Essay On Dorothy's Trauma Syndrome

Stolen Health & Life: How Chronic Fatigue Syndrome Marauds Its Victims
The Golden Girls was an eighties sitcom about four women that shared a home in Miami. The sitcom presented a myriad of topics from homelessness to age discrimination. One of its more poignant episodes was about the diagnosis of Chronic Fatigue Syndrome. This two part episode showed how Dorothy (portrayed by Bea Arthur), struggled to find the cause of an ongoing illness that mimicked flu like symptoms. After visiting a multitude of physicians, she was finally diagnosed with Chronic Fatigue Syndrome. Her symptoms were all explained by this unknown disease that wreaked havoc on her life. By dissecting the episode, you see that the diseased prevented her from effectively working daily, performing

her activities of daily living (ADLs), and diminished her memory skills.

She went from being an active substitute teacher to a weak person that could barely take care of herself. Thanks to TV magic, within one hour, she was able to be diagnosed and confront the physician that was the main proponent to tell her she was fine, and nothing was wrong with her. In observing that episode, two things can strike you. One, it was great that she was able to maintain a diagnosis and give hope to millions of people that happen across this episode that they may have an explanation for the similar symptoms that Dorothy had. The second is that since the original airing in 1989, the medical community has not publicly address what goes on with Chronic Fatigue Syndrome (“Golden”). Light is made of the name and the disease is still dismissed as a catch all diagnosis when there is no scientific explanation for patients’ symptoms (Institute). Chronic Fatigue Syndrome (CFS) is a debilitating disease that renders its victims unable to function. The causes of this disease are unknown, so are the exact ways to treat it. CFS is a disease of many mysteries that physicians

