,
because that compresses the internal anatomy and impairs the
downward movement of the diaphragm. 2. Faintness can also be due to wearing tight
collars because they also reduce blood flow to the brain, so
always wear the collars loose.
8.
Faintness can also be due to the looseness of internal organs
(visceroptosis) which move excessively when the body is subjected
to gravitational or centrifugal forces. This movement can compress
abdominal blood vessels and impair blood flow from the feet to
the brain. The problem can be relieved by stabilising the body
and contracting the abdominal muscles to minimise the movement
of internal structures.
9.
The effort syndrome has been called neurocirculatory asthenia
because it features a weakness in the circulation of blood. This
results in a tendency to faintness and dizziness because of an
abnormal disturbance to blood flow in response to such things
as sudden intense exertion, sudden loud noise, or sudden changes
in gravitiational or centrifugal forces. Hence the person may
feel faint, or as if they are about to collapse when they suddenly
sprint (e.g. when they hurry to catch a bus) or when they are
exposed to sudden loud noise, or when they suddenly move from
the laying to the standing position or when they ride in a lift.
In order to deal with these it is useful to recognise that they
are not natural responses, and that therefore the natural way
of dealing with them is not effective. However in much the same
way as riding a bicycle is an unnatural method of travelling
which is different to walking, and can be learned through practice,
the method of dealing with the symptoms of the effort syndrome
can be learned. This essentially requires a mixture of periodic
resting, and the practice of breathing deeply and regularly three
or four times in order to relieve any symptoms when they occur,
and repeated practice and experience makes this more effective.
10. The
effort syndrome can be effectively managed by restricting lifestyle
and exercise levels within particular limits so that the person
gives the appearance of being in perfect health. In fact maintaining
optimal fitness within those limits is useful in managing the
condition. However this appearance of health is often misconstrued
or misrepresented as being evidence that the person is in perfect
health, and that they should be able to maintain any lifestyle
and participate in any exercise that they wish, and they are
accused faking. The fallacy of these accusations needs to be
understood by the patient so that they are not coerced into going
beyond their limits and bringing about a relapse of prolonged
unremitting exhaustion. (which has some similarities to being
on a overdose of coffee - The Kramer Syndrome - where rest, relaxation,
and sleep are not easily attained, or effective in relieving
the fatigue)
About the
author and exercise training; A biography of CFS
The Banfield Principles
continued:
Specific methods
for treating the Effort Syndrome
A. exercise as
a treatment
1. If rest is necessary then rest is the best treatment at
that time
2. If walking is possible then walking is the best exercise
3. Any improvement in fitness levels should be gradual
4. Do not carry heavy weights when walking, especially in
the early stages.
5. As a general guide avoid sprinting, especially if carrying
weights.
6. Avoid anaerobic exercises such as weight lifting or forced
movement against any form of resistance.
7. Set your own pace in exercise and do not be concerned with
the improvement rates of other people because they may have a
higher aerobic capacity.
8. Walk on flat ground, especially in the early stages when
you are assessing your aerobic capacity.
9. As a gereral guide do not walk up steep hills until you
understand your fitness limits, and then only do so if you think
that it is practical and possible, and at a pace determined by
your experience.
10. If you occasionally feel as if you are not getting enough
air when you are walking or jogging, then take two or three forced
deep breaths each time, and you should be able to continue.
B. Treating
faintness
1. If abruptly moving from the laying to the standing position
makes you feel faint, then first move to the sitting position
and then stand up slowly, and wait a second or two before walking.
2. If riding in a lift makes you feel as if you are about
to faint, then avoid lifts and use escalators. If you need to
use lifts then enter the lift and take three or four slow, deep
breaths before the lift begins to rise, and again each time it
slows to stop.
3. If you have to use lifts, then it is likely that your natural
reflexes can adjust to the movement of lifts, but it will require
more time than normal, and will require the practice of breathing
techniques to reduce the effect of the gravitational forces which
are involved in the lifts movement.
4. If travelling by aircraft makes you feel faint and distressed,
then try the same treatment as specified above when the plane
accelerates to take off or decelerates to land, or when it drops
in an air pocket.
5. If riding on whirling sideshow rides causes you to feel
faint and distressed then avoid them.
6 If you feel faint when you are a passenger in a car which
is speeding around a curve in a country road, then brace your
arms against the dashboard and contract your adominal muscles
to stabilize your body. Alternatively avoid such journeys, or
ensure that you are the driver so that you can brace your arms
against the steering wheel and can adjust the speed of the car
according to the way your body is responding.
7. If you feel faint when your car is braking to stop at stop
lights, then approach the lights slowly, and brake gradually,
and take a few deep breaths before braking, and brace your arms
against the steering wheel so that you do not slump forward as
the car stops.
8. If you feel faint or dizzy when squatting down and leaning
forward, then avoid activities which involve squatting, especially
for prolonged periods of time.
9. If you feel faint when leaning toward a desk, the kitchen
sink, or the washing machine, then move closer to the task so
that you reduce the tendency to slump forward, and try to keep
your back straight by bending at the hips instead of the midriff.
10. If you feel faint or dizzy in a crowded room or theatre
then sit in an aisle seat so that you can leave if necessary,
without disrupting other people. The faintness may have been
due to the noise of the movie, or to high concentrations of CO2
which can accumulate in crowded areas.
11. If you are in a theatre and feel faint or experience palpitations
when a crescendo of music is followed by a loud clashing sound
(for the purpose of creating suspense), then take a few deep
breaths to break the effect of the soundwaves, or leave the theatre
auditorium temporarily, until the symptom eases.
12. If you are tempted to sprint for some urgent reason, as
when hurrying to catch a bus, then ensure that your increase
in pace is modified and within the limits which you have learned
from experience, or do not hurry at all.
13. If you feel faint it may be partly due to the fact that
you are wearing tight belts, girdles, corsets, or collars which
reduce blood flow to the brain, so loosen such garments, and
lay down for a few minutes, preferable with your head and shoulders
slightly elevated and your knees raised with your legs bent.
As a preventive measure, never wear tight or constricting garments.
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The possibility that many different problems have been lumped together under the same general fatigue category, which has previously been labeled by hundreds of different titles, has long been recognised, and there have been many attempts to distinguish the sub-groups. This category has included several main groups which include those relating to the function of the circulatory system, the post-viral category, and the psychological possibilities. Hence the same broad group of syndromes has been labeled as neurocirculatory asthenia, myalgic encephalomyelitis, or anxiety state, and there has been a general tendency to lump all people with fatigue in the same way (to fit square pegs into round holes). Hence they have all been deemed by some to have circulatory problems, or by others to all have a post-viral condition, and of course there have been suggestions that they are all anxiety states, or depressives, or are complaining excessively about normal fatigue It is worth noting that all people experience fatigue after strenuous or prolonged exertion, but they usually recover in a few minutes or hours, or by the next day. It is also common to have fatigue during an infectious illness but this usually only persists in the course of that illness, and or in the convalescent period, but in some cases it persists chronically for months or years afterwards. Others notice that when they are anxious they get fatigued, and when the are depressed they may be too apathetic or too tired to get out of the bed in the morning. However, regardless of the number of different conditions which are involved, there is a group of people who have chronic persistent problems with fatigue, and who also experience a set of symptoms in relation to exertion, yet they are not anxious, nor depressed, and some have been former athletes or sportsmen, so the idea that their symptoms are due to a fear of exercise is unlikely. When examining the aerobic capacity of any 100 people with chronic fatigue there are usually a small percentage who have very low aerobic capacity, and this has been customarily regarded as proof that the fatigue does not have a physical basis, otherwise, it has been said, they would all have low aerobic capacity. However, if all the individuals with low aerobic capacity were considered separately as having a specific problem, for which the term "the effort syndrome" is apt, they could probably be identified, not as being contradictory, but as having some consistencies, and some of the confusing aspects of these problems would be solved. Those aspects which are particularly relevant to an effort syndrome are included in the accompanying list. |
The distinguishing features of The Effort Syndrome 1. low aerobic capacity 2. defective aerobic metabolism 3. poor breath holding ability 4. reduced capacity for exertion 5. disproportional shallow breathing during exertion 6. readily induced oxygen debt in response to exertion 7. high blood lactate production during exertion 8. sensitivity to high concentrations of CO2 9. ready fatigability 10. fatigue accruing out of proportion to particular types and levels of exertion or strain 11. poor stamina for high levels of exercise 12 inability to sprint for short distances with, in some cases, a concurrent average stamina for low levels of exercise 13. reduced capacity for anaerobic exercise 14. exaggerated response of pulse rate in proportion to effort 15. Slow deceleration of pulse rate after exertion 16. abnormalities to pulse rate in relation to stooping or squatting, or to changes in posture such as standing suddenly 17. abnormalities in the circulation of blood in response to sudden loud noise 18 abnormailities in the circulation of blood in response to sudden or intense changes in gravitational or centrifugal forces 19 labile blood pressure |
