This is the last in a three-part series on the very severely ill in chronic fatigue syndrome (ME/CFS):
- What is Whitney Dafoe’s Extremely Severe ME/CFS Story Telling Us? – Whitney Dafoe describes in penetrating detail what it’s like to be extremely severely ill. (From the Health Care Journal Special edition on the severely and very severely affected.)
- We are Failing People with Very Severe ME/CFS – Amber Ella poses ways we can better support the very severely ill.
The last part of this series is an overview of an unusual journal publication, “Special Issue ‘ME/CFS – the Severely and Very Severely Affected'”, devoted to severely ill people with ME/CFS.
Devoting an entire edition to the severely ill with ME/CFS was shocking. Not only do the severely ill often not have access to doctors they hardly ever participate in research studies. If what we think we know about the prevalence of severe ME – as much as 25% of the ME/CFS population – is correct (see below) they make up a considerable portion of the ME/CFS population. As long COVID emerges the severely ill, in particular, present a cogent warning of how bad post-infectious diseases can get. This is a timely edition.
This landmark edition (edited by Kenneth Friedman, Lucinda Bateman, and Kenny De Meirleir) contains 21 papers, studies, and editorials which flesh out the experiences and biological aspects and needs of the severely ill in a way we’ve never seen before.
Severely Ill ME day seemed like a good time to provide an overview of the edition.
An Overview
“Our intent is to redefine ME/CFS as the serious disease that it is”. Editors of the Special Issue on ME/CFS – the Severely and Very Severely Affected.
High Prevalence Found
ME/CFS is one of the most functionally disabling diseases there is.
The “Homebound versus Bedridden Status among Those with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome” study used a nice big sample size (n=2138) to conclude that the 25% figure for the severely ill is actually probably accurate (!). That suggested as many as 385,000 people in the U.S. may have a severe ME/CFS illness that leaves them home or bedbound.
Surely no other chronic illness comes close to matching those figures. We know that, relative to its needs, ME/CFS is easily the most underfunded disease at the NIH. It’s remarkable, indeed, that we’ve lacked good prevalence data for the severely ill. In fact, we lack the data needed to definitively determine a crucial epidemiological figure – disability-adjusted life years (DALYs) – which are used to determine if health care dollars are going where they are most needed. We’ve been banging on the CDC’s door for more dollars for a major epidemiological survey, and have gotten close, but we’re not there yet.
Studies like the above will hopefully open some eyes and get some more money flowing our way.
Snow to the Eskimo – Functionality to the ME/CFS Field
There’s an old report which points to the multiple terms Eskimos have for snow. They, apparently have distinctions for snow that we could never dream of. They just know snow. The ME/CFS community – from patients to doctors to researchers – just knows functionality. The ME/CFS field is creating terms and new ways of assessing functionality that the medical field hasn’t thought of in a hundred years.
In “Cerebral Blood Flow Is Reduced in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients During Mild Orthostatic Stress Testing: An Exploratory Study at 20 Degrees of Head-Up Tilt Testing”, the Van Campen, Visser and Rowe team, which has done so much important work recently, took their studies of functionality and cerebral blood flows to the severely ill.
Nobody wants to do a tilt table test. I, with my mild to moderate case of ME/CFS, did one years ago and was miserable throughout. It made sense that Van Campen et. al. asked if maybe a less severe tilt table test would suffice for the severely ill? There’s no need, after all, to torture someone confined to their home or bed with an aggressive tilt test.
Instead of a 30-minute 70-degree tilt table test, they tried a 15-minute 20-degree tilt and found that was indeed sufficient to send their severely ill ME/CFS patients’ heart rates soaring, their hearts’ stroke volume declining, their CO2 levels dropping, and their blood flows to the brains tanking.
What other disease would assess functionality by developing a “feet on floor” measure?
Those precipitous declines (and the heart rate increases) even at that mild tilt led them to go even further. If even a mild tilt smacked the severely ill patients’ cardiovascular systems, what effect would something as innocuous as sitting up have?
This study found there was no need to do a regular, or even a mild, tilt table test to produce significant reductions in brain blood flows in many people with severe illness: all they had to have them do was sit up! Simply sitting up caused about a 27% reduction in blood flows to the brain in the severely ill.
