Physiologic Responses To Upright Posture
In response to standing, approximately 500750 mL of an adults blood volume is redistributed to vessels below the level of the heart. A similar circulatory change is thought to occur in adolescents. At all ages, the response to the gravitational pooling of blood is a reduction in blood return to the heart, in turn leading to a drop in cardiac output, less stretch of baroreceptors, and ultimately less blood flow to the brain. The nervous system response involves an increase in sympathetic neural outflow, improved vasoconstriction, up to a 40 bpm increase in HR, and the return of enough venous blood to maintain BP and cerebral perfusion . Symptoms of OI can appear when these adjustments do not occur in an efficient manner.
Figure A1. The three main pathophysiologic influences on orthostatic intolerance are shown in this Figure. Increased pooling of blood, or defective vasoconstriction in the lower half of the body, along with lower intravascular volume are each important, and can be present in the same individual. Upon assumption of an upright posture, exaggerated sympathetic nervous system and adrenal hormone responses lead to increased release of epinephrine and norepinephrine . It is postulated that the relative balance of NE to Epi is one factor in determining whether the phenotype of OI is POTS or neurally mediated hypotension . Some patients with POTS in the early phase of orthostatic testing go on to develop a classic NMH pattern later in the test.
Psychological Reactions Secondary To Me/cfs: Distinction From Depression And Anxiety Disorders
Studies focusing on psychological problems in pediatric ME/CFS patients are limited. In this section, available studies have been supplemented by the insights of our experienced clinicians. It is important to distinguish: normal emotional reactions to ME/CFS from clinically significant psychiatric symptoms such as depression or anxiety secondary to ME/CFS and from a primary psychiatric illness such as Major Depressive Disorder or an anxiety disorder without co-existing ME/CFS.
Emotional Responses to a Chronic Illness
Emotional responses to the difficulties of ME/CFS are common. These responses are similar to the responses of young patients with other chronic illnesses. Grief and anger can arise over illness-related losses, from negative responses to the illness from family members, friends and school staff, and from the pervasive stigmatization of this particular illness. Apprehension commonly follows the onset of an illness, which can be undiagnosed and about which there is generally ignorance. There can be frustration with the inability to do things that were easily done beforehand. Outbursts of weeping can stem from excessive tiredness and/or feeling overwhelmed. Emotional distress can also occur because of disbelief by others regarding the reality of the illness, or by the prescription of inappropriate remedies by health-care providers.
Identifying Clinically Significant Depression and Anxiety Co-Existing with ME/CFS
Factitious disorder by proxy .
School refusal .
Clinical Presentation And Implications
The clinical presentation of CFS is heterogeneous with the most common symptoms being mental and physical fatigue, cognitive dysfunction, and mood disturbances. Cognitive dysfunction has been subjectively reported and objectively measured in experiments . Orthostatic hypotension is also common and may be debilitating . CFS may share similarities in presentation with idiopathic intracranial hypertension, and given that these are both diagnoses of exclusion affecting a similar patient population, it has been postulated that they may be related . Consequently, there is a need to develop objective measures rather than reliance on subjective reporting of symptoms . Understanding the pathogenesis of CFS is important in making accurate diagnoses and improving treatment and management. Children and adolescents with CFS have higher rates of school absenteeism, resulting in missed educational opportunities as well as valuable psychosocial experiences . Given the trend of recent data pointing towards a biological basis of CFS, novel treatments will likely be similarly directed .
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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 .
Facts About Chronic Fatigue Syndrome
- The CDC estimates up to 2.5 million Americans have ME/CFS.
- Anyone can get it, including children and teens.
- It’s most common in women in their 40s and 50s.
- Women are more likely to develop it than men.
- Most cases are mild or moderate.
- About 1 in 4 people with the condition have severe symptoms.
If you have mild ME/CFS, you can probably manage on your own. Moderate symptoms can make it hard for you to move around. For example, you might need to sleep in the afternoons.
Severe symptoms can impact your quality of life and abilities as badly as if you had lupus, heart disease, or rheumatoid arthritis.
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Joint Hypermobility Connective Tissue Laxity Ehlers
Some 60% of young patients who meet the criteria for ME/CFS also have joint hypermobility, compared with about 20% of healthy adolescents . Although joint hypermobility is a physical trait that can confer advantages in athletics and dance, some patients with joint hypermobility also have constitutional symptoms including tiredness, difficulty sleeping, gastrointestinal symptoms, arthralgias, myalgias, lightheadedness, and OI suggestive of undiagnosed co-morbid ME/CFS.
Joint hypermobility is one of the clinical features of Ehlers-Danlos syndrome . Other features of this heritable connective tissue disorder can include: stretchy or fragile skin, delayed wound healing, easy bruising, unusually wide or thin scars, striae in the absence of marked weight changes, blue sclerae, easy eversion of the upper eyelids, and a positive Gorlins sign . Some with EDS develop early onset of varicose veins. In the classical form of EDS there can be hemosiderin deposition around the knees and shins. Those with the hypermobile form of EDS are more likely than those with other forms of EDS to have OI . Constitutional symptoms that overlap with symptoms of ME/CFS are common in EDS. Fatigue and pain are substantial contributors to impaired quality of life in EDS . The mechanism for the overlap of ME/CFS and joint hypermobility or EDS has not been explained.