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2. Some individuals may be too readily exhausted to exercise, and if they benefit from rest, they should rest. If they are able to exercise the exertion should be faster than standing still and slower than sprinting, and the level of starting should be determined by the indivudual, and the rate of improvement should be gradual. 3. If the individual is walking or training with other people they may be always passed by other paticipants or walking at the back of the pack. This should not be a deterrent but if it is then people with this ailment should train in groups where all participants are aware of the nature of the problem and the programme. (Exercise ability is proportional to aerobic capacity and the Effort syndrome involves an abnormally low aerobic capacity which varies from person to person). 4. Healthy people recognise that when they train fast they can often force themselves past any perceived limits of endurance with the expectation of getting a second wind that enables them to proceed in comfort. This is a common observation amongst marathon runners, but it may be non-existant or ineffective in The Effort Syndrome and should not be relied upon. 5. While walking or jogging a sense of breathlessness can occur at irregular distances, sometimes after twenty yards, and then after the next fifty yards, and then again thirty yards further. This symptom can be relieved by taking two or three forced breaths each time without causing any problems. If these do not relieve the symptom, slow your pace, or stop if necessary, but sometimes these forced breathes may be occasionally necessary, even at rest. The breathlessness is probably due to inefficient function of the diaphragm (the main breathing muscle), and a forced inhalation expands the chest sideways and improves the oxygenation of the lungs which is deficient because of less downward movement of the diaphragm. 6. If distressing symptoms of palpitations, faintness, or dizziness occur at improved levels of exercise then return to a lower level, and improve gradually again later. 7. Faintness can be due to any factor which traps blood below the waist, especially if the blood vessels have been strained by many years of stooping which can result in a tendency of blood to pool in the blood vessels below the waist and reduce the efficiency of circulation. Therefore faintness may be induced by stooping, or leaning forwards, or by any factor which constricts the waist such as tight belts and girdles. Hence to prevent faintness those factors should be avoided. It is worth noting that 19th century women tended to faint because they wore very tight wasp-waisted whalebone corsets. They relieved the faint by loosening their corset laces, and by laying in a chaise-lounge, with their body horizontal, and their head and shoulders slightly elevated on the arm of the lounge. The faintness was relieved partly because the waist constriction was released, and partly because the gravitational load on the blood vessels was removed, and blood could therefore flow toward the head unimpeded. In fact fainting results in falling to the floor, and this is natures way of getting the body into the horizontal position so that blood can flow to the head and the person can recover. Additional notes on faintness: 1. Even snug fitting belts can cause problems because they restrict the free expansion and contraction of the abdomen which accompanies breathing, because that compresses the internal anatomy and impairs the downward movement of the diaphragm. 2. Faintness can also be due to wearing tight collars because they also reduce blood flow to the brain, so always wear the collars loose. 8. Faintness can also be due to the looseness of internal organs (visceroptosis) which move excessively when the body is subjected to gravitational or centrifugal forces. This movement can compress abdominal blood vessels and impair blood flow from the feet to the brain. The problem can be relieved by stabilising the body and contracting the abdominal muscles to minimise the movement of internal structures. 9. The effort syndrome has been called neurocirculatory asthenia because it features a weakness in the circulation of blood. This results in a tendency to faintness and dizziness because of an abnormal disturbance to blood flow in response to such things as sudden intense exertion, sudden loud noise, or sudden changes in gravitiational or centrifugal forces. Hence the person may feel faint, or as if they are about to collapse when they suddenly sprint (e.g. when they hurry to catch a bus) or when they are exposed to sudden loud noise, or when they suddenly move from the laying to the standing position or when they ride in a lift. In order to deal with these it is useful to recognise that they are not natural responses, and that therefore the natural way of dealing with them is not effective. However in much the same way as riding a bicycle is an unnatural method of travelling which is different to walking, and can be learned through practice, the method of dealing with the symptoms of the effort syndrome can be learned. This essentially requires a mixture of periodic resting, and the practice of breathing deeply and regularly three or four times in order to relieve any symptoms when they occur, and repeated practice and experience makes this more effective. 10. The effort syndrome can be effectively managed by restricting lifestyle and exercise levels within particular limits so that the person gives the appearance of being in perfect health. In fact maintaining optimal fitness within those limits is useful in managing the condition. However this appearance of health is often misconstrued or misrepresented as being evidence that the person is in perfect health, and that they should be able to maintain any lifestyle and participate in any exercise that they wish, and they are accused faking. The fallacy of these accusations needs to be understood by the patient so that they are not coerced into going beyond their limits and bringing about a relapse of prolonged unremitting exhaustion. (which has some similarities to being on a overdose of coffee - The Kramer Syndrome - where rest, relaxation, and sleep are not easily attained, or effective in relieving the fatigue) About the author and exercise training; A biography of CFS
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1. If rest is necessary then rest is the best treatment at that time 2. If walking is possible then walking is the best exercise 3. Any improvement in fitness levels should be gradual 4. Do not carry heavy weights when walking, especially in the early stages. 5. As a general guide avoid sprinting, especially if carrying weights. 6. Avoid anaerobic exercises such as weight lifting or forced movement against any form of resistance. 7. Set your own pace in exercise and do not be concerned with the improvement rates of other people because they may have a higher aerobic capacity. 8. Walk on flat ground, especially in the early stages when you are assessing your aerobic capacity. 9. As a gereral guide do not walk up steep hills until you understand your fitness limits, and then only do so if you think that it is practical and possible, and at a pace determined by your experience. 10. If you occasionally feel as if you are not getting enough air when you are walking or jogging, then take two or three forced deep breaths each time, and you should be able to continue. 1. If abruptly moving from the laying to the standing position makes you feel faint, then first move to the sitting position and then stand up slowly, and wait a second or two before walking. 2. If riding in a lift makes you feel as if you are about to faint, then avoid lifts and use escalators. If you need to use lifts then enter the lift and take three or four slow, deep breaths before the lift begins to rise, and again each time it slows to stop. 3. If you have to use lifts, then it is likely that your natural reflexes can adjust to the movement of lifts, but it will require more time than normal, and will require the practice of breathing techniques to reduce the effect of the gravitational forces which are involved in the lifts movement. 4. If travelling by aircraft makes you feel faint and distressed, then try the same treatment as specified above when the plane accelerates to take off or decelerates to land, or when it drops in an air pocket. 5. If riding on whirling sideshow rides causes you to feel faint and distressed then avoid them. 6 If you feel faint when you are a passenger in a car which is speeding around a curve in a country road, then brace your arms against the dashboard and contract your adominal muscles to stabilize your body. Alternatively avoid such journeys, or ensure that you are the driver so that you can brace your arms against the steering wheel and can adjust the speed of the car according to the way your body is responding. 7. If you feel faint when your car is braking to stop at stop lights, then approach the lights slowly, and brake gradually, and take a few deep breaths before braking, and brace your arms against the steering wheel so that you do not slump forward as the car stops. 8. If you feel faint or dizzy when squatting down and leaning forward, then avoid activities which involve squatting, especially for prolonged periods of time. 9. If you feel faint when leaning toward a desk, the kitchen sink, or the washing machine, then move closer to the task so that you reduce the tendency to slump forward, and try to keep your back straight by bending at the hips instead of the midriff. 10. If you feel faint or dizzy in a crowded room or theatre then sit in an aisle seat so that you can leave if necessary, without disrupting other people. The faintness may have been due to the noise of the movie, or to high concentrations of CO2 which can accumulate in crowded areas. 11. If you are in a theatre and feel faint or experience palpitations when a crescendo of music is followed by a loud clashing sound (for the purpose of creating suspense), then take a few deep breaths to break the effect of the soundwaves, or leave the theatre auditorium temporarily, until the symptom eases. 12. If you are tempted to sprint for some urgent reason, as when hurrying to catch a bus, then ensure that your increase in pace is modified and within the limits which you have learned from experience, or do not hurry at all. 13. If you feel faint it may be partly due to the fact that you are wearing tight belts, girdles, corsets, or collars which reduce blood flow to the brain, so loosen such garments, and lay down for a few minutes, preferable with your head and shoulders slightly elevated and your knees raised with your legs bent. As a preventive measure, never wear tight or constricting garments.
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The measurement
of The Effort Syndrome
Introduction
If a motor vehicle is
supplied with the wrong fuel mix and has faulty spark plugs and
a faulty or sticking choke, a slipping clutch, faulty steering
and faulty brakes, it may neverthless still drive normally and
safely at low speed. However it will tend to rev fast when it
is idling, not take off as fast as it has been designed to, miss
or vibrate when it is speeding, sway when it is turning, and
keep going after the brakes have been applied.
The mechanical function of motor
vehicles has some similarities to the function of the human body
which provides some analogies which assist in the understanding
of The Effort Syndrome which has been called a functional disorder.
