Ingabe ICFS Iyisifo Esingokoqobo?
“NGABAHAMBA bonke odokotela,” kuchaza uPriscilla, ophethwe iCFS (isifo sokukhathala esingamahlalakhona) waseWashington State, eU.S.A. “Igazi lami lahlolwa futhi ngabuzwa imibuzo ngokuphathelene nendlela yami yokuphila. Bathi akukho ngempela okwakungahambi kahle kimi futhi basikisela ukuba ngifune iseluleko sikadokotela wezifo zengqondo. Akekho kodokotela owayezimisele ukungithatha ngokungathi sína mina noma izimpawu zokugula kwami.”
Lokhu okuhlangenwe nakho kuvamile. Udokotela othile ebhala kuJAMA (Journal of the American Medical Association) ngonyaka odlule wathi: “Isiguli esineCFS esivamile ngaphambili sasiye kodokotela abahlukahlukene abangu-16. Eziningi zatshelwa ukuthi zaziphile ziyimiqabavu, ukuthi zazicindezelekile, noma zazingaphansi kokucindezeleka okukhulu. Eziningi zathunyelwa kodokotela bezifo zengqondo. Isimo singcono namuhla, kodwa asingcono kakhulu.”
ICFS iphakamisa izinselele eziyingqayizivele, njengoba iAmerican Journal of Medicine iphawula: “Kuyacindezela kakhulu ukubhekana nesifo lapho umuntu ebukeka ephilile ngokomzimba, lapho uhlolwa umzimba utholwe ungenalutho, nemiphumela yokuhlola okwenziwa ezindlini zokuhlola zezesayensi ingabonisi lutho. Isifo esinjalo ngokuvamile sihlotshaniswa nobuhlobo obungebuhle phakathi kwabantu abashadile, ezinye izihlobo, abaqashi, othisha, ochwepheshe bezempilo, kanye nezinkampani zomshuwalense.”
Inselele kodokotela iwukuthi ukukhathala kuwuphawu oluvame kakhulu. “Uma udokotela ubethola [u-R3] ngesiguli ngasinye esikhononda ngokukhathala, ubengayeka ukusebenza,” kubhala umhleli wezokwelapha. Kodwa, ngokusobala, bambalwa abakhononda ngokukhathala abaneCFS. Njengoba kungekho ndlela yezokwelapha yokuhlola lesifo, udokotela angasithola kanjani?
Incazelo YeCFS
NgoMarch 1988 iCDC (Izikhungo Zokunqanda Izifo ZaseU.S.) yashicilela kuAnnals of Internal Medicine iqoqo lezinkomba nezimpawu zonke zihlangene eziphawula iCFS. (Bheka ibhokisi elihambisana nalesihloko.)
Izinkomba ezinkulu zokubona iCFS yilezi (1) ukuhlasela okusha kokukhathala okuhlala isikhathi esingaphezu kwezinyanga eziyisithupha futhi kunciphise izinga lokusebenza komuntu ngamaphesenti angu-50 kanye (2) nokungahlanganiswa kwezinye izimo zezokwelapha noma izimo zengqondo ezingabangela izimpawu. Nokho, ukuze kutholakale ukuthi isiguli sineCFS, kufanele futhi sibe nezinye izimpawu ezingu-8 kwezingu-11 ezisohlwini lwezinkomba ezincane noma eziyisithupha kwezingu-11 zalezimpawu kanye nezimbili kwezintathu ezisohlwini lwezimpawu ezingokomzimba.
Ngokusobala, labo abatholwa ukuthi baneCFS basuke begule kakhulu isikhathi eside. ICDC yenza incazelo yeCFS yalinganiselwa kakhulu ukuze babonakale kahle labantu. Labo abanezinhlobo ezingezimbi kakhulu zalesifo okwamanje abahlanganisiwe kulencazelo.
Kungenzeka Yini Ukuthi ICFS Iwukucindezeleka?
Kuthiwani ngodokotela abathi iziguli ezineCFS ziphethwe ukucindezeleka kanye nezinye izifo eziphathelene nokusebenza kwengqondo? Ingabe leziguli zinazo izimpawu zokucindezeleka eziyisibonelo?
