Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
At 21 years of age, Sarah Jones* felt like she was falling
apart.
Once an energetic cheerleader and member of a professional dance team,
full of energy and life, Jones gradually found herself bedridden and unable to
work. As time went on she became more confused as to why she was feeling
constantly tired.
Then one day a friend of hers, who was a nurse, asked if she had ever
heard of chronic fatigue
syndrome.
"My doctor back then didn't believe in chronic
fatigue syndrome," Jones
says. "It was still up in the air; people didn't believe it existed. I think
it's better now, but back then it wasn't."
Jones found herself undergoing a series of tests,
and when they were finished, she was diagnosed with chronic fatigue syndrome, a
disease which inhibits people from performing everyday activities due to severe
tiredness. Although
the cause of chronic fatigue syndrome is still unknown, doctors can diagnose it
by ruling out other possible causes of fatigue.
Chronic fatigue syndrome (CFS) is defined by two major criteria, chronic severe fatigue for at least
six
months not caused by a diagnosable disease or relieved with rest and at least
four
other specific symptoms that occur at the same time or after the development of
severe fatigue.
The cause of CFS is unknown.
Risk factors are not clearly
understood, but the majority of adults diagnosed are adult women age range of
40s to 50s; pediatric patients diagnosed are usually teenaged.
The symptoms
and signs of CFS are relatively specific: chronic severe fatigue for at least
six
months not caused by a diagnosable disease and at least four other specific
symptoms such as cognitive impairment, muscle and/or
joint pains, new types of
headaches, tender lymph nodes, sore throat, non-refreshing sleep and malaise
after exercise, that occur at the same time or after the development of severe
fatigue.
CFS is diagnosed by the two major criteria and symptoms and signs
listed above.
Treatment of CFS is based on treating the symptoms patients
exhibit.
The prognosis for CFS in adults is only fair to poor; children have a
better or good prognosis with treatment.
Adopting a healthy lifestyle is the
usual preventive advise given by clinicians that treat CFS patients.
Additional
sources of information and support groups are available for CFS.
What is chronic fatigue syndrome (CFS)?
Controversy about the definition of chronic fatigue syndrome (CFS) finally
led an international panel of CFS research experts in 1994 to establish a
precise definition of CFS so that the syndrome could actually be diagnosed.
There are two criteria developed by this panel that both define and diagnose
CFS. The patient must have both of the following criteria:
1. Have severe chronic fatigue of six months or longer duration with other
known medical conditions excluded by clinical diagnosis
2. Concurrently have four or more
of the following symptoms: substantial impairment in short-term memory or
concentration; sore throat; tender lymph nodes; muscle pain; multi-joint pain
without swelling or redness; headaches of a new type, pattern, or severity;
non-refreshing sleep; and post-exertion malaise lasting more than 24 hours
In
addition, four symptoms of the symptoms listed above must have persisted or
recurred during six or more consecutive months of illness and must not have
predated the severe chronic fatigue (the symptoms must have occurred at the same
time or after severe chronic fatigue appeared, but not before). Although most of
the medical community accepts this definition, there are some that either do not
or think the criteria needs revision.
Why so much controversy? There are at
least three major reasons for controversy:
1. Chronic fatigue is a symptom of
many illnesses, so chronic fatigue syndrome had to have criteria that
distinguished it from similar medical conditions that have chronic fatigue as a
major symptom (for example, fibromyalgia, chronic
mononucleosis, myalgic
encephalomyelitis, neurologic problems, sensitivity to certain chemicals). Other
treatable illnesses and conditions that may have chronic fatigue as one symptom
among many others include hypothyroidism, cancers, autoimmune diseases, adrenal
gland problems, subacute or chronic infections, obesity, sleep apnea,
narcolepsy, reactions to medicines, hormonal disorders, schizophrenia,
bipolar
disorders, eating disorders, depression, alcohol and substance abuse, and
malingering.
2. In addition to the two criteria above needed to fit both the
definition and diagnosis of CFS, many patients have additional symptoms that,
depending on their severity, may predominate and overshadow the CFS symptom
criteria. These symptoms include chest pain, abdominal pain, shortness of breath,
chronic cough, diarrhea,
nausea, night sweats, jaw and muscle
stiffness and pain, double vision, and psychological problems such as panic
attacks, anxiety, and depression.
3. There is no laboratory test that can give a
definitive diagnosis of CFS, and there are no physical signs that specifically
identify CFS.
Consequently, the disease is diagnosed by excluding the diseases
that may cause the symptoms (termed a diagnosis of exclusion) listed above yet
still fit the two defined criteria established by the panel of CFS experts in
1994. It is not unusual for patients to undergo an extensive battery of tests to
rule out other diseases before a patient is determined to fit the CFS diagnostic
criteria. Unfortunately, many patients that have subsequently been diagnosed to
have CFS also have had some of the conditions and symptoms listed above. Without
the CFS criteria, diagnosis would even be more controversial.
Controversy still
remains, some individuals want to rename the disease, some clinicians want to
change the 1994 criteria and others do not. Until a definitive cause is proven,
controversies about names, diagnosis, treatments, and other aspects of CFS will
likely remain.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Most sore throats are caused by viruses or mechanical causes (such as mouth breathing) and can be treated successfully at home. However, a person should be seen by a health care professional if they have a sore throat that has a rapid onset, and is associated with a fever or tenderness of the front of the neck; a sore throat that causes the person to have difficulty swallowing (not just pain swallowing) or breathing; or if a sore throat lasts for more than a week.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Dizziness is a symptom that is often applies to a variety of sensations including lightheadedness and vertigo. Causes of dizziness include low blood pressure, heart problems, anemia, dehydration, and more. Treatment of dizziness depends on the cause.
Panic attacks are sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms: racing heartbeat, faintness, dizzyness, numbness or tingling in the hands and fingers, chills, chest pains, difficulty breathing, and a feeling of loss or control. There are several treatments for panic attacks.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Middle ear infection or inflammation (otitis media) is inflammation fo the middle ear. There are two types of otitis media, acute and chronic. Acute otitis media is generally short in duration, and chronic otitis media generally lasts several weeks. Seventy-five percent of children in the U.S. suffer from otitis media at some point. Treatment depends upon the type (chronic or acute).
Myofascial pain syndrome is muscle pain in the body's soft tissues due to injury or strain. Symptoms include muscle pain with tender points and fatigue. Treatment usually involves physical therapy, massage therapy, or trigger point injection.
Dry eyes are caused by an imbalance in the tear-flow system of the eye, but also can be caused by the drying out of the tear film. This can be due to dry air created by air conditioning, heat, or other environmental conditions.
A number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. Not getting enough sleep can hurt memory performance, health, and your mood.
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Secondary insomnia is the most common type of insomnia. Treatment for insomnia include lifestyle changes, cognitive behavioral therapy, and medication.
Orthostatic hypotension symptoms include lightheadedness, weakness, blurred vision, and syncope or passing out. Causes of orthostatic hypotension include dehydration, anemia, medication, blood loss, low blood pressure, heat related illnesses and more. Treatment of orthostatic hypotension depends on the underlying cause.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.
By Angela Generoso
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