How Is Myalgic Encephalomyelitis/chronic Fatigue Syndrome Diagnosed
Your doctor diagnoses ME/CFS by performing a mental and physical examination. Doctors will ask about your medical history and order blood and urine tests to check for infection. In many cases, doctors refer people with suspected ME/CFS to other specialists to rule out other illnesses that could be causing symptoms.
For your doctor to diagnose ME/CFS, you must have these 3 symptoms:
- Severe fatigue lasting at least 6 months that does not improve with rest or sleep
- Difficulty sleeping
- Fatigue that gets worse after mental or physical exercise
Additionally, you must have at least 1 of the following symptoms:
- Orthostatic intolerance
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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Talking With Your Healthcare Provider About Your Symptoms
Since chronic fatigue syndrome can be difficult to diagnose, it is helpful to come prepared to your doctors appointment. Think back to when your symptoms first started, and whether they may be linked to a stressful event or an illness. Make a note of all the symptoms you have experienced, even if they do not seem directly related to chronic fatigue syndrome. This can help your doctor rule out other conditions.
You may also want to prepare a list of questions to ask your doctor. Treatment for chronic fatigue syndrome tends to focus on managing symptoms through medication, therapy, and lifestyle changes. Tell your doctor about your preferences regarding activity levels, so they can help establish a treatment plan that works for you. They may need to refer you to specialists for more targeted treatment of certain symptoms.
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Biomarker For Chronic Fatigue Syndrome Identified
Stanford scientists devised a blood-based test that accurately identified people with chronic fatigue syndrome, a new study reports.
Ron Davis is the senior author of a paper that describes a blood test that may be able to identify chronic fatigue syndrome.Steve Fisch
People suffering from a debilitating and often discounted disease known as chronic fatigue syndrome may soon have something theyve been seeking for decades: scientific proof of their ailment.
Researchers at the Stanford University School of Medicine have created a blood test that can flag the disease, which currently lacks a standard, reliable diagnostic test.
Too often, this disease is categorized as imaginary, said Ron Davis, PhD, professor of biochemistry and of genetics. When individuals with chronic fatigue syndrome seek help from a doctor, they may undergo a series of tests that check liver, kidney and heart function, as well as blood and immune cell counts, Davis said. All these different tests would normally guide the doctor toward one illness or another, but for chronic fatigue syndrome patients, the results all come back normal, he said.
A paper describing the research findings was published online April 29 in the Proceedings of the National Academy of Sciences. Davis is the senior author. Esfandyarpour, who is now on the faculty of the University of California-Irvine, is the lead author.
What Questions Should I Ask My Doctor
- Take along a list of all the symptoms you are experiencing in case you forget some of them during your talk with the doctor or nurse.
- Talk about how much you can do at work or school and around the house.
- Ask if there are any financial supports or services you could apply for.
- Ask for help with pain, sleep and remaining active if these are problems for you.
- Ask about what you should be eating.
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How Chronic Fatigue Syndrome Is Diagnosed
The path to a diagnosis of chronic fatigue syndrome can be frustrating. The condition is characterized by its symptoms and there is no single test that can confirm it. Complicating the issue even further is the fact that many CFS symptoms mirror those of other illnesses, including heart, lung, thyroid, and even psychiatric disorders.
As a disease, chronic fatigue syndrome is diagnosed when other possible explanations for how you are feeling have been explored and excluded.
The condition is also called myalgic encephalomyelitis or systemic exertion intolerance disease .
Things No One Tells You About Chronic Fatigue Syndrome
Imagine feeling too exhausted to get out of bed, let alone go to work or spend time with your family. Now combine that kind of physical exhaustion with severe stomach pain, aching joints, and brain fog that makes it impossible to read a book or sustain a thought. Finally, imagine telling a doctor how you feel, and having him roll his eyes.
This is reality for many of those who suffer from the disease most know as chronic fatigue syndrome. Theres often little help or support available to them from the medical community or from friends and family.
