Definition of Terms


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This web site is primarily concerned with the treatment of Chronic Fatigue Immune Dysfunction Syndrome (CFIDS), most commonly known as Chronic Fatigue Syndrome (CFS) for short. First of all, let us define our terms before we explore the basic concepts. For brevity, the term 'Chronic Fatigue Syndrome' or CFS has been used throughout this section.

http://en.wikipedia.org/wiki/Chronic_fatigue_syndrome

It is not this site's purpose to make gross generalisations about CFS/CFIDS. It is complex condition, or rather set of conditions, where the patient is suffering from a complex web of minor or major disorders or deficiencies. To interpret such patients as having one problem, and trying to fix with a single, universal cure or supplement will not work in the vast majority of cases, however well intentioned. Each case is unique, and takes many years to develop. People's physiology, psychology and genetic make up is different before we even subject each person to different factors and influences. Each patient has a unique combination of internal and external stressing factors, in varying degrees. In order to be successfully treated, one must get to the root(s) of the problem. Without addressing the primary causes, treatment may help for a while but is ultimately unlikely to be effective.

CFS is defined by the USA's CDC criteria (reference: Annals of Internal Medicine, 1994, 121, 953-959). This is a somewhat arbitrary definition defining CFS as fatigue that lasts more than 6 months, presumably with anything less being defined as PVFS.

www.annals.org/cgi/content/full/121/12/953

CFS is also defined in categories World Health Organisation (WHO) International Classification of Diseases (ICD)-10: G93.3 (the same as ME) and G53.82. This is discussed further down in the section on Post Viral Fatigue Syndrome.

The Recommendation of the Name Change Workgroup has been to change the name of CFS/CFIDS to Neuroendocrineimmune Dysfunction Syndrome (NDS). This new terminology has not been so far widely adopted:

www.cfids-cab.org/MESA/adv2.html

NDS is also known as CNDS - Chronic Neuroendocrineimmune Dysfunction Syndrome.

In the vast majority of cases, the processes in the body that result in the symptoms experienced by patients as being CFIDS/CNDS are of a composite nature, including the neurological system, the endocrine system, mitochondrial function, the immune system etc. There systems are all interdependent and to isolate one is not strictly correct. This is explored more on the Causes and Effects page, which follows on in this section.

In a general sense, medical terms for diseases try to precisely describe the causes or process of the disease, rather than just the most obvious symptoms to the patient. Let us examine the terms used for CFS in this manner:

Some argue that CFS is a non-definition, as many diseases result in chronic fatigue. Some of these diseases or conditions are actually mentioned on this web site, e.g. hypothyroidism. Others are not. This is why some argue that CFS is an unmbrella term for a variety of possible diseases or combination of diseases/conditions - hence the term 'syndrome' rather than disease. It is my opinion that CFS/CFIDS and indeed PVFS are not simply a single identifiable disease, but that each case is subtly different, and the predominant root causes may vary, for example, may be a Stealth Virus in one individual, mycoplasma in another individual and mercury toxicity in another. Cases are rarely deriving from one cause however, but a combination of causes. The term CFIDS is slightly more specific, but as described above, still leaves the door wide open to actual

The whole concept of referring to people as having CFS, for example, is meaningless, as it confuses the issue and groups together people who probably have vastly different reasons for their health problems, but happen to display similar symptoms in many areas. What we are really looking at is many millions of different combinations and exact natures of biochemical and electromagnetic problems. Examining symptoms of course can be useful from a diagnostic perspective, to give indications of what areas to be looking at. But the fundamental approach is the same. The medical profession normally categories patients by the cause of their problem, not by their symptoms! When you are categorised by your symptoms, it normally means that the medical establishment doesn't know what to do with you and does not understand what the underlying causes are. No treatment is likely to be successful in curing the patient if there is no fundamental understanding of the actual causes and processes involved.

What is Post Viral Fatigue Syndrome? Is it the same as CFS/CFIDS?