What Can I Do To Manage Covid
People always want to know how long postCOVID-19 fatigue lasts. The answer is, doctors dont currently know. It can be weeks or even months.
The best thing you can do to manage COVID-19 fatigue is to practice self-care and be kind to yourself.
Here are some tips from the United Kingdoms National Health Service on how to take care of yourself while you heal.
In the interim you might want to:
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Discussing Treatment Options With A Doctor
The medical community differs over the exact treatment courses for those living with CFS. Youll need to work closely with a healthcare team to determine which symptoms are impacting your quality of life the most.
You may start with treatment of these issues and progress to others in time. Many treatment options are available, ranging from over-the-counter drugs to alternative therapies.
The most effective treatment for CFS is the one thats catered to you and your specific symptoms. A doctor may suggest a variety of treatments depending on what youre experiencing and what your treatment goals are.
How Is Me/cfs Treated
There isn’t a cure yet for ME/CFS. So the keys to living with ME/CFS are learning how to pace your activities and treating your symptoms.
There are some things you can do to treat the most common symptoms.
- For symptoms that are worse after activity , learn how to manage your activity. Think about how much energy you have on a given day and try not to “spend” more than you have.
- If you feel dizzy or weak while sitting or standing, you can try wearing pressure stockings or putting your feet up. Or your doctor may recommend eating more salt or taking certain medicines.
- Sleep problems may improve with better sleep habits. You can also ask your doctor how medicines can help.
- Pain can be treated with over-the-counter medicines. Some prescription medicines may also help.
- If you’re feeling depressed, talk to your doctor.
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Symptoms Of Chronic Fatigue Syndrome
The main feature of ME/CFS is a type of exhaustion known as post-exertional malaise, crash or payback. This means having flu-like symptoms after exercise and not having enough energy for daily activities.
Research shows that people with ME/CFS have a different physiological response to activity or exercise from other people. This includes abnormal exhaustion after any form of exertion, and a worsening of other symptoms. The response may be delayed, perhaps after 24 hours. Depending on the amount and type of exercise, it may result in post-exertional malaise for a few days, or serious relapses lasting weeks, months or even years.
- problems with thinking, concentrating, memory loss, vision, clumsiness, muscle twitching or tingling
- disrupted sleep
- sore throat, tender lymph nodes and a flu-like feeling
- inability to cope with temperature changes.
What Do Doctors Prescribe For Extreme Fatigue
The doctor can determine the systemic injuries that are causing fatigue. The doctor will conduct an examination, assign the necessary diagnostic tests.
There is no effective way to treat chronic fatigue syndrome, but treating the symptoms can improve your condition. If your doctor thinks it is necessary, he or she may prescribe painkillers, antidepressants or other medications he thinks will help for chronic fatigue and fibromyalgia.
A rehabilitation medicine specialist will teach you how to plan your day so you can be living with chronic fatigue syndrome and use the time for well-being for yourself. You may need the help of a psychologist.
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What Is Happening To Me
This is an issue that several patients raise themselves and sadly, theres not a black and white answer. Since the late 80s, this condition has nonplussed health care professionals theres merely no conclusive thanks to take a look at for it.
Patients have toughened backlash, despite the fact that theyd find yourself bed-bound to the purpose that even a ten-minute walk might cause them to crash for days even weeks. Some describe it because the worst contagion youve ever had combined with the worst hangover potential.
Believed to have an effect on between 836,000 and 2.5 million individuals within the u. s., if youre living with this condition grasp that youre not alone despite the fact that youll want it. Though the cause remains being debated, some consultants suppose this condition is triggered by an infection that then develops thanks to malicious antibodies.
Other theories embrace inflammation within the brain, still as a potential lining of bacterium and undigested proteins within the lining of the gut. With the assistance of patient advocates, analysis centers and even crowdfunding campaigns, grants and funds have unendingly poured in order that researchers will notice the solution that chronic fatigue syndrome patients merit.
Chronic Fatigue Syndrome Symptoms
The symptoms of myalgic encephalomyelitis/chronic fatigue syndrome may seem similar to many other diseases. There is no diagnostic test to confirm ME/CFS with certainty. The disease can be unpredictable. Symptoms may come and go or may change over time.
This disorder is characterized by severe and chronic mental and physical fatigue that usually affects previously healthy and active individuals. It affects women more often, younger and mature.
The illness usually starts abruptly, after overcoming a cold or after a more stressful event in life .
The most common chronic fatigue symptoms are:
- Fatigue fatigue with no explanation, with physical and mental exhaustion that reduces daily activities and is not eliminated by rest.
- General malaise
- Sleep disorders sleep that does not refresh. In addition, waking up is common, sleep duration is too short.
