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    Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of, and finding treatments for, complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia, long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.

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Time for the Big Talk. How's the CAA doing?

justinreilly

Senior Member
Messages
2,498
Location
NYC (& RI)
Just to be clear: what Fred Friedberg is saying is that the treatment for every single person who is in the bottom quartile of activity levels (bottom quarter) is that they should do more. (This would be a wider group than housebound people I think)

There could be some of these people who could do more just as there are some of the more active people who could do more. But I don't accept that every single one of the people in the bottom quarter needs to do more activity on its own (i.e. without another treatment helping them improve first so they can do more).

I agree Tom, we know blanket approaches don't work that well with ME. And I guess we differ in that I think it is probably so rare that an ME patient is underactive that it doesn't bear mentioning, much less prescribing the entire 1/4 do GET.

I think the 25% group maintains that this bottom quartile is homebound.

And if he means 'movement and stretching' for this group, he's got to say exactly that never graded exercise; the danger of iatrogenic morbidity is just too great in using this term.
 

Dolphin

Senior Member
Messages
17,567
I agree Tom, we know blanket approaches don't work that well with ME. And I guess we differ in that I think it is probably so rare that an ME patient is underactive that it doesn't bear mentioning, much less prescribing the entire 1/4 do GET.
I wasn't really arguing with you (in this post: http://www.forums.aboutmecfs.org/sh...-s-the-CAA-doing&p=60354&viewfull=1#post60354 ). I was just doing it more as a ("logical") argument: all one needs to do is prove that a reasonable number of the bottom quarter shouldn't be trying to do more/told to do more to win the argument that the advice is bad (technically, logically, all one would have to do is choose one person).

You could well be right with your point.

I think the 25% group maintains that this bottom quartile is homebound.
They say that but I remain to be convinced. I think the figure may be based on the bottom quarter who are members of groups. But I think there are a lot of more mildly affected people who don't join groups. (Aside: Leonard Jason found that only 9% of people with CFS in Chicago were diagnosed). The figure of 25% being homebound (or maybe 1 in 1000 of the population) doesn't ring through to me knowing my patch of 4 million quite well. But that's probably a debate for another day - Dr. Friedberg may be thinking of a more severe group also. But one can probably say that 25% are severely affected as a lot of people are quite disabled just not homebound.
 
K

_Kim_

Guest
Yeah, Lissette!

CAA may need CBT to correct erroneous beliefs about what a patient advocacy org is supposed to do:

"OK, Kim, now I want you to effectively advocate in front of the mirror one time before next session. Then we will ratchet it up to effectively advocating to an actual person even you're so not used to that that this will knock you on your butt for a month.":Retro smile:

Yes, Cort, I know CAA and Kim have done advocacy. But I couldn't resist. Let me blow off some steam so I don't explode. :Retro smile:

Who me? Oh right, you're talking about that Kim. I wish that Kim had a bit of the fire that this Kim has.
 

usedtobeperkytina

Senior Member
Messages
1,479
Location
Clay, Alabama
For me, heating the muscles and then stretching twice a day has been the most effective therapy I have tried. I think everyone should try this. But, when recommended it should be recommended as "stretching" not "Graded Exercise" with the footnote that if all you can do is stretch, then stretch.

For the bedbound, they should be advised under "Movement for the Bedbound" to "move their limbs a bit each day and roll to the side to prevent bed sores, and blood pooling." Any mention of GET in this or any other context (except for those who are a 7 out of 10 in fatigue, as per Dr. Lerner) is totally inappropriate.

Agreed. Semantics in this illness is big. We all know how misleading "fatigue" and "syndrome" can be.

So for activity, maybe something like "some body activity" is much better than "exercise." Or something like... "Stretching is good for all with CFS and may be the only body activity a severely ill person can do. Hopefully, a slow increase of body activity, possibly over a period of months or years, can be achieved. But this must be taken carefully based on the person's physical condition."

Those type words would be much better.

Tina
 

usedtobeperkytina

Senior Member
Messages
1,479
Location
Clay, Alabama
But one can probably say that 25% are severely affected as lot of people are quite disabled just not homebound.

This is what I think the 25% is. It is the ones who are diagnosed who are on disability, that is get government benefits because they can't work full time. (by the way, many with CFs are likely working part time. I am one of them)

Tina
 

Kati

Patient in training
Messages
5,497
Someone mentioned a few pages ago that ordering CBT and GET is assuming that the person is doing something wrong, and I cannot agree more with this concept.

