How Do Doctors Diagnose Chronic Fatigue Syndrome

Why Is This Important

The new research finds many CFS/ME patients feel unsupported by health professionals, which can make the illness all the more distressing. Patients want to be listened to, have their symptoms believed and be given realistic support that takes their life circumstances into account. They also want their beliefs about CFS/ME to be acknowledged, even if they are different to current medical theories. However, the study also found that views about the condition are highly polarised. This means it is challenging for professionals to provide the kind of care people want for CFS/ME.

The researchers suggest healthcare professionals should give personalised, empathetic care to their CFS/ME patients, and suggest treatments that minimise the impact on daily life. They say health professionals should provide a sense of safety. This way, patients may feel more able to work through complex issues, such as the mental health implications of CFS/ME, without feeling defensive or dismissed.

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What Does Chronic Fatigue Syndrome Treatment Look Like

We recommend a treatment plan tailored to your needs and concerns, with the caveat that progress while living with CFS is slow work, but very rewarding.

We believe in the functional medicine approach, and we try to heal your body as a whole, not concentrating on just one area.

Treatments include:

• An anti-inflammatory diet, specific to you and your needs to help alleviate your aches and pains.
• Investigate the possibility of allergies, or an additional undiagnosed autoimmune disease.
• Integrative therapies such as acupuncture and nutritional therapy

These treatments are intended as a long-term solution to reduce your symptoms and help you lead a more functional life.

What Are The Symptoms Of Me/cfs

The key symptom or feature of ME/CFS is called post-exertional malaise . This means that your symptoms get worse after exercise or mental effort and dont improve after sleep or rest. PEM can be very disabling and can reduce your ability to function during regular daily activities. PEM is also common if you have long COVID.

ME/CFS may start suddenly or gradually over months or years. The level of activity that triggers your PEM will vary from person to person and can depend on how severe your condition is. For example, if your ME/CFS is relatively mild, you may experience PEM after going for a walk or a jog, but if your ME/CFS is severe, just reading a book or brushing your teeth could bring on your PEM. Your PEM may appear immediately after activity or may sometimes be delayed by up to 3 days. It can last for 24 hours or for a few days. A more serious relapse can last for weeks or months.

A common misconception is that people with ME/CFS have chronic fatigue and are just very tired. Persistent and profound fatigue is just one symptom of ME/CFS.

Other common symptoms of ME/CFS, that may also increase with PEM include:

• thinking problems, loss of memory or poor concentration
• gastrointestinal changes such as nausea, constipation or diarrhoea
• sensitivities to light or noise, food, medicines or chemicals
• problems with temperature regulation

Everyone is different, so you might experience only mild symptoms, or you might develop more severe symptoms.

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What Can I Do To Cope With Me/cfs

Talking about your feelings with a friend or family member can help. Sometimes it also helps to talk with people who are going through the same thing. Consider joining an ME/CFS support group. See the ME/CFS Organizations section at the end of this fact sheet for a list of organizations that offer additional information on ME/CFS and can help you find ME/CFS support groups.

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How Can I Help My Child

To help your child cope with the emotional symptoms of chronic fatigue syndrome:

• Encourage your child to keep a daily diary to identify times when he or she has the most energy and help plan activities for these times.
• Have your doctor plan an exercise program to maintain strength at whatever level is possible. This can help your child feel better physically and emotionally.
• Help your child to recognize and express feelings, such as sadness, anger, and frustration. Its OK to grieve the loss of energy.
• Get support from family and friends because emotional health is important when coping with a chronic health problem.
• Allow more time for your child to do things, especially activities that take concentration or physical exertion.

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Appendix 1 The Interview Guide

What follows is a guide some themes may emerge spontaneously so the order of the questions varied as the interview and analysis phase developed allowing for the exploration of themes from the initial interview. The researcher probed and asked for examples to explore each topic as time permitted.

How Is Me/cfs Diagnosed

Because many symptoms of ME/CFS are also symptoms of other illnesses or side effects of medicine, your doctor will need to do physical exams and tests to help determine if you have ME/CFS. There are no standard lab tests to diagnose ME/CFS.

If you think you may have ME/CFS, see your doctor. Your doctor may:

• Ask you about your physical and mental health.
• Do a physical exam.
• Order lab tests based on your symptoms, such as urine and blood tests, which will tell your doctor if something other than ME/CFS might be causing your symptoms.
• Order tests that check for problems found in people with ME/CFS.
• Classify you as having ME/CFS if:
• You have the main symptoms of ME/CFS, including extreme fatigue or exhaustion that does not go away and that prevents you from doing the things you want and need to do for you and your family exhaustion that comes after mental or physical exercise sleep problems and pain AND
• You have had the extreme fatigue and other symptoms for 6 months or longer AND
• You and your doctor cannot find another explanation for your symptoms.