The severely ill, like the less severely ill, however, are not a monolithic group. An interesting subset also appeared: severely ill ME/CFS patients who did not complain of orthostatic intolerance did not have reduced blood flows to the brain upon sitting. Something else was contributing to their severe illness.
The ME/CFS field is continuing to blast apart traditional measures of functionality. No one, to my knowledge, has felt the need to assess the effects of mild tilt table tests. Nor have other fields produced a measure like time spent with “feet on the floor”. Nor has anyone, apparently, attempted to determine if simply sitting up could mimic a tilt table test in the more severely ill.
Exercise Testing the Severely Ill
Van Campen, Visser, and Rowe then asked whether more severely ill ME/CFS patients did worse, as might be expected, on a two-day cardiopulmonary exercise test (CPET). They used the following classification:
- mild: approximately 50% reduction in activity;
- moderate: mostly housebound;
- severe: mostly bedbound;
- very severe: bedbound and dependent on help for physical functions.
They analyzed the CPET results of 82 patients, of which 31 were classified as severe. As expected, as patient severity got worse – so did their ability to generate energy, peak oxygen consumption, as well as oxygen consumption, peak workload, and workload – all at the ventilatory threshold. In fact, the severely ill ME/CFS patients posted the lowest CPET values yet reported in ME/CFS studies. This study suggested that energy production productions are, indeed, the distinguishing characteristic of ME/CFS.
Interestingly the drop in oxygen consumption (energy production) from day 1 to day 2 was not greater in the severely ill. All the groups had similar drops in energy production. This may suggest that exercise doesn’t mess up energy production more in this group but that they simply start from a lower baseline of energy production. The idea that they might not get whacked harder by a 2-day CPET test than moderately ill patients might good news for some more severely ill patients who are worried about tolerating these tests for a disability evaluation.
Life-Threatening Malnutrition in Very Severe ME/CFS
Amber Ella pointed in a recent blog on Health Rising “We are Failing People with Very Severe ME/CFS” the often-overlooked role that stomach issues and malnutrition present in the severely ill.
“The 5-case series reports in Helen Baxter’s paper ”The ‘Life-Threatening Malnutrition in Severe ME” validated Amber’s concern. Baxter et. al noted that all five ME/CFS patients became “seriously malnourished and dehydrated” before they were provided nutrition via tube feeding.
An inability to swallow on the part of some of them was believed to be psychological in origin and anorexia nervosa was often invoked – yet oddly enough treatments for severe anorexia nervosa were not provided. Several were threatened with being “sectioned” under the Mental Health Act if they did not start eating and drinking again.
Essentially the doctors had no idea, or interest, in the fact that severe malnutrition and dehydration can accompany severe ME/CFS. Instead, they focused on psychological issues but with a potentially deadly twist. Feeding tubes are provided to people with anorexia nervosa who need them but not for this group – at least not in a timely manner. Each of the five people developed life-threatening dehydration/malnutrition issues which were resolved only after they were given nutritional support. Getting dieticians involved was important in rescuing several of the ME/CFS patients.
The authors recommended that an ‘early warning system” be created so that if severely ill ME patients stop eating, they can be provided nutrition in another way before they become dangerously debilitated.
Loneliness and ME/CFS
“The Lonely, Isolating, and Alienating Implications of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome” paper highlights the extra burden people with ME/CFS often carry. Noting the myriad of negative non-physical consequences that come with having a disease like ME/CFS, the authors report that the “adjustment period” to having a chronic illness – never an easy time – is, in the case of ME/CFS “filled with many new expected and unexpected vulnerabilities.”
The authors make a distinction between solitude and loneliness. One is a choice one makes and the other is a burden that causes “excruciating physical and mental suffering.” Loneliness, the authors assert, is an emotion that was created so that we will connect to others. As humans, “we need to feel connected to significant others”.
Isolation can have its own negative impacts
Loneliness doesn’t simply have emotional impacts – studies show it can have biological ones as well. Loneliness, in fact, is associated with a wide range of health problems and has been linked to an increased risk of dying, increased risk of cardiovascular disease, and reduced immune responses (including NK cells). They have as potent an effect on health as cigarette smoking, high blood pressure, obesity, and a sedentary lifestyle. In short, having social ties is helpful both emotionally and physically.