Post Viral Fatigue Syndrome (PVFS) aka Postviral Fatigue Syndrome (PFS) is a very wide ranging term used to define various types of fatigue following on from a severe viral episode.

http://en.wikipedia.org/wiki/Postviral_fatigue_syndrome

It may describe temporary fatigue following a viral episode, for example, a few weeks to a couple of months of severe fatigue once the viral symptoms have disappeared. This the most common usage of the term, used by medical professionals and is indeed the most common type of 'PVFS'. The fatigue may arise after an/each incidence of the common cold or flu (most commonly), or other viri such as polio (e.g. post-polio syndrome) or mononucleosis (aka Pfeiffer's disease or 'mono' in the USA or glandular fever in Europe). Whilst the actual knock on effects on the viri in question may produce similar symptoms and probably similar biochemical problems, the viri in question are somewhat different. Whether the exact cause is really of any consequence or not once it has happened is another matter. This type of temporary PVFS is frequently seen to occur for many years and often not resolve without proper treatment. It is not uncommon for those who develop CFIDS or indeed ME or Fibromyalgia to have experienced PVFS for many years or even decades prior to the onset of these more severe conditions (often after a viral episode). In such cases, one could perhaps view these conditions as a continuation and increase in severity of the PVFS (symptomatically and in terms of causation). Temporary PVFS may not exhibit all the possible symptoms of CFS, or at least not quite so severely (e.g. mild insomnia) - the main defining feature is round the clock fatigue.

PVFS also describes illness/disease characterised by fatigue that does not resolve after an unlimited amount of rest after a severe viral episode. This can include post-viral CFIDS, ME (discussed below) and Neuromyasthenia (a superceded term for muscle weakness).

PVFS is defined by the WHO's ICD10 as a group header in the category of 'Other Disorders of the Brain', a neurological category G93.3. ICD is an acronym for Interational Classification of Diseases.

www.who.int/classifications/icd/en

www.who.int/classifications/apps/icd/icd10online

G00-99: 'Diseases of the Nervous System'

G93.3: 'Other Disorders of the Brain'

G93.3 Postviral fatigue syndrome - subcategories:

Benign myalgic encephalomyelitis
Chronic fatigue syndrome, postviral

Excludes1:chronic fatigue syndrome NOS (R53.82)

Chronic Fatigue Syndrome NOS is defined as fitting into the R53.82 category:

R00-99: 'Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified'

R53: Malaise and fatigue
- Asthenia NOS
- Debility:
i) NOS
ii) chronic
iii) nervous
General physical deterioration
Lethargy
Tiredness

R53.82 Chronic fatigue, unspecified - subcategories:

Chronic fatigue syndrome NOS

Excludes1:postviral chronic fatigue (G93.3)
postviral fatigue syndrome (G93.3)

The allocation of non-viral triggered CFS into the R category and separate from the G category seems rather arbitrary in nature, and indeed, the rigid classifications of the conditions in the G93.3 category also seem somewhat arbitrary as they do not account for the diverse effects of the conditions concerned.

Of course, instances of CFIDS or ME, and indeed numerous other conditions may also follow a bacterial or mycoplasma infection etc., and exhibit the same post-infection fatigue as PVFS. To categorise ME and CFIDS (that originate from a viral episode) thus seems a rather narrow definition.

Incidences of CFS or ME that do not develop following a single viral episode are classified as 'other'. This could presumably include those occurring after a mycoplasma infection or indeed from toxicity build up, etc. However, unless the root cause is still present in the body, the original root cause is perhaps irrelevant, as it is the current condition and pattern that needs to be addressed.

What is the difference between CFS and ME?

Whilst this web site's primarily focus is on CFS/CFIDS, and also temporary PVFS, it also directly relates to Myalgic Encephalomyelitis (which very few people can remember or pronounce, so it is normally referred to as 'M.E.' or 'ME'. Many people use this term interchangeably with CFS/CFIDS, including support organisations and doctors as well as patients. Whilst there are subtle differences between the two conditions, the possible root causes are virtually identical or identical on a high level to those of CFS/CFIDS. So whilst there may be subtle differences on a symptomatic level, on a process level, they are virtually identical. The classical definition of ME encompasses CFIDS-like symptoms but also includes Fibromyalgia-like aches and pains (although Fibromyalgia differs with its multiple tender spots, usually close to the spine).