- Pain throughout the body muscle pain and/or joint pain , headaches, painful lymph nodes and sore throat, and especially abdominal pain are common.
- Neurological/cognitive manifestations confusion, forgetfulness, mental fatigue, difficulty concentrating and short-term memory, disorientation, perceptual and sensory disorders, muscle weakness.
- Autonomic disorders a neurologically mediated pressure drop, pressure drop after getting up, extreme pallor, nausea and irritable bowel syndrome, palpitations and difficulty breathing.
- Immune disorders a slight increase in lymph nodes, sore throat, general malaise.
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Treat The Worst Symptom First
Start by listing your worst symptomsthe ones that make it hardest to get through the day. With your doctor, focus first on treating those symptoms. Decide whether a specialist might be helpful for any of them.
The most common ME/CFS symptoms can also be the most treatable.
- Symptoms worse after activity .
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Learning how to manage your activity can help you be as active as possible without causing your symptoms to get worse. This includes:
- Estimating how much energy you have on a given day. This is sometimes called your “energy envelope.” You spend only that much energy, and not more.
- Estimating how much energy an activity takes and how long you can do that activity. You stop when you reach that time, and then take a break.
- Not pushing yourself to get more done on days you feel well.
- Adapting activities to make them easier. One example is sitting down while doing the dishes.
- Sleep.
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Good sleep habits can help improve the quality of your sleep. If you also try medicine for sleep, it’s best to start on a low dose. Certain antidepressants help with sleep, mood, and chronic pain, so your doctor may suggest trying one.
The Possible Impact Of Me/cfs On The Family
A child or adolescent affected with ME/CFS presents challenges for the entire family. The challenges are similar to those faced by families of children with other chronic illnesses such as leukemia or juvenile rheumatoid arthritis, but with the additional challenges of widespread disbelief in the authenticity of the illness, the pervasive social stigma associated with a diagnosis of ME/CFS and a paucity of medical professionals who are knowledgeable about the illness.
In our experience, the majority of families draw on their strengths. The parents are usually able provide the necessary care, and siblings learn to cope with diminished parental attention. When families cope well with their childs illness, the risk of emotional damage to siblings is minimized.
Research has shown that siblings of young patients with ME/CFS are more anxious than normal adolescents. Siblings identified factors having a negative impact on their lives, as lack of knowledge about the illness, change in their role in the family, lack of communication within the family, new restrictions placed on family life, change of parental focus, emotional reaction to having a sick sibling, and the social stigma of being the sibling of a young person with ME/CFS. Communication within the family, social support and extra activities were found to have a positive impact .
Helpful strategies to support the family can include:
Participation of both parents in the evaluation and management of the patient.
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Impact Of Me/cfs Symptoms On Learning
Several prominent ME/CFS symptoms affect the students ability to learn. Cognitive problems are evident in most students even if they are less severely affected. Students experience mental confusion, forgetfulness, difficulty concentrating, a short attention span and a slowing of mental processing speed. Working memory can be significantly reduced and there is often increased distractibility, which can be exacerbated by noise in the classroom . IQ scores might be lower than the scores of healthy peers . Cognitive problems can sometimes mimic attention deficit disorder without hyperactivity. For those with more severe illness, cognitive problems are very limiting. Generally, if students are homebound, the most that they can manage are one or two essential or core subjects. Although not easy and requiring a real commitment, completing school work can give the student a real sense of achievement, which is important. The homebound student usually needs regular help from someone such as a Visiting/Homebound Teacher.
Students with ME/CFS are often unable to handle simple math calculations. They might be able to complete the steps to solve a complex problem correctly, but can make simple addition, subtraction, or multiplication mistakes. Teachers should be aware of this problem when grading tests .
Chronic Fatigue And Ciguatoxin Link
Just to let people know. I have added some more additional information regarding the ciguatoxin to the Q & A page – “Do I have Chronic Fatigue syndrome.” There is also information in the Q & A page – “Chronic Fatigue Syndrome and Disability.” that I added. Please read them if you think you have the disease.
I’m on disability and am officially diagnosed with chronic fatigue syndrome, which has been going on for 7 years now and started shortly after I developed mononucleosis.
Six months ago, I stopped using all forms of oil high in either Omega 6 OR Omega 3 switching exclusively to coconut oil, and using also some butter and some olive oil. Due to this switch, I noticed an immediate improvement in my chronic fatigue.
I did that based on othe research of Ray Peat, PhD after YEARS of using stuff like grapeseed oil and fish oil/krill/cod liver oil thinking that I needed the Omega 3’s, or in the case of grapseed oil, thinking the high smoke point would save me from oxidation more than other cooking oils would.
I had also hoped the coconut oil would help with weight loss, as I’ve gained 30 lbs in the past year for no particular reason. It did not help with my weight loss but I noticed a significant improvement within a few days in regards to clarity of mind and energy. In fact, for the first week or so, I felt significantly improved, and thought I was well on my way to being cured. At that point, I was eating 3-5 tablespoons of the stuff each day.
Thanks, Dina
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