Radionuclide Measurement Of Upper Gi Motility
Details and normal ranges of this double isotope test have been previously published . The solid meal consisted of 100 g of cooked ground beef containing 40MBq in-vivo labelled 99mTc-sulfur colloid-chicken liver, and the liquid meal consisted of 150 ml of 10% dextrose in water containing with 20 MBq of 67Ga-ethylenediaminetetraacetic acid . All medication was discontinued for 24 hours prior to each study. The test was performed at 10 am and monitored for at least two hours with the subject in the sitting position with the scintillation camera behind. The study commenced with a standardised oesophageal clearance study followed by eating the solid meal and then immediately drinking the glucose solution. Each study was continued for at least 2 hours. Oesophageal clearance was expressed as time to 95% clearance , Liquid gastric emptying as half-clearance time and solid emptying as amount remaining at 100 min .
The GI questionnaires were compared between CFS and control by Chi2, and Gastric emptying indices compared with historical normal range , and correlated with the mean symptom score .
The Study was approved by The Human Research Ethics Committee of the Royal Adelaide Hospital and informed consent given by the subjects.
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How Long Does Chronic Fatigue Syndrome Last
Because there is no test available, a diagnosis from your doctor is generally only arrived at by ruling out other illnesses such as hypothyroid, sleep disorders, kidney problems etc. Additionally a diagnosis can only be given after you have had the symptoms for at least 6 months.
Unfortunately from a naturopathic point of view, this is 6 months during which time you could have already started testing to find out what lies at the root cause of your chronic fatigue syndrome. Its also 6 months during which time your symptoms and illness may be getting worse.
Some people mistakenly believe that they cannot recover from chronic fatigue syndrome because standard allopathic medicine has no cure, theres no pill they can be given to make chronic fatigue syndrome go away.
At the other end of the spectrum, others think if they just wait it out, chronic fatigue syndrome will disappear of its own accord. While this might happen, if you are lucky, its pretty unlikely. Without getting proper treatment, which gets to the root cause of your particular form of chronic fatigue syndrome it can not only last for many years, but during that time, gradually get worse.
Time can pass without your symptoms worsening, or new symptoms making an appearance. There can even be periods of time when you start to feel a little better. But there will be times too when you relapse and get worse. This is the point when your health declines even further.
What To Think About
Along with the treatment you get from your doctor, you might find that other treatments help too. Some people may try different diets or natural health products to help manage their symptoms. If you try a new diet or natural health product pay attention to how your body and symptoms respond to it. It may help to work closely with your doctor to figure out what works best for you.
Your mind and body are connected and affect each other. Physical illnesses can be made worseor betterby your feelings and attitudes, and vice versa. Learn as much as you can about ME/CFS. Then work with your doctor to learn ways to cope with your symptoms. Get emotional support from your health professionals as well as from your family and friends.
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Where Can I Get Support
ME/CFS can have a significant emotional and financial impact on your life. A lack of understanding and awareness about ME/CFS means patients can experience disbelief, and even discrimination, from friends, family, health and social care professionals and employers.
Information on entitlements to welfare benefits, accessing health and social care and others sources of support for patients and carers are available from Action for M.E. They also offer resources and services for children and young people affected by ME/CFS and their families.
What Are The Symptoms Of Myalgic Encephalomyelitis/chronic Fatigue Syndrome
For many people, the symptoms of ME/CFS resemble other diseases, like influenza. Symptoms may come and go over time and may increase or decrease in severity. ME/CFS symptoms vary widely from person to person.
Many of the symptoms of ME/CFS make daily life difficult. These symptoms include:
- Severe fatigue lasting at least 6 months that does not improve with rest or sleep
- Difficulty sleeping
- Flu-like symptoms, including swollen lymph nodes , headaches, and joint pain
- Cognitive difficulties, including attention and memory problems
Less common symptoms of ME/CFS include:
- Problems with vision
- Irritable bowel, an intestinal condition causing painful bloating, gas, constipation and diarrhea
- Psychological issues, including mood swings, irritability and anxiety
- Tingling or numbness in the feet, hands or face
For many people, ME/CFS symptoms get worse following physical exercise or strenuous mental exertion. In some cases, orthostatic intolerance causes dizziness, weakness, and fainting.
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Tips For Exercising Safely With Me/cfs
If you feel you can tolerate some exercise, be guided by your doctor or specialist, but general suggestions include:
- Experiment to find the type of exercise that works best for you. Choose from a range of gentle activities such as stretching, yoga, tai chi, walking and light weight training. Often, people find exercises lying down use less energy.
- Keep an activity diary so you have a long-term picture of your performance levels and factors that might impact on your symptoms. Some people with ME/CFS find they feel good straight after exercise, but then crash later on, so make sure you monitor how you feel, hours to days after exercise.
- Stop the physical activity well before you feel any symptom flare. Pacing yourself is very important.
- Remember that the amount of exercise you can do will change from one day to the next.