Most people with a chronic illness have to deal with some form of isolation. The authors acknowledge, though, the special problems ME/CFS poses in maintaining social relationships.
“It is quite clear that being riddled with such symptoms for a lengthy period of time would make socializing, interpersonal connection, and remaining connected to others problematic and would most often require a termination of those relationships.” Simply the newfound difficulty of keeping up a conversation poses its unique problems.
The question is what can one do about that? There are no easy answers. With the goal being to reduce the stress associated with isolation, there are no easy answers. The one takeaway – finding a way to reduce the isolation associated with severe ME (or ME for that matter) may help.
Joining support groups, interacting on social media, not giving energy to catastrophic thoughts, learning deep muscle relaxation are some suggestions. Another idea is that instead of choosing to see the social isolation produced by the disease as a burden and a loss, try to flip that viewpoint and see it as an opportunity to explore mindfulness/meditation and other spiritual practices in more depth than would otherwise be possible.
A Doctor’s View: “When Suffering is Multiplied”
“Chronic Fatigue Syndrome: When Suffering Is Multiplied“, by Anthony Komaroff is simply a lovely, heartfelt piece from a doctor and researcher who has thought about ME/CFS and its place in the medical field for many years.
Using Whitney Dafoe’s very severe ME/CFS story as a backdrop, Komaroff speculated why people with ME/CFS – in particular, people with severe ME/CFS – have had so much trouble with doctors. Why has the disease – even after thousands of studies – failed to attain legitimacy in many medical circles?
I still vividly remember Dr. Bateman’s comment after she and Ron Davis enrolled researchers, saying ME/CFS was a fascinating disease to study. Paraphrasing what she said, “Researchers weren’t hard – if you give them the facts, they get it about ME/CFS. Doctors, on the other hand, are the hardest to convince”.
But why? Komaroff notes that the symptomatic diagnosis does not help – but also notes that recognized diseases such as migraine are diagnosed on the basis of symptoms as well. It didn’t help that standard blood tests – which can reveal the presence of so many problems and conditions – are not totally illuminating in ME/CFS.
The choices doctors make can either alleviate suffering or increase it.
I still remember a jarring meeting with a doctor I’d looked forward to seeing after I found out he was a backpacking buff – my kind of guy, I thought! As he paged through my sheaves of unilluminating medical tests, I could see his anger build. His tone grew sharp. He was clearly emotionally disturbed by all these unrevealing tests. It wasn’t what he expected at all. Instead of seeing me as someone trying hard to find the answers, he saw me as a dead end, a problem, a kind of blight upon the medical system. By the end of our session, he was the one who needed psychological help – not me. (He sent me onto a psychologist – who promptly reported I was not depressed.)
At that, Komaroff says they have some pretty clear choices:
- They could entertain a new hypothesis and explore further;
- They could admit defeat and acknowledge that the medical profession just hasn’t figured this out yet;
- They could try treatments that might help the symptoms even if they don’t know what caused them;
- Even though they know that the “standard” tests they had ordered represented only a tiny fraction of all of the tests available to them”, they could decide “there’s nothing wrong with you”.
Komaroff noted how “efficient” a solution the last one was. It washed the doctor’s hands of the patient, leaving her/him to their own devices. That diagnosis oftentimes continued to insidiously do more harm by damaging the credibility of the patient in the eyes of her/his family, friends, work environment, etc., and in doing so, likely multiplied the patient’s suffering markedly.
How much easier it would have been for everyone – patients, family, even perhaps the doctor living with the niggling concern that he/she might have just betrayed their Hippocratic oath (and did harm, instead of good) – if he/she had just said: something is wrong, but I don’t know what.
Decades after dealing with all four categories of doctors, I get nervous telling a doctor I have ME/CFS/FM. I avoided telling a recent primary care doctor about it for a year or more into our relationship, at which point I said “there’s something I haven’t told you”. Luckily, he responded well. So did the next doctor I told.
Komaroff reported that if a doctor cares to look, he will find that the impact of new medical technologies on our understanding of ME/CFS has been massive. While we don’t know what causes it, it’s insane, at this point, to think that nothing is wrong.