(a functional disorder is a condition in which symptoms occur
because of a functional disorder where there is no known physical
explanation).
There are some aspects of The
Effort syndrome which need to be detected, measured and explained.
Namely why do abnormal palpitations occur at high levels of exertion,
why is there an abnormal sense of faintness when the body is
subjected to gravitational or centrifugal forces, why is there
an abnormal sensitivity to carbon dioxide, why does fatigure
tend to abnormally accrue, and why is there a prolonged delay
in the recovery from fatigue.
The following descriptions relate
to some of the possibilities.
The measurement of cardiovascular fitness in The Effort
Syndrome
Pulse rate increases according to the
amount of effort being exerted. The relative increase varies
from person to person and can be measured, and that measurement
is referred to as their cardiovascular fitness.
In one method of measurement the person
is required to ride a stationary ergometric cycle while their
pulse rate is being monitored and a load or pressure is applied
to the wheel so that more force is required to peddle against
it. The person rides the cycle against low resistance for one
minute, and then they have a one minute rest, during which time
the load on the wheel is increased and they are required to ride
for another minute. This riding and resting proceeds several
times and each time the load on the wheel is increased again.
A graph can then be drawn on the basis of the pulse rate which
was recorded at each level of resistance, and can be used to
determine which level is required to produce a pulse rate of
150 beats per minute. This level of resistance is known as their
kilopon rating and gives an indication of cardiovascular fitness.
When these experiments have been conducted on groups of people
with the chronic fatigue syndrome there is always a percentage
of them who have abnormally low levels and these are the ones
who could be identified as having a type of cfs for which the
term The Effort Syndrome is appropriate.
As a guide for comparison an athlete
would have a capacity of 1200 kilopons, and a person of average
fitness 900 kilopons. Some people with cfs have readings below
that of individuals who have other chronic illnesses, and for
the purpose of consideration anyone with cfs who has a level
below 500 kilopons could be regarded as having a sub-group of
the condition for which the term The Effort Syndrome applies.
The person can then participate in an
exercise programme where they are required to train for one hour
a day, three days per week for three months. During each session
they should attempt to walk or jog with their pulse rate reaching
120 to 140 beats per minute for 20 minutes. There can also be
20 minutes of formalised aerobic, but non-weight bearing exercises,
and 20 minutes of other physical but non-vigorous game activity.
At the end of the three month training
session a second ergometric test can be conducted to determine
if the programme has resulted in any measurable improvement in
cardiovascular fitness, and then a further three months training
performed, and the test repeated again.
This programme would determine the persons
kilopon rating, and if it improved with exercise, and would also
show their upper kilopon limit.
Example results:
1. At outset zero kilopons, after three
months 355 kilopons, after 6 months 355 kilopons.
2. At outset 260 kilopons, after three
months 240 kilopons, after 6 months 250 kilopons.
3. At outset 325 kilopons, after three
months 500 kilopons, after 6 months 540 kilopons.
4. At outset 375 kilopons, after three
months 450 kilopons, after 6 months 780 kilopons.
Note that in example 1 the measurement
of zero resulted from the graph being drawn in the usual manner
as a straight line, but a more precise reading can be achieved
at the lower levels if the graph is drawn with a curve. The first
level of zero was achieved peddling up to a maximum resistance
of 150 kg, the second of 355 up to a maximum resistance of 450
kg and the third of 355 up to a maximum resistance of 750 kg
indicating that measurable cardiovascular fitness had plateaud
despite an increased ability to peddle against resistance.
When I discussed these results with
one research cardiologist I said that they were scientific evidence
of a physical basis for persistent fatigue. He replied with a
tone of resentment in his voice and said "No! that meant
nothing!"
More details about the research project and a graph
showing results
The Aerobic Ceiling
The aerobic ceiling is the maximum aerobic, or cardiovascular
capacity that a person is capable of achieving regardless of
how much exercise they do. For example a healthy person may have
an aerobic capacity of 900kps and if they participate in an exercise
programme they may be able to increase this to 1200kps, but no
further, regardless of how much exercise they do in the future.
Similarly a person with the effort syndrome may have an aerobic
capacity of 300kps, and if they participate in an exercise programme
they may increase this to 500kps, but it will remain at that
level regardless of the fact that they increase the level and
frequency of exercise in the future. M.B.
The exertion crisis in The Effort Syndrome, and its
management
There have been reports of recruits who have been required
to carry heavy knapsacks and sprint along an obstacle course
at army training camps, and as they increase their pace they
suddenly collapse and they roll about the ground having spasms
and fits. Their symptoms have been attributed to a fear of exercise
or a sub-conscious fear of battle, and they have been deemed
unfit for military duties for psychological reasons. However
a closer study of these recruits reveals that many of them were
known to have had the symptoms of an effort syndrome for many
years previously in civilian life.
It is most probable that these people had been managing their
condition by limiting their activities until such time as joining
the army and being required by their training officer to exceed
their physical limits.
There have been numerous attempts to cure the effort syndrome
by using exercise programs which gradually improve physical fitness
to normal levels, however the majority of those programs invariably
failed.
Some years ago I heard about a fitness program which was being
conducted at an oval in the grounds of a mental hospital to treat
patients who were suffering from fatigue, so I made some enquiries,
and when I spoke to the psychiatrist who was organising the program
I suggested that, if a physical method was being used to treat
chronic fatigue then it was a bit incongruous to regard it as
a mental illness, and he responded with embarrassed silence.
Many people with chronic fatigue report that they feel physically
distressed when they attempt to increase their level of exertion.
The heart pounds with excessive force with each contraction,
but when it expands again there is a sense that the heart muscle
is weak and becoming more exhausted and may not have enough strength
to contract again, so there is a sensation of an impending faint.
This sensation is relieved when they reduce the pace of their
jogging, so if they are asked or told to run faster than they
feel capable of they simply drop out of the course.
However some of them do, usually only once, exceed their limits,
as for example, when being required to participate in a relay
race, and the following symptoms occur as they rapidly increase
their pace. Firstly their heart suddenly begins to pound and
rock violently in their chest, and then all vision disappears
and is replaced by a black visual field with thousands of small
bright spots, like shooting stars, darting in all directions,
and then the person feels faint, as if they are about to collapse.
Then to avoid collapsing uncontrollably they lower themselves
to the floor and crawl about on their hands and knees, feeling
the continuing violent pounding of their heart for a minute or
two, as well as an intense sense of hyperactivity, as if their
bloodstream has been saturated with twenty cups of strong coffee,
so that any restraint of movement causes distressing physical
agitation, and a sensation that if they do restrict their movement
they will lose consciousness. They therefore pace about restlessly
on their hands and knees and they tell other people who come
near them to help to keep away, and not to touch them or restrict
their movement. They then have to reach for breath to get oxygen
into their lungs to satisfy an intense air hunger, and they avoid
talking because the exhaling of air to produce speech drains
them of energy to the extremes of exhaustion. As they pace about
on all fours the effort exhausts them so they have to rest, but
after a few seconds the restraint of movement causes profound
distress so they have to pace about again, and they continue
in this alternating way for about 10 minutes. The symptoms then
ease somewhat and it is possible for the person to carefully
lift themselves onto a chair, but the effort exhausts them so
they slump in the chair, but the slumping restricts their breathing
so they have to sit upright. If that effort exhausts them they
may have to move back to the floor again for a few more minutes
of rest and slow pacing, and then they can lift themselves up
into a chair again. After another 10 minutes or more their rapid
pulse, and their breathlessness, and their sense of intense hyperactivity
eases, and they can stand to walk. They will then have to intermittently
rest and sleep and pace about slowly for about a week before
resuming any exercise program, and then only at a lower level
than was achieved before, and with a more gradual improvement
regime, and they will be unlikely to ever exceed their own perceived
limits again. They may ultimately achieve considerable improvements
to their physical capacity but not be able to return to a normal
level of fitness regardless of how frequently they train because
there is probably an anatomical limit to their aerobic capacity.
There are several possible reasons for this crisis occurring
despite the fact that there is no evidence of the type of coronary
artery disease, or heart muscle disease which causes a heart
attack, and despite the fact that there is no evidence of a heart
attack having occurred, simply because it is not an ischemic
heart attack, even though the word attack might seem appropriate.
For example, it may be due to visceroptosis (cardioptosis) where
the long narrow heart is loose and rotates excessively and kinks
in response to rapid exertion, so that the blood flow through
the heart is temporarily blocked, in which case the consequent
symptoms are part of a reflex attempt to restore normal blood
flow. The problem may alternatively be due to an excessive prolapse
of the mitral valve which temporarily allows the blood to flow
backwards into the left atrium, where the symptoms would be due
to the disruption of normal blood flow and a reflex attempt to
restore forward blood flow. Nevertheless the immediate crisis
lasts only a few seconds, the extreme after effects last for
a minute or two and remain intense and distressing for 10-20
minutes, and the recovery period before resuming any significant
exertion is about a week.