When you tell people how you feel, they say, Well, Im tired, too,’ says Carol Head, a recovered CFS sufferer and president of the Solve ME/CFS Initiativea charitable organization that funds medical research in pursuit of a cure for chronic fatigue.
Part of the problem, Head says, is that non-sufferers hear fatigue and think they understand what a CFS sufferer is going through. But they really dont. People who have endured both chemotherapy and ME/CFS say ME/CFS is even more debilitating, so fatigue is not a good word for it, she says.
The ME in ME/CFS stands for myalgic encephalomyelitisan alternate name Head and other sufferers prefer to chronic fatigue syndrome. CFS is such a lightweight name, she says. The term myalgic encephalomyelitis has actually been around longer, and it has the advantage of sounding like the serious, real disease that this is.
Its often debilitating.
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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.
Articles On Chronic Fatigue Syndrome
Thereâs no simple blood test or X-ray to diagnose chronic fatigue syndrome â also known as myalgic encephalomyelitis . And many of the symptoms of the illness — deep tiredness, unrelieved by rest or sleep, feeling worse after physical or mental exertion, trouble concentrating, feeling worse after standing and remaining on oneâs feet and other symptoms– are also seen in other conditions, too, making the diagnosis of ME/CFS more difficult.
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Chronic Fatigue Or Chronic Laziness
I am really tired right now. What I mean by right now is pretty much my entire life. Every morning when I wake up my first thought is I wonder when I can take a nap. Even while Im thinking it I realize the futility in this thought I havent actually taken a nap in months.
So last week while I was doing my usual work day multi-tasking eating lunch and working on a paper for one of my masters degree classes, I got sucked-in to the to the break room TV, which is perpetually on CNN, and caught a bit they were doing on Chronic Fatigue Syndrome . As I watched, I began to wonder, What constitutes chronic fatigue? Do I have it? Is it really a viable disorder? Whats the difference between chronic fatigue and chronic laziness?
Its been said that the pharmaceutical companies invent illnesses to get consumers to purchase their drugs. Anyone who watches TV at least a couple of times a week can attest to the barrage of pharmaceutical commercials which assault viewers, offering solutions to new categories of illnesses, illnesses which seem to be devised on a daily basis. Sometimes it makes me feel like screaming Im just trying to watch The Office, lay-off Pfizer!!!
Is CFS another one of these illnesses invented to help drug makers increase their bottom line?
On emedicinehealth.com , I found the following explanation about what CFS is
However, I think Ill try and get a bit more sleep before I get strapped to the tilt table.
Guidelines For Diagnosing Me/cfs
Guidelines from the National Institute for Health and Care Excellence say doctors should consider diagnosing ME/CFS if a patient has extreme tiredness that cannot be explained by other causes and the tiredness:
- started recently, has lasted a long time, or keeps coming back
- means you cannot do the things you used to do
- gets worse after activity or gentle exercise, such as a short walk
You must also have some of these symptoms:
- problems sleeping, such as insomnia
- muscle or joint pain
- fast or irregular heartbeats
- doing exercise or concentrating makes your symptoms worse
The GP should consult a specialist if they’re unsure about the diagnosis or if you have severe symptoms.
If a child or young person under 18 has symptoms of possible ME/CFS, they may be referred to a paediatrician.
As the symptoms of ME/CFS are similar to those of many common illnesses that usually get better on their own, a diagnosis of ME/CFS may be considered if you do not get better as quickly as expected.
The diagnosis should be confirmed by a doctor after other conditions have been ruled out, and if your symptoms have lasted at least 3 months.
Page last reviewed: 29 October 2021 Next review due: 29 October 2024
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I Don’t Have Insurance How Can The Affordable Care Act Help Me
If you’re uninsured or have been denied coverage in the past for ME/CFS, the Health Insurance Marketplace may be able to provide you with access to affordable coverage. With health insurance plans in the Marketplace, you can no longer be refused coverage just because you have a pre-existing health condition. Medicaid and the Children’s Health Insurance Program also can’t refuse to cover you or charge you more because of a health condition. They also can’t charge women more than men. Learn more about the Affordable Care Act and the Health Insurance Marketplace at Healthcare.gov.