The process to make a final diagnosis of ME/CFS can take a long time, so try to be patient. It is usually best to develop a relationship and follow up often with one doctor so that he or she can get to know you and see how you respond to treatment over time.

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Small Fiber Neuropathy And Dysautonomia

Chronic inflammation may damage nerve fibers that help control circulation, a condition called small fiber neuropathy. The damaged fibers, seen in skin biopsies, are associated with dysautonomia, a malfunction of automatic functions like heart rate, breathing, and digestion that is very common in long Covid patients.Keller

Just one small study provides evidence of small fiber neuropathy in long COVID, but many studies indicate its present in ME/CFS/FM. Keller, interestingly, embraces Systroms and others hypothesis that the SFN found in the skin is the most obvious but least troubling manifestation of an issue that has body-wide consequences and which includes the diversion of blood away from the muscles.

Dysautonomia, of course, is a common theme in ME/CFS, fibromyalgia, and postural orthostatic tachycardia syndrome and appears to be present in long COVID as well. Lower heart rate variability ratings that are indicative of sympathetic nervous system dominance, are found in ME/CFS, FM, POTS, and long COVID. A simple standing test that stresses the autonomic nervous system has been proposed as a diagnostic test by ME/CFS practitioners, and reduced heart rate variability measures were predictive of poor sleep.

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The Chronic Fatigue Syndrome Also Presents Problems In Definition And Measurement Is Associated With Even More Morbidity Than Chronic Fatigue Itself And Is Often

For years, many professionals within the medical community did not recognize cfs as a true condition, nor was there agreement on its prevalence. Describes the symptoms, diagnosis, and treatment of nephrotic syndrome in children for parents and a physical exam may help diagnose childhood nephrotic syndrome. For the clinical picture of chronic pancreatitis , the following main syndromes are characteristic: Progressive synosteosis in aperts syndrome , with a description of roentgenographic. There are different theories about what causes chronic fatigue syndrome and few certainties. in almost all cases, the etiology is unknown different kinds of leukemia are believed to have different. The first step is to see if there is any other explainable cause for your fatigue. Acute hf develops within a few hours and requires immediate hospitalization in the hospital. Causes abnormalities of chromosomes have been found in. The role of schauerte e. Diagnostic criteria for chronic fatigue syndrome6. Fatigue can be defined as a pervasive sense of tiredness b: The exact cause of chronic fatigue syndrome is unknown, but it is believed that a combination of genetic predisposition and environmental factors.

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How Does Me/cfs Affect People

ME/CFS affects different people in different ways, some more severely than others. There are four levels of severity of ME/CFS, which give an indication of the level of disability ME/CFS can create:

• mild: 50% reduction in pre-illness activity
• moderate: mostly housebound
• severe: mostly bedridden
• very severe: totally bedridden and need help with basic activities including nutrition and hydration.

The severity of ME/CFS can vary over time. A person living with ME/CFS could be at one level of severity now, then their disease could either improve or deteriorate over time. For some patients, their disease can worsen significantly with no known cause. Other patients have a fluctuating illness where they have better and worse periods, which last for months or years. It is unclear why this happens.

For most people, ME/CFS is a lifelong disease. Full recovery is rare and estimated at less than 10%. For some people with ME/CFS, as time passes and their disease improves, they will find they can do more, but it is a slow and gradual process. However, this is not the case for everyone. Some people find their disease worsens over time, others may remain somewhat stable. With support and pacing, people can often improve their quality of life.

What Is The Outlook For Someone With Chronic Fatigue Syndrome

The long-term outlook varies quite a bit. There may be times when your symptoms are not too bad and other times when they flare up and become worse. However, many people improve over time and some recover well. Children and younger people have a better rate of full recovery. Early diagnosis and treatment may lessen the impact of the illness. The important thing to remember is that this is not a progressive or life-threatening disease and that for many people full recovery is possible.

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What Are The Symptoms Of Chronic Fatigue Syndrome

Symptoms of CFS often mimic the flu. The following are the most common symptoms of CFS. However, each person may experience symptoms differently. Symptoms may include:

• Sensitivity to light
• Low-grade fever

The symptoms of CFS may look like other medical conditions. Always talk with your healthcare provider for a diagnosis.

Continued Research Should Lead To Better Understanding And Treatments

A great deal more is known about ME/CFS today than 35 years ago. With continued and expanded support from the NIH, CDC, and private foundations dedicated to ME/CFS, I expect a lot of progress in the coming decade. Instead of doctors saying, The tests came back normal, there is nothing wrong, they will say, Tests showed us what was wrong, and we have treatments to fix it.

And doctors will recognize the wisdom of the wise advice we all learned in medical school: Listen to your patient. The patient is telling you the diagnosis.

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Me/cfs Is Not A Somatization Disorder

Somatization disorders occur when a person misidentifies psychiatric symptoms for physical ones. The high levels of mood disorders present in ME/CFS and its many symptoms have sparked efforts by psychiatrists to label the disease as a somatization disorder.