I have also referred to the Exertion Crisis as Sudden Exertion
Shock or Sprint Shock. M.B.
The cause and nature of The Mitral Valve Prolapse
Syndrome
There have been some observations that the chronic fatigue
syndrome or the effort syndrome are associated with the prolapse
of the mitral valve which is between the left ventrical and the
left atrium of the heart so the condition is also known as the
mitral valve prolapse syndrome. The prolapse occurs because the
leaflets of the mitral valve or the chords which support them
are thin, thickened, or lengthened so that the valve tends to
buckle backwards into the atrium during contractions of the heart.
This can produce sensations such as flutterings of the heart,
or skipped beats, or the sensation that the heart has stopped
for a few seconds, though there is no evidence of disease of
the arteries or the muscle of the heart and no association with
heart attacks.
When the cause of the weakness of the valve or its supporting
chords is not known the condition is called primary mitral valve
prolapse, but when the condition follows other factors such as
bacterial infection it is called secondary mitral valve prolapse.
Numerous other symptoms are associated with the condition which
are not caused by the prolapse of the valve itself so the overall
condition is called The Mitral Valve Prolapse Syndrome. The broad
range of symptoms includes chest pains, fatigue, lightheadedness,
shortness of breath, gastrointestinal disturbances, difficulty
swallowing, and discomfort in the arms, shoulders, and back.
The frequency of symptoms is likely to be increased by many factors
which include excessive fatigue, lack of sleep, caffeine, dehydration,
menstruation, or by laying on the left or right side. The number
and variety of symptoms is not related to the severity of the
prolapse of the valve and symptoms differ from person to person,
so the cause of the syndrome and the reason they are associated
with mitral valve prolapse remains obscure but may be due to
autonomic nervous dysfunction, decreased intravascular volume,
and renin-aldosterone regulation abnormalities.
The condition is more common among people with thin physiques
who have spinal deformities such as hunchback, scoliosis (sideways
curvature of the spine), or abnormally straight backs, and those
who have flat chests or chests where the breastbone inclines
backwards instead of forwards, and they may also have unusual
joint flexibility.
This review of the Mitral Valve Prolapse Syndrome and chronic
fatigue is derived from the following website http://www.nursing.wright.edu/practice/mvp/default.htm
which presents information about the book "Taking Control:
Living with the mitral valve prolapse Syndrome" by Dr. K.A.
Scordo (1996, 2001).
If the mitral valve prolapse is associated with the lengthening
of the chords which support the leaflets of the valve, and also
with a thin body shape which includes a stooped spine, a flat
chest, and scoliosis, then postural factors may be the cause.
For example people with long narrow chests tend to have long
narrow hearts, so the chords of the mitral valve would also be
disproportionately long. Furthermore, when a person with such
a physique leans forward the chest buckles backwards pushing
the breastbone backwards and upwards and crushing the heart while
dragging it upwards. However the lower tip of the breastbone
also pushes the stomach, and the central portion of the diaphragm
downwards and this would tend to drag the lower end of the heart
downwards. With the body of the heart being pushed upwards, and
the base being dragged downwards, the heart would be stretched
lengthwise, and that would stretch and lengthen the mitral valve
chords. This would be more likely to occur in people who were
involved in activities where they were repeatedly leaning forwards.
Furthermore, if the person also had sideways curvature of the
spine, which is most commonly curvature to the right side, then
the breastbone is tilted to the right, and the left side of the
heart would be compressed downwards while the right side would
be stretched upwards, and that may also lengthen the mitral valve
chords.
Postural factors could therefore explain the cause of the
mitral valve prolapse and the fluttering sensations of the pulse,
and why other factors which are not caused by the prolapse of
the valve, are associated with the condition. i.e. postural pressure
on the diaphragm and stomach could account for the shortness
of breath and the digestive disturbances, and postural strain
on the spine could account for the shoulder, arm and back discomfort.
The fact that some symptoms can occur when the person lays on
the left or right side may relate to the postural displacement
of internal anatomy (visceroptosis).
Also if infections can weaken the chords of the mitral valve
it is presumable that they could also weaken the attachments
which support other parts of the anatomy, which may produce a
mild visceroptosis to account for some of the secondary symptoms.
Furthermore the unusual joint flexibility of MVP patients may
be an indication of excessive flexibility of tendinous attachments
which support internal structures, and that may produce an additional
contribution to the tendency to visceroptosis.
This would explain two different causes for mitral valve prolapse
i.e. primary mitral valve prolapse where the chords of the valve
are lengthened by postural strains, and secondary mitral valve
prolapse where the chords of the valve are weakened by infection.
This indicates the same two causes for the chronic fatigue syndrome.
M.B. 20-5-02.
Normal
Chest - Side View
Diagram Reference: Clinical Anatomy for Medical Students (1981)
p. 50
Flat
Chest - Side View
Diagram adapted from Clinical Anatomy for Medical Students (1981)
p. 50
When a person with
a stooped spine and a flat chest leans forward the breastbone
compresses the heart and pushes it backwards and upwards M.B.
The measurement of abnormalities
in blood pressure changes in relation to posture using the tilt
table test for patients with symptoms of faintness and chronic
fatigue
Dr. Peter Rowe of Johns Hopkins University
has had an article about the relationship between chronic fatigue
and blood pressure abnormalities published in The Lancet in March
1995 (345:623-624). This article was entitled "Is neurally
mediated hypotension an unrecognized cause of chronic fatigue?"
When Dr.Rowe was interviewed by Rebecca Moore of CFIDS Alliance
News, he said that some people who have recurrent episodes of
fainting have "profound abnormalities in the regulation
of blood pressure". This is called "neurally mediated
hypotension". However he discovered that some people with
the chronic fatigue syndrome have the same problem and although
they have never actually fainted they often complain of faintness,
fatigue and memory problems. The blood pressure drops abnormally
when the person changes posture, for example from the laying
to the standing position, and this can be measured while they
are placed on a tilt table where their blood pressure can be
measured when the table is tilted at various angles. This is
a new finding in relation to chronic fatigue. He found that as
the table is tilted the patients blood pressure is maintained
for a short time but they gradually develop symptoms and then
their blood pressure drops suddenly. He found that when these
patients increased their dietary salt intake and were prescribed
beta blocking drugs some of them reported less faintness and
fatigue, and their ability to concentrate, comprehend text, and
remember the text they had read all improved.
He suggested that the symptoms occurred
because the blood of some patients with CFS tended to pool abnormally
in the lower limbs, so that less blood circulated through the
brain, and that by laying flat, or by increasing salt intake
and therefore increasing circulating blood volume, and by the
use of beta blocking medications, the blood flow to the brain
improved, with the consequence that the symptoms of faintness,
fatigue, and memory difficulties were relieved. He added that
some patients with cfs paradoxically had high blood pressure
so they should consult a doctor before increasing their dietary
intake of salt because that can increase their blood pressure
further.
Also more research was required to follow
up these findings.
The following web pages contains more
detailed information about this interview.
http://www.ourfm-cfidsworld.org/dr__rowe_interview.htm
http://www.immunesupport.com/95spr004.htm
Posturally
and visceroptosis induced hypotension (faintness)
The loose abdominal organs of visceroptosis slide down when
a person moves from the laying to the standing position and this
changes the outer contour of the body as they crowd into the
lower abdomen. This is different to the features of obesity.
Diagram reference: Illustrated Family Doctor (1935) p.699.
One possible explanation for the results of the tilts test
is that some people with The Chronic Fatigue Syndrome, particularly
those with The Effort Sydrome, have visceroptosis. In that case
all of the major internal organs would be loosely suspended,
and hence would be significantly movable in the abdomen. Therefore
when the body is tilted the intenal organs would begin to slide
and cause symptoms, until eventually they compress the major
abdominal veins and reduce the blood flow returning from the
feet to the heart, and hence reduce blood pressure, and induce
the sense of faintness. (This sense of faintness can be quite
different from normal faintness and may be very distressing to
the patient.) The movement of the internal organs could be ascertained
by doing x-rays at each phase of the tilt test.
A similar symptom can occur when the patient moves suddenly
from the laying to the standing position because the abdominal
organs drop forcefully within the abdomen, but that can be prevented
by first moving from the laying to the sitting position and then
standing up slowly.
By constrast when the person moves from the standing position
to the laying position the abdominal organs slide toward the
heart (like fluid inside a half-full bottle flows toward the
cork when it is laid on its side), where the pressure can cause
the symptom of palpitations. This symptom can be prevented by
first moving to the sitting position and then laying down slowly
onto three pillows which keep the head and shoulders slightly
eleveated. After a few minutes two of the pillows can be removed.
Similar symptoms can sometimes also occur during pregnancy
because of the movement of the heavy pregnant womb which occurs
when the woman changes position.
