Or is it chronic fatigue syndrome ?

I think they're inseparable. No one really knows what causes CFS is but recent thinking is that it's what happens when your mitochondria (the "batteries" in every cell) can't keep up with the energy supply that your body needs. Think of a torch just before the batteries pack up completely - that dim, flickering light is how CFS sufferers feel all the time.

Why your mitochondria can't meet demand is because they get damaged and/or depleted in some way. I read somewhere that we actually have 60% more mitochondria than we actually need so we can put a spurt on if chased by a tiger. This surplus also allows for damage from viruses and chemical toxins which can be both environmental (traffic, agricultural and industrial pollution) and pharmaceutical (several types of prescribed drugs actually damage our mitochondria). Many of us are born with genetic deficiencies which are either apparent immediately or get triggered in later life. Depending on your age, lifestyle, level of fitness and any genetic deficiencies, your mitochondria will either stand up to many insults and you grow old gracefully, gradually slowing down as the years roll by OR something from the list above causes so much damage that they are simply not able to keep up. Once the rate of decline is faster than the rate of replacement then you get the symptoms of constant fatigue, brain fog, aches and pains often associated with CFS and Fibromyalgia. In the case of genetic deficiencies the symptoms usually take a clear path that leads to a proper diagnosis of a mitochondrial disorder.

Fluoroquinolones have been proved to cause mitochondrial dysfunction and also oxidative stress (similar to the damage caused by smoking). Some people are seriously affected by just one or two tablets and it's believed that these people already have mitochondrial damage of some sort. Others have no problem with taking one or two courses (or no problems that they are aware of as their mitochondria can cope with a bit of damage). They then take a third or fourth course and the agony sets in - it's often described as a time bomb going off. I've heard from a few people who say they've taken maybe 30 or 50 courses over the years before they were plunged into pain. How they survived that many fluoroquinolones we can only speculate - they must have cast iron mitochondria! Of course, many people take a couple of courses, nothing happened except they got better from the infection, and now they wonder what I'm making a fuss about. Most people (including doctors) don't understand that it's not a simple case of either you do get affected or you don't - it's more a case of you will get affected eventually but nobody knows whether it will be your next tablet, next course, or even never if you never take another fluoroquinolone.

The only cure for any mitochondrial problem seems to be rest and good nutrition - your mitochondria need a delicate balance of micronutrients that your body can only supply if you eat the right stuff. If you eat the things that have the nutrients your body needs and avoiding all the things it doesn't need (sugar, junk food, bad fats, diet drinks, chemicals and additives) oyu may be able to restore the balance. You can also take supplements such as antioxidants, vitamins and essential fats and minerals. Some supplements are very expensive and claim many things so you have to pick and choose wisely! There are many books and blogs about it so, again, choose wisely - I look for people who are not trying to make money!

Many have noted that sufferers of CFS and Fibro (neither of which need a cause for a diagnosis) rose rapidly from the 90s through to about 2010. The use of fluoroquinolones and Cipro in particular also rose rapidly during this period then fell off a bit as antimicrobial stewardship made doctors more cautious about prescribing them for all and sundry infections. I've noticed on this forum that there are far less people saying they've been given Cipro for sinus and prostate infection and UTIs. My guess is that many people with a diagnosis of Fibro and/or CFS might be able to look back at the months before it started and will remember a trauma of some kind (accident or infection perhaps) where a course of antibiotics was prescribed.

Thank you Miriam another excellent and informative post. You really should have a weekly Radio or TV slot to spread the word..

I am surprised that my question and your excellent reply did not get and comments.