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Reprinted with permission of the Annals of Internal Medicine. The American College of Physicians is not responsible for the accuracy of this translation. Reference: Ann Intern Med 1996;125:398-405.


War Syndromes and Their Evaluation: From the U.S. Civil War to the Persian Gulf War

Kenneth C. Hyams, MD, MPH1

F. Stephen Wignall, MD2

Robert Roswell, MD3

U.S. Naval Medical Research Institute, Bethesda, Maryland

U.S. Naval Medical Research Unit No.2, Jakarta, Indonesia

Department of Veterans Affairs, Bay Pines, Florida

The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or reflecting the views of the U.S. Navy, Department of Defense, or Department of Veterans Affairs.


Purpose: To better understand the health problems of veterans of the Persian Gulf War by analyzing previous war-related illnesses and identifying possible unifying factors.

Data Source: English-language articles and books on war-related illnesses published since 1863 that were located primarily through a manual search of bibliographies.

Data Extraction: Publications were assessed for information on the clinical characteristics of war-related illnesses and the research methods used to evaluate such illnesses.

Data Synthesis: Poorly understood war syndromes have been associated with armed conflicts at least since the U.S. Civil War. Although these syndromes have been characterized by similar symptoms (fatigue, shortness of breath, headache, sleep disturbance, forgetfulness, and impaired concentration), no single recurring illness that is unrelated to psychological stress is apparent. However, many types of illness were found among evaluated veterans, including well-defined medical and psychiatric conditions, acute combat stress reaction, post-traumatic stress disorder, and possibly the chronic fatigue syndrome. No single disease is apparent, but one unifying factor stands out: A unique population was intensely scrutinized after experiencing an exceptional, life-threatening set of exposures. As a result, research efforts to date have been unable to conclusively show causality, have been subject to reporting bias, and have lacked similar control populations. In addition to research limitations, war syndromes have involved fundamental, unanswered questions about the importance of chronic somatic symptoms and the factors that create a personal sense of ill health.

Conclusion: Until we can better understand what constitutes health and illness in all adult populations, we risk repeated occurrences of unexplained symptoms among veterans after each war.


After returning home in 1991, some veterans of the Persian Gulf War began reporting diverse symptoms that have been collectively called a mystery illness or the Gulf War syndrome (1). Extensive programs have been initiated by the governments of the United States, Great Britain, and Canada to provide medical care for veterans of the Persian Gulf War, to define any new syndrome, and to determine the causes of the veterans' illnesses (2-4). In the search for the cause of a previously uncharacterized complex of signs and symptoms (or syndrome), the question arises whether a similar illness occurred during or after previous wars. If an analogous illness affected veterans of other wars, its cause may be related to common wartime experiences rather than to a unique event during the Persian Gulf War. In this historical review, war-related syndromes from the U.S. Civil War to the Persian Gulf War were analyzed to identify possible unifying factors.

War Syndromes

U.S. Civil War

During the U.S. Civil War, Da Costa (5) did one of the first studies of a war syndrome. Da Costa evaluated 300 soldiers referred to him for a syndrome that he called irritable heart; this syndrome was principally characterized by shortness of breath, palpitations, and sharp or burning chest pain, particularly on exertion. Other symptoms included fatigability, headache, diarrhea, dizziness, and disturbed sleep (Table 1). There was no consistent sign of physiologic disease, and most patients appeared to be in fair overall health.

Symptoms of the irritable heart syndrome were not restricted to soldiers who had been in combat, and Da Costa believed that the condition occurred in civilian populations. Because many of the patients had had a recent episode of diarrhea, upper respiratory infection, or febrile disease, Da Costa concluded that an infectious disease was the cause in 48% of patients. Thirty-five percent of cases were attributed to strenuous military duties and 18% to miscellaneous causes. Da Costa reported that 38% of patients recovered from the disorder and that administration of several drugs, including digitalis, may have had a beneficial effect.

On the basis of Da Costa's clinical descriptions, it is difficult to confidently determine specific diagnoses; however, various illnesses could have caused the symptoms in these patients (6, 7). Few patients had conclusive evidence of heart disease. Many patients were debilitated from malnutrition, lack of exercise, infectious diseases (including malaria and typhoid), and other adverse medical conditions. Some patients had symptoms of a psychological illness or stress reaction (8).

In addition to the irritable heart syndrome, a war-related illness attributed primarily to psychological factors was reported during the U.S. Civil War. Young soldiers with obsessive thoughts of home received a diagnosis of a severe form of homesickness called "nostalgia," which was characteristically accompanied by extreme apathy, loss of appetite, diarrhea, and sometimes fever (9, 10).

World War I

A syndrome similar to the one described by Da Costa became a major problem during World War I: Soldiers had to be evacuated to England because of shortness of breath, palpitations, and chest pain (11). Affected soldiers also commonly reported fatigue, headache, dizziness, confusion, concentration problems, forgetfulness, and nightmares (Table 1) (12-14). This complex of symptoms became known as soldier's heart or the effort syndrome because symptoms were exacerbated by effort. It was also called the Da Costa syndrome, disordered action of the heart, and, in the United States, neurocirculatory asthenia (15).

At the beginning of World War I, the effort syndrome was frequently attributed to cardiac hypertrophy caused by heavy marching packs compressing the chest (16, 17). However, as the war progressed, the effort syndrome was believed to encompass a mixed group of illnesses and causes, including constitutional nervous weakness and physical weakness; an infectious disease or debility from previous infections; exhaustion from lack of sleep and exertion in the trenches; the effects of poison gas; malingering; and, rarely, heart disease (12-14, 18-23). In some cases, onset of symptoms was also associated with acute stress resulting from combat or burial duties (12, 22).

Digitalis and other drugs did not benefit patients with the effort syndrome, but a structured rehabilitation program with a graduated exercise regimen and encouragement from a supervising medical staff were effective (12, 22). It was also found that if symptoms of the effort syndrome were attributed to heart disease, recovery and return to duty were hindered (12, 13). As a result, physicians were advised not to tell soldiers that they had a heart condition so that the soldiers would not think of themselves as patients who required evacuation from the front (12, 21, 22, 24).