It is pretentious to think that a PWC is at fault and guilty of bring so low emotionally, cognitively or deconditioned. These people obviously have never experienced CFS, PEM, OI and all the symptoms that CFS can engender.

Without feeling like a victim, I think that there has been lots of wrong judgements to benefit insurance companies, psychiatrists, governments and disability plans. This is why patients are so reluctant to hear about GET and CBT.

Personally, I would gladly accept SUPPORTIVE and CONFIDENTIAL therapy from a counsellor, and perhaps some advice on strengthening exercises that could help me maintaining my condition while my disease is taken care of by a medical doctor, hopefully an infectious disease doctor. Staci Stevens would be one that I would trust. Occupational therapist sent to me from the disability insurance, not so much.

Content for CAA: I will reiterate before that biological research for cause and treatment should be the #1 priority. Please leave the emotional well-being and physical therapy up to the patient. I suspect that each one of us has the competence to reach out for these needs in due time, in case they can't help themselves. This forum has proven to be full of peer to peer expertise where sharing is encouraged and cherished.
 

Stuart

Senior Member
Messages
154
Who me? Oh right, you're talking about that Kim. I wish that Kim had a bit of the fire that this Kim has.

You know, I like the idea of you job swapping with the 'other Kim,' I think you would be great!
 

starryeyes

Senior Member
Messages
1,558
Location
Bay Area, California
This is so important. As someone else said on PR, I makes absolutely no sense to tell someone who is struggling to take care of themselves to do additional meaningless activity. This is either impossible or is excruciating and will make them crash. It's also insulting and alienating.

Pacing/staying in the envelope is the key in this area. I agree totally with Dr. Lerner- no extra activity until you can work without relapse.

Thank you Justin. This is exactly where I'm at and I'll decide when it's worth it to push through it all or when I'm able to, not someone else!

Thank you Cort!! Now that you've got the single quote function down, why not try the multi-quote function? Click the [double quote +] button for all the posts you want to quote, then click [+Reply to Thread]. Everyone's quote will be in your text box and you can insert comments after each of them.

Awesome Kim! I always wondered how to do this. :Retro smile: You're still one of our best admins!

What is totally weird to me is that these hard liners are agreeing and emphasizing PEM. Peter White says that PEM is a cardinal feature. The NICE definition is the Oxford definition (merely idiopathic chronic fatigue) plus PEM. The UK psych CBT emphasises pacing to prevent exertion and crashing.

Yet they still push their harmful GET and CBT that says exercise has been proven to only help you and never harm you and that you have 'erroneous beliefs' that have to be corrected.

They're taking their "let's see how much damage we can do to the patients and still get away with it" core approach and pushing it to the maximum extreme. They're actually admitting PEM is perhaps the central feature of ME and then pushing a 'therapy' CBT that says the exact opposite in a demeaning way to patients and forcing patients to exercise. It's sickening and bizarre.

I don't think they get it because everyone keeps saying that PEM is "Post Exertional Malaise". That doesn't sound so bad. However, my PEM, and I suspect many others with ME is horrid. I'm in Hell for 3 days following activity of any kind with horrible pain and super sickness and fatigue that leaves me flat as a pancake and dead to the world. I suffer with PEM and sometimes even have to use a wheelchair for up to 4 days in a row if I push through my symptoms and exert myself.

That aint' malaise, but that's the word that's used for it. :Retro mad:
 

Stuart

Senior Member
Messages
154
I don't think they get it because everyone keeps saying that PEM is "Post Exertional Malaise". That doesn't sound so bad. However, my PEM, and I suspect many others with ME is horrid. I'm in Hell for 3 days following activity of any kind with horrible pain and super sickness and fatigue that leaves me flat as a pancake and dead to the world. I suffer with PEM and sometimes even have to use a wheelchair for up to 4 days in a row if I push through my symptoms and exert myself.

That aint' malaise, but that's the word that's used for it. :Retro mad:

I nominate Justin for Wordsmith of the year for the more accurate "PEM" as Post Exertional MORBIDITY.

I would state that increased morbidity has been due to more than 'exertion,' many events or episodes of injury or illness, etc. have set up a worsening of morbidity that lasts days, weeks, or months. Perhaps 'Post Event Morbidity' is even better? :thumbsup:
 

Mithriel

Senior Member
Messages
690
Location
Scotland
Professor Hooper refers to post exertional muscle fatiguability and malaise which is much more accurate, as is post exertional exacerbation of symptoms. The muscle fatiguability is important because that is the phrase used in MS and RA whereas muscle fatigue is deconditioning - semantics again.

