| Onset | | | | Another sufferer was Stuart Murdoch of the |
| | | | Scottish indie-rock band, Belle & Sebastian. |
| Some cases of CFS start gradually, but the | | | | Murdoch was afflicted before graduating from |
| majority start suddenly, often triggered by a | | | | university and was unable to work. He has |
| 'flu-like viral or similar illness. People | | | | commented that the degree of isolation he |
| with CFS may improve or recover after several | | | | suffered directly contributed to his strong |
| months, or many years, or not at all. It is | | | | Christian faith and his choice to become a |
| not known whether any CFS sufferer has truly | | | | song-writer and singer. |
| recovered to pre-illness levels, or whether | | | | |
| their symptoms have merely subsided enough | | | | Post-exertion symptom exacerbation |
| for them to live a more normal life. Some | | | | |
| sufferers have a remission for months or | | | | One of the most common and recognizable |
| years only to later relapse, often more | | | | aspects of CFS is what is called |
| severely. | | | | "post-exertional malaise". When people with |
| | | | CFS exert themselves beyond their limits (and |
| Sudden onset cases | | | | their limits may change daily), their |
| | | | symptoms worsen. Exertion includes cognitive |
| Many people with CFS report a sudden, drastic | | | | effort. The harder the exertion and the |
| start to their illness. Some people can | | | | longer it lasts, the worse the symptoms will |
| remember a specific day or even hour when | | | | be afterward, and with greater recovery time. |
| they first became ill. | | | | Although symptoms may increase immediately |
| | | | and proportionally, usually their full extent |
| Often CFS starts with, or is triggered by, | | | | is delayed by 24 or more hours, which can |
| another illness. Many people report getting a | | | | make judging appropriate activity difficult. |
| case of the 'flu', exposure to an allergen (a | | | | |
| cough or sniffle caused by paint, a new pet, | | | | A cyclical pattern can occur when patients |
| or construction dust), or a severe infection | | | | work harder because they "feel better" or are |
| such as bronchitis, from which they seem | | | | having a "good day", leading them to think |
| never to fully recover and which slowly | | | | they can exert themselves more than usual. |
| evolves into CFS. Some patients claim that | | | | However, the excess exertion leads to worse |
| vaccination, especially with recombinant | | | | symptoms on the following day. Thus it is |
| vaccine against hepatitis B, is another cause | | | | difficult for patients to maintain an even |
| of acute onset CFS. Other patients begin with | | | | level of activity, or to tell if they are |
| Lyme disease, which despite a standard course | | | | improving. In sufferers without a diagnosis |
| of treatment, may 'evolve' clinically from | | | | of CFS, or a proper understanding of how CFS |
| the symptoms of acute Lyme to those of CFS. | | | | affects exertion, this can lead to a |
| Because CFS symptoms bear a striking | | | | "downward spiral", where a sufferer will try |
| similarity to those of late-stage Lyme | | | | to work harder to make up for the previous |
| disease,[9] this has become an area of great | | | | day's lack instead of resting. This exhausts |
| controversy. Some clinicians assume the Lyme | | | | them further, and often can trigger a relapse |
| infection has been eradicated after a course | | | | or worsening of their condition. If the |
| of treatment and diagnose CFS by the Fukuda | | | | original exertion, which can be physical or |
| definition, while others treat such cases as | | | | mental in nature, was particularly severe, |
| seronegative, chronic Lyme infection (see The | | | | the sufferer may deteriorate to a point where |
| Lyme controversy). Other, noninfectious | | | | they are unable to care for themselves. Many |
| triggers may include car accidents, moving | | | | cases then result in hospitalisation because |
| house, and stressful life situations. Some | | | | the condition has deteriorated a great deal. |
| patients say they felt unusual or uneasy for | | | | |
| a short period (days or weeks) before the | | | | However, it must be noted that patients may |
| onset. | | | | deteriorate due to external stressors, |
| | | | complications, co-morbid illness, or for |
| Gradual onset | | | | unknown reasons, and in those cases, patient |
| | | | exertion cannot be blamed for a patient's |
| Other cases have a very slow, gradual onset, | | | | deterioration. Also, some patients have a |
| sometimes spread over years. People with | | | | progressive course which cannot be explained |
| gradual onsets may not realize there is | | | | through activity levels. |
| anything wrong for quite some time. Patients | | | | |