For more information on visceroptosis see The
Visceroptosis Webpage
To view a diagram of sliding visceroptosis see the
sliding visceroptosis diagram
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Pulse rate increases according to the amount of effort being exerted. The relative increase varies from person to person and can be measured, and that measurement is referred to as their cardiovascular fitness. In one method of measurement the person is required to ride a stationary ergometric cycle while their pulse rate is being monitored and a load or pressure is applied to the wheel so that more force is required to peddle against it. The person rides the cycle against low resistance for one minute, and then they have a one minute rest, during which time the load on the wheel is increased and they are required to ride for another minute. This riding and resting proceeds several times and each time the load on the wheel is increased again. A graph can then be drawn on the basis of the pulse rate which was recorded at each level of resistance, and can be used to determine which level is required to produce a pulse rate of 150 beats per minute. This level of resistance is known as their kilopon rating and gives an indication of cardiovascular fitness. When these experiments have been conducted on groups of people with the chronic fatigue syndrome there is always a percentage of them who have abnormally low levels and these are the ones who could be identified as having a type of cfs for which the term The Effort Syndrome is appropriate. As a guide for comparison an athlete would have a capacity of 1200 kilopons, and a person of average fitness 900 kilopons. Some people with cfs have readings below that of individuals who have other chronic illnesses, and for the purpose of consideration anyone with cfs who has a level below 500 kilopons could be regarded as having a sub-group of the condition for which the term The Effort Syndrome applies. The person can then participate in an exercise programme where they are required to train for one hour a day, three days per week for three months. During each session they should attempt to walk or jog with their pulse rate reaching 120 to 140 beats per minute for 20 minutes. There can also be 20 minutes of formalised aerobic, but non-weight bearing exercises, and 20 minutes of other physical but non-vigorous game activity. At the end of the three month training session a second ergometric test can be conducted to determine if the programme has resulted in any measurable improvement in cardiovascular fitness, and then a further three months training performed, and the test repeated again. This programme would determine the persons kilopon rating, and if it improved with exercise, and would also show their upper kilopon limit. Example results: 1. At outset zero kilopons, after three months 355 kilopons, after 6 months 355 kilopons. 2. At outset 260 kilopons, after three months 240 kilopons, after 6 months 250 kilopons. 3. At outset 325 kilopons, after three months 500 kilopons, after 6 months 540 kilopons. 4. At outset 375 kilopons, after three months 450 kilopons, after 6 months 780 kilopons. Note that in example 1 the measurement of zero resulted from the graph being drawn in the usual manner as a straight line, but a more precise reading can be achieved at the lower levels if the graph is drawn with a curve. The first level of zero was achieved peddling up to a maximum resistance of 150 kg, the second of 355 up to a maximum resistance of 450 kg and the third of 355 up to a maximum resistance of 750 kg indicating that measurable cardiovascular fitness had plateaud despite an increased ability to peddle against resistance. When I discussed these results with one research cardiologist I said that they were scientific evidence of a physical basis for persistent fatigue. He replied with a tone of resentment in his voice and said "No! that meant nothing!" |
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The aerobic ceiling is the maximum aerobic, or cardiovascular capacity that a person is capable of achieving regardless of how much exercise they do. For example a healthy person may have an aerobic capacity of 900kps and if they participate in an exercise programme they may be able to increase this to 1200kps, but no further, regardless of how much exercise they do in the future. Similarly a person with the effort syndrome may have an aerobic capacity of 300kps, and if they participate in an exercise programme they may increase this to 500kps, but it will remain at that level regardless of the fact that they increase the level and frequency of exercise in the future. M.B. |
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There have been reports of recruits who have been required to carry heavy knapsacks and sprint along an obstacle course at army training camps, and as they increase their pace they suddenly collapse and they roll about the ground having spasms and fits. Their symptoms have been attributed to a fear of exercise or a sub-conscious fear of battle, and they have been deemed unfit for military duties for psychological reasons. However a closer study of these recruits reveals that many of them were known to have had the symptoms of an effort syndrome for many years previously in civilian life. It is most probable that these people had been managing their condition by limiting their activities until such time as joining the army and being required by their training officer to exceed their physical limits. There have been numerous attempts to cure the effort syndrome by using exercise programs which gradually improve physical fitness to normal levels, however the majority of those programs invariably failed. Some years ago I heard about a fitness program which was being conducted at an oval in the grounds of a mental hospital to treat patients who were suffering from fatigue, so I made some enquiries, and when I spoke to the psychiatrist who was organising the program I suggested that, if a physical method was being used to treat chronic fatigue then it was a bit incongruous to regard it as a mental illness, and he responded with embarrassed silence. Many people with chronic fatigue report that they feel physically distressed when they attempt to increase their level of exertion. The heart pounds with excessive force with each contraction, but when it expands again there is a sense that the heart muscle is weak and becoming more exhausted and may not have enough strength to contract again, so there is a sensation of an impending faint. This sensation is relieved when they reduce the pace of their jogging, so if they are asked or told to run faster than they feel capable of they simply drop out of the course. However some of them do, usually only once, exceed their limits, as for example, when being required to participate in a relay race, and the following symptoms occur as they rapidly increase their pace. Firstly their heart suddenly begins to pound and rock violently in their chest, and then all vision disappears and is replaced by a black visual field with thousands of small bright spots, like shooting stars, darting in all directions, and then the person feels faint, as if they are about to collapse. Then to avoid collapsing uncontrollably they lower themselves to the floor and crawl about on their hands and knees, feeling the continuing violent pounding of their heart for a minute or two, as well as an intense sense of hyperactivity, as if their bloodstream has been saturated with twenty cups of strong coffee, so that any restraint of movement causes distressing physical agitation, and a sensation that if they do restrict their movement they will lose consciousness. They therefore pace about restlessly on their hands and knees and they tell other people who come near them to help to keep away, and not to touch them or restrict their movement. They then have to reach for breath to get oxygen into their lungs to satisfy an intense air hunger, and they avoid talking because the exhaling of air to produce speech drains them of energy to the extremes of exhaustion. As they pace about on all fours the effort exhausts them so they have to rest, but after a few seconds the restraint of movement causes profound distress so they have to pace about again, and they continue in this alternating way for about 10 minutes. The symptoms then ease somewhat and it is possible for the person to carefully lift themselves onto a chair, but the effort exhausts them so they slump in the chair, but the slumping restricts their breathing so they have to sit upright. If that effort exhausts them they may have to move back to the floor again for a few more minutes of rest and slow pacing, and then they can lift themselves up into a chair again. After another 10 minutes or more their rapid pulse, and their breathlessness, and their sense of intense hyperactivity eases, and they can stand to walk. They will then have to intermittently rest and sleep and pace about slowly for about a week before resuming any exercise program, and then only at a lower level than was achieved before, and with a more gradual improvement regime, and they will be unlikely to ever exceed their own perceived limits again. They may ultimately achieve considerable improvements to their physical capacity but not be able to return to a normal level of fitness regardless of how frequently they train because there is probably an anatomical limit to their aerobic capacity. There are several possible reasons for this crisis occurring despite the fact that there is no evidence of the type of coronary artery disease, or heart muscle disease which causes a heart attack, and despite the fact that there is no evidence of a heart attack having occurred, simply because it is not an ischemic heart attack, even though the word attack might seem appropriate. For example, it may be due to visceroptosis (cardioptosis) where the long narrow heart is loose and rotates excessively and kinks in response to rapid exertion, so that the blood flow through the heart is temporarily blocked, in which case the consequent symptoms are part of a reflex attempt to restore normal blood flow. The problem may alternatively be due to an excessive prolapse of the mitral valve which temporarily allows the blood to flow backwards into the left atrium, where the symptoms would be due to the disruption of normal blood flow and a reflex attempt to restore forward blood flow. Nevertheless the immediate crisis lasts only a few seconds, the extreme after effects last for a minute or two and remain intense and distressing for 10-20 minutes, and the recovery period before resuming any significant exertion is about a week. I have also referred to the Exertion Crisis as Sudden Exertion Shock or Sprint Shock. M.B. |