A concerted clinical and research program was developed during World War I to determine the causes and most effective treatment of the effort syndrome (11). This program involved clinical care and empirical observations in two specialized hospitals in England (12) and a specialized referral center in the United States (7, 17). After the war, the Medical Research Council continued to oversee clinical evaluation and additional studies for the British government (11). Further investigations were given high priority because the effort syndrome was the third most common reason for disability and compensation assessment in England; 44 000 veterans eventually received pensions for this condition (11, 14, 25).

Although clinical studies published at the end of the war (26-28) indicated that the effort syndrome was caused by psychological factors, there was little agreement on what specific symptoms constituted the effort syndrome, whether it was primarily a physiologic or psychological illness, and even what the official name of the condition should be (29). However, there was a consensus that the effort syndrome was not caused exclusively by unique wartime exposures, because many soldiers reported having had similar symptoms before the war (12, 19, 22).

Each year for 5 years after World War I, a survey was mailed to 601 British veterans who had received a diagnosis of the effort syndrome and who had received pensions (30). Data from this survey and available medical records identified 52 veterans who had developed various defined illnesses, including 22 cases of pulmonary tuberculosis and 6 confirmed cases of cardiac disease. The health of most other veterans had remained stable, and mortality did not increase.

In addition to the effort syndrome, an acute illness attributed to combat stress (which was called shell shock or trench neurosis) was investigated during World War I. This acute combat stress reaction was first attributed to a strange new disease, possibly caused by concussion from modern weapons; however, a psychological cause was soon determined (31, 32). Typical manifestations of acute combat stress reaction included breakdown in battle, dazed or detached manner, exaggerated startle response, and severe anxiety (32, 33).

During World War I, it was determined that soldiers with shell shock could be rapidly rehabilitated if they were cared for near the front, expecting a quick recovery (32). After soldiers with shell shock were taken away from their comrades and treated as patients in a hospital, they were much less likely to return to combat. Also, the British used the nonspecific term "not yet diagnosed, nervous (NYD)" for the initial designation of possible victims of shell shock; this designation prevented soldiers from concluding that they had a medical condition that required hospitalization (32, 33).

World War II

At the beginning of World War II, the effort syndrome again became an important medical consideration for the British military (14). Whether the effort syndrome was predominantly a physiologic or psychological illness had not been resolved (14, 34). However, after Wood's influential clinical studies of 200 patients (35-37), the effort syndrome was generally considered to be a psychoneurosis and not a medical disease (7).

Acute combat stress reaction (which was known as battle fatigue, combat exhaustion, or operational fatigue among aviation personnel during World War II) also became better understood at this time (33, 38). Studies of combat personnel determined that acute combat stress reaction frequently manifested as somatic symptoms, including fatigue, palpitations, diarrhea, headache, impaired concentration, forgetfulness, and disturbed sleep (Table 1) (39).

As in World War I, soldiers with acute combat stress reaction were more likely to return to duty if they were treated quickly and near their combat units and received a diagnosis of a normal response to extreme stress rather than an abnormal condition. Consequently, use of such diagnostic labels as "war neurosis" was discouraged because they connoted that soldiers were sick and should be treated as patients (33, 39, 40).

Korean Conflict

Possibly because the effort syndrome had been attributed to psychological causes during World War II, it was not reported as a major medical problem during the Korean Conflict (7). Since the 1940s, the effort syndrome has been identified less frequently as a unique disease entity (41-43), but the lineages of many illnesses not related to war have been traced back through the effort syndrome to the Da Costa syndrome. Such illnesses include anxiety neurosis and manic-depressive conditions (44), panic disorders (45), the mitral valve prolapse syndrome (17, 46), the hyperventilation syndrome (47), and the chronic fatigue syndrome(48).

As in World War I and World War II, acute combat stress reaction was an important clinical problem during the Korean Conflict (33, 38).

Vietnam War

The most prominent illness related to the Vietnam War was post-traumatic stress disorder (49), which was initially called post-Vietnam syndrome (50, 51). Whereas acute combat stress reaction is the immediate consequence of psychological trauma, post-traumatic stress disorder more often refers to the long-term consequences of extreme psychological stress (52). Post-traumatic stress disorder has also been recognized as a problem in veterans of both the Korean Conflict and World War II (53), especially former prisoners of war (54, 55), and has been found in civilians exposed to extreme trauma not related to war (51).

No other prominent, poorly understood war syndrome was associated with the Vietnam War (56-58), although controversy about the role of Agent Orange (dioxin) exposure in the development of various medical problems and birth defects continues (59). Chronic somatic symptoms have generally not been linked to the effects of herbicide exposure in Vietnam. However, it is noteworthy that the somatic symptoms frequently described by Vietnam veterans who may have been exposed to Agent Orange (56, 58, 60) are similar to the symptoms commonly associated with other war-related illnesses (61), including acute combat stress reaction (39) and post-traumatic stress disorder (62-68) (Table 1).

Persian Gulf War

After Iraq invaded Kuwait in August 1990, 697 000 soldiers from the United States, 45 000 soldiers from Great Britain, and 4500 soldiers from Canada were deployed to the Persian Gulf during a 5-month buildup period; this period was followed by a 39-day air war and a 4-day ground war in February 1991. Far fewer casualties than anticipated occurred among coalition forces, and morbidity rates were low compared with those in previous wars (69, 70).

After the war ended, troops returned home, and veterans from diverse military units of the United States, Great Britain, and Canada began reporting various chronic symptoms, often referred to as the Gulf War syndrome (71-77). Fatigue, headache, muscle and joint pain, diarrhea, skin rashes, shortness of breath, and chest pain have been common symptoms (Table 1) (2, 78-80). Various neuropsychological symptoms also have been common -- particularly sleep disturbances, impaired concentration, forgetfulness, irritability, and depression. Currently, no characteristic physical sign or laboratory abnormality has been identified (2, 80, 81).

No medical reports of similar unexplained illnesses among other coalition troops or among persons indigenous to the Persian Gulf have been published. During World War II, no similar unexplained illnesses were seen among the British and U.S. forces stationed in the Persian Gulf (82).

Personal accounts of family members developing symptoms similar to those of relatives who served in the Persian Gulf War and increased birth defects among children born after the war have been reported (2, 83). Other recent war-related conditions have been associated with medical and psychological problems among family members (59, 84), but accounts of health problems among family members of veterans who received a diagnosis of a war-related illness did not increase during World War I or World War II.