For his part, Komaroff believes that all signs are point to the brain. The neuroinflammation, the autoimmune findings, the metabolic problems, the autonomic nervous system issues, and the gut problems all either emanate from the brain or affect it. The big question for him and this field is: where does it all start? What’s the core abnormality all these others feed off of?
In the end, Komaroff believes that ME/CFS is going to be a great teacher. Whitney Dafoe called it his greatest teacher, and Komaroff agrees. It’s not just that understanding what’s going on in ME/CFS is going to, as he and Ron Davis believe, help us understand what’s going on in “many other diseases”, but the teaching role he believes ME/CFS will play in the medical system as a whole. Never again, Komaroff, believes, will the medical system be so quick to believe that “nothing’s wrong”.
“if patients tell you they are suffering, your default assumption should be to believe them—even if you cannot find an answer with the diagnostic technology you first deploy. Above all, never succumb to the temptation to dismiss the patient’s symptoms because you cannot explain them. That may ease your anxiety, but it only multiplies the patient’s suffering.”
ME/CFS has been batted around by doctors, researchers, the NIH, the CDC, and other institutions for decades. It’s not that the NIH, CDC, and others are blasting ME/CFS. It’s more that they’re killing it with benign neglect; i.e. they’re saying all the right things, evoking sincere concern, providing (oral) support – while doing very little.
Telling the ME/CFS community that it’s responsible for raising itself by its bootstraps, for funding its own clinical trials and research studies, that it’s responsible for increasing researcher interest, may temporarily ease the NIH’s anxiety, but it does nothing to diminish their responsibility for creating a system which has allowed millions of very sick people to be essentially ignored for decades.
The response to the ME/CFS chapter constitutes a vast moral failure on the part of the NIH, the CDC, and the medical system overall. Hopefully, the long-COVID situation will shine a spotlight on that failure, and provide the NIH and the medical profession the opportunity to relieve their burden – and ours.
Perhaps it will give them the opportunity to acknowledge – if they have the guts – how badly they screwed up, and what the costs of that failure have been for many ill people. That would give them the opportunity to find ways to make up for that cost; to learn how they ended up acting so contrary to their missions, and to put in place procedures to ensure that they don’t happen in the future. We would all be happier for that.
To end this overview of some of the papers in the Special Edition, check out a series of videos on Severe ME from Natalie Bouton. Note also that all the papers in the Special Edition are free.
Severe & Very Severe ME / CFS – an Introduction / Symptoms and Management / Hospital Admission
Also, check out a powerful video Jonathan Avery’s 19-year-old daughter made for Severe ME day which juxtaposes her when she was healthy with her being ill. People with severe ME say expresses much of how they feel.
And do check out a poem “The Unsung Heros of Our Time” from Whitney Dafoe.
The Unsung Heroes of Our Time – A Poem by Whitney Dafoe for Severe ME Day
Whitney Dafoe provided the most complete illustration of a very severe ME Illness in his Extremely Severe ME/CFS—A Personal Account piece in the Special Edition. For Severe ME day, he provides an uplifting poem.
Image from Whitney Dafoe
“ME/CFS patients are the unsung heroes of our time. We fight the suffering in this world silently and never get recognition from anyone. But still we fight. For freedom. For life. From the shadows we rise like pond lilies. Shining light. Silently, unbeknownst to the world we live in. Our courage soaked into the walls of time. And the rest of them. They ride the wave that silent heroes make. Alone. Generating the will to endure from someplace deep inside. And the rest of them. They live with that strength everyday. But they never know where it came from. No one does. It came from us. The ME/CFS heroes that cling to the edge of life for endless years, radiating that life outward to all. Because that’s what we do. We change the world. In silence. And without acknowledgement. But we don’t need it. That’s not why we fight. We do it for the light. That everyone else uses to see. And they never knew where it came from. It came from us. The silent ones. The forgotten ones. The ones who live our whole lives in darkness. We give that to the world. For free. And we don’t ask for gratitude. Because it’s what we do. We are ME/CFS patients. And we never stop giving off light. It flows from us endlessly. It weaves the fabric of the world. And the rest of them. They never knew where it came from. It came from us. The unsung heroes of our time.”