ME has been classified by the World Health Organisation (WHO) (since 1969) as a neurological disease, as reference ICD-10-G93.3 (under the heading 'Post Viral Fatigue Syndrome'). CFIDS has not been classified by the WHO, but CFS has. As of August 2007, the WHO does not appear to list Myalgic Encephalomyelitis in the Health Topics section on their web site, which is rather strange.

www.who.int/classifications/apps/icd/icd10online/gg90.htm

www.who.int/classifications/icd/en/bluebook.pdf

The ME Association in the UK uses the terms CFS and ME interchangeably, as 'CFS/ME', defining the condition as 'CFS/CFIDS/PVFS/ME'. The ME Association holds that whilst there are 'classic' cases of CFS and ME respectively, there are a large number of individuals who do not fit into either category who possess some of the 'classic' symptoms defining one category but not the whole set. To therefore pigeonhole sufferers with specific terms and treat them as distinct conditions is therefore not considered practical or sensible.

www.meassociation.org.uk/content/view/90/83

ME Research UK uses the terms CFS and ME interchangeably, as 'CFS/ME', although it mainly just refers to 'ME'. ME Research UK believes that ME is a sub class of CFS, rather than a completely separate disease. ME is thought here to represent CFS sufferers who are experiencing specific neurological symptoms (i.e. muscle pain). This is the definition used by Wikipedia also.

www.meresearch.org.uk/information/whatisme.html

National Alliance for Myalgic Encephalomyelitis (NAME) USA believes that ME is not connected to CFS, but is a separate and unique condition - a specific neurological disease, as opposed to the blanket term for CFS which they believe can describe any number of conditions. A well known and outspoken proponent of this theory is Dr Byron Hyde of The Nightingale Research Foundation. Dr Hyde uses a very rigid definition of ME. This is briefly summarised as follows.

The Nightingale Definition of ME: ME is an acute onset biphasic epidemic or endemic (sporadic) infectious disease process (meaning bacterial/fungal/parasitic/viral - which are explored on this web site). This is a slight widening of the definition from the WHO definition which is strictly of viral origin. ME is deemed to always start with a primary infection phase, followed by a diffuse change in the function of the Central Nervous System (CNS); and finally the presence of or absence of various pain syndrome, which is deemed to be highly variable - in acute phases may include severe headaches, neck rigidity and occipital pain, retro-orbital eye pain, migratory muscle and arthralgia pain and cutaneous (skin) hypersensitivity. Chronic phases may include any of the previous plus Fibromyalgia-like pain syndromes. Some of the 'testable criteria' are deemed to include diffuse brain injury, decreased ability to concentrate or process multiple factors simultaneously (deemed neurological in origin), sleep dysfuction, muscle dysfunction, heart palpitations, other cardiovascular dysfunction, decrease in circulating blood volume, bowel dysfunction, Ethlers-Danlos Syndromes Group illnesses (e.g. easy bruising), blood clotting defects, elevation of anti-smoooth muscle antibodies, endocrine dysfunction and bladder dysfunction.

www.name-us.org

www.name-us.org/DefintionsPages/DefHyde.htm

Let us examine the term Myalgic Encephalomyelitis (M.E.). Myalgia refers to muscle pain. Encephalomyelitis refers to inflammation of both the brain and spinal cord. This definition describes a small subset of the overall symptoms of muscle pains (in those that experience muscle pains); and it also refers to a subset of the causatives in some patients, but does not describe the bowel problems, post exertion fatigue, mitochondrial inefficiency or endocrine problems etc.

As discussed above, CFS is in a sense a blanket term, a syndrome rather than a specific disease. M.E. by contrast is classified as a disease, with a defined set of symptoms. However, those with M.E. are not unknown to experience round the clock fatigue, as CFS sufferers experience. M.E. has a number of overlapping symptoms with CFS, for example IBS symptoms, immune dysfunction, insomnia, rapid mitochondrial depletion, for example, after exercise or mental activity etc. Although most if not all M.E. support and research organisations claim not to believe there is a known cause or most likely a single cause (hence why it has not been found by them), M.E. cases are seen to be resolved by a variety of methods, ranging from addressing mycoplasma infections to assisting in structural problems or even in stimulating lymph flow and detoxification in general. This would lead me to believe that despite the claims of some, M.E. does not have a defined set of causatives either, and is somewhat of an umbrella term or syndrome rather than a disease. This is further reinforced by the fact that many M.E. cases go on to develop CFS symptoms and also conditions such as Fibromyalgia or Lupus. It seems to me that these are not isolated and unconnected diseases but have a considerable amount in common in term of root causes and downstream effects.