The health problems experienced by veterans after service in the Persian Gulf War have been considered a serious matter by the involved governments, a response similar to that seen for the effort syndrome in World War I. A tri-agency coordinating board has been established in the United States to supervise a comprehensive clinical and research program (85-87), and compensation is being provided to disabled war veterans who have unexplained illnesses (U.S. Public Law 103-446, 2 November 1994). In addition, the U.S. Department of Veterans Affairs, the U.S. Department of Defense, and the governments of Great Britain and Canada have established self-referred health registries and specialized centers that provide comprehensive clinical examinations and medical care (2-4).

Clinical evaluation of more than 80 000 veterans and initial epidemiologic surveys have identified a broad range of health problems (2, 80, 88, 89), including symptoms of post-traumatic stress disorder in 5% to 15% of some veteran populations (90-94); however, a new or unique syndrome has not yet been identified (80). Preliminary results of epidemiologic studies of veterans of the Persian Gulf War show no overall increase in hospitalization rates (95), birth defects (96), or mortality due to medical causes (97).

Available information on the nature and cause of illnesses among veterans of the Persian Gulf War has been evaluated by five independent panels in the United States (70, 98-101). These panels did not identify a new illness (70, 98, 100) or establish a case definition of a unique syndrome (70, 98, 99, 101); they concluded that veterans of the Persian Gulf War had numerous illnesses that resulted from various causes (70, 98). However, one advisory committee concluded that a rare or mild illness could be missed by large case series, such as the Persian Gulf health registries, which have examined approximately 10% of all U.S. veterans of the Persian Gulf War (100).

Comparison of War Syndromes

Since the U.S. Civil War, two general categories of war-related illnesses have been recognized: one poorly understood group thought to be associated with physiologic disease and another group of psychological illnesses attributed to wartime stress (Table 2). Although there have been two general types of war-related illnesses, war syndromes have not been consistently defined or identified by a pathognomonic physical sign or laboratory abnormality. As a result, the diagnosis of a physiologic or psychological illness in individual patients has been imprecise and has depended on self-reported symptoms and the impression of the examining physician (8, 13, 34, 61, 98).

The war syndromes thought to be associated with organic pathology have been characterized by two similarities that could indicate a related disease. From the Da Costa syndrome to the more recent Gulf War syndrome, the first common feature has been the similarity of reported symptoms. Shared symptoms include fatigue, shortness of breath, headache, sleep disturbances, impaired concentration, and forgetfulness (Table 1). Common symptoms alone, however, do not show that veterans of various wars had a related disease process, because such symptoms are nonspecific and are frequently found in all adult populations (102-106), particularly among persons with psychological stress (39, 56, 107) and post-traumatic stress disorder (62, 63, 108).

A second possible unifying factor has been the high frequency of reported diarrhea and other infectious diseases preceding the onset of these syndromes (5, 13, 19, 109). The significance of this factor is unclear because crowded populations of military personnel, particularly troops sent to tropical and developing regions, have an inevitably high rate of infectious disease (58, 82). However, no unique, deployment-related syndrome has been reported after large peacetime military exercises. In addition, infectious diseases have not been proven to cause chronic somatic symptoms in the absence of measurable signs of disease (110), except possibly among persons prone to depression (111, 112). Nevertheless, convalescence can be prolonged after many infections (113), and the chronic fatigue syndrome, although not associated with characteristic signs of disease, is suspected of having an infectious origin (114).

Other than these two similarities, there is little additional evidence of a single, unique war syndrome that is unrelated to psychological stress. However, 19th-century and early 20th-century clinical characterizations are difficult to compare with modern data, and the psychological aspects of illness were not as well appreciated and reported in the past. Furthermore, because of the general improvement in health and nutrition during this century, it is difficult to compare the illnesses of military populations of different eras.

Although historical data are difficult to compare, ample evidence shows that numerous complex factors were responsible for the health problems of war veterans, as in any population, and that many illnesses were described after successive wars. A substantial proportion of veterans with chronic somatic symptoms were found to have various physiologic and psychological illnesses (13, 30, 80, 89). In addition, veterans of each war had high rates of acute combat stress reaction and post-traumatic stress disorder (33). Still other veterans had illnesses that meet the recently suggested criteria for a diagnosis of the chronic fatigue syndrome (48, 70, 89, 115).

Although no single, recurring war-related disease has been identified, many aspects of the process used during the past 130 years to evaluate the health problems of veterans have been repeated with each war. The most important and consistent factor is that this process has involved medical evaluation after the critical event, thereby precluding a definitive demonstration of causality. Consequently, numerous illnesses that occur after a war may be attributable to wartime exposure, and epidemiologic studies, regardless of their size or design, cannot conclusively resolve medical, legal, and political questions about the causes of post-war health problems (116). In addition to the problems of interpreting the results of retrospective studies, it has been difficult to identify similar control populations because of the exceptional nature of wartime experiences and the unique characteristics of military populations.

Because studies of war-related illnesses have been done after exposure and without similar control groups, research efforts have frequently been limited to the evaluation of a series of clinical cases. Research efforts have been further hampered because war syndromes have not been associated with characteristic and measurable signs of disease that would allow for the development of specific case definitions (8, 98). In addition to these research limitations, the problem of diagnostic labeling has played a critical role in the evaluation of war syndromes. The naming of a syndrome has repeatedly exerted a powerful effect on the medical approach toward, official recognition of, and patient perception of these poorly understood conditions (11, 33). A medically recognized diagnosis fundamentally alters the lives of active-duty military personnel and veterans, influencing everything from type and location of duty assignment to medical treatment, expectations of recovery, and eligibility for compensation (13, 37). The influence of a medical classification has also been found to be substantial among nonmilitary populations (117-119).


Despite enormous progress in medical science, poorly understood war syndromes have recurred at least since the U.S. Civil War. No single, previously uncharacterized illness or underlying cause that is unrelated to psychological stress is apparent from the available reports. However, many illnesses have been found among war veterans evaluated for these syndromes. As expected in any large adult population exposed to complex environmental and psychological conditions, various health problems have developed.

Although no unique war-related disease is evident, one unifying factor has been prominent in the evaluation of these syndromes: A unique population was intensely scrutinized after experiencing an exceptional, life-threatening set of exposures. The process by which these syndromes were evaluated and defined is the most evident similarity.

Designing studies to evaluate the health of war veterans inevitably presents several serious methodologic problems (116). For example, it is difficult to obtain accurate health and risk factor data after a potentially harmful experience, particularly if there has been extensive or sensational media coverage, because of reporting bias (120-122). During wartime conditions, it is not feasible for the military to collect comprehensive exposure data among combat troops because the primary focus must be to fight and win the war.