are working to solve to help the victims in the wake of its destruction.
According to the Centers for Disease Control and Prevention (CDC), Chronic Fatigue Syndrome (CFS) is a debilitating and complex disorder characterized by profound fatigue that is not improved by bed rest and that may be worsened by physical or mental activity (“Chronic”). The disease is also referred to as chronic fatigue immune dysfunction syndrome, myalgic encephalomyelitis/CFS, and CFS/myalgic encephalomyelitis (Steefel). There is a recommendation to rename the disease “systemic exertion intolerance disease” (SEID) because of misperceptions on the part of clinicians and the public and lack of evidence of brain inflammation (Institute). Symptoms may include post- exertional malaise lasting for more than 24 hours, tender or swollen lymph nodes, recurring sore throat, unrefreshing sleep, insomnia, significantly impaired short- term memory and/or concentration, headaches, muscle pain or joint pain (“Chronic, Hudson). Other symptoms that are not as common, but can accompany CFS are abdominal pain, alcohol intolerance, bloating, chest pain, chronic cough, diarrhea, dizziness, dry eyes or mouth, earaches, irregular heartbeat, jaw pain, morning stiffness, nausea, night sweats, psychological problems (depression, irritability, anxiety, panic attacks), shortness of breath, skin sensations (such as tingling), and weight loss (“CFS”). The diagnosis for CFS requires that it meets three criteria: (1) The individual has had severe chronic fatigue for six or more consecutive months that is not due to ongoing exertion or other medical conditions associated with fatigue (these other conditions need to be ruled out by a doctor after diagnostic tests have been conducted); (2) The fatigue significantly interferes with daily activities and work; and (3) The individual concurrently has four or more of the following eight symptoms: *post-exertion malaise lasting more than twenty four hours; *unrefreshing sleep; *significant impairment of short-term memory or concentration; *muscle pain; *pain in the joints without swelling or redness; *headaches of a new type, pattern or severity; *tender lymph nodes in the neck or armpit; and *a sore throat that is frequent or recurring (“CFS”). The cause of CFS continues to be a mystery, even after years of research (“Causes”). It is believed that there could be a number of causes to include infections, stress, trauma, immune disorders, and toxins (“Causes”). It has prevalence among white women of ages ranging from their 40s to their 60s, but can occur in all ages, races, and socioeconomic backgrounds (Anderson). Many of the persons that suffer with CFS have co-morbidities that make it difficult to diagnose CFS (Steefel). Co-morbidities in women, such as interstitial cystitis, fibromyalgia, temporomandibular joint disorder (TMJ), vulvodynia, and endometriosis, increase the pain that comes with CFS (Steefel). It is estimated that eighty four to ninety one percent of individuals with CFS have not been diagnosed and continue to suffer with the symptoms (Institute).
The emergence of CFS occurred in the mid-1980s when two large outbreaks of an illness resembling mononucleosis happened in Nevada and New York (Institute). Symptoms of the illness included “chronic or recurrent debilitating fatigue and various combinations of other symptoms, including sore throat, lymph node pain and tenderness, headache, myalgia, and arthralgia’s” (Institute). The illness was thought to be connected to the Epstein-Barr virus (Institute). Because of this assumption, the illness was referred to as “chronic Epstein-Barr virus syndrome” (Institute). In 1987, the Centers for Disease Control and Prevention (CDC) decided to review the nuances of the disease to appropriate the most descriptive name for the disease process (Institute). The names that were considered were all ruled out; including Epstein-Barr virus, because of the virus was not the cause of the virus (Institute). The CDC decided on the name of “chronic fatigue syndrome” because of its neutrality, noting that “myalgic encephalomyelitis” was the name most accepted in other parts of the world (Institute).
Because there is no known cause for CFS, there is difficulty with diagnosing this chronic disease. Other difficulties that present themselves with diagnosis of CFS are: there is no diagnostic laboratory test or biomarker found in the blood for CFS; fatigue and other symptoms of CFS are shared by many illnesses; symptoms vary from person to person in type, number, and severity; no two CFS patients have exactly the same symptoms; CFS has a pattern of remission and relapse; and people with CFS don’t look ill (Steefel). To rule out other disease processes, physicians must follow a set of guidelines to aid in proper diagnosis (Anderson). The protocol steps should be: *a detailed medical history will be needed and should include a review of medications that could be causing the fatigue and symptoms; *A thorough physical and mental status examination will also be needed; *A battery of laboratory screening test will be needed to help identify or rule out the possible causes of the symptoms that could be treated; and *the doctor may also order additional tests to follow up on results of the initial screening test (Anderson). There are a number of blood tests that are run by the physicians to help with diagnosis. They are alanine aminotransferase (ALT), albumin alkaline phosphatase (ALP), blood urea nitrogen (BUN), calcium, complete blood count with differential (CBC w/ diff), creatinine, electrolytes, erythrocyte sedimentation rate (ESR), globulin, glucose, phosphorus, thyroid stimulating hormone (TSH), total protein, transferrin saturation, and urinalysis (Anderson).
Even though there have been many years of research, no definitive cause for CFS has been found (“Causes”). Numerous types of infections have been studied to determine which of them may trigger CFS (“Causes”). Among the infections are: Epstein-Barr virus infection, Human herpesvirus 6 infection, Enterovirus infection, Rubella, Candida albicans, Bornaviruses, Mycoplasma, Ross River virus, Coxiella burnetti, and Human retrovirus infection (“Causes”). However, with these infections that may be triggers, there is still no evidence of one single infection connected to the development of CFS (“Causes”). Through research, some studies show that approximately ten to twelve percent of CFS cases developed after post-infective conditions of Epstein-Barr virus, Ross River virus, and Coxiella burnetti (“Causes”). There have been mixed findings that connect CFS to a victims’ immune system (“Causes”). While there are some patients with CFS that have immune complexes and auto-antibodies, there is no associated tissue damage typical of autoimmune disease (“Causes”). Also, while some patients present with T-cell activation markers, not all researchers have consistently observed these differences (“Causes”). Many patients have allergic diseases and secondary illnesses, however, not all patients with CFS have allergies (“Causes”). The physical or emotional stress that precludes conditions in CFS patients alters parts of the central nervous system (“Causes”). The activity of the hypothalamic-pituitary-adrenal axis (HPA axis) is altered, resulting in the releases of corticotrophin-releasing hormone, cortisol, and other hormones (“Causes”). When these hormones are released, they influence the immune system and many other body systems (“Causes”). While some CFS patients have lower levels of cortisol than healthy persons, their cortisol levels are still within normal ranges (“Causes”). Because of this fact, cortisol levels cannot be used by physicians to diagnose patients with CFS (“Causes”). Some patients with CFS have a difficulty with autonomic regulation of blood pressure and pulse. Neurally mediated hypotension (NMH) or postural orthostatic tachycardia (POTS) are conditions that are triggered by many of the symptoms (“Causes”). Not all CFS patients have NMH or POTS, but should be careful when changing positions, after eating, following unusual amounts of or inadequate fluid intake, or increases in activity (“Causes”). And, because there is no connection to nutritional deficiency and CFS, patients should eat a balanced diet for overall health (“Causes”).