One incidence of M.E. that has been documented as 'outbreak', in 1955 in the Royal Free Hospital in London, does not necessarily mean that this is evidence for it being distinctly different from CFS in causality, because this outbreak could merely reflect one cause in one particular instance, for example, a viral or bacterial infection (or even incidence of poisoning) from a common water source or from food or other in the hospital, in those with weakened bodies or compromised immune systems. Such instances are rare, and it is not contagious! Other ME cases in more recent times may well derive from other causes. The above outbreak could perhaps have been a polio virus outbreak, resulting in 'post-polio syndrome' in some sufferers, a condition which is sometimes confused with ME.

Whilst some of the symptoms described by The Nightingale Foundation are very specific, few are unique to ME. In fact, the only area that could be said to be totally unique are those relating to muscle pains and Fibromyalgia-like pains. The others seem to be shared with CFS, and if you follow their logic, then CFS has 'neurological' components also. The WHO also defines post-viral Chronic Fatigue as a Neurological condition.

For example, Dr Peter Julu of BreakSpear Medical Group, has studied a large number of CFS and ME patients and has observed a similar pattern of Abnormal Spontaneous Brainstem Activation in these patients, including myself.

Whilst some ME cases do not experience constant fatigue, but only after exercise, the same can be said of some CFS cases. CFS as ME cases are not static entities but evolve with time, on account of downstream effects of the root causes of the conditions and the 'process' of the 'diseases'. For example, I experienced fatigue after excessive mental exertion or physical exertion which resolved more or less after anything between a few hours and a few weeks later, depending on level of mitochondrial depletion. However, this evolved to the point where I felt fatigued all the time to some extent, and particularly fatigued after 'overdoing things'. This latter phase is also experienced by many ME sufferers. Whilst generalising somewhat, muscle pain appears to be the only real unique differentiator between CFS and ME, unless you want to take the view that ME cases 'develop CFS' independently, and that they are 'not related', which is in my view not a credible position. The definition of the onset of ME does appear to be somewhat rigid and narrow in its definition also.

Whilst this web site acknowledges that there are differences between the classical definitions of both conditions of CFS and ME, it has chosen to use the word 'ME' in its new URL 'www.HowToCure.ME' for three reasons. Firstly, the 'ME' can be interpreted as 'me' as in 'I' - the first first. This web site is about providing people with the tools and information to seek out the relevant diagnostic and treatment resources to be cured, i.e. 'How To Cure Me!' Secondly, this web site holds that whilst the symptoms may be subtly different, the root causes of ME appear to derive from the same set of possibly causes as CFS. Thirdly, as most of the British public use the term ME to mean CFS, even though they have no idea what the acronym stands for, then this web site has chosen the term 'ME' in its URL (literally a Montenegro domain) to reach a wider audience, and not to miss anyone by rigidly sticking to terms that not everyone actually uses. Whilst this may be perpetuating confusion on some level, it is hoped that you the visitor will be reading this page and that this should help clarify any possible confusion, in particular, with further reading of this web site. In the ideal world, this web site would not use the term CFIDS, CFS or ME at all, but merely discuss symptoms, root causes/conditions, their downstream effects on the body in biochemical terms, and the relevant treatments. However, probably very few people would visit the web site as most people are not familiar with the root causes and causality. It is too technical/medical for the average lay person. However, it is hoped with time that this will not be the case, but the potential root causes will be common knowledge and firmly accepted in the public domain and mainstream medical community.