I have long felt that Post exertional malaise is a bad term. It was fine when we used it amongst ourselves, we knew what we meant, but anyone who suddenly gardens one weekend will have a week of postexertional malaise and it is obvious that nowadays the psyches are using it as if it means what happens when you exercise when deconditioned.

It is always worth going back to Ramsay's work. The original ME experts spoke about an abnormal response to exercise. The response was induced by an abnormally low level of activity, was abnormally out of proportion to the level of activity and was abnormally prolonged. It also happened when someone was not experiencing symptoms before being active.

We need to find a phrase which conveys that precisely and distinguishes it from the normal, if severe, response to exercising when you are already ill.

ME was always about activity not fatigue.

The 25% phrase was Ramsay's. He said that of the people he followed after the epidemics, 25% recovered within two years, 50% had relapsing remitting or constant illness while 25% became severely ill or gradually deteriorated. So 25% improved, 50% stayed the same, 25% deteriorated.

Mithriel
 

oerganix

Senior Member
Messages
611
Orwellian/Wesselian doublethink in GET/CBT

Someone mentioned a few pages ago that ordering CBT and GET is assuming that the person is doing something wrong, and I cannot agree more with this concept.

It is pretentious to think that a PWC is at fault and guilty of bring so low emotionally, cognitively or deconditioned. These people obviously have never experienced CFS, PEM, OI and all the symptoms that CFS can engender.

Without feeling like a victim, I think that there has been lots of wrong judgements to benefit insurance companies, psychiatrists, governments and disability plans. This is why patients are so reluctant to hear about GET and CBT.

Personally, I would gladly accept SUPPORTIVE and CONFIDENTIAL therapy from a counsellor, and perhaps some advice on strengthening exercises that could help me maintaining my condition while my disease is taken care of by a medical doctor, hopefully an infectious disease doctor. Staci Stevens would be one that I would trust. Occupational therapist sent to me from the disability insurance, not so much.

Content for CAA: I will reiterate before that biological research for cause and treatment should be the #1 priority. Please leave the emotional well-being and physical therapy up to the patient. I suspect that each one of us has the competence to reach out for these needs in due time, in case they can't help themselves. This forum has proven to be full of peer to peer expertise where sharing is encouraged and cherished.

This is how I feel about it, too. I first went to a doctor to find out why I could not DO what I used to DO. He was already captured by the "it's depression" ideology, so he turned my complaints around backwards and told me that I had gained weight because of doing less and this weight gain was making me tired and made me feel like I could only do less! No amount of facts could re-orient his thinking.

This is exactly what the psychobabble/doublethink group does. It takes the facts and turns them around backwards. (ME/CFS doesn't make you "tired" or "sick". Your belief in this non-existant illness is what makes you "tired" and "sick".)

As Kati said, this attitude stems from the belief, or desire to make one believe, that the PWME is wrong...in behavior, in thought. For those who have eyes to see, and from those who look for the truth without the politics, there have been 1000's of studies over the last 20 years and more that have shown multiple biological abnormalities that show cause for our symptoms. They've proven patients are not wrong. These studies have gotten more and more convincing over time, if one is open minded.

The whole GET/CBT promotion is an example of what George Orwell, in 1984, called doublethink:

Doublethink lies at the very heart of Ingsoc, since the essential act of the Party is to use conscious deception while retaining the firmness of purpose that goes with complete honesty. To tell deliberate lies while genuinely believing them and to forget any fact that has become inconvenient, and then, when it becomes necessary again, to draw it back from oblivion for just so long as it is needed, to deny the existence of objective reality and all the while to take account of the reality which one denies - all this is indispensably necessary.

This is why, for those of us stuck in objectivity and unseduced by doublethink, it so crazy-making to have this kind of doublethink appear in what we hope is a newletter that both understands and supports us.

The fact that we are even debating the merits of GET/CBT infers that it must have some benefit. I believe this only indicates the success of the Orwellian/Wesselian Party in injecting this virus into the conversation. The antidote, IMO, is not to have any more of this unless and until a cause and a treatment are found. Focussing on "coping" gives implicit agreement that nothing can be done about ME/CFS and I think that is highly inappropriate at this time.
 