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There have been some observations that the chronic fatigue syndrome or the effort syndrome are associated with the prolapse of the mitral valve which is between the left ventrical and the left atrium of the heart so the condition is also known as the mitral valve prolapse syndrome. The prolapse occurs because the leaflets of the mitral valve or the chords which support them are thin, thickened, or lengthened so that the valve tends to buckle backwards into the atrium during contractions of the heart. This can produce sensations such as flutterings of the heart, or skipped beats, or the sensation that the heart has stopped for a few seconds, though there is no evidence of disease of the arteries or the muscle of the heart and no association with heart attacks. When the cause of the weakness of the valve or its supporting chords is not known the condition is called primary mitral valve prolapse, but when the condition follows other factors such as bacterial infection it is called secondary mitral valve prolapse. Numerous other symptoms are associated with the condition which are not caused by the prolapse of the valve itself so the overall condition is called The Mitral Valve Prolapse Syndrome. The broad range of symptoms includes chest pains, fatigue, lightheadedness, shortness of breath, gastrointestinal disturbances, difficulty swallowing, and discomfort in the arms, shoulders, and back. The frequency of symptoms is likely to be increased by many factors which include excessive fatigue, lack of sleep, caffeine, dehydration, menstruation, or by laying on the left or right side. The number and variety of symptoms is not related to the severity of the prolapse of the valve and symptoms differ from person to person, so the cause of the syndrome and the reason they are associated with mitral valve prolapse remains obscure but may be due to autonomic nervous dysfunction, decreased intravascular volume, and renin-aldosterone regulation abnormalities. The condition is more common among people with thin physiques who have spinal deformities such as hunchback, scoliosis (sideways curvature of the spine), or abnormally straight backs, and those who have flat chests or chests where the breastbone inclines backwards instead of forwards, and they may also have unusual joint flexibility. This review of the Mitral Valve Prolapse Syndrome and chronic fatigue is derived from the following website http://www.nursing.wright.edu/practice/mvp/default.htm which presents information about the book "Taking Control: Living with the mitral valve prolapse Syndrome" by Dr. K.A. Scordo (1996, 2001). |
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If the mitral valve prolapse is associated with the lengthening of the chords which support the leaflets of the valve, and also with a thin body shape which includes a stooped spine, a flat chest, and scoliosis, then postural factors may be the cause. For example people with long narrow chests tend to have long narrow hearts, so the chords of the mitral valve would also be disproportionately long. Furthermore, when a person with such a physique leans forward the chest buckles backwards pushing the breastbone backwards and upwards and crushing the heart while dragging it upwards. However the lower tip of the breastbone also pushes the stomach, and the central portion of the diaphragm downwards and this would tend to drag the lower end of the heart downwards. With the body of the heart being pushed upwards, and the base being dragged downwards, the heart would be stretched lengthwise, and that would stretch and lengthen the mitral valve chords. This would be more likely to occur in people who were involved in activities where they were repeatedly leaning forwards. Furthermore, if the person also had sideways curvature of the spine, which is most commonly curvature to the right side, then the breastbone is tilted to the right, and the left side of the heart would be compressed downwards while the right side would be stretched upwards, and that may also lengthen the mitral valve chords. Postural factors could therefore explain the cause of the mitral valve prolapse and the fluttering sensations of the pulse, and why other factors which are not caused by the prolapse of the valve, are associated with the condition. i.e. postural pressure on the diaphragm and stomach could account for the shortness of breath and the digestive disturbances, and postural strain on the spine could account for the shoulder, arm and back discomfort. The fact that some symptoms can occur when the person lays on the left or right side may relate to the postural displacement of internal anatomy (visceroptosis). Also if infections can weaken the chords of the mitral valve it is presumable that they could also weaken the attachments which support other parts of the anatomy, which may produce a mild visceroptosis to account for some of the secondary symptoms. Furthermore the unusual joint flexibility of MVP patients may be an indication of excessive flexibility of tendinous attachments which support internal structures, and that may produce an additional contribution to the tendency to visceroptosis. This would explain two different causes for mitral valve prolapse i.e. primary mitral valve prolapse where the chords of the valve are lengthened by postural strains, and secondary mitral valve prolapse where the chords of the valve are weakened by infection. This indicates the same two causes for the chronic fatigue syndrome. M.B. 20-5-02.
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The measurement of abnormalities in blood pressure changes in relation to posture using the tilt table test for patients with symptoms of faintness and chronic fatigue Dr. Peter Rowe of Johns Hopkins University has had an article about the relationship between chronic fatigue and blood pressure abnormalities published in The Lancet in March 1995 (345:623-624). This article was entitled "Is neurally mediated hypotension an unrecognized cause of chronic fatigue?" When Dr.Rowe was interviewed by Rebecca Moore of CFIDS Alliance News, he said that some people who have recurrent episodes of fainting have "profound abnormalities in the regulation of blood pressure". This is called "neurally mediated hypotension". However he discovered that some people with the chronic fatigue syndrome have the same problem and although they have never actually fainted they often complain of faintness, fatigue and memory problems. The blood pressure drops abnormally when the person changes posture, for example from the laying to the standing position, and this can be measured while they are placed on a tilt table where their blood pressure can be measured when the table is tilted at various angles. This is a new finding in relation to chronic fatigue. He found that as the table is tilted the patients blood pressure is maintained for a short time but they gradually develop symptoms and then their blood pressure drops suddenly. He found that when these patients increased their dietary salt intake and were prescribed beta blocking drugs some of them reported less faintness and fatigue, and their ability to concentrate, comprehend text, and remember the text they had read all improved. He suggested that the symptoms occurred because the blood of some patients with CFS tended to pool abnormally in the lower limbs, so that less blood circulated through the brain, and that by laying flat, or by increasing salt intake and therefore increasing circulating blood volume, and by the use of beta blocking medications, the blood flow to the brain improved, with the consequence that the symptoms of faintness, fatigue, and memory difficulties were relieved. He added that some patients with cfs paradoxically had high blood pressure so they should consult a doctor before increasing their dietary intake of salt because that can increase their blood pressure further. Also more research was required to follow up these findings. The following web pages contains more detailed information about this interview. |
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One possible explanation for the results of the tilts test is that some people with The Chronic Fatigue Syndrome, particularly those with The Effort Sydrome, have visceroptosis. In that case all of the major internal organs would be loosely suspended, and hence would be significantly movable in the abdomen. Therefore when the body is tilted the intenal organs would begin to slide and cause symptoms, until eventually they compress the major abdominal veins and reduce the blood flow returning from the feet to the heart, and hence reduce blood pressure, and induce the sense of faintness. (This sense of faintness can be quite different from normal faintness and may be very distressing to the patient.) The movement of the internal organs could be ascertained by doing x-rays at each phase of the tilt test. A similar symptom can occur when the patient moves suddenly from the laying to the standing position because the abdominal organs drop forcefully within the abdomen, but that can be prevented by first moving from the laying to the sitting position and then standing up slowly. By constrast when the person moves from the standing position to the laying position the abdominal organs slide toward the heart (like fluid inside a half-full bottle flows toward the cork when it is laid on its side), where the pressure can cause the symptom of palpitations. This symptom can be prevented by first moving to the sitting position and then laying down slowly onto three pillows which keep the head and shoulders slightly eleveated. After a few minutes two of the pillows can be removed. Similar symptoms can sometimes also occur during pregnancy because of the movement of the heavy pregnant womb which occurs when the woman changes position. For more information on visceroptosis see The Visceroptosis Webpage To view a diagram of sliding visceroptosis see the sliding visceroptosis diagram |
The measurement of biochemical abnormalities in The
Effort Syndrome
The various types of Chronic Fatigue Syndrome involve abnormal
physiological responses to exercise, and or abnormalities in
fatigue responses which influence rest and sleep patterns which
would predictably be associated with measurable metabolic abnormalities.
This alters the biochemical characteristics within the body which
can be assessed by examining the blood and urine. A number of
studies have now shown differences in the biochemical characteristics,
and there have been attempts to use this data to identify different
sub-groups of CFS and as these studies are continuing more categories
are being detected and distinguished.
The following biochemical characteristics may be relevent
in distinguishing The Effort Syndrome
1. Fibrillar and non-fibrillar catabolism
are abnormally high -
this provides evidence of infection, trauma, or fatigue associated
changes to amino acid catabolism.
2. The amino acid levels Serine,
Glycine, Leucine, and Phenylalanine are abnomally low
3. The amino acid l-methy-histidine
is high
4. The organic acid Succinic acid
level is low, while the citric acid level is high - which may indicate abnormalities in TCA cycle
metabolism.
5. The organic compounds UM27 and
Hippuric acid levels are high.
This data is derived from extracts of
studies by the Department of Biological Sciences at New Castle
University in N.S.W. Australia. The chart on the right shows
an example of the measurements in a case of The Effort Syndrome.
The chart below shows the same case with Non-fibrilla and Fibrilla
catabolism being abnormally high, approximately levels 9 and
10 respectively.
Example of E.S. levels %
Normal levels %
Lower
than normal
UM 13
0.00
0.12
UM 14
0.00
0.20
UM 15
0.00
0.05
UM 15b
0.00
0.09
UM 17
0.00
0.20
leucine
0.14
0.48
succinic acid
0.25
1.37
beta-amino-isobutyric
0.27
1.45
valine
0.36
1.31
phenylalanine
0.39
1.05
threonine
0.52
2.17
proline
0.89
2.66
aspartic acid
0.90
1.66
ethanolamine
1.06
2.27
aconitic acid
1.56
4.39
alanine
1.61
7.08
serine
2.37
9.16
glycine
4.53
20.81
Higher
than normal
UM 28
0.82
0.05
UM 13a
0.85
0.16
tyrosine
1.52
0.23
ornithine
2.38
0.56
UM 27
3.17
0.27
3-methyl-histindine
3.90
1.33
citric acid
6.15
0.74
1-methyl-histidine
16.14
0.83
hippuric acid
38.04
16.37
Levels
above 5 are consistent with CFS and are associated with the Effort
Syndrome
0
5
10
Non-fibrilla catabolism
Fibrilla catabolism
A curious quote from
the past
"The urine often shows a white or pink-coloured deposit
on standing, and there may be a movable kidney - this condition
being, indeed, a well recognised cause of neurasthenia in women
. . . True neurasthenia is purely a functional disease - i.e.
there is nothing wrong with the machinery."