Conclusion
While several of the pieces in the Special Edition do not focus on the severely ill, most do, and they provide an introduction into the world of the severely ill for doctors, researchers, patients, and caregivers. If the goal was to “redefine ME/CFS as the serious disease that it is,” it was at least partly achieved.
The edition also showed a light on what’s missing with the severe ME/CFS population; a better understanding of prevalence, how they differ from the less severely ill (illness onset, duration, biological findings), what the risk factors for very severe illness are, how much medical attention they are getting, etc. Are they moderate ME/CFS cases that have simply worsened, or are they atypical in some way?
We should be getting a lot more biological findings with the publications coming out of the Open Medicine Foundation’s Severe ME/CFS study, as well as the (knock on wood) Center for Disease Control’s Multi-site study, which in its last iteration included a significant population of the severely ill.
Oh, my.. this was an excellent article!
Amd the poem by Whitney Defoe moved me to tears.
All time favorite article , Cort!
Thank you so much for writing in such a clear and honest way.
Thanks!
i can not read it now but we need worldwide urgently adapted homes with adapted care and nurses and gp’s etc who knows about our illness. read just a post of someone who even can not stay at home allthough surrounded by loved ones. they can not take care for him anymore because to severe. if money is not there for research, let there please be money worldwide for adapted homes. we are the forgotten of the forgotten!
and even in an old man house, it is not adapted. the noise, the light, the touch, the vibration, the food of food tube, the temperature, that they may not come in the room only if sedated, all those stuff people take for granted. and they do not know shit how to treat us. awfull story’s of abuse etc
for ms etc there are (to few) adapted homes, please let us lay or die in piece
Very good read. Thank you Cort as always.
“The True Horror Of ME/CFS” by Whitney Dafoe
https://www.whitneydafoe.com/mecfs/?post=the-true-horror-of-me-cfs
In his blog, Whitney mentions noise, light, bright colors, food and medicines. I’d also add that some of us can’t tolerate odors/scents/perfumes, chemicals, or mold, and may have further sensitivities or allergies.
Where are we supposed to safely live and still have as much of a life as possible? How are we supposed to pay for it? How can we get the knowledgeable help and care we need? Why isn’t this being addressed AT LEAST EQUALLY with everything else in our community?
In 2019, Kenneth J. Friedman wrote
https://www.frontiersin.org/articles/10.3389/fped.2019.00131/full
“Despite HIV/AIDS currently being considered a manageable disease, the proposed U.S. HIV/AIDS budget for 2018 was $32 billion of which 85 % ($20.7 billion) was for domestic care and treatment programs, 9% ($3.1 billion) for domestic care and housing assistance, 7 % ($2.2 billion) for domestic research, and 2 % ($0.7 billion) for domestic prevention (52). There are no domestic care, treatment, prevention, or housing programs for ME/CFS patients. For ME/CFS, a disease estimated to have more than double the number of patients, and with a quality of life judged to be as or more diminished than that of HIV/AIDS, the disparity in patient care and patient benefits is unsettling.”
July 28, 2021 https://www.thebody.com/article/long-covid-myalgic-encephalomyelitis-chronic-fatigue-syndrome Dr. Nath is quoted as saying that the $1.15 billion for Long COVID “might be a record sum”.
The $1.15 billion over 4 years for Long COVID, which may help ME/CFS, is a joke and a slap in the face.
#DemolishDisabledPoverty
https://twitter.com/search?q=%23DemolishDisabledPoverty
Such a moving article. The ridicule of doctors has been among the most devastating parts of my 31 years with this illness.
Let’s hope that burden will finally be lifted….As if being sick wasn’t enough – then there’s battling doctors! Dismissive doctor’s doing harm is another issue that long COVID is bringing into the limelight. My experience was mild compared to others and most of my experiences have been fine but decades later that and another one still rankles.
I’ve been reading a bit on the history of ME/CFS. There was an interesting period for a number of diseases that were neurological in origin: the time of Dr Jean Martin Charcot – considered the founder of modern neurology. You may have heard the name in Charcot-Marie-Tooth disease (some with hEDS receive this diagnosis too). He was also involved in the study of MS, ALS, Parkinson’s, railroad spine (which I think has gotten replaced with Traumatic Brain Injury [TBI], as we moved from trains to cars), neurasthenia and hysteria.