- Listen to your body if you dont feel up to exercising on a particular day, dont.
- Find out as much as you can about your ME/CFS. Make sure you consult with health professionals who fully understand ME/CFS as a biomedical disease
How Can My Doctor Manage Fatigue
To find out what is causing your fatigue, your healthcare provider will ask questions about your lifestyle and medications and will conduct a physical examination. They might order some lab tests to test blood and urine. If you are a woman of child-bearing age, your provider will probably order a pregnancy test.
To relieve fatigue, your provider will treat the condition or disorder thatâs causing it. Depending on your health, your treatment plan may include a combination of medication, exercise, or therapy. If youâre taking a medication that makes you feel exhausted, talk to your healthcare provider about the risks and benefits of stopping the medication or trying another one.
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Chronic Fatigue Syndrome: Gradually Figuring Out Whats Wrong
In 1983, a health professional in her 30s walked into my office and said, Ive been healthy all of my life. A year ago, I came down with some kind of virus sore throat, aching muscles, swollen lymph glands, fever. My fatigue was so bad I was in bed for nearly a week. Many of the symptoms gradually improved, but the terrible fatigue and difficulty thinking have not gotten better. Theyre so bad I cant fulfill my responsibilities at home or at work. This illness is affecting my brain, stealing my energy, and affecting my immune system. Its keeping me from realizing my dreams.
Theres a piece of advice attributed to a famous physician, William Osler, that every medical student probably has heard: Listen to your patient. The patient is telling you the diagnosis. But I wasnt sure it applied in this case.
What Are Nausea And Vomiting
Nausea causes stomach discomfort and the feeling like you may vomit. Sometimes, you even do throw up. It can be for a moment , temporary , or lasting .
Vomiting is when the body forcefully gets rid of whats in the stomach by bringing it back up and out through the mouth. You almost always feel nauseated before vomiting.
Nausea, with or without vomiting, is most commonly caused by a stomach bug and food poisoning. Pregnant women often feel nauseousor even vomitduring their first trimester.
Other causes include motion sickness, migraines, drinking too much alcohol, and side effects from medications. Sometimes, it is caused by an underlying condition, like an ulcer, gallbladder disease, or heart attack.
There are medications to treat nausea if needed. But when nausea is a symptom, the treatment is usually for the underlying problem.
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Will I Still Be Able To Work With Me/cfs
Research shows that about half of people with ME/CFS work part-time or full-time jobs. For some people with ME/CFS, the ability to work is possible thanks to a supportive employer and certain workplace accommodations, including a flexible schedule, a quiet comfortable place to rest, and memory aids.
But, if you can’t work because of ME/CFS, you may be eligible for Social Security benefits. Learn more about applying for disability through the Social Security Administration.
Chronic Fatigue Cause No : Food Allergies
While food is supposed to give us energy, some doctors believe hidden food intolerances or allergies can do the opposite. According to Rudy Rivera, MD, author of Your Hidden Food Allergies Are Making You Fat, even mild food intolerance can leave you feeling sleepy. Eat the offending food long enough and you could find yourself feeling continually exhausted.
Evidence indicates food intolerance as a cause of fatigue, and even suggests that fatigue may be an early warning sign of food intolerance, Rivera says.
If you suspect that food may be behind all that yawning, Rivera says to start with an elimination diet, cutting out foods that cause you to feel sleepy within 10 to 30 minutes of eating them. You can also talk to your doctor about a food allergy test.
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What Causes Ms Fatigue
âThere are many reasons someone with MS experiences fatigue, Dr. Cohen says. Some are directly related to MS, and some are not.â
Some of the types of fatigue that may affect people with MS are:
- Indirect Fatigue Stress, trouble sleeping due to muscle spasms, side effects from medication, and depression that may go along with a chronic illness like MS can all cause fatigue. âDoctors should also rule out unrelated causes of fatigue, such as anemia or thyroid disease,â Cohen says.
- Neurologic FatigueâMS symptoms, like tremors, muscle weakness, and muscle spasms, use up a lot of energy and can lead to fatigue, Cohen says. Damage that has been sustained over time along nerve pathways can be aggravated by stress, activity, fever, and heat exposure. All of these factors contribute to MS fatigue.â
- Autoimmune FatigueâPersistent tiredness, or lassitude, is common in many autoimmune diseases and is probably the most common type of MS fatigue,â Cohen says. âIt is very similar to the type of fatigue experienced in chronic fatigue syndrome.â
The Importance Of Education
The physician might need to take an active role in supporting young people with ME/CFS and ensure that they receive an education that is appropriate for their physical condition. Long-term follow-up of young people with ME/CFS shows that engagement in education is a key issue that improves their ability to function regardless of whether or not they recover . Students can become demoralized if they are asked to withdraw from school. Education helps students to fulfill their aspirations and allows important aspects of their lives such as socializing with their peer group, to develop . It widens the range of possible occupations in later life. Work that is low skilled is usually more physically demanding. Although students with ME/CFS have cognitive dysfunction and reduced energy reserves, intellectual reasoning is frequently retained and most students with ME/CFS are capable of keeping up with their peers in some academic classes provided that the number of their classes is strictly limited .