An apparent solution to these methodologic problems is to gather more extensive baseline medical and exposure data and to design large prospective studies before any future conflict. As a result of numerous recent overseas deployments, the U.S. Department of Defense is developing a greatly enhanced surveillance system. For military operations in Bosnia, which began in 1995, environmental and infectious disease surveillance teams have been deployed; U.S. troops are being provided extensive health guidance before, during, and after the operation; medical and psychological screening will occur before and after deployment; and a repository for serum collected before and after deployment is being established (123).

Intensive surveillance will substantially aid in the evaluation of veterans' health. However, it will be difficult to design prospective studies to answer all post-war health questions because the location and nature of each war varies too greatly to predict every health risk. In addition, studies of military populations alone will not sufficiently explain war-related syndromes because these syndromes involve fundamental, unanswered questions about health and illness. To more fully understand the health of any population, military or civilian, research efforts will have to be done to answer two basic questions: 1) What is the relation between chronic, non-specific symptoms and physiologic and psychological illness (124-127)? 2) What factors -- medical, environmental, psychological, or social -- create a personal sense of ill health (128-131)?

Evaluating fundamental questions of health in large populations is always extraordinarily difficult, but is particularly so after traumatic and complex wartime events. Nevertheless, unless these difficult questions are answered, we risk repeated occurrences of unexplained symptoms among veterans after each war.

This work was supported by the U.S. Naval Medical Research and Development Command, NMC, NCR, Bethesda, MD.


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Table 1. Somatic Symptoms Commonly Associated with War-Related Medical and Psychological Illnesses*

War and Illness

Symptom U.S. Civil War Da Costa Syndrome World War I, Effort Syndrome World War II, Combat Stress Reaction Vietnam, Agent Orange Exposure Vietnam and Other Conflicts,

Post-Traumatic Stress Disorder Persian Gulf, Unexplained Illnesses

Fatigue or exhaustion + + + + + +

Shortness of

breath + + + + + +

Palpitations and

tachycardia + + + +

Precordial pain + +

Headache + + + + + +

Muscle or

joint pain + +

Diarrhea + + + +

Excessive sweating + + +

Dizziness + + + + +

Fainting + +

Disturbed sleep + + + + + +

Forgetfulness + + + + +


concentrating + + + + +

Table 2. Comparison between Categories of War-Related Illnesses

Category of Illness


Physiologically Attributed

Psychologically Attributed

U.S. Civil War Da Costa syndrome

(irritable heart) Nostalgia

World War I Effort syndrome

(soldier's heart,

neurocirculatory asthenia) Shell shock

trench neurosis)

World War II Effort syndrome Battle fatigue,

Combat exhaustion,

operational fatigue

Korean Conflict Battle fatigue,

combat exhaustion

Vietnam War Agent Orange exposure Post-traumatic

Stress disorder

(Post-Vietnam syndrome)

Persian Gulf War Gulf War syndrome Post-traumaticstress disorder


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Guest tearose

Dearest Steph, well bless your little energized brain! This is very interesting and loong. It will take me a few more readings to absorb it all. Where are you getting your energy these days!

Sometimes I can't read all that is out there so I focus on just dealing with the consequences of the dysautonomia and not the original cause. I need to say that mine came from the lyme disease just so I can move past my wonder, but I really am not sure! It is the Mayo and Lyme physicians "best guess" but that may all change when they understand more.

I am curious about what caused our dysautonomia but sometimes I think the information is changing constantly and I wonder if this information is still current belief. I think when we are able to pull it together, we should have the latest researchers give us a two day workshop on the current understanding and treatment options for dysautonomia.

Do you think not being sure what brought on their dysautonomia is causing many people frustration? I guess it has been so long since I first had my symptoms that maybe I forgot.

I wish we all had the answers. I admire your dedication to all this research and hope you come out with the summary version for me!!! warmest regards, tearose

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Thanks for being kind as I'm sure that my ongoing Gulf War Posts might be frustrating some, I am sorry for that. I actually found these articles over the past 2 years and was too tired and confused to post them then. I keep posting them because it really is a coincidence if you research it.

I would imagine that when we all got sick we started doing our own research that's how we found DINET and NDRF. When we got our diagnosises we continued to research. So, in the beginning of my research of symptoms I kept stumbling onto Gulf War Syndrome, which actually ticked me off because I'm not in the Military. But now I'm starting to wonder and understand the Vets who are trying to fight the government for validity.

Many POTS patients are familiar with some of the other names for POTS, i.e. Soldier's Heart and Irritable heart; that in itself kept me wondering why the change in names for this illness.

What keeps me going on this subject. Have you ever seen the medical website (can't find it at the moment) showing a picture of a women on a day bed sick, around the early 1900's? Also about the time of military personnel complaining of similar symptoms. Did someone miss the connection?

OK, where do I get my energy. Well, 3 years of research and plenty of time in bed pondering. Recently Dr. Grubb's tx of IV Iron, Epogen, Beta Blocker, etc and definitely my recent usage of Vitamins has contributed to resumed function.

However, tonight I woke up ill and couldn't lay back down. I have difficulty breathing when I lay down at night to sleep. Not sure if it's because my HR and blood pressure drop. Recently my HR is in the upper 40's laying down and 130 standing up. My BP swings from 80's to 150's systolic. The only thing different is I'm not suffering that god awful fatigue 24/7 that keeps you in bed with those vitals. :P

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Guest tearose

Hi again, I just can't seem to do my chores so here I am...

Please continue to post your findings. It is a great service you are doing for us! If someone doesn't want to read the thread, they can move to another one. It is you sharing your healing journey with those who walk beside you. Those who choose to be there will learn from what you contribute. I am grateful for all your work! I know I will also go back to the archives in the future and it will be there.

So now that my brain is in gear...what is your gut feeling Steph? Do you have any ideas yet? Do you think we all caught a virus or were exposed to some toxin? I actually did not make any connections yet. Maybe I haven't read enough yet.

I'm still upset that many people are treated for somatic disorder rather than dysautonomia. I sometimes feel "blessed" that I have documented denervation and visible lymphedema because constantly having to prove this disorder would be my demise!

again, tearose

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Hey TeaRose

You always make me feel good, thank you!