It’s interesting – at first he regarded hysteria to be a neurological disease. Later on his life, he shifted to labeling as being psychological in origins.
At some point, Freud got involved.
It seems that neurasthenia was the first of the diseases that Freud proposed to have a sexual etiology.
Remember that MS was also for a while regarded as psychological. It is fairly recently that it was recognized to have biological origins.
I think the current attitudes towards ME/CFS in the medical field have largely been shaped by that time. For a while, I was cursing Freud and the people that accepted his ideas – that the psychoanalysis field held back proper research into these diseases for almost 100 years.
Neurasthenia was regarded as an urban phenomena… rich person’s problem. It reminds me of the yuppie flu of the 80s… There is an interesting paper comparing the attitudes toward men vs women with the disease. In men, it was the result of a changing society and too much pressure on men. In women, the onus was on them as individuals – they were bringing it on themselves.
Gym culture, the idea of incorporating fresh air and light in urban settings – they also have an origin in attitudes towards neurasthenia.
Maybe at some point someone will look at how neurasthenia later connects to Roda Barnes and the prevalence of hypothyroidism up until the 1970s. Interesting that ME/CFS appears in the 80s, as the TSH tests were introduced as the standard to measure thyroid function, and left a lot of people out, without a diagnosis and proper treatment. And the labels of ME/CFS, FMS and hEDS were created.
I wish I could post links here – they are multiple, I cobbled together the history from different sources. If you are interested, you can search the different individuals, and diseases. I’m sure there is more that I have missed.
I have also read cultural differences towards ME, how in East Asia it has its own history.
M this is fascinating–thank you. I spent some time searching + browsing healthrising and don’t see similar content. Maybe you can create a guest blog post?
We love guest blogs 🙂
I’ll keep it in mind!
It’s interesting to watch Ian Curtis’ most recent documentary, “Can’t Get You of My Head”, while keeping in the back of your mind our ME problems and the medical system. (they are all up for free online)
It gives you a bigger context of what has been happening in the Western society – mostly the States and UK.
There’s a bit about the trend to quantify everything – where that comes from and how it fails.
We see that in our case with the routine workups, how useless they are in telling about how the body is doing in ME/CFS, etc. And how doctors trust that instead of trusting symptoms, patients or other markers of illness. The bababaloo with thyroid blood test markers too.
And there is also the shift of power structures. The medical system and government in our case.
We know very little in general of ME/CFS in other cultures/countries outside Europe and the US.
I wish for Whitney’s article to be translated into Spanish at the very least.
Adam Curtis!
https://archive.org/details/adamcurtis2021
“Interesting that ME/CFS appears in the 80s,”
It was here way before—but medicine in the 60’s and 70’s was extremely basic and no one had a clue. I’ve been sick since around around age 2 or earlier can’t recall right now the exact year, when I was given a small pox vaccination which sent me into febrile seizure with a nasty “rash” that they now know was HHV6 —and it all went down hill from there.
Spent my entire youth either in the hospital or sick in bed at home—no one ever knew what was wrong and mistreatment was unending.
Missed the majority of school and when I did manage to make it to school spent most of the time was spent a lavatory stall on the floor with gastrointestinal pain. Yup, it was all psychological, and “nerves”, which was commonly used phrase used alot in the 60’s—which was the nice way of saying the person was mentally unstable—and everything is psychological. Yeah it was “nerves” alright —they just didn’t realize the real truth behind that word.
Oops forgot to say that I’m 66 years old.
Nicely written article Cort.
The disease itself is bad enough. But the disbelief of doctors and especially loved ones makes it extra hard. In fact it is mental abuse. We will not have a formal apology.
We’ll have to deal with it. That makes me sad. All that suffering, why?
We probably won’t have a formal apology. I saw somewhere Francis Collis being a bit defensive about the NIH’s commitment to ME/CFS – which seemed kind of unusual to me. He’s usually so smooth.
A formal apology would do wonders for us and FOR THEM. They’ve got a lot of bad karma floating around….Apologizing would give them a chance to reset the slate and make up for past wrongs.
It would take guts that’s for sure. No one ever seems to apologize in our environment.