A 2019 study which assessed the effects of having a comorbid disorder such as fibromyalgia or a mood disorder on the symptoms associated with ME/CFS attempted to clear up that issue. Since mood disorders have a multiplier effect on somatization disorders the researchers determined if the presence of mood disorders (or comorbid disorders such as exacerbated the symptoms associated with ME/CFS.

Because mood disorders did not exacerbate the symptoms associated with ME/CFS but have a comorbid disease did, the researchers determined that ME/CFS is not somatization disorder and is not closely allied with mood disorder but that it is closely allied with diseases like FM and irritable bowel syndrome . The increased rate of mood disorders in ME/CFS is most likely simply the result of having a difficult, chronic illness.

Living With Chronic Fatigue Syndrome

There are strategies for dealing with the daily challenges of CFS. These may work for you, especially in combination with medications prescribed by your doctor.

• Keep a daily diary to identify times when you have the most energy. Plan your activities for these times.
• Keep up some level of activity and exercise, within your abilities. Your doctor can help you plan an exercise program to maintain your strength at whatever level is possible. Exercise can help your body and mind.
• Give yourself permission to recognize and express your feelings, such as sadness, anger, and frustration.
• Ask for support from family and friends. Look for support groups or counseling in your community. Your doctor is another important source of help. Emotional support is important in coping with a chronic health problem.
• If your memory and concentration are affected by chronic fatigue, keep lists and make notes to remind yourself of important things. Also, give yourself more time for activities that take concentration. Medicine may also help you sleep better, which might improve your memory and concentration.

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Does A Rheumatologist Treat Chronic Fatigue Syndrome

Doctors that specialise in treating CFS include rheumatologists, immunologists and endocrinologists. So yes, you can consult with me about your chronic fatigue symptoms and undergo a set of diagnostic tests that will help uncover the cause of your symptoms.

The main aim of getting a proper diagnosis and the right treatment for CFS is to manage your symptoms and improve your quality of life effectively. Many people with CFS can work hold down a job that allows some flexibility.

However, it is essential to manage your symptoms with the best combination of medications, therapy, diet and lifestyle practices to make sure you can live your very best life. This is why it makes sense to work with my team and me to ensure you get the very best support.

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Management Of Chronic Fatigue Syndrome Symptoms

Rest and sleep in CFSRest periods in the daily routine are part of management strategies for all people with chronic fatigue syndrome. Relaxation techniques at the beginning of each rest period can be helpful. Try to balance the need for rest during the day against how you are sleeping at night. Introduce changes to your sleep pattern gradually.

Physical functioning and mobility problems in CFSStrategies to help maintain and prevent deterioration of your physical function and mobility need to be carried out in small amounts and spread out throughout the day. Strategies should include joint mobility, muscle flexibility, balance, postural and positional support, muscle function, bone health and cardiovascular health.

Care and support plans in relation to physical functioning and mobility may include bed mobility, moving from lying to sitting to standing, transferring from bed to chair, using mobility aids, walking, joint mobility, muscle stretching, muscle strength, balance, and going up and down stairs.

People with CFS may experience intolerance of changing position, such as when first standing up. This may include postural orthostatic tachycardia syndrome . You may need to be refered to a specialist if your symptoms are severe or worsening, or there are concerns that another condition may be the cause.

Pain in CFSChronic pain is commonly associated with CFS. You may need referral to specialist pain services if appropriate.

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The Other Care Providers

There are other people that might be able to help you other care providers like chiropractors, physical therapists and even massage therapists. There are good chances that you would be going to one of them and you could ask them if they could recommend a good doctor that will help in your treatment of CFS.

What Causes Myalgic Encephalomyelitis

The underlying cause of ME/CFS is still not well understood. Prior to a ME/CFS diagnosis, patients are mostly healthy, fully functional and have a good quality of life.

• Approximately 50-80% of people with ME/CFS start suddenly with a flu-like illness.
• ME/CFS is often found after infection by a virus, bacterium, or parasite, suggesting an immunological dysfunction, accompanied by a strong genetic predisposition, as shown in twin analysis.
• Viral involvement is a well-supported theory due to the high index of an infectious onset in at least half of the patients.
• Life stressors can cause a negative impact on the neuroendocrine circuits of stress, leading to other complications besides immunological impairment.
• In addition to immune and viral aetiology, the attenuation of the hypothalamus-pituitary-adrenal axis is documented in adult and adolescent ME/CFS patients, with marked evidence of systemic hypocortisolism, which can influence immunological and neuronal homeostasis.
• Studies have reported enhanced sympathetic nervous activity, as well as increased levels of catecholamines in ME/CFS, providing some evidence for a neuroactive pattern in the pathophysiology of ME/CFS.

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