Whilst some patients are accurately labelled by doctors as having M.E., many use the term to describe anyone who is experiencing prolonged chronic fatigue that does not resolve with rest. Some doctors describe those who have chronic fatigue but no muscle pain as having M.E. Labelling patients as having CFS or ME often acts as an excuse for a doctor to deal with the patient as he would with every other person who is classified in the same manner, often just trying to mask symptoms rather than treat the underlying causes. The use of the terms often reflects a lack of understanding of the root causes, and tends to focus the mind on the symptoms, which is all that many doctors can perceive, as they are not looking/testing in the right places. So one labels a patient with having CFIDS rather than ME. But to what effect? How does that actually help the patient, other than allowing the patient to be able to point a stick at their malaise. Whilst some doctors acknowledge that CFS and ME are complicated medical conditions that they know very little about and are unable to cure, others believe it is 'all in the mind' and have a rather disrespectful and scornful attitude towards their patients. However, attempts to relieve symptoms in both cases are often the same. Prescribing sleeping pills, antidepressants, and recommendation to participate in graded exercise programmes and cognitive therapy. Cognitive therapy can of course be of benefit to most of the population. Graded exercise programmes can help some patients whilst make others worse, depending on how slowly they are allowed to build up their exercise program and at what level they are allowed to cap it. None of this really gets to the bottom of the root causes or provides any significant and real targetted treatment to the patient. This web site attempts to examine most of the most common root causes of CFS and ME, and to explore (drug free) methods of treatment of these specific problems, to not only cure the patient, but return the body to optimal health. The principles are examined, but identification and treatment is something that must be conducted by a skilled holistic practitioner or specialist (or number of specialists).

Putting someone into a category has its uses, and provides a patient with certainty - the patient is able perhaps for the first time in many years to point a 'stick' at their condition and say 'I was right all along, I was not just imagining it'. Unfortunately in many cases, finding a label often saps people's motivation or interest in looking for further answers in terms of causes and treatments of their conditions. This however applies to nearly all severe medical conditions. People crave a feeling of certainty, having been in a nightmare situation where no one has any certainty about their condition. Doctors will often tell patients that there is no cure, because they do not understand the condition and hence have no chance of developing a treatment programme or cure for it. Assuming that one cannot be cured does provide that sense of certainty, and this is indeed the impression the medical establishment gives sufferers. Let us hope that in the future, terminology will be redefined, and will actually describe what is happening in the patient, the causes, rather than a blanket category to describe people with broadly similar symptoms, and thus can be used to accurately describe each person's condition. Terminology should define and reduce confusion, not cause confusion. CFS is a non-definition. In a sense we should not give 'it' a term at all, as it only causes confusion and misunderstanding about the very nature of the individual's unique condition.

As stated above, the usefulness of the term CFS or ME are in question, as they do not adequately describe the conditions. Some specialists refuse to use or acknowledge the terms, but rather talk about the specific biochemical problems they have identified in a given individual (which may not be exactly the same in the next individual suffering from 'CFS' or 'ME'). This is a more useful approach, but unlikely to win public support or to be a useful tool in trying to communicate the nature of the conditions to the (often ignorant) public. It would be too technical and not meaningful. Therefore, the terms CFS or ME are often used. For purposes of simplicity and brevity, this web site has chosen to use the term CFS, even though it does not consider it a useful term. This may seem somewhat contradictory, but I am sure given the above brief overview that you can understand this position - sometimes compromise must be reached in order to best communicate a message to as large an audience as possible. However, this web site does attempt to examine the main possible causes that affect patients and to explain these causes on a high level, so that patients can have a better understanding of how to proceed and what type of doctor to approach, and to help determine whether the doctor they are seeing knows wha they are doing or not. This is very important as picking a doctor at random or by sticking to a doctor that is allocated to you is most likely to end in failure to make any significant progress. One must understand the principles for oneself and seek out the best specialist one can find; try to further one's own understanding as much as possible - do one's own research; and work in a kind of 'partnership' with one's doctor, rather than simply waiting to be spoon fed. One's own observations and feedback are essential and valued by good specialists, who can also be an excellent educational resource for the patient if one asks enough/the right questions and has a genuine desire to further one's understanding.

