An overpowering tiredness

With the theme of this year’s Homeopathy Awareness Week focussing on tiredness, Dr Charlotte Mendes Da Costa looks at how homeopathy may be able to help patients suffering from a condition causing such intense mental and physical exhaustion their lives are seriously affected.

Henry is 71 years old and has intermittent fatigue. It is cyclical, occurring every ten days and lasting for five days. It started a few years previously following a flu immunisation (he has not had another one since). With the fatigue he has stiff joints, loss of appetite, poor balance and is irritable. He also has episodes lasting about half an hour where he just feels “ill”, which he describes as a bit like having the flu. He generally feels a bit feverish with the fatigue. Catnaps help a bit and gentle exercise also helps sometimes.

I learn Henry has diabetes and had a heart attack in 2006 after which he needed coronary artery bypass surgery. He takes various drugs for these conditions (five in total).

For his general symptoms Henry hates hot weather, doesn’t mind the rain but dislikes wind because of the noise. There are no particular food desires or dislikes, but he likes strong tastes when he is fatigued as he feels his appetite is dulled. He sleeps excessively when fatigued but sleep is good.

Henry is a retired bookseller. He says he’s generally contented. Feeling he has done his duty by his family, he now wants to do the things he is interested in like drawing and painting. He admits he can get angry over little things and can be selfish. His wife has complained to me separately about this on occasion.

From the consultation it is clear to me Henry is suffering from chronic fatigue syndrome (CFS), but how can homeopathy help this man and others with this condition.

CFS
Chronic fatigue syndrome is a debilitating illness with many sufferers in the UK. Over the years this condition has been called different names including among other things neurasthenia, post-viral fatigue syndrome and myalgic encephalitis (ME).

There are an estimated 250,000 people in Britain affected by this illness the cause of which is largely unknown. The main symptoms of CFS are severe and debilitating fatigue, both physical and mental. The fatigue can be persistent or come and go but will have lasted at least four months before a diagnosis can be made: it is not relieved by rest. The fatigue is accompanied by a myriad of physical and mental symptoms. Physical symptoms include painful muscles, joint pains, sore throat, headache, dizziness, flu-like symptoms or difficulty regulating ones temperature. Mental symptoms include poor short-term memory and concentration; depression is also common. Sufferers often complain of disturbed sleep and that the fatigue is usually worse a day or two after increased mental or physical activity and can then be prolonged. Infections or immunisations may also precipitate a worsening of the fatigue. Many people also become completely intolerant of alcohol.

While no single cause of CFS has been identified there are known triggers. These are often infections particularly glandular fever caused by the Epstein Barr virus. A fatigue state may be brought on if a person has insufficient rest during an infection or sometimes if fever suppressant drugs are used. Less common triggers include major trauma and operations, vaccinations and organophosphate pesticides. There is wide debate as to the causes of CFS but as yet no laboratory tests exist to confirm the diagnosis. What is known is that it is commonly associated with a respiratory or gastrointestinal viral infection and is related to a resulting abnormality in the immune system, which is seen by some as being in a state of overactivity. There is some evidence that the mitochondria (parts of the cell which provide energy) in muscles of patients with CFS are also abnormal.

CFS can have a huge impact on those suffering from the condition, as they are often severely limited in their ability to carry out normal activities of daily living including work, household duties, social and sporting pastimes. The severity of CFS is defined by the degree to which the condition affects a person’s functioning and daily life. This is quite simply mild, moderate or severe. With mild CFS people are mobile, can care for themselves and may be able to work, although they will often need a whole weekend to rest. At the severest end of the scale sufferers are unable to do any activity for themselves, may spend most of their time in bed, have severe cognitive problems and are often wheelchair dependent.

Difficult diagnosis
Diagnosis is not easy and should only be made by a healthcare professional or specialist (usually a neurologist). It is a diagnosis of exclusion, so other possible diagnoses must first be excluded and the symptoms should persist for at least four months in an adult or three months in a child, where a paediatrician should confirm the diagnosis. There are a multitude of illnesses causing severe and prolonged fatigue, and these need to be excluded by a doctor. The doctor should have taken a clinical history, examined the patient which characteristically in cases of CFS involves a thorough physical examination. Conditions that have symptoms very similar to CFS include: hormonal (diabetes, hypothyroidism), infection (glandular fever, hepatitis B or C), neurological (multiple sclerosis), rheumatological (rheumatoid arthritis), cancer (any type), gastrointestinal (coeliac disease, inflammatory bowel disease). The doctor of a patient presenting with CFS symptoms will request investigations, which will be mainly blood tests. These include checking for anaemia, specific infections – for example the Epstein Barr virus – liver and kidney function.