You commented about doctors saying ‘Something is wrong but I don’t know what.’ I had exactly that answer from a psychotherapist in 1990. She told me that she believed there was something physically wrong with me but she didn’t know what it was. She encouraged me to keep exploring until I found an answer. She even said ‘Would you consider going to a herbalist or ??? (can’t remember the other option)? I’m not saying you should. I am just asking if it is something you would think about.’ That was March and by the end of that year I finally got a diagnosis of ME. (The psychotherapist also told me that I had all the symptoms of clinical depression but I was NOT depressed. That has stayed with me.)
The same psychotherapist told me that when patients report physical symptoms, there is generally a physical cause. This happens even with patients in mental health care situations. If a doctor takes the time to hunt for a cause, in 95% of patients they will find a physical illness behind reported physical symptoms.
WOW! That’s amazing! A psychotherpist with a brain. Is she still in practice? I’d love to contact her and find out where she got her training and if she has published any papers. I’ve been depressed and it really ticks me off when I’m not depressed but these “know it alls” tell me I am and try and prescribe psych meds. There should be a law….
I had just one good doctor who did her best to find out what was wrong and worried that she was missing something. She believed that I was ill, a person who had never been ill in 72 years. She did, in the end, diagnose me with ME/CFS. She unfortunately left the practice. Since then I have met with disbelief, ignorance and abuse and believe that I have been harmed by those doctors. I can take not knowing but still trying to help but when you are made to feel like a nuisance it does take its toll. Just getting those attitudes to change would make so much difference to so many people.
Cort, I found this piece of writing especially profound because your own experiences and emotions were shining through. It is a very personal piece.
I think most of us can identify with being disbelieved, dismissed, or abandoned by the medical community. It is beyond frustrating, not only for those with severe disease, but the ‘moderates’ as well.
I consider myself the ‘fix it’ girl. At least I still have enough energy to challenge my doctors and to research to try to figure out potential causes and treatments–but often even neglected simpler needs get in the way–like grocery shopping or transportation. Or support from friends and family.
I recently had, who I thought was a dear friend, tell me about an outdoor- get-together with mutual friends. He told me how much fun they had. I felt unhappy at hearing this and asked why he hadn’t invited me. He replied, ‘You’re always sick, and you never can come’ (which isn’t entirely true), so why bother?’ I responded, ‘At least you could have asked.’
This incident has made me profoundly sad that not only have my doctors misunderstood my situation, but so has someone who has known me for decades. ‘Why bother indeed?’
Sometimes I wonder where the compassion and empathy has gone. Everyone is caught up in their own life while some of us spend our days indoors or in bed, waiting for, if not help, at least understanding.
Nancy B. For me it is difficult to ask for help….It is difficult to ask for help when people say things like— if you ever can’t get ……to the dr…….to a pharmacy……etc., “make sure you call me.”. When called. they say……is it really so important to pick up your medicine… can’t it wait til next week… ( tho they help when they can, this is still discouraging to hear.)
So I understand this may not be a helpful suggestion, here is a suggestion.
Would it be an opportunity to say to that friend…. there are times I am feeling well enough to go visit for a short time. What stops me is getting a ride there and a ride to leave after an hour. ( or what I need is for someone to supply a chair for me…. or a quiet place to lay down and rest for an hour while there…. or…..? There may be events that arrangements can be planned in advance, with the understanding you still may not feel up to it when the day arrives.
Sunie,
Thank you for the kind comment and suggestions. When I do show up, it is when I have enough energy to do so, so my friend does not think I am really sick–even though I have made attempts to ‘educate’ him. Also, getting around to various cities in the San Francisco Bay Area frequently involves lots of time and driving. The area is very congested and simply getting across the Bay can take well over an hour in even moderate traffic. I do have to arrange for important trips to Stanford (over 100 miles r/t) as Uber would be prohibitively expensive. All my neighbors are working people and so I dread the day when I am unable to even make occasional near-by trips.
As for the extra chair to rest in, or the quiet room–I’ve no problem with finding those kinds of accommodations. Yet there is always the issue of never knowing how one is going to feel. I have the problem that my energy can seriously drop within an hour and then I can barely move. It’s like a switch suddenly gets turned to ‘off.’ And that’s in addition to the PEM which can last for days. How do you explain that–even to doctors?