When Should I Call The Doctor About Chronic Fatigue Syndrome
People seek medical care when the fatigue and cognitive difficulties of chronic fatigue syndrome affect their quality of life. People who have questions about a particular treatment should contact a qualified health-care provider, local medical society, or university medical school for additional information.
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Subjective Assessment Of Characteristic Symptoms
While several symptoms can be assessed objectively, other characteristic symptoms cant be quantified easily due to their nature. These symptoms include pain , abdominal pain and other gastro-intestinal symptoms, sickness behavior , intolerance of light , sound and odors , food and chemicals, and disturbed thermoregulation. However, several of these symptoms could logically be explained by aberrations observed in ME/CFS patients or subgroups. Pain e.g., could be the result of inflammation reduced oxidative metabolism, mitochondrial dysfunction or damage low cardiac output and reduced blood and oxygen supply to the brain and muscles, possibly leading to acidosis, accelerated glycolysis and elevated lactate levels central sensitisation, as a potential sequel of inflammation and oxidative and nitrosative stress and elevated pain receptors.
When assessing patients it is crucial to keep in mind that while various symptoms are obligatory for the diagnosis ME, they are not obligatory for to fulfil the CFS diagnostic criteria. As argued, objective tests are to be preferred when possible. Nevertheless, when questionnaires and subjective measures are used to assess the clinical status of a patient, applying minimum thresholds for the frequency and the severity of symptoms can reduce the likelihood of possible misclassification of healthy persons and ME/CFS patients.
Blood Flows To The Brain
Another research group found that long Covid may significantly reduce the amount of blood that reaches the brain, a finding that has was also seen in patients with a related chronic condition, ME/CFS, before the pandemic. Keller
The evidence for reduced blood flows to the brain first surfaced in 1996 and has waxed and waned over the years. The brain blood flow question was largely resolved when Visser/Van Campen/Rowe, using a newer, more accurate technique, found reduced brain blood flows in virtually everyone with ME/CFS, including people who did not meet the criteria for orthostatic intolerance.
Further studies indicated that after tilt table testing, blood flows to the brain take much longer to return to normal in ME/CFS, that blood volume a crucial aspect of circulatory function is low, that in severe ME/CFS even sitting or mild tilting can result in significantly reduced brain blood flows, and that tilt-table testing produces similar effects in long-COVID patients.
Medows eye-opening 2014 study demonstrated the dramatic impact reduced oxygen flows to the brain may be having in ME/CFS. When Medow used phenylephrine in ME/CFS patients with orthostatic intolerance to increase blood flows to their brains, their cognitive issues and symptoms completely disappeared during the dreaded tilt table test.
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Uncovering The Mystery Of Cfs
Some people may be genetically predisposed to the CFS, plus viruses and stress appear to play a role. A weakened or compromised immune system and hormonal imbalances have been found in conjunction with CFS diagnoses, so they may have a part in its development too.
Because CFS has been linked to several viral infections in the past, it is thought that it could be more of an end-stage symptom than a unique condition of its own. Individuals with severe infections seem to be at greater risk for developing CFS than others. However, there are also cases of CFS reported in which no viral infection has ever been identified, so it continues to be a mystery.
What doctors and scientists have been able to identify are risk factors. Along with viral infections, there seem to be certain factors that up your chances of getting CFS.
It most commonly develops later in life between the ages of 40 and 50.
Women are more likely to be diagnosed than men.
Allergies, stress, and environmental factors also seem to increase your risk.
Who Is At Risk For Chronic Fatigue Syndrome
Because the cause of CFS is not known, its hard to know what might put someone at risk for getting the condition. However, certain factors are seen more often in people with CFS. These factors include:
- Gender. CFS happens up to 4 times more often in women than in men.
- Age. CFS commonly affects middle-aged people, but people of any age can get it.
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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.