Treating chronic fatigue syndrome
There is no conventional drug treatment for CFS although antidepressants are sometimes used to treat the depression. The essence of treatment is conventionally “activity management” and graded rehabilitation. There is evidence that cognitive behaviour therapy is helpful. Other approaches that can be beneficial in the treatment of CFS are:

  • Rest periods are essential although they should not be too lengthy e.g. 30 minutes at a time.
  • A good and healthy diet

Returning to the case of Henry, I concentrated on his general symptoms and prescribed Lycopodium clavatum as a 12c potency to be taken twice daily for five days out of every fortnight. At a follow-up appointment a couple of months later Henry reported that he had had no more episodes of the fatigue and felt extremely fit. When I bumped into his wife outside the surgery not long after, she thanked me for her husband’s new personality as he was a much easier man to live with now!

The homeopathic approach
After this lengthy introduction to CFS, which is essential in understanding something about the illness and the impact it has on sufferers’ lives, we can now look in more detail at how homeopathy can play a part in treating it. It should be pointed out, however, that CFS is not an easy illness to treat, so it is important not to promise an instant cure while at the same time remaining positive, emphasising that even if cure is not possible some alleviation of symptoms may well be hoped for. Under the symptom heading “Weakness” in our homeopathic repertory there are at least 900 homeopathic medicines. So choosing the right one is not easy, especially as the main symptom is often fatigue that worsens with any kind of exertion.

As always in homeopathy, once a definite diagnosis of CFS has been made it is vital to take a full homeopathic history. The emphasis should be on what is individual and special about the patient’s symptoms, for example the particular feelings they have in their muscles e.g. twitching, or the type of headaches they have. General symptoms are also important such as their reaction to the weather and temperature, the time of day, along with food desires and aversions. Particular note should be taken of any cause of the CFS if it is known, for instance influenza, or gastroenteritis, or glandular fever, and also if any conventional treatment was given at that time. Choosing the correct medicine will usually take time and consideration with the homeopath and patient having to be prepared to try more than one homeopathic medicine if there is no result with the first. The patient needs to be patient!

Here are examples of a few medicines that are more commonly indicated in CFS. However, in many cases a homeopathic medicine that does help a patient could well be one in which fatigue is not necessarily the first symptom that springs to mind. From the following descriptions it can be seen that different homeopathic medicines can have a lot of symptoms in common, so generally it would be advisable to seek help from a professionally qualified homeopath before deciding on a particular medicine, and a doctor should always be consulted to exclude other serious illnesses that CFS may mimic – or vice versa.

Gelsemium: Indicated by weakness with drowsiness, dizziness, dullness and trembling. Muscle aches with heaviness and weakness. Tremors and twitching of the muscles may also be a feature. The sufferer might have a dull heaviness in the head and have blurred vision, feel worse in damp, cold weather and mentally be dull with a lot of anxiety. A strange symptom with Gelsemium is that symptoms are better for profuse urination.

Kali phosphoricum: Possibly one of the most widely used remedies for CFS, especially if the illness follows a bout of influenza. The mental symptoms of Kali phosphoricum are anxiety with depression, insomnia and nightmares. The anxiety may present as a fear of crowds and agoraphobia. Loss of memory might be a problem. There is muscle weakness and aches and pains, all worse with exercise, the cold and mental effort. The symptoms are better from sleep, eating and gentle movement. A suitable dose might be 6c twice daily, reducing with improvement.

Mercurius solubilis: Also known in the abbreviated form Merc sol, this is often a good remedy for acute glandular fever (caused by the Epstein-Barr virus). If those symptoms become more chronic and result in CFS, then Merc sol may still be a good medicine to give. The patient may have a persistent sore throat with enlarged cervical lymph nodes (glands) and have a lot of salivation. They may also be sensitive to both heat and cold. Insomnia with great restlessness at night and nightmares may also be a feature. The muscle pains will be deep with tender bones. As with Kali phosphoricum there may be loss of memory and poor recall of names.