I honestly am not sure what to believe anymore. What came first the chicken or the egg :P Stupid saying, but true.

Anyone reading as far back as the documented cases of military personnel getting sick with the same symptoms as we have, well, I hope someone else sees the coincidence. That is before they started mentioning all the neurotoxins. I think it will be decades and a lot of research before we get a clear idea. It doesn't help that the government keeps trying to bury the thought of Gulf War Syndrome.

I don't even like the terminology Gulf War Syndrome, because as you can see the military personnel have been sick for many decades (before there was ever a gulf war.)

It's interesting to see how the symptoms have evolved from the World War I.

I have 2 more articles that I would like to post, but I can't find one (It has nothing to do with gulf war illness. It talks about women in the early 1900's being ill with dysautonomia type symptoms. The other is about the gulf war though and it's the last one that I will probably post here, I worry about posting it because I haven't verified it's validity yet and I don't want to post bogus information here.)

It makes me made to hear about Somatic disorder too. What a cop out. I read a story about a mother and daughter about 6-9 months ago. They committed the daughter to a psych ward because they couldn't help her with her multiple medical symptoms and they said that she really didn't have any. After much time had lapsed and the mother had fought for her teenage daughter, they discovered she had Lyme disease. How do you think all the sick military feel being told that they really don't have real medical problems.

I agree 100% with you about trying to prove dysautonomia would be my demise too. 10 years ago it was nearly my demise. I rarely complained to the doctor about my numerous problems. I didn't want them to think I was nuts for having so many health issues at one time. I often gave half the story of the worst symptoms and omitted the little problems. The doctors were already skeptical.

I'm sorry that I'm not familiar with Lymphedema. What is it?

OK, I had more to say but I literally can't think anymore...Off to bed with me.

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Very interesting, I too find it odd that they keep changing the names of "syndromes", mabey they hope it will go away. Somethimes it takes people like us to make the conections that scienctists in perticular fields either don't know about or just don't see. It is very sad that just because someone doesn't understand something that they feel it just can't be real/true. Untill I took in printouts about POTS to my doc (gp), he couldn't understand how someone could have so many different problems from one illness. I have even had a doc that didn't know what dysautonomia was, scary isn't it. Please continue to share with us. I enjoy the "boost" my brain gets just thinking about this stuff.

Thanks, Blackwolf

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I found one of the missing articles that I was talking about from the early 19th century -


From Richard N. Fogoros, M.D.,Your Guide to Heart Disease / Cardiology.

A family of misunderstood disorders

In the 19th and early 20th centuries there used to be a condition called neurasthenia. People would find themselves suddenly unable to function, due to a host of inexplicable symptoms, often including fatigue, weakness, strange pains, dizziness and passing out. Doctors would not find anything to explain these symptoms, so they were attributed to a "weak nervous system," or neurasthenia. Women with neurasthenia (for men were not given this diagnosis, by and large) were often confined to their beds, where they would either recover or, eventually, die. And while nobody knew what caused this condition, everyone - doctors and laymen alike - took it seriously.

Most modern doctors hearing about this mysterious condition merely shake their heads in wonder. Few seem to consider the possibility that "neurasthenia" is still with us. Consequently they are less capable of recognizing the manifestations of this condition than were their old-time counterparts, and tend to be far less sympathetic to its victims.

Yesterday's neurasthenia, today's dysautonomia

People who a century ago would have been called "neurasthenics" today are given a host of diagnoses. These include chronic fatigue syndrome (CFS,) vasovagal or neurocardiogenic syncope, panic attacks, anxiety, inappropriate sinus tachycardia (IST,) irritable bowel syndrome (IBS,) postural orthostatic tachycardia syndrome (POTS,) or fibromyalgia. Sufferers of all these conditions tend to experience an imbalance, and most often a peculiar volatility, in the autonomic nervous system - an imbalance that we now call dysautonomia.

The autonomic nervous system controls the ?unconscious? bodily functions, such as heart rate, digestion, and breathing patterns. The autonomic nervous system consists of two parts: the sympathetic system and the parasympathetic system. The sympathetic system can best be thought of as controlling the ?fight or flight? reactions of the body, producing the rapid heart rates, increased breathing, and increased blood flow to the muscles that are necessary when an individual is in danger or under stress. The parasympathetic system controls the ?quiet? body functions, for instance, the digestive system. In short, the sympathetic system gets the body ready for action, while the parasympathetic system gets the body ready for rest. And in normal individuals, the parasympathetic and sympathetic components of the autonomic nervous systems are in perfect balance, from moment to moment, depending on the body?s instantaneous needs.

In people suffering from dysautonomia, the autonomic nervous system loses that balance, and at various times the parasympathetic or sympathetic systems inappropriately predominate. Symptoms can include frequent, vague but disturbing aches and pains, faintness (or even actual fainting spells), fatigue and inertia, severe anxiety attacks, tachycardia, hypotension, poor exercise tolerance, gastrointestinal symptoms such as irritable bowel syndrome, sweating, dizziness, blurred vision, numbness and tingling, anxiety and (quite understandably), depression.

Sufferers of dysautonomia can experience all these symptoms or just a few of them. They can experience one cluster of symptoms at one time, and another set of symptoms at other times. The symptoms are often fleeting and unpredictable, but on the other hand they can be triggered by specific situations or actions. (Some people have symptoms with exertion, for instance, or when standing up, or after ingesting certain foods.) And since people with dysautonomia are usually normal in every other way, when the doctor does a physical exam he or she often finds no abnormalities.

Page 2 - Evaluating patients with dysautonomia

The problem of evaluating dysautonomia

The severity of the symptoms in people with dysautonomia are typically far out of proportion to any objective physical or laboratory findings (especially when the doctors don't know which findings to look for.) This lack of objective findings makes life very difficult. In modern medical practice, grounded as it is in the gathering and interpretation of objective data, when patients have the audacity to complain of symptoms without providing the objective medical findings to back them up, they are often written off as being hysterical.

Patients lucky enough to be taken seriously by their family doctors are likely to be referred to a specialist. The type of specialist they are sent to usually depends on the predominant symptom they are experiencing, or on the symptom that most impresses the family doctor. And the diagnosis they are ultimately given depends on their predominant symptoms and which specialist they end up seeing. Thus: Those whose main complaint is easy fatigability are likely to be diagnosed with CFS. Those who pass out are labelled as vasovagal or neurocardiogenic syncope. Those whose resting pulses are noticeably high are said to have IST. If dizziness on standing up is the chief problem, POTS is the diagnosis. Diarrhea or abdominal pain buys you irritable bowel syndrome. Pain elsewhere ends up being fibromyalgia. Whatever the diagnosis, however, a dysfunctional autonomic nervous system almost always plays a major part in causing the symptoms.