Reference: The Modern Family Doctor (1928) p.479-480.
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The measurement of chest width, depth, and sternum
angles
There have been numerous observations
that people with CFS often have thin and narrow chests, but other
patients have normal or obese builds therefore it is possible
that the thin chested physique may be more specific to The Effort
Syndrome. This is because such a physique crowds the heart and
lungs and alters their shape and the sharpness of the curves
of the main arteries, and would probably influence cardiovascular
function, as well as disposing to visceroptosis. Therefore the
following measurements would probably be relevant.
1. Chest shape measurements
The severity of the spinal stoop, the
narrowness of the chest, and the flatness of the chest could
be measured directly by measuring the curve of the spine, the
width of the chest, and the angle of the breastbone, but perhaps
a better guide would be the measurement of the distance between
the lower tip of the breastbone and the spine. These measurements
may show that the smaller this distance, the more likely the
incidence of The Effort Syndrome
2. Heart shape measurements
The shape of the heart may influence
heart function, and in this respect the measurement of the length
of the heart in relation to body height, and the width of the
base of the heart may be relevant. A pyramid shaped heart of
average height with a broad base may tend to be more stable in
its function, whereas a bowling pin shaped heart which is tall
and thin with a narrow base might have a greater tendency to
unstable wobbling palpitations, and a more common association
with The Effort Syndrome.
The measurement
of the extent of visceroptosis
There have been numerous observations
of a link between visceroptosis (the displacement of abdominal
organs) and CFS but these associations have been dismissed because
of some inconsistencies. However further studies may produce
a more reliable link between visceroptosis and The Effort Syndrome,
and the more significant the visceroptosis the more likely the
association. The following suggested measurements could be made.
1. Minor visceroptosis with significant displacement of one abdominal
organ.
2. Moderate visceroptosis with significant displacement of up to three
abdominal organs,
3. Severe visceroptosis with obvious displacement of five or more abdominal
organs, and with the base of the stomach extending below the
navel.
For more information about visceroptosis
see The Visceroptosis
Webpage
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There have been numerous observations that people with CFS often have thin and narrow chests, but other patients have normal or obese builds therefore it is possible that the thin chested physique may be more specific to The Effort Syndrome. This is because such a physique crowds the heart and lungs and alters their shape and the sharpness of the curves of the main arteries, and would probably influence cardiovascular function, as well as disposing to visceroptosis. Therefore the following measurements would probably be relevant. 1. Chest shape measurements The severity of the spinal stoop, the narrowness of the chest, and the flatness of the chest could be measured directly by measuring the curve of the spine, the width of the chest, and the angle of the breastbone, but perhaps a better guide would be the measurement of the distance between the lower tip of the breastbone and the spine. These measurements may show that the smaller this distance, the more likely the incidence of The Effort Syndrome 2. Heart shape measurements The shape of the heart may influence heart function, and in this respect the measurement of the length of the heart in relation to body height, and the width of the base of the heart may be relevant. A pyramid shaped heart of average height with a broad base may tend to be more stable in its function, whereas a bowling pin shaped heart which is tall and thin with a narrow base might have a greater tendency to unstable wobbling palpitations, and a more common association with The Effort Syndrome. |
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There have been numerous observations of a link between visceroptosis (the displacement of abdominal organs) and CFS but these associations have been dismissed because of some inconsistencies. However further studies may produce a more reliable link between visceroptosis and The Effort Syndrome, and the more significant the visceroptosis the more likely the association. The following suggested measurements could be made. 1. Minor visceroptosis with significant displacement of one abdominal organ. 2. Moderate visceroptosis with significant displacement of up to three abdominal organs, 3. Severe visceroptosis with obvious displacement of five or more abdominal organs, and with the base of the stomach extending below the navel. For more information about visceroptosis see The Visceroptosis Webpage |
The
different types of Chronic Fatigue Syndrome
In the past there has been a general tendency to describe
all forms of CFS as the same disorder when in fact there is a
lot of evidence that different types occur and have been confused
as one.
This list presents some possible different sub-groups
1. Anxiety disorders
2. Chemical sensitivity disorders
3. Common chronic fatigue syndrome
4. Depressive disorders
5. The Effort Syndrome
6. Overtraining Syndrome
7. Overwork Syndrome
8. Posture syndromes * may be the same as 5 & 12
9. Post-viral disorders
10. Reassurance induced fatigue syndrome
11. Sleep metabolism disorders
12. Visceroptosis induced fatigue.
The all in
the mind ideas
Throughout history there has been a general tendency to describe
all undetectable illnesses as being caused by psychological factors
and this has been the case with the Chronic Fatigue Syndrome.
The following types of arguments have been used to sustain
the idea that all forms of chronic fatigue are due to psychological
factors.
A. It has been said that there was no scientific (x-ray or
biochemical) evidence of an organic basis for the fatigue therefore
it must have a psychological cause.
B. It has been said that anxiety causes fatigue, therefore
chronic fatigue must be caused by chronic anxiety.
C. It has been noted that some people with CFS show no obvious
signs of anxiety, therefore they must have sub-conscious anxiety.
D. It has been said that some people with CFS show no obvious
signs of anxiety or depression or any other psychological disorder,
therefore they must be suffering from a very obscure, mysterious,
or extremely deep-seated sub-conscious psychological problem
that not even the most thorough psychiatric investigations have
been able to find.
E. Where there has been evidence that some people with CFS
have extremely low aerobic capacity which could account for their
condition it has been said that there are other people with CFS
who have average or high aerobic capacity, therefore those with
low capacity must simply be unfit because of a lack of exercise
which is due to a fear of exercise.
F. Where there has been evidence of biochemical differences
in people with CFS it has been said that these are trivial differences
which have no significance.
Note that all of the arguments dismiss
the evidence of a physical cause and chop and change in a variety
of ways to suit the one conclusion of a psychological cause.
Furthermore, those who present physical
evidence are required to prove it to stringent scientific standards,
whereas the psychiatric explanations are accepted simply by default,
without any requirement of scientific proof.
In effect the conclusion of any discussion
about this type of disorder has always been predetermined in
favour of a psychiatric diagnosis.
Common causes
of chronic fatigue
There has been
a lot of disinformation about the cause and nature of chronic
fatigue with an overemphasis being placed on psychological factors,
and with dismissive terms such as Yuppie Flu being fashionable,
and a disregard for the more realistic physical causes which
are described below.
Battle fatigue
Fatigue
which affected World War 1 soldiers who fought in the trenches
which were being bombarded day and night for months, while the
soldiers were poorly fed, unable to sleep because of the noise,
and exposed to the cold and wet of the trenches which were flooded,
and infested with insects and rats, and where the soldiers contracted
food poisoning and other infections including the worst flu epidemic
in history. In many cases the fatigue became chronic.
The common chronic fatigue syndrome
A state of chronic
fatigue which occurs as the result of a combination of factors
such as overwork for long hours without adequate rest or sleep,
poor nutrution, and exposure to extreme heat or cold, infections,
or noise.
Marathon runners fatigue syndrome
A state of chronic
fatigue which affects marathon runners, athletes, sportsmen,
and people who attempt world records, who overexert themselves
or train excessively for long periods of time without adequate
rest, and who push their bodies beyond their physical limits.
Also called the Overtraining Syndrome.
The overwork fatigue syndrome
Fatigue
which affects sedentary and manual workers who work excessively
or for long hours each day without adequate rest or sleep for
months or years, and where they keep working when they have become
overfatigued and exhausted, and persist until it is impossible
to continue. If prolonged rest is taken in the early stages complete
recovery is possible, but if it is not taken until severe fatigue
occurs, then only partial recovery is possible. e.g. the industrial
fatigue which affected coal miners of average physique who had
to shovel the same tonnage of coal per day as the stronger workers.
Posture fatigue syndrome
A
condition which affects sedentary workers with particular physiques
where their chest buckles backwards each time they lean toward
a desk. The breastbone compresses the heart and lungs and interferes
with the circulation of blood. After several years circulatory
weakness develops (neurocirculatory asthenia) until the person
feels faint each time they lean toward the desk and gains relief
each time lean back. The symptom of faintness is associated with
labile blood pressure, postural hypotension, and a more general
accrual of ready fatiguability which can become chronic.