It has been estimated that 250,000 people in the UK are suffering from what one would classify as 'CFIDS' or 'ME'. This is approximately 0.5%. It has estimated that 5-10% of the population of the USA has suffered from mild symptoms/effects of Chronic Fatigue or related conditions at some point in their lives. It is estimated that approximatley 90 million people worldwide have 'CFIDS' or 'ME'. Everyone seems to know someone with 'ME' nowadays. This is abnormal! Is this a coincidence? Or is this condition actually increasing? Or are more people just admitting it now? And is there a link to our modern lifestyles? More and more people suffer from CFS and related conditions, but very few people seem to actually know how to treat or cure their conditions. Those who have friends or family with CFS or related conditions (as well as the general public) seem to be largely ignorant and have little understanding of the conditions involved. Perhaps they assume the victim of CFS is an 'exception', a 'freak anomaly that doesn't threaten their world view about health and cause and effect' and that it 'can't happen to me'.

The unfortunate reality is that most sufferers are in the dark, get little or no help from their health service, from people they know, the media and private medical professionals. In most cases, they are told that they should rest and that there is no cure and that they must just manage their condition. The internet is full of confusing information and in many cases is conflicting and varying in credibility and accuracy. Sometimes it is safer to know nothing than to know only half the truth. Partial truth is often dangerous in any area of life. Many sufferers are forced to independently figure out what their illness or condition is caused by, and try treatments that seem plausible or that are recommended to attempt recovery and treatment. Health authorities should be providing proper guidance. Sufferers can feel emotionally isolated, mistreated, forgotten and often lack hope. It is sad that so many sufferers are in this situation and that the health service and government do so little to really tackle the problem and educate people. Many never figure their condition out and suffer needlessly for a large part of their adult lives. Literally millions of years of people's lives are being wasted because of widespread misinformation, misunderstanding and unwillingness by the governments and health services to look into the facts more closely. This affects not just CFS but health in general.

The good news is that CFS is indeed cureable, but that the course of treatment is highly complex and has to be tailored to the individual's unique set of problems.

Whilst the root causes of CFS is discussed on this site, there is significant evidence to suggest that some of these may also be major factors in a wide variety of conditions and diseases, such as Irritable Bowel Syndrome (IBS), Irritable Bowel Disease (Ulcerative Colitis and Crohn's Disease), Myalgic Encephalomyelitis (M.E.), Fibromyalgia (FM, FMS), Myofascial Pain Syndrome (MPS), and even Gulf War Syndrome, Multiple Sclerosis, Lupus, Autism and Cancer.

The causes of ME, FMS, IBS and MPS seem to follow those of CFS most closely, but may indeed be unconnected and/or vary in which factors apply, in which combination and severity, depending on the individual. It would be a mistake for sufferers of the aforementioned conditions, and in particular, sufferers of FMS or IBS (for example) to look at the title of this web site and think that it did not apply to them as their condition was 'completely separate'. As discussed above, the symptoms and possible underlying causes of CFS and ME are extremely similar if not identical. Whilst FMS symptoms are somewhat different, for example in the large number of tender points in and around the spine, FMS does appear to overlap with the majority of the 'classic' CFS symptoms, causes and biochemical processes. Many FMS sufferers are also diagnosed with CFS if the fatigue symptoms are significant enough. Dr Jacob Teitelbaum M.D. links CFS and FMS together in terms of causality in his book From Fatigued To Fantastic, where the approach is the same regardless and the likely causes considered to be virtually identical. I strongly recommend anyone with Fibromyalgia to study this web site.

Indeed, the rigid classification of some of these 'unusual' conditions is largely pointless as each condition in each individual is a unique combination of factors, and often predisposes individuals to seek a 'generic' treatment for the condition, which by definition will not work with everyone. There are a large number of people who suffer from only some of the symptoms of the above conditions severely, but suffer none of the other symptoms of the classic categorisation, and thus do not fit into any of the above categories. Indeed, most of the population suffers from some of the causes outlined in this web site in lesser degrees, meaning that they only experience some of the symptoms of 'classic' CFS very mildly, and not enough to stop them carrying on normal lives. Their symptoms are just an inconvenience. The investigative approach is usually the same regardless of the condition. Treatment of conditions such as MS, Autism and Cancer are clearly much more complex than treating CFS or related conditions. Prevention rather than cure is of course more desirable and much simpler! Prevention is however not always so profitable. Even Gordon Brown, the British Prime Minister, in 2008, has made statements to the effect that he wants people to take the responsibility to look after their own health more and act preventatively, rather than abusing their bodies and in many cases eventually expecting a cure or treatment on the National Health Service.