| may believe they have a minor illness, or | | | | When the illness is coupled with |
| ascribe their weakened condition to stress, | | | | unaccommodating family, friends, colleagues, |
| and assume they will improve with time. It is | | | | often due to stigma, and social repercussions |
| only when the patient realized that their | | | | such as financial needs, housing problems, |
| condition is truly debilitating, or the | | | | the struggle to obtain disability benefits or |
| stress is removed and the symptoms remain, | | | | insurance, discrimination and misconception |
| that the patient will begin to seek | | | | within the care sector, it can put demands on |
| treatment. | | | | the sufferer exceeding their safe |
| | | | capabilities. Many sufferers describe needing |
| There is no standard course for CFS. For a | | | | to do things for themselves in the times they |
| patient to be officially diagnosed with | | | | feel better simply because there is no-one to |
| chronic fatigue syndrome, the symptoms must | | | | delegate to. |
| have persisted for at least six months. | | | | |
| However, the Fukuda paper also contains a | | | | Duration |
| definition of "chronic fatigue" which is | | | | |
| reserved for those who do not meet the full | | | | People with CFS may improve after a few |
| criteria for CFS. Since the 50% rule of | | | | months, or after many years, or never at all. |
| Holmes et al was dropped, it is possible that | | | | They may reach a plateau at some constant |
| there are people with CFS whose level of | | | | level of health, or may progressively |
| disability is so low that they never seek | | | | decline. Often, the symptoms change over |
| treatment, or receive an accurate diagnosis, | | | | time, or cycle irregularly. Relapses are |
| though this is not permitted by the Canadian | | | | common, especially after stressful life |
| definition. | | | | events or additional illness. Exertion can |
| | | | cause not merely a relapse, but a worsening |
| Activity levels | | | | of overall health. Undiagnosed cases of CFS |
| | | | often worsen as the sufferer attempts to |
| Activity levels vary widely among CFS | | | | return to a 'normal' level of activity, only |
| patients. While some are able to lead a | | | | to make their condition worse through |
| relatively normal life, others are totally | | | | exertion. |
| bed-bound and unable to care for themselves. | | | | |
| Almost all patients find they must | | | | Of those CFS patients moderately to severely |
| drastically reduce their activity from | | | | affected, many may expect to remain so for an |
| pre-illness levels, regardless of their | | | | indeterminate period, even for the duration |
| previous level of athleticism, and must | | | | of their life. It is not known whether any |
| severely modify or give up physical hobbies | | | | patients truly 'recover' entirely from the |
| and exercise. Many patients find themselves | | | | illness, or merely recuperate enough to |
| unable to work full-time, or at all. A | | | | regain previous levels of activity. Few |
| considerable number of CFS cases in many | | | | patients report a total 'cure'. CFS can prove |
| countries are on disability benefits or | | | | to be fatal, as in the case in the UK of |
| private insurance, or have made claims and | | | | Sophia Mirza, where the coroner recorded a |
| been denied. | | | | verdict of "Acute anuric renal failure due to |
| | | | dehydration arising as a result of CFS". The |
| One notable CFS sufferer is soccer legend | | | | pathologist said, "ME describes inflammation |
| Michelle Akers, who reported struggling with | | | | of the spinal cord and muscles. My work |
| the illness for many of the later years of | | | | supports the inflammation theory. There was |
| her career. However, more severe sufferers | | | | inflammation in the basal root ganglia." (It |
| felt that an active professional athlete | | | | should be noted that inflammation of the |
| "poster child" like Akers helped to | | | | 'muscles' is erroneous, as opposed to the CNS |
| trivialize the syndrome in the eyes of the | | | | inflammation, as this has never been a |
| public, and made it much more difficult for | | | | criteria for a ME diagnosis). CFS has been |
| highly incapacitated patients to be taken | | | | linked[1] to heart damage and cardiac arrest |
| seriously. It is worth noting that the | | | | among other causes of death; research has not |
| condition can strike persons of all activity | | | | yet progressed to determine whether this is |
| levels, and that patients may have had high | | | | in fact the case, and some patients die from |
| levels of physical health and activity before | | | | co-morbid diseases. To date there is one |
| onset. | | | | study on CFS life expectancy |
| | | | |