POW fatigue syndrome
Fatigue
induced in World War 2 prisoners of war who were used as slave
labour and forced to do heavy manual work while being poorly
fed and who lost more than a third of their body weight. Some
of those soldiers were still suffering from problems with fatigue
50 years after the war had ended.
The reassurance induced fatigue syndrome
Severe
fatigue which affects workers who are advised by their doctors
that the symptom is trivial or imaginary, or no different to
ordinary fatigue, and which they are told has no physical basis
and that staying in the situation which is causing it will do
them no harm, so that the worker persists until their state of
fatigue is so severe that it is impossible to continue. The prolonged
self-imposed rest which follows only provides a partial recovery
but chronic ready fatiguability remains.
Visceroptosis induced fatigue
Fatigue
which occurs because the internal anatomy has been displaced
by poor posture, pregnancy, corsets, shockwaves, or violent car
accidents etc.. The displacement of anatomy probably causes fatigue
by impeding the blood flow through the body and altering the
regulatory mechanisms of circulation (vasoregulatory asthenia).
Sleeping Tablets as a cause of chronic fatigue
Sleeping tablets are
routinely prescribed for patients with sleep problems such as
insomnis. Does the dosage of those tablets, or the prolonged
use, or the severe withdrawal symptoms indicate that they contribute
to the development of a chronic sleep disorders. (do those drugs
have a permanent effect on the regulation of blood pressure and
blood flow).
Severe Effort
Syndrome
If a state of fatigue develops and the person remains in the
situation which is aggravating it their condition may become
severe. This condition is called neurasthenia gravis where the
person experiences symptoms in response to the slightest physical
exertion. For example, if they attempt to walk and lift their
left foot off the ground to move forward their pulse rate will
rise and their heart will pound in their chest until they return
their foot to the ground, when the pulse rate settles. When they
lift their right foot to continue walking their pulse will pound
again.
At some stage between the mild and severe conditions the medical
reassurance that the symptoms do not have a physical basis and
that continuing in the situation where they occur will not do
any harm becomes unbelievable, and suggestions that rest will
not provide a benefit become irrelevant because the patient will
simply have to rest as it is the only way of relieving the symptoms.
At that stage, if the patient cannot co-opt the doctor into authorising
leave, they will have to commence a prolonged period of self-imposed
rest This is a very common necessity where the decision to rest
is often misrepresented as a mental breakdown.
It is salient to observe that a doctor may continually reassure
a poor patient that there is nothing physically wrong with them,
but when advising a wealthy patient who has the same condition,
they will insist that they take immediate extended rest in order
to prevent the fatigue from becoming chronic.
Keep pushing, keep pushing, the doctor says that nothing
shows up on x-rays so there is nothing organically wrong. Keep
pushing, keep pushing!!! He says that leaning forwards cannot
be causing these problems and that continuing to aggravate the
symptoms cannot do any physical harm. Keep leaning and pushing,
keep pushing!!! Medical advise is based on scientific evidence
so how can it be wrong? Keep pushing, keep pushing!!!
How long can the human body endure this, and when
is enough enough? Keep pushing, keep pushing!!!
The voice text
(above the diagram) is based on one of the original Posture Theory
diagrams
A relevent quote
from another source
"As far as the virus theory of CFS (chronic fatigue syndrome)
is concerned, I feel the jury is still out. It really would be
nice to find a quick, simple cure for this condition, but I still
am not inclined to believe that such exists. A large percentage
of my CFS patients have no history of such infections,
but they do have a history of having pushed
themselves beyond their strength time and time again until they
could push no further. Therefore, I feel that even
if such a virus were found, it would be helpful in only a small
percentage of patients. My experience with CFS tells me that
there are usually plenty of other reasons most patients develop
this condition, and unless we reverse those reasons, that is,
change the life-style that brought on the conditions in the first
place, there is little hope of a real cure." Gerald E. Poesnecker,
N.D., D.C., December 1998. Quote from http://www.chronicfatigue.org/
level of fatigue
and, or more generally, the tendency to fatigue
years
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Phase one
period of normal health
Phase two
chronic fatigue development phase
Phase three
chronic fatigue recovery phase
Phase four
residual phase
The Typical
Effort Sydnrome Phases Graph © 30-4-2002
This graph is subject to copyright
but may be reproduced for review purposes on condition that the
source is acknowledged as The Posture Theory, with reference
to this webpage.
The development
phases of chronic fatigue
The table above is designed to illustrate an example of the
nature and development of chronic fatigue in the Effort Syndrome.
In phase one the person has normal health and fatigue levels.
In phase two the person may be in a situation which is contributing
to persistent fatigue, and as their health deteriorates the fatigue
becomes disproportionately worse each year until it is intolerable
and the person decides to begin a period of usually self-imposed
rest. In phase three, the rest period, the person is slowly recovering
a small amount each year. In phase four the persons health stabilises,
but a persistent level of fatiguability remains greater than
it was before the chronic fatigue developed. In milder cases
the fatigue can occur more quickly, not progress to such a severe
extent, and recovery can occur in a period of months rather than
years, and may, in some cases result in a return to normal health.
During the fourth, or residual phase of cases of severe chronic
fatigue, new recurrances of severe fatigue are more likely to
occur when attempting to return to a normal full lifestyle because
the fatigue occurs more readily, accumulates more rapidly, and
continues more persistently during the rest phase. For example,
where the first instance of severe fatigue may have accumulated
over a period of several years, the next instance of severe fatigue
may accumulate over a period of several months. Hence a person
who has one major period of fatigue, is likely to have a series
of bouts of severe fatigue over the next few years or decades
until they recognise that they need to make permanent modifications
to their lifestyle. M.B.
"Neurasthenia . . . Relapses
are prone to occur, and the outlook is worse if the disease has
been of slow and gradual development." Reference: The
Illustrated Family Doctor (1935) p.499.
The nature of relapses of chronic fatigue in the effort
syndrome
(and why it is wrong to advise patients with the effort syndrome
to fight against fatigue)
To understand the difference between normal fatigue and relapses
of chronic fatigue it is useful to have a numerical and therefore
mathematical model which makes the comparison clear, and this
is provided in the following description.
After developing the chronic fatigue syndrome the person may
have had to leave their employment, but after a period of rest
and recovery they may decide to re-enter the work force. However
they would have become aware from experience that their stamina
for various activities has been impaired so they may choose an
occupation which allows for flexible working hours and work load.
The work of commission sales offers this facility where the person
can choose to attend 10 customer appointments per day and achieve
two sales to earn the equivalent in commission of a full time
salaried worker, but they can choose to see only one potential
customer per day if they wish.
They may decide to start gradually to assess the viability
of the job with a work load of two appointments in the morning
and one in the afternoon for three days of the week (allowing
for intermittent days of rest). If, after two or three weeks
there is no obvious increase in the amount of fatigue they may
decide to increase the workload to three appointments in the
morning, and two in the afternoon for four days per week (allowing
for one day mid-week for rest). By this time there may be a subtle
but perceptible increase in the sense of fatigue but if it is
within reasonable limits they may decide to increase their workload
to four appointments in the morning and four in the afternoon
for five days per week (allowing the week-end for rest). They
may then start noticing an increase in their level of fatiguability
which they can deal with by eliminating all social activity in
the evening. They may then increase their workload to five appointments
in the morning and five in the afternoon and achieve a normal
workload, but find that they have to eliminate all social activity
in the evenings and on the week-end, and that, despite this,
they start the following Monday slightly exhausted. By this time
they have no social life whatsoever, and despite this their exhaustion
continues to accrue, so to relieve the problem they may reduce
their workload to four appointments in the morning and four in
the afternoon. However despite this, and after a week-end of
rest, they commence the following week with more fatigue than
they had at the start of the previous week. They may then decide
to commence the next Monday with only three appointments in the
morning and two in the afternoon, and work for only four days
per week. Nevertheless they commence the following week more
exhausted than they were at the start of the previous week so
they may decide to reduce the workload again to two appointment
in the morning and one in the afternoon and work only three days
per week. However after attending the first appointment on the
Monday morning they are so exhausted that they have to force
themselves to get to the second. It then becomes obvious that
it is a waste of time continuing because, even if they do manage
to complete their second appointment, they will be too exhausted
to attend the third, and too exhausted do anything the next day,
or for the remainder of the week, so they may decide to catch
the next bus and go home. It may take many months of rest and
sleep before they return to a vaguely normal state of health.
Such an experience of fatigue has no similarity to the normal
cycle of work, rest, sleep, recuperation, and starting again
refreshed, and is unsustainable.
Normal fatigue readily dissipates
with normal periods of rest and sleep, whereas chronic fatigue
persists and accumulates, so the objective in managing the condition
is to prevent the accumulation. M.B.
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The Posture Theory:
The section on the chronic fatigue
syndrome in progress from 8-3-02 was completed here on 25-6-02
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