Q: You've explained why many different triggers can cause the same set of symptoms that are seen in different people with CFS/FMS. What are some common triggers, though, for these syndromes?

A: Although the multiple different triggers for CFS/ FMS did initially cause confusion, they now offer clues that help determine the best treatments. A good way to begin is by asking the following questions:

1. Did the illness begin gradually or suddenly?
   
2. What was going on in your life in the months preceding the illness?

Q: What if my illness had a sudden onset?

A: About half of you had a sudden onset and this was also the way that my CFS/FMS began in 1975. When a sudden onset is present, it gives us clues in how to proceed in our detective work. The most common thing to look for if the illness started suddenly is an infection. If so, was it:

1. Predominantly flu-like with symptoms of sore throat, runny nose, generalized achiness, headache, fever and malaise. If so and you had any blood tests that were done at the onset of the illness, did your doctor check a white blood cell (WBC) count or tests for specific viruses? If a WBC test was checked (and this is a very common test to do during infections) it being under 6000 (especially with an elevated lymphocyte or atypical lymphocyte score) suggests an initial viral infection as the trigger. If the WBC is over 9000, this would be more suggestive of an antibiotic sensitive infection.
2. Largely focused in your lungs/chest. If so, an unusual Doxycycline/Cipro antibiotic sensitive infection is more likely to be the case. This is especially so if you continue to have lung congestion and/or low-grade fevers (in this disease, a fever is anything over 98.6 degrees Fahrenheit). In this situation, an extended course of the antibiotics Doxycycline or Cipro (usually for 6 to 24 months -- take nystatin to avoid yeast overgrowth) can be very helpful.
3. Predominantly a bowel infection with severe diarrhea. In these situations, looking for parasites would be critical -- especially if you were traveling when you got it. The vast majority of labs in this country (I suspect) will miss parasites most of the time. The lab I recommend for stool parasite testing is the Parasitology Center (480-777-1078) although the Great Smoky Mountain labs (800-522-4762) also does a good job. If the parasite test is negative, a bacterial stool test at great Smoky Mountain labs can also be helpful. If the diarrhea began after a course of antibiotics, a test to check the stool for Clostridium Difficile toxin is important (this can be done at any lab). Usually, however, this means that it is important to treat yeast overgrowth.
4. Other infections such us hepatitis, chronic bladder infections, prostatitis (low-grade and often missed on a doctor visit) also give important clues and can help to direct effective treatment.

---

Dr. Teitelbaum is a board certified internist and director of the Annapolis Research Center for Effective CFS/Fibromyalgia Therapies, where he sees CFS/Fibromyalgia/Chronic pain patients from all over the world (410-266-6958). Having suffered with and overcome these illnesses in 1975, he spent the next 28 years creating, researching, and teaching about effective therapies. He is the author of the best-selling From Fatigued to Fantastic!" and the newly released "Three Steps to Happiness! Healing through Joy". His web site can be found at: www.vitality101.com