Iziguli eziningi ezineCFS ziyacindezeleka, kodwa njengoba uDkt. Kurt Kroenke, uprofesa esikoleni sezokwelapha eBethesda, eMaryland, U.S.A., abuza: “Ingabe bekungeke kwenzeke yini ukuthi noma ubani acindezeleke uma ubehlala ekhathele unyaka wonke noma ngaphezulu?” Ngakho kufanelekile ukubuza: Ingabe ukucindezeleka kuyimbangela yeCFS, noma ingabe kuwumphumela wayo?
Ngokuvamile lowombuzo kunzima ukuwuphendula. Udokotela angase acabangele iphuzu lesibili lezinkomba ezinkulu, elithi ‘izimo zengqondo ezingabangela lezimpawu kufanele zingahlanganiswa,’ futhi aphethe ngokuthi isiguli siphethwe ukucindezeleka kodwa asiphethwe isifo esithinta isitho esithile noma umzimba. Nokho, ezimweni eziningi lona akuwona umphumela wokupopola owanelisayo.
Iphephabhuku lezokwelapha iCortlandt Consultant laphawula: “Ubufakazi obuqand’ ikhanda bokuthi iCFS iyisifo ‘esingokomzimba’ ukuhlasela kwaso ngokungazelele ezigulini ezingamaphesenti angu-85. Iningi leziguli lithi ukugula kwalo kwaqala ngosuku oluthile ngokugula okwakuzishaya samkhuhlane okwakuphawulwa imfiva, [umphimbo obuhlungu, ukuvuvuka kwamalymph node, ukuqaqamba kwezicubu], kanye nezinye izimpawu ezifanayo.” Odokotela abaye basingatha iziguli ezineCFS bayaqiniseka ukuthi ukucindezeleka ngokuvamile akuyona imbangela yalezimpawu.
“Lapho siqhathanisa izimo zethu,” kubika uDkt. Anthony Komaroff, isikhulu seGeneral Medicine eBrigham naseWomen’s Hospital eBoston, eU.S.A., “samangazwa iphuzu lokuthi iziguli eziningi zathi zaziphile ziyimiqabavu, zinamandla futhi ziphumelela ekuphileni kwaze kwaba ngolunye usuku lapho zaba khona nomkhuhlane, noma ibronchitis futhi ayizange iphele. Izimpawu ezazingase zicatshangelwe njengezingokwengqondo—ukucindezeleka, ukucobeka komzimba, nokungalali kahle kanye nokunye—zazingekho ngaphambi kokuqala kwalesifo.”
Olunye uphawu lokucindezeleka oluyisibonelo ukuphelelwa isithakazelo kuyo yonke into. Kodwa uDkt. Paul Cheney wachaza: “Leziguli zihlukile. Zikhathazeka ngokweqile ngalokho okushiwo izimpawu zazo. Azikwazi ukwenza noma yini. Azikwazi ukusebenza. Eziningi ziyesaba. Kodwa aziphelelwa isithakazelo ezintweni ezizizungezile.”
Izindlala ezivuvukele, imfiva, izibalo ezingavamile zamangqamuzana amhlophe egazi, ukungenwa komgudu wokuphefumula igciwane ngokuphindaphindiwe, ukuqaqamba kwezicubu namalungu, futhi ikakhulukazi ukucobeka komzimba okuyinqaba nobuhlungu bezicubu okungase kwenzeke ngisho nangemva nje kokuzivivinya okusesilinganisweni—lezimpawu azizona neze ezesifo esihlobene nokucindezeleka.
Ubufakazi Obuningi Bamuva
Kumagazini wayo wangoNovember 6, 1991, iJAMA yabika: “Ukwaziswa kokuqala okuvela ekuhlolweni okuqhubekayo kweziguli ezifanelana nencazelo yeCDC yesifo sokukhathala esingamahlalakhona (CFS) kubonisa ukuthi iziguli eziningi ezinalesifo azizona izisulu zokucindezeleka noma zezinye izinkinga zengqondo.”