And whatever the symptoms and whatever the diagnosis, all these syndromes are real, honest-to-goodness physiologic (as opposed to psychologic) disorders ? probably variants of the same general disorder of the autonomic nervous system ? and while they can make anybody crazy, they are not caused by craziness.

What causes dysautonomia?

Dysautonomia (and all of the above syndromes) are caused by many different things, and do not have one, single, universal cause. It seems clear that some patients inherit the propensity to develop the dysautonomia syndromes, since variations of dysautonomia often run in families. Viral illnesses can trigger a dysautonomia syndrome. So can exposure to chemicals. (Gulf War Syndrome is, in effect, dysautonomia ? low blood pressure, tachycardia, fatigue and other symptoms ? that, government denials aside, appears to have been triggered by exposure to toxins.) Dysautonomia can result after various types of trauma, especially trauma to the head and chest. (It has been reported to occur after breast implant surgery.) Dysautonomias caused by viral infections, toxic exposures, or trauma often have a rather sudden onset. Chronic fatigue syndrome, for instance, most classically begins following a typical viral-like illness (sore throat, fever, muscle aches, etc.,) but any of the dysautonomia syndromes can have a similar onset.

What becomes of people with dysautonomia?

Fortunately, the prognosis appears far better than it was in the days when the disorder was called neurasthenia. This is likely because bed rest is no longer considered the treatment of choice. Most victims of dysautonomia eventually find that their symptoms either go away or abate to the point that they are able to lead nearly normal lives. Sometimes, in fact, the probability that things will ultimately improve on their own may be the only thing to keep some of these individuals going.

But whether the symptoms eventually improve or not, many victims of dysautonomia experience symptoms that completely disrupt their lives, and the search for competent medical assistance in rendering their symptoms tolerable is all too often a difficult one.

] Page 3 - Treating dysautonomia

How is dysautonomia treated?

Unfortunately, just as there is no generally accepted nomenclature for the dysautonomia syndromes, just as there is no generally accepted set of criteria for diagnosing many forms of dysautonomia, just as there is no general agreement on their causes or on the precise mechanism that produces the autonomic imbalance, so there is no generally accepted approach to treatment. Possibly the most important step in treatment is to find a physician who understands the nature of the problem, is sympathetic toward it (i.e., does not consider you merely a crazy person,) and who is willing to take the prolonged trial-and-error approach that is often necessary in reducing symptoms to a tolerable level.

In any case, since the underlying cause of dysautonomia is not known, treatment is largely aimed at controlling symptoms, and not at "curing" the problem.

Non-drug therapies

Physical activity: While most doctors don't realize it, the experiment as to whether restricting physical activity helps dysautonomia was done 100 years ago. The experiment failed. Big time. Thus: maintaining a daily level of physical activity is probably the most important thing people with dysautonomia can do. Some daily level of moderate activity helps to stabilize the autonomic nervous system, and in the long run makes "relapses" of symptoms more rare and of shorter duration. Physical activity may even hasten the day when symptoms go away on their own.

Physical therapy and similar "alternative" treatments such as yoga, tai-chi, massage therapy, and stretching therapy have been reported to help as well.

Dietary supplements: Any time a medical condition exists that doctors treat poorly, purveyors of dietary supplements have an open field for pushing their products. Not only do patients feel they may have no better alternative, but also the medical profession, embarrassed by its failure to treat effectively, has little grounds for complaint. Consequently, thousands of unsubstantiated claims have been made about the ability of various vitamins, coenzymes and herbal preparations (all the usual suspects - you know the ones) to relieve the symptoms of dysautonomia. As a member of the embarrassed medical establishment, DrRich can only say - it's your money; try not to spend it on anything that will hurt you.

Drug therapies

A host of pharmaceutical agents have been tried in patients with dysautonomia. Those most commonly felt to be useful include:

Tricyclic antidepressants - such as amitriptyline (Elavil,) desipramine (Norpramin,) and nortriptyline (Pamelor) - have been used, in low dosage, to treat several of the dysautonomia syndromes. Selective serotonin reuptake inhibitors (SSRIs) - such as fluoxitine (Prozac) sertraline (Zoloft,) and paroxetine (Paxil) - have also been used to treat these syndromes. When effective, the tricyclics and the SSRIs appear to do more than merely control any depression that might accompany the dysautonomias. There is some evidence that they might help to "re-balance" the autonomic nervous systems in some patients.

Anti-anxiety drugs - such as alprazolam (Xanax) and lorazepam (Ativan) help to control symptoms of anxiety, especially in patients with panic disorder.

Anti-low blood pressure drugs - Fludrocortisone (Florinef) helps prevent the symptoms caused when the blood pressure drops when the patient is upright (a condition called orthostatic hypotension.) Orthostatic hypotension is prominent in vasovagal syncope and in POTS.

Non-steroidal antiinflammatory drugs - Ibuprofen (Motrin, Advil,) and naproxen (Naprosen, Aleve) can help control the pains associated with the dysautonomias, especially fibromyalgia.

It is worth mentioning again that there is no tried and true treatment method that always works in treating patients with dysautonomia. A trial and error approach, requiring the patience of both doctor and patient, is almost always necessary. In the meantime, victims of dysautonomia can try to reassure themselves by remembering two facts. First, dysautonomia usually improves as time goes by. Second, the academic medical community (and the pharmaceutical companies ) have now accepted the dysautonomia syndromes as real, physiological medical conditions. Consequently, a tremendous amount of research is going on to define the precise causes and mechanisms of these conditions, and to devise treatments that are effective more often and to a greater extent than many of the treatments being used today.

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Blackwolf, your post reminds me of my favorite comment by one of the doctors I have seen in the last year: "You have too many symptoms for your problem to be anything physical."


I laughed. "But it's OK to have that many symptoms when you have a mental problem?" I asked.

The doctor shrugged and gave me one of those immodest you're-making-this-all-up looks. I let her know that I have plenty of better things to do than be at the doctors' office making crap up -- especially when I had a pretty clean medical history and the only reason I had ever been to the doctor in my life was for a few bacterial infections, childbirth & minor panic attacks (10 years prior, which were successfully treated on the first try and I never argued with the diagnosis).