Many doctors, web sites and books have a tendency to promote the cure that worked for them, which of course may or may not work for everyone else, depending on what the predisposing factors are, what the root causes are. This site is not denying that many 'out of the box' or 'off the shelf' treatments for CFS and FMS do work and have considerable success with a large number of people. This site supports all progress in CFS patients and is respectful of the techniques that people use to treat their conditions. Whilst fixed solutions may indeed provide partial or full recovery in some patients, a single treatment may not work for everyone because of its specific focus, and because it does not identify and systematically treat the different possible permutations of different causes in other patients. This site encourages sufferers to carry on with whatever is working for them, but that they keep their options open and consider other possible causes and eliminate them one by one, and treat those that remain, in order to compliment what they are already doing and to amplify the effects of their current treatment or treatments. It is best not to make any assumptions or conjecture about what other contributory factors do and do not apply, until they have been definitely proven or ruled out.

Let's use a metaphor for a second. If doctor is used to treating people with cut fingers and routinely puts a plaster on the victims' fingers, making them feel better, he is likely to continue this approach with all other people who have cut fingers. Person A has just been in an explosion, and has had his leg severed, and happens to have a badly cut finger. If the doctor comes across person A, but it is a little dark, then he will try to help him of course. If however the doctor gives person A a plaster for his finger, and perhaps give him a manicure, but does not notice the absence of a leg because he wasn't looking carefully enough (it is dark!), then although person A's situation has indeed been improved in certain respects, but he is unlikely to feel any better! One of his problems (i.e. his cut finger) has been cured, but the overriding problem (i.e. his blown off leg and the resulting bleeding and infection) hasn't been tackled. For a doctor or specialist to prescribe a single solution to people who fit into a certain category or arbitrary classification without knowing what their actual individual problems are is unlikely to be successful or effective in all cases, even though he may well enjoy some success in some patients. It is more sensible to identify what the specific problems are in each individual, and then specifically treat them, in the order of highest priority first, taking into account any other complications.

In addition, without knowing the exact severity of a problem, then taking too much or too little of the right supplement could be unnecessarily harmful or ineffective. For example, if you want to hammer a nail into a piece of wood, you won't get very far with a kid's plastic hammer. Nor will the piece of wood look very good if you drive over it with a steamroller (but the nail would be pushed in though!) So in addition, to identifying the problems, we need to establish the severity of each and therefore the most conservative but effective course of treatment.

Please try to read this Health Section in the correct order. Please read the Symptoms page next, then the Causes and Effects page, followed by the Identification page, before going on to read about each individual area. It is very important to get a basic high level overview of CFS, and also to understand the general approach and philosophy of this site, before delving into specifics. Otherwise you may misunderstand the context of the treatments described and perhaps get the wrong end of the stick. Thank you for your patience.

This site is for informational purposes and is not prescribing any kind of medical treatment. This web site is not intended to be a 'complete guide to curing CFS yourself, without the assistance of a doctor or specialist.' It is not a DIY fix it guide. It is not intended to replace your own research. It is essential that you consult with an experienced practitioner when devising any kind of treatment programme. It is important to continue to do your own research and to continue to ask questions. If you just rely on this web site and its contents alone, then you will not be taking responsibility for yourself or using your grey matter. Attempting to soley rely on 'self diagnosis' according to what you think sounds right and plausible, and selecting treatments accordingly, you will likely overdo some areas, engage in unnecessary treatments, get the order of priority wrong, and leave other issues and needs chronically untreated. You will not be able to measure your progress and tailor your treatments accordingly. You will likely flush a great deal of money down the toilet if you use this approach! And most likely waste time or get worse when you could have been targetting your core issues effectively from the start with outside assistance.

The whole purpose of this web site is to encourage you to start thinking for yourself and to take responsibility for yourself. Anyone following any recommendations on this site do so entirely at their own risk. Anyone seeking treatment or instigating dietary changes should do so under supervision of a qualified specialist. Please see the terms of use page.

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