Myalgic Enceophalomyelitis: Chronic Fatigue Syndrome Flashcards
explain the orthostatic excersise test findings in CFS
they have a second day cardiopulmonary exercise test
- on the 2nd day, there is a maximal RER, but their workload is lower. Consistnet with only Me/CFS. if workload is lower in other diseases, RER is often also lower because metabolism is also compromised.
ME/CFS etiology in sexes and age
70% of female, and 74% are between 25-64 years old– working age
there is no diagnostic test yet, but what’re some screening questions for ME/ CFS?
- how did your illness start?
- what hpapens when you engage in normal/physical or mental exertion
- how much activity does it take to make you feel ill or to trigger illness worsening?
- how lond does it take to recover from this physical or mental effort? (should be over 24 hours for Me/CFS)
- do you avoid or change certain activiities because of what happens after you do them?
what labs would be normal in ME/CFS?
almost everything.in case studies, patients have normal:
- Maria has normal
- CBC, lytes, TSH, B12, folate
- Borellia and co-infections
- Hs CRP, Rh factor, albumin/globulin ratio and ANA
- Urea, Creatinine
- Fasting blood glucose and HbA1c
- CK
- Vitamin D
- Liver fuction
- BUT wiith persistent pain and hypersensitivity to stimuli
goal of treatment for ME/CFS
CFS is chronic, the recovery rate is less than 5%. the foal is to increase the quality of life
managing post exertional malaise
pacing: adapt activity level to fit available energy.
- single most useful managemnet tool is:
chunking, switching, and resting
treating orthostatic intolerance
- many individuals with ME/CFS have low blood pressure and low blood vollume
- WHO rehydration salts as effective as IV saline
- oral salt and electrolytes are helpful, as well as midodrine
What kind of environmental sensitivites to people with ME/CFS have?
they often have sensitivities to chemicals and fragrances, foods and medications
- they react within seconds with multi-systemic symptoms
- it’s important to enforce a fragrance free policy in your office
importance of psychological support for ME/CFS
patients often need support to come to terms with their alterd lives. this is a life shattering disease and suicide is a high risk in PE/CFS
- the goal of therapy is to accept the present and have hope for the future.
compare and contrast ME/CFS vs Fibromyalgia
there are some overlapping symptoms: over 50% of people with condition meet the criteria for the oehr. Me/CFS has PEM though (post exertional malaise) +other symptoms
FM has chronic pain and fatiue, unrefreshing sleep and cognitive impairment (similar)
ME/CFS is more severe: 25% are housebound. People with FM benefit from moderate activity whereas Me/CFS get PEM if they have too much activity.
FM also gets small fiber neuropathy– numbness of extremities
how does Me/CFS and depression differ?
Immune overactivity and
orthostatic intolerance not seen in Depression.
in depression, there is a loss of ability to experience pleasure– you can still have pleasure with ME/CFS.
- CFS also has other symptoms and PEM in addition to the general exaustion
current pathophysiology model for ME/CFS
ME/CFS is considered to be a hypo-metabolic state.
- cells are in a type of “dauer”; a type of hibernation
- there is a huge decrease in mitochondria membrane potential and decreased ATP is produced when cells are under stress.
most people feel better based on a keto diet to precent over exertion of mitochondria
ME/CFS is considered to be a ____-metabolic state.
- cells are in a type of “___-“; a type of hibernation
- there is a huge decrease in mitochondria ___ ____ and decreased ____ is produced when cells are under stress.
most people feel better based on a ___ diet to precent over exertion of mitochondria
ME/CFS is considered to be a hypo-metabolic state.
- cells are in a type of “dauer”; a type of hibernation
- there is a huge decrease in mitochondria membrane potential and decreased ATP is produced when cells are under stress.
most people feel better based on a keto diet to precent over exertion of mitochondria