UDkt. Walter Gunn, owaqaphelisisa ngokuseduze ukucwaninga ngeCFS eCDC, wachaza kulomagazini weJAMA: “Naphezu kwephuzu lokuthi odokotela abaningi babengacabanga ukuthi leziguli [ezazihlolwa] zazicindezelekile, sathola ukuthi zingu-30% kuphela iziguli ezineCFS ezazinobufakazi bokucindezeleka ekuqaleni kokukhathala.”
Kungase ngisho kube khona nokungafani okungokomzimba phakathi kweziguli eziningi ezineCFS kanye nalezo ezihlushwa ukucindezeleka. “Iziguli ezinesifo sokucindezeleka okukhulu (MDD) ngokuvamile zinokuphazamiseka kokulala okuba nesikhathi sokunyakaza kwamehlo okusheshayo (REM), kuyilapho iziguli ezineCFS zinokuphazamiseka [kokulala] okungenaso isikhathi sokunyakaza kwamehlo okusheshayo,” kuphawula iphephabhuku lezokwelapha iFemale Patient.
Umagazini iScience wangoDecember 20, 1991, wabika okunye okuphawulekayo okwatholwa. Wathi ukucwaninga kubonisa ukuthi “iziguli ezineCFS zinamazinga ahlukile amahormone athile obuchopho” futhi waphawula: “Nakuba ukungefani kubantu abangenaso lesifo kwakusesilinganisweni, iziguli ezineCFS njalo zazibonisa amazinga aphansi ehormone yesteroid icortisol, kanye namazinga aphakeme ehormone yepituitary okuthiwa iACTH (adrenocorticotropin hormone), okuhluke ngokuphelele ezinguqukweni ezibonwe kwabanokucindezeleka.”—Omalukeke sizenzele.
Kuthiwani Uma ICFS Iyisifo Esingokoqobo?
Ochwepheshe bezokwelapha bayangabaza ngezifo abangaziqondi, ezinjengeCFS. “Ukungabaza kugcwele ebuchwephesheni bethu,” kubhala uDkt. Thomas L. English. “Ukungabaza okunengqondo kuyindlela ethandwayo manje yokucabanga kodokotela abahlakaniphile, abaqondayo.” Nokho, uDkt. English ubuza ukuthi kunenzuzo kangakanani ngesiguli esiphathekile “uma iCFS iyisifo esingokoqobo.” Ubuza odokotela abangabazayo abakanye nabo: “Kuthiwani uma ninephutha? Iyini imiphumela ngeziguli zenu?”
UDkt. English ngokwakhe uneCFS, futhi ngonyaka odlule iJAMA yashicilela isihloko sakhe esasiqondiswe kodokotela akanye nabo. Wabacela ukuba bazibeke esimweni sesiguli esiphathekile, echaza lesisifo:
“Ungenwa ‘umkhuhlane’ futhi kamuva izinga lokuphila kwakho lishintsha ngokungenakukhohlweka. Awukwazi ukucabanga kahle . . . Ngezinye izikhathi kudinga wonke amandla akho ukufunda iphephandaba noma ukugxila engxenyeni ethile yohlelo lwethelevishini. Uzizwa sengathi unokugula okubangelwa ukuhamba ngendiza kodwa kungapheli. Uyatotoba esimweni esibucayi esisibekelwe inkungu sokunakekelwa kwesiguli, endaweni oke wahamba kuyo ngokuzethemba. Izinhlungu zezicubu ziwudunga wonke umzimba. Izimpawu ziba khona zibuye zinyamalale, zikhule zibuye zinciphe. . . . Nawe ngokwakho ubungase ube nokungabaza ngezinye zezimpawu zesifo sakho ukuba awuzange uxoxe nezinye iziguli ezinokuhlangenwe nakho okufanayo . . . noma uxoxe nodokotela abaye babona iziguli eziningi ezinesimo esifanayo. . . .