Ah, it is so frustrating… I just try to muddle along…
All I really wanted from my friend was to be invited, to feel like I was mentally included, regardless of my ability to attend.
Included is such a nice word and feeling. I hope your friend learns.
+1 to the many comments above–this post means so much to me and is so familiar as an ME patient. Thank you for it, and for all your work on healthrising Cort.
Thanks, Anne and everyone else for their kind words 🙂
Hey Cort…Like always, another great article you’ve written!!…This one however, hits close to home!…The loneliness, depression, pain, suffering, fatigue and frustration that this disease causes, can have its toll on our mental and physical state…I worry about the suicide rates going up because of sufferers not seeing much hope from the medical and political community…I do think, however, the lockdown was kind of a God-send for us to help us feel less alone and for some of us who can still do office-type work, we can work from home…But I hope and pray that we, as a family of ME/CFS/FM sufferers will keep on encouraging, fighting and helping in any way possible to support each other as best we can, and pray we find funding and a cure!…
I cried when I read this blog Cort. Far too many of us seem to have had ‘that’ doctor. My version also sent me to a psychologist to discuss how my thinking was manifesting in psychosomatic symptoms. The psychologist then sent me back to the doctor for a diagnosis of M.E and told me to keep changing doctors until I got it.
When I begged for the diagnosis, my doctor told me that she had ‘classified’ me with ‘chronic fatigue syndrome’ nearly a decade earlier. She kept me in the dark for all those years while my body steadily deteriorated. Looking back, I am certain that she was dogmatically following the old advice from Weseley etc that you shouldn’t enable mistaken illness beliefs by providing a label that implies CFS is a legitimate illness. Her parting words to me were to think myself well.
Her treatment really scarred me and mismanagement also meant that my illness deteriorated from mild to moderate. It is utterly horrendous to imagine the very severely ill being denied nutrition and compassionate care when they are already so fragile. It is inhumane.
I remember Tracey Anne once wrote a lovely comment about the deserving and undeserving sick. It’s not like doctors don’t see the illness, especially with the severely ill. It’s just that for so many years the medical profession has seen it and judged us to be undeserving.
The poem by Whitney is beautiful, more tears.
By the way Cort, I think your doctor lost out when he didn’t recognise the gem in front of him. He treated you like a second class citizen but you have done more good in this world than I imagine he will ever do, even as a doctor.
Thought I’d share a multi-disciplinary set of recommendations on how to treat long-Covid. It does make references to similarities with ME/CFS.
https://onlinelibrary.wiley.com/doi/epdf/10.1002/pmrj.12684
Unfortunately, I find the study suggestions to be rather ‘ho hum’ and I didn’t see much new to what has been suggested for all of us. It does fall back on some sort of graded exercise but with the warning that too much can provoke PEM.
Good article, however there is an error of attribution. The ‘Life Threatening Malnutrition in Severe ME’ article (https://www.mdpi.com/2227-9032/9/4/459) was not written by Amber Ella. It was written by HelenBaxter, Nigel Speight, and William Weir. Please correct this.
I can see the problem. The blog provided a link to Amber’s blog “We are Failing People with Severe ME/CFS” early in the piece. The section was titled “The ‘Life Threatening Malnutrition in Severe ME’ correctly but I can see how things got muddled.
I added
“The 5-case series reports in Helen Baxter’s article ” The ‘Life-Threatening Malnutrition in Severe ME” indicated that Amber was right. Baxter et. al noted that all five ME/CFS patients became “seriously malnourished and dehydrated” before they were provided nutrition via tube feeding.”
to clean that up. Thanks! 🙂
Thanks Cort! Awesome article. You really nailed it with this one!
I believe very strongly that Cipro causes chronic fatigue and foggy head…I sleep so much in the daytime, low BP, feel faint, unsteady on my feet and so many other symptoms..The only med I am on is synthroid and that has been checked several times….Been on Cipro 2 x now and the fatigue started after the first time..Just starting to connect the dots after 3 1/2 years of suffering….
Every disease that received attention had a famous person advocating it. Morgan Freeman has spoken about having this disease and so has lady GAGA who made lots of money from her movie and interview with Oprah., But why not anyone take the torch?