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Thanks for sharing this information. My POTS is genetic but I wonder how the first person got the mutation. It was more than 100 years ago.

I had a client a few years ago who was sick and I told him to go to the hospital because I could not help him. He was hospitalized and after a few weeks of testing and no diagnosis they told him it was psychological. He died one month after. On the death certificate they wrote as the cause of death "cancer". I guess they can be intelligent enough to figure that you don't die of a somatic disorder.

When I read what we all go through with medical world I wonder how sick do we have to be for doctors to believe us.


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You have some good points.

I know enough now that I really don't want to waste my time trying to convince doctor's anymore, they either believe me or they don't, that's their problem not mine.

All I really need to do is believe in myself and not let anyone tell me differently. I think that's where we have all gotten into trouble, by letting them talk us into something that isn't true or them trying to convince us that it's in our head. Stand by your convictions I say! :unsure:

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Guest veryblue

Interesting articles....but about one illness developing into another...POTS is not a disease...its a syndrome or a collection of symptoms...its an excuse doctors give to people when they dont know whats up and dont want to test anymore. Actually, I really wish I could find where I found this information and I think I have said it before...but POTS is hardly ever a disorder in itself...its usually a result of somthing else wrecking havioc on the nervous system. If doctors would take the time to test for other aliments...I bet every single person with a sudden onset POTS would get treatment and be cured...genetic people well thats another story. I'm just reminding all those people out there with no congential underlying predispistion to this **** that they sould be persistant with docs until they find out what is going wrong. Currently I'm being a jerk with my doc trying to convince him that I might have a pitutary tumor...and I wont stop until I get what I want!

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Very Blue

I think my point in posting these articles from so very long ago is that they've only been paying attention to pots since what the later 80's, early 90's.

So a hundered years ago people were really screwed. They were called hypochondriac's, nut cases and they really weren't paid any attention. They diagnosed them as having Neurasthenia (definition an emotional and psychic disorder that is characterized especially by easy fatigability and often by lack of motivation, feelings of inadequacy, and psychosomatic symptoms) Some say todays Dysautonomia. :unsure:

I just wanted you guys to have a point of view. Even though we go through **** today, imagine what it would have been like a century ago. And think about the thousands of people out in the world right now that have this illness that are being told there is nothing wrong with them.

Kind of like the evolution of Gulf War syndrome, should it really be called the Gulf War syndrome, when every war has seen similar symptoms.

Keep pushing your doc or find someone that will help you.


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  • 1 year later...


One of my earliest books that I bought on the topic of mitral valve prolapse syndrome had the reference to "soldiers heart" and DaCosta etc. I remember reading how they said women who passed out/fainted were said to have the "swoon" or "vapors" and sometimes they were told to stay in bed which did not help many at all and even hurt some and some eventually recovered or were able to function day to day with this.

Interest post. :unsure:

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Just a quick question for all of you who have been following the Gulf War posts closely (I confess, I haven't. :unsure: Sorry, steph! What I have read has been interesting!).

I don't want to sound dense or skeptical or anything other than curious, but what is your hypothesis as to the connection between POTS and all of the "war-related" conditions. Are you suggesting that:

1) the soldiers had POTS but it was called something else and has continued to change names as doctors continued to puzzle over the strange condition

2) the present POTS generations received a mutant gene from forefathers who experienced problems during the war

3) it's just interesting that these conditions are interesting in that they have many similarities, including the fact that they puzzle researchers


4) something that I haven't thought of. :ph34r:

I'm just trying to understand what part of this research is so compelling to all of you and relevent to POTS. Maybe the question has already been answered in the archival GWS posts, but I thought it might be more clear to just ask here after the "unveiling" of a new GWS document.

Thanks in advance for the clarification!


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I have spent the past few years trying to find any links or answers to my questions so this has just been one of the things that I came across.

What I find interesting is that if you look at some of the earlier soldiers heart symptoms they are exactly the same as POTS. So to better answer your question it would seem that this illness has been around probably more than a century but no one made the connections. For women around the turn of the early 1900's I believe it was called Neurasthenia.

Do you think that this illness just mysteriously puffed out of no where just recently? :unsure:

I think it's been so multi-symptom that it hasn't appeared clear to doctor's or it's easier to call us nut cases rather than realize it's a much larger problem and hey there is the autonomic system which they really don't understand.

So I hope that I didn't miss understand your question and gave you at least a somewhat satisfactory answer.

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  • 4 weeks later...

:angry:;):wacko::o:huh::):(:unsure::ph34r: wow! i have only seen a few things about links to the military and these syptoms.

I WAS IN THE MILITARY WHEN I GOT SICK! I WAS IN THE BEST SHAPE OF MY LIFE! I OUT PTed MOST OF THE OTHER MARINES! MALES BEAT ME ON THE RUNS BUT NO OTHER FEMALE DID!- which brings up another question i have... if they say that POTS patients need to build up their leg muscles/ tone them, whatever... then why when i had 16 more pounds of pure muscle on me, did i start fainting? okay i only weight like 90lbs now so 16 lbs is a lot! i weighed 90lbs going in to boot camp, 3 months later i weighted at 106lbs when i graduated at parris island, sc--- then i went to MCT (marine combat training) for a month--- then i was at redstone arsenal, al--- ammo/explosives training and i was there only a week when i started fainting left and right. hmmm.... and i remind you... 3 balanced square meals a day, lots of water, lots of pt-ing (muscles tighting and toning 5 days a week, hello?) i was in the best shape ever! sigh!!!!!!!!!!!!!!!!

i know quit a few other marines/ former marines who have the same condition or very similar. i am definately going to find me a printer and print this information up and i shall keep it with my medical files. thank you very much! i have been trying ot find something so people might stop telling me that i am doing somehing wrong and that is why i am sick. you know for a year and a half on active duty, still doing all the duties of a marine--- i was told that i was just dehydrated and it was all in my head! for a year and a half! i love the marine corps and there was no way that i was faking any of that. i have posted before about the nightmares. they are unbearable now because they are so vivid and i always wake up. 3 days now and i have slept 4 hours! i can't stay asleep! i feel horrible! everything hurts. oh and i also have posted about the sore and hurting joints and all those other types. the military had no problem what so ever taking blame for me being sick. hmmm....