“Ngiye ngaxoxa neziguli eziningi esikanye nazo ezaya kodokotela bezokwelapha ziyofuna usizo, kodwa ezabuya zidumele, zithukuthele, futhi zesaba. Imizimba yazo yayizitshela ukuthi ziyagula, kodwa ukucabangela kodokotela bazo kokuthi isifo sazo sasibangelwa ukuphazamiseka kwengqondo kwakumane nje kwesabise futhi kuthukuthelise—kwakungaqinisekisi. Kwakubatshela ukuthi odokotela babo banokuqonda okuncane ngenkinga yangempela. . . . Ingabe kufanele sikholelwe ukuthi ngenxa nje yokuthi izimpawu ziyinqaba futhi azivamile ngeke zibe ngokoqobo? Ingabe kufanele sicabange ukuthi ukuhlola okwenziwa ezindlini zesayensi kuyakwazi ukubona izifo ezintsha kanye nezindala? Ukungayethembi imiqondo emisha kudala njengesintu; injalo nemiphumela elimazayo yalokho kungethembi.”—JAMA, February 27, 1991, ikhasi 964.
Ukubaluleka Kokuvuma Ukuthi Kuyisifo
“Odokotela abachitha isikhathi esiningi bexoxa neziguli ezineCFS bezwa indaba efanayo ngokuphelele; lendaba iyefana neyabanye abanalesifo,” kuphawula uDkt. Allan Kind, uchwepheshe wezifo ezithathelwanayo. “Enginganitshela khona ukuthi iSifo Sokukhathala Esingamahlalakhona singokoqobo.”
Odokotela abaningi ngokwengeziwe manje bayavuma. Kanjalo iFemale Patient yakhuthaza odokotela: “Kuze kube yilapho sesitholakele lesifo futhi sekungenziwa indlela efanelekile yokwelapha, udokotela unomthwalo wemfanelo okhethekile wokutshela leziguli ukuthi zinaso ngempela isifo esingokoqobo, nokuthi akusiyo nje ‘inkinga esengqondweni.’”
Inzuzo yokuqinisekisa ukuthi isiguli sinesifo ingaba nkulu kakhulu. Lapho udokotela othile etshela omunye wesifazane ukuthi wayeneCFS, lona wesifazane wathi: “Ngavele ngakhala.” Ukuzwa udokotela ethi wayenesifo esingokoqobo, nokuthi sinegama, kwakuyimpumuzo enkulu kuye.
Nokho, yini ebangela iCFS? Yini eye yembulwa ukucwaninga?
[Ibhokisi ekhasini 7]
IZINKOMBA ZOKUBONA ISIFO SOKUKHATHALA ESINGAMAHLALAKHONA
Izinkomba Ezinkulu
1. Ukukhathala okusanda kuqala okuhlala isikhathi esingaphezu kwezinyanga eziyisithupha kanye nokuncipha kokusebenza ngamaphesenti angu-50
2. Azikho ezinye izimo ezingokwezokwelapha noma ezithinta ingqondo ezingabangela izimpawu zaso
Izinkomba Ezincane
Lezimpawu kufanele ziqale lapho kuqala ukukhathala noma ngemva kwalokho
1. Umkhuhlane osezingeni eliphansi
2. Umphimbo obuhlungu
3. Ubuhlungu bamalymph node
4. Ubuthakathaka bazo zonke izicubu
5. Ubuhlungu bezicubu
6. Ukukhathala okuthatha isikhathi eside ngemva kokuzivivinya
7. Izinhlungu zekhanda
8. Ukuqaqamba kwamalungu
9. Ukuphazamiseka lapho ulele
10. Izinkinga eziphathelene nezinzwa kanye nokusebenza kwengqondo, ezifana nokukhohlwa, ukukhungatheka, ubunzima bokugxilisa ingqondo, ukucindezeleka
11. Ukuhlasela okunzima (okuthatha amahora ambalwa kuya ezinsukwini ezimbalwa)
Izinkomba Ezingokomzimba
1. Umkhuhlane osezingeni eliphansi
2. Ukuvuvukala komphimbo
3. Ukuthamba kwamalymph node
[Isithombe ekhasini 8]
Odokotela kufanele baqaphele ukuba bahlukanise phakathi kokucindezeleka kanye nesifo sokukhathala esingamahlalakhona