Why Do Some People Not Get Better?

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By Charles W. Lapp, M.D.

Note: Dr. Lapp is Director Emeritus of the Hunter-Hopkins Center in Charlotte, a medical clinic that specializes in treating people with Chronic Fatigue Syndrome and fibromyalgia.

You've done everything right --taken rest periods, maintained regular low level exercise, eaten nutritious meals, and tried all the trendy supplements-- but you're just not getting better. Why? And now what?

The experienced clinician recognizes that even model behavior does not guarantee improvement in a chronic illness like CFS/ME or FM. Occasionally it pays to look for unrecognized problems that impede progress. Sometimes the answer is a previously unappreciated disorder such as Addison's disease, a toxic exposure, Lyme disease, an inflammatory bowel condition, a sleep disorder. But there are other factors that may be impeding progress.

Overexertion

Carol used to do it all: take evening classes, raise her children, maintain the house, volunteer at church, and attend to her husband, so now she does not understand why she can only manage a couple chores or errands per day. She regularly makes out a To Do list and unwittingly attempts more than she can handle. Carol needs to re-evaluate her current abilities and defer, delay, or delegate whatever responsibilities she can.

Hidden Stressors

Elizabeth doesn't realize that her family is in constant chaos. Mother and father are getting older, and not only expect lots attention but demand it. Her teenage daughter is doing poorly in school and dating the "wrong kind of boys." Her son's grades are declining and he is becoming disrespectful, angry, and withdrawn. Her husband was spoiled as a child and now believes that men go to work and women must handle everything else.

For years Elizabeth has been working dutifully raising the children and maintaining the household and paying the bills. But now Elizabeth just doesn't have the energy or stamina to cope with all of these issues that were once day-to-day problems. Now they accumulate like falling snow. Things will not improve until this weight is lifted.

Inadequate Coping Skills

Poor coping mechanisms --such as denial, guilt, prolonged grief, and anger-- can lead to stress. Robert was injured in a freak industrial accident. He gets livid with anger and rage as he repeatedly recalls the incident. Karen detests that she lost her job as a high paying executive, and she grieves the recognition, the money, and the future that she once had. "I can't accept a life like this," she says. Mary has three children and an overworked husband, so she feels guilty as a mother and as a wife because she is not contributing her fair share to the family.

Robert, Karen, and Mary expend enormous amounts of precious energy on anger, grief, denial, and guilt. The cards have been dealt, and these individuals need help in understanding and playing their hands.

Multiple Medical Problems

It is axiomatic in chronic illnesses that the more medical problems, the harder it is to improve. Multiple problems complicate and conflict. For example, a person with drug and chemical sensitivities may not be able to tolerate medications needed to manage sleep and pain. A diabetic with hypertension and gastric ulcers already spends lots of time and money on self-management and drug therapies. So when multiple medical conditions co-exist with CFS/ME/FM, it is necessary to address those problems first.

It's Not Time

Lastly, CFS/ME and FM are chronic illnesses, and chronic implies constant, persistent, or recurring. Clearly, some persons are impatiently waiting for the tide to turn. While the vast majority of individuals with CFS/ME or FM improve over time, the progress is usually measured in painstaking months and years. Patients have been known to recover after 11, 15, and even more than 20 years. So when improvement is not forthcoming, be patient. It may not yet be your time.

So if you are doing everything right - resting, limit setting, assuring good nutrition and daily activity -- then address those hidden perpetuators. Improvement almost always follows acceptance, adaptation to the illness, a favorable attitude, and patience.