and to think a lot of the research was done where i was diagnosed at and lived at for 8 months! and is where i continue to fly to for my appointments!!!

okay... i did get retired with full benefits, free medical for the rest of my life, great life insurance, and i am going to be compensated with disability from the VA as well (which means i really can't complain bc you guys don't necessarily have those advantages).... but i have also given up my quality of life. i would rather have my health any day... i signed the contract knowing that i could loss my life or quality of life depending on how i may have gotten hurt... so really i can't complain if there is even a link at all. though on the contract they also promised to take care of me if anything happened so the contract was met. but if there is a link... between being in the military and being sick... i think it will help me feel better about my illness and perhaps it will help others not be so condisending when i tell them what is wrong... perhaps they won't look at me as a nut case or a hypochondriac but as someone who made a sacrifice for their freedom. whatever though. people will have their opinions as we have all learned.

i am interested to know how many other iraq veterans will come up with this illness and what it will be called. i deeply thank you very much for your time and for posting! if you have any other links between the military and the illnesses could you please pm me with the web addresses. thank you very much.

dionna :)

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Thank you Steph for the interesting articles----I will read them when I'm having a more energized day---lately the fatigue is terrible---fighting a virus too......... That is so nice of you to look all of that up for us------ :)

I have been on this forum from the beginning, but had to change my user name--------------

There is always the possibility of Toxins in WAR also---(in addition to PTSD ect.)---- -----here's some links on Gulf war....






Here's another good link---mentions OI--low blood pressure---tachycardia


Anyway---I have always wondered on the environmental factors in ANS dysfunction. Now I know for some it's genetic, viral, secondary to something else------but over the last 5 years or so I can't seem to get this OHIO thing out of my mind-------so many OHIO folks sick with ANS dysfunction.

I was exposed to some terrible toxins at my employer because they were too cheap to improve the ventilation system-------so fumes came into the front office----------so noxious it was unbelievable. That is when I had my first real ANS crash----but I didn't know it at the time---not familar with POTS.dysautonomia, so it was chalked up to my MVP acting up.

When they were busted and fined by the EPA---the toxic fumes went away. They had to alter the processing of the soiled shop towels with ink solvents and ink toxins. Of course there was PERK---for dry cleaning, fuel oil pumped into the ground weekly ect. And at one point heavy levels of lead was found in my urine, but it was never properly investigated. When they ran blood work it was not found---but the blood life for lead is only 35 days----then the kidneys is the next stop.

Then you have pesticides sprayed----even in neighborhoods for Mosquitos------Ohio has a lot of farming, and so does Michigan, Penn, Ill.

I have read some of the articles on Gulf war syndrome----and the "soldiers heart syndrome" in the past-----I definately think environmental causes need to be further investigated. I don't know what it is----but when environmental causes for illness get brought up-------people get tight lipped----professionals......

BIG CAN OF WORMS-------------THAT ONE.........

Maxine :0)

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I've read hundreds of articles.

I have pursued some of the GWS stuff but don't feel like I can post much of it here and it doesn't apply to me as I'm not military, I was just hoping to show how far back the symptoms went. Much of it is speculation and following documentation which the medical community still hasn't put the (2 + 2) together.

I'm glad that you guys are finding some of my older posts more interesting, especially since I'm not on much anymore.

thx and keep up the good reading!


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I know I kind of carried on about the environmental issues----related to Gulf war---and not related---but, I think that is another area where some medical professionals have not correlated with ANS dysfunction.

On the links I posted---I noticed some of them mentioned ANS issues---tachycardia/palpitations and other neurological illness dating back to the 1st world war.

Please forgive---as I trailed off a bit-------------- :):):)

Maxine :0)

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Okay, I'm probably gonna get disagreed with or yelled at even.

First I haven't read the articles.

But here's the deal as far as I've been told my my doctor.

DeCosta was the frist Doctor who documented all or most of the symptoms of NCS and POTS and the like. Yes he HAPPENED to be a Civil War doctor treating Civil War SOLDIERS.

Even among civilian docs there are still tons of different names for this. So naturally military docs are going to come up with their own names just like the civilian docs did. And its not that common for military docs to colaborate with civilian ones or the other way around. And the populations they were seeing the most were ones in HIGH STRESS areas/situations that happened to be soldiers because they don't treat civilians. Its completely normal that soldiers, sailors, and airmen would develop it after going to war, because that's a major stress, and that's one of the major reasons most of us develop it as civilians, from some MAJOR STRESS. They most likely already had the tendancy to develop it, but needed something to trigger it, the way a car crash or mono or pregnancy or some other major stress tiggered it for most of us. Its what Michael J. Fox said about MS, you're born with a loaded gun, and something happens to trigger it.

I'm sure for some of them they developed it from chemicals and toxins they were exposed to because those things affected the ANS so of course they'd develop the same SYMPTOMS as the rest of us because its the same SYSTEM that's affected. Its like if you break your leg riding your bike by accident and some bully breaks your leg on purpose because you forgot your lunch money. You're going to have the same symptoms from different causes because its the same thing/area/system that's affected.

And jsut because you're not military doesn't mean what they do or the research they come out with doesn't apply to you. That's like saying I AM military to the research and treatment civilian docs do for this don't apply to you because you got sick while you were in the military even though you didn't go to war.

Okay, done with my thing here for now.


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I'm not sure what your all fired up about Unicorn but if you look at the date of this original topic it was started 2 years ago.

2 years ago when I started this thread it was because I needed answers. The Question for me was, is this really a new illness or how far back can I dig to find answers? HOW LONG HAS DYSAUTONOMIA REALLY BEEN AROUND, NO MATTER WHO HAD IT OR WHAT IT WAS CALLED!!!

The answer that I found was that it would seem that our symptoms have been around and documented for over a century! It just so happens that it was the military that had documented them.

In fact if you go back and read my posts from 2 years ago you would see that!

As far as DeCosta, I've read some very controversial information regarding his diagnosis and I don't agree with what he was thinking at the time. In fact I believe if you research DeCosta syndrome it would seem to lean more towards psych then medical. In my opinion, I think things were over looked and the doctor's either didn't realize that they were dealing with the ANS or can't begin to comprehend the extent of it!

I wasn't trying to differentiate between Military and the Civillian population. So if you feel the need for a tangent for some reason I hope you identify the real problem first!


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