Phosphoric acid and other “acid” remedies: Weakness and exhaustion is a feature common to all the “acid” remedies. With Phosphoric acid the nervous exhaustion comes first, followed by the physical. It may be the remedy to give when someone has CFS following an illness such as prolonged diarrhoea. The patient may be listless, apathetic – even sullen – find it difficult to cope and suffering depression as well. They may also be very sensitive, especially to music. The patient’s physical symptoms may include looking worn-out, pale and thin, and they may have blue rings round the eyes. They will probably be very chilly with a poor appetite while being very thirsty.

The other acid remedies include Picric acid, Muriatic acid and Sulphuric acid. Exhaustion is the common feature of these acid remedies. The exhaustion in these remedies may have been preceded by overactivity, and Vithoulkas has described the mental exhaustion of Picric acid, the emotional exhaustion of Phosphoric acid and the physical exhaustion of Muriatic acid. Picric Acid has extreme muscular weakness with trembling and twitching. The legs may feel tight or have pins and needles and the person will have to lie down, which does provide relief.

Scutellaria: Also known as Mad-dog skullcap, Scutellaria is a plant native to North America and has been used in folk medicine to treat many nervous disorders like epilepsy, anxiety and headaches. Dr Margaret Tyler, author of Homeopathic Drug Pictures, described Scutellaria as her “sheet-anchor in treating post influenza neuroses”. As such it can be used in the treatment of CFS especially following flu, where the patient is nervous and forgetful, having frequent dull headaches accompanied by aching and weakness of the limbs and muscle twitching.

Zincum metallicum: The Zincum picture is one of weakness with restlessness and depression. The memory is poor and the patient is lethargic, irritable and hypersensitive especially to noise; restless legs accompanied by muscular twitching are also common features. Numbness and coldness and strange sensations in arms and legs are also common. All symptoms are worse from alcohol.

Nosodes: I have included the general term nosodes as the approach of using nosodes to treat CFS can be a useful one. A nosode is a homeopathic medicine derived from diseased tissue including micro-organisms. They are useful when there has been a history of a particular illness and the individual has reported being unwell ever since that time. So in relation to the homeopathic treatment of CFS, Influenzinum may be used when CFS has developed following flu; or the Glandular fever nosode following glandular fever, and so forth.

While these homeopathic medicines are generally indicated in the treatment of CFS, they are by no means the only ones.

Sophie’s story
Sophie is 24 years old and has complained of feeling tired all the time. Her symptoms started five years before when she’d had prolonged diarrhoea while living in Singapore. The diarrhoea had lasted on and off for a few months. She feels lethargic on waking and by mid-afternoon feels exhausted. She is able to work full-time and can take exercise, but this produces aching muscles especially in her legs. She feels numbness in her fingers and toes as well as cramping. She has headaches, sometimes lasting for about five days.

Diagnosed as having a mildly underactive thyroid two years ago, Sophie was prescribed a low dose of thyroxine but this made her unwell and she lost weight, so she was advised to stop the medication.

Sophie likes hot and sunny weather, dislikes the cold and always has cold hands. Thunder makes her feel on edge and she feels better when near the sea. She desires potatoes and pasta, while milk, bread and cheese aggravate her causing diarrhoea. She is generally an easy-going person, quite calm, with no real fears. She likes to be organised and tidy.

Mainly on the basis of the fatigue symptoms alone and the fact that her thyroid gland was underactive previously, Sophie was prescribed Thyroidinum 6x three times daily. This is an isopathic medicine made from a sheep’s thyroid gland. An isopathic medicine is derived from the causative agent of the disease itself or from a product of the disease process. It was expected that this would be the first prescription and she would need a more “constitutional” medicine based on her general symptoms and her personality such as Silicea or Phosphorus or China. However when Sophie was reviewed about six weeks later she was much better, less fatigued and now felt energised by exercise, not exhausted, so she was advised to continue the Thyroidinum for a few more weeks.

Summary
Although the two cases I’ve highlighted  show how effective homeopathic intervention can be in treating CFS, it is important to remember that in most chronic fatigue cases it is highly likely that more than one remedy will be needed on different occasions. CFS is a serious and disabling illness, causing varying degrees of disability. In the past it has not always been given much recognition as a severe illness –mainly by doctors, it must be said – probably because the direct causes and pathology of CFS are not really known.

To help patients with this illness more than one approach will usually be needed, homeopathy being one, as well as physiotherapy and psychological treatments. Support groups can be useful. The ME Association offers particularly good advice and support. For more information visit www.meassociation.org.uk