MEKoan

Senior Member
Messages
2,630
Muscle fatiguability vs muscle fatigue.

At the end of my "remission" - during which I was able to push and crash while living a good life even if my muscles became fatigued more quickly than others - I was attempting to clap along with some friends at a party. This was impossible. My muscles would simply fail and my arms would fall at my side. Even during my remission I had marvelled at how long most people could applaud after performances since I simply could not. But, when I began to slide again they would suddenly fail and hang useless until "recharged".

We experience muscle fatiguability leading to muscle failure. That's different.
 

oerganix

Senior Member
Messages
611
Muscle fatiguability vs muscle fatigue.

At the end of my "remission" - during which I was able to push and crash while living a good life even if my muscles became fatigued more quickly than others - I was attempting to clap along with some friends at a party. This was impossible. My muscles would simply fail and my arms would fall at my side. Even during my remission I had marvelled at how long most people could applaud after performances since I simply could not. But, when I began to slide again they would suddenly fail and hang useless until "recharged".

We experience muscle fatiguability leading to muscle failure. That's different.

I hear you, Koan. When I first got sick and started the downhill slide into more and more muscle fatigue I wore hard contact lenses. One of the things that I told my doctor, which was ignored, was that just the movement of my thumb and forefinger, in cleaning my contacts, gave my thumb the feeling of lactic acid buildup, the "painful burn" that one gets when the muscle is not getting enough of what it needs to keep functioning properly.

Painful cleaning of contact lenses? That couldn't be true....must be imagining it.
 

starryeyes

Senior Member
Messages
1,558
Location
Bay Area, California
I nominate Justin for Wordsmith of the year for the more accurate "PEM" as Post Exertional MORBIDITY.

I would state that increased morbidity has been due to more than 'exertion,' many events or episodes of injury or illness, etc. have set up a worsening of morbidity that lasts days, weeks, or months. Perhaps 'Post Event Morbidity' is even better? :thumbsup:

I really like Post Event Morbidity but we need our support group to adopt it.

Koan wrote: Even during my remission I had marvelled at how long most people could applaud after performances since I simply could not.

Me too Koan! Never thought it was the CFS. Figured they were just way more motivated by what they had seen than me or something. I thought, "Gosh, don't their hands hurt? Mine do!" and I always had to stop and rub them.
 

jackie

Senior Member
Messages
591
Me three! Right up to the time of the final, big crash...I had extremely well developed arm/hand/shoulder/upper-back muscles (in fact, I had a doctor ask if I was a LONGSHOREMAN!!! as my upper body was OVERdeveloped and very strong!...from a lifetime of painting/sculpting).

One of the first things I noticed was how difficult it was to hold a paintbrush (a tiny detail paintbrush! light as a feather!)...and then an inability to work in clay or sculpt (the immediate, intense muscle "burn"). This was soon followed by obvious neurological problems such as intention tremors, inaccurate depth perception etc.

I VIVIDLY remember walking across a campus, towards the parking lot and my car, carrying my usual two 25# bags of clay (one on each shoulder)...and out of the blue, the need to SIT down (or FALL down) on the asphalt to rest!

What a surreal moment that was for me...and the beginning of the end.

(Yep...as a matter of fact - I couldn't applaud at performances, either!)
 

Navid

Senior Member
Messages
564
Me too Koan! Never thought it was the CFS. Figured they were just way more motivated by what they had seen than me or something. I thought, "Gosh, don't their hands hurt? Mine do!" and I always had to stop and rub them.

this is sooo funny to me. i would get tired too...but would think enough already why are these people clapping for so darn long...and standing ovations....i thought they were just so darn unnecessary. when really it was because standing still and clapping like that was physically uncomfortable for me...but my cocky brain just turned it around...."SO's are so overdone these days!!!!!"

I'm beginning to recognize more and more physical things that i have compensated for...prior to my illness, that were actually early signals of the great collapse of 2004...hmmm it's just like the economy, the warning signs were there...but i was "rich and happy" so paid no mind to them.

maybe your (in)ability to clap at a performance (and particularly standing ovations) can become a new biomarker for cfid's/OI

bye
 

flex

Senior Member
Messages
304
Location
London area
Koan

try putting your doctors head in between your hands if you need some motivation to clap harder and longer!!!!

STOP SNIGGERING KOAN YOU KNOW WHAT HEAD I MEAN!!!