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Diagnostic Criteria For Me/cfs Using The National Academy Of Medicine Clinical Criteria
For a diagnosis of ME/CFS, the person must have the following three symptoms:
Diagnosis also requires at least one of the following two symptoms:
It is important to note that these are not the only symptoms of ME/CFS, just the minimum needed to meet the diagnostic criteria.
While diagnosis requires that a person has had symptoms continually for six months, early intervention with pacing and rest can help reduce symptoms, improve quality of life and reduce the risk of exacerbating the disease. Research suggests that patients who are able to pace their activity and not push themselves tend to do better in the long term. Pacing and rest can start even prior to an official diagnosis.
While there is currently no cure and no evidence-based treatments, it is important to find a doctor who is not only sympathetic to ME/CFS, but can work with you to help manage your symptoms.
A Sjogrens Syndrome Segue
Sjogrens Syndrome is of interest because of its growing association with POTS in particular. A Johns Hopkins 2014 case series used a high resolution magnetic resonance neurography to diagnose abnormal dorsal root ganglia in ten Sjogrens Syndrome patients.
The authors pointed out that the burning sensations found in SS often do not follow the typical stocking and glove pattern that occurs with most people who have small fiber neuropathy. They called small fiber neuropathy a surrogate marker of DRG neuronal loss but noted that the unusual distribution of SFN in SS can complicate getting an SFN diagnosis. Plus, some SS patients with burning or raking pain may have dorsal root ganglia problems without having small fiber neuropathy.
Five of the ten SS patients in the study had abnormal DRGs. The fact that none had evidence of small fiber neuropathy, and that two of the patients improved markedly on IVIG therapy, suggested that dorsal root ganglionitis by itself can cause these burning, painful sensations. It also suggested a new way to search for sensory ganglionitis.
In any case, the finding of sensory ganglionitis in Sjogrens Syndrome suggests that it may not be long given the proper studies before its also found in POTS, FM and ME/CFS.
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Pacing Activity For People With Me/cfs
Pacing, or keeping within your available energy, is a self-management strategy to help people with ME/CFS make sure that they dont overdo activity or exercise. It reduces the likelihood of triggering PEM and can help reduce symptoms. Pacing is not a cure for ME/CFS and does not treat the underlying, physical cause of the disease.
The goal of pacing is for activity to be sustainable, so that the person can have some stability in their symptoms and what they can do each day. Pacing should be used in conjunction with rest.
The most challenging aspect of pacing is that PEM is very often delayed by as much as 24-48 hours, which can make it difficult to recognise when youve done too much. Using tools like an activity diary or heart rate monitor help you learn about your body and how much activity you can safely tolerate.
Suggestions on how to pace yourself include:
Chronic Fatigue Cause No : Caffeine Overload
Many of us grab an espresso, latte, or cola for a quick burst of energy, but for some women, caffeine has the opposite effect.
In an article published in the journal US Pharmacist, W. Stephen Pray, PhD, RPh, reports that caffeine is a stimulant, but if you take too much, the tables can turn.
In some patients, continued abuse results in fatigue, says Pray. And if you think this means you simply require more caffeine to get the kick, this isnt the case. Any attempts to solve the problem by increasing caffeine intake causes the fatigue to worsen, he says.
The solution to caffeine overload? Eliminate as much caffeine from your diet as possible. This means not only cutting out coffee. Chocolate, tea, soda, and even some over-the-counter and prescription medications also contain caffeine and could be causing unexplained fatigue.
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What We Know Now
As I discussed in a recent article in the journal JAMA, research has documented underlying biological abnormalities involving many organ systems in people with ME/CFS, compared with healthy controls. Heres an overview of what the current science suggests.
The brain. Tests of brain hormones, formal tests of thinking, magnetic resonance imaging , and positron emission tomography scans of the brain are abnormal in a substantial fraction of patients with ME/CFS. Tests of the autonomic nervous system, which controls vital functions including body temperature, blood pressure, heart rate, breathing rate, and movement of the intestines and bladder, also are abnormal. Not all of these abnormalities of the brain are present in every person with ME/CFS, and they appear to come and go.
Energy metabolism. We are alive because the cells of our body are alive. And theyre alive because they can make energy, and use that energy to do their jobs and remain alive. Our cells make energy out of the oxygen in the air we breathe, and out of the sugars, fats, and proteins we eat. In ME/CFS, research has shown that the cells have trouble both making and using energy. That is, people with ME/CFS feel they dont have enough energy because their cells are not making enough, nor using what they make efficiently. The ability of cells to extract oxygen from the blood and use it to make energy appears particularly defective after physical and mental exertion.
