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annoying case history on Medscape diagnosing CFS

Discussion in 'General ME/CFS News' started by daisybell, Apr 15, 2015.

  1. daisybell

    daisybell Senior Member

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    I was alerted to a case history this morning at http://reference.medscape.com/viewarticle/842828
    Sorry, you need to be logged in to view this.
    Essentially there is insufficient evidence for the diagnosis to be made.. I certainly didn't recognise it, and it seems as though other people who are ticking the multiple choice answers don't either, which is something at least! But it's annoying that the article makes it seem so easy to diagnose, particularly as it says it is a diagnosis of exclusion....
    There are the usual culprits in there in terms of treatment options, and I was very irritated by the fact that having too much rest is described as harmful....
     
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  2. halcyon

    halcyon Senior Member

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    I saw that, it was pretty awesome. There was nowhere near enough information to make any of the listed diagnoses. It was a perfect example of what happens in reality. Do a half-assed workup, toss her in the CFS wastebasket because she has fatigue, joint pain, and headaches.

    I was baffled by them including the data about the IOM criteria in there, when the patient didn't even meet that criteria. Then they went on to advise CBT/GET (GET for exertion intolerance, huh?) and noted that the patient improved on these interventions. Complete garbage.
     
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  3. Sidereal

    Sidereal Senior Member

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    The patient has an ANA titre of 1:160 and joint pain.
     
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  4. halcyon

    halcyon Senior Member

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    I know, I kept waiting for them to talk about that, and nothing. :confused:
     
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  5. SDSue

    SDSue Southeast

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    She also has a TSH of 4. Many labs now consider 3 to be the top of "normal" range.

    (Of course, lowering the number every few years does nothing for those who suffered undiagnosed hypothyroidism and lost years of their lives while being told there was nothing wrong with them. Don't get me started lol.)
     
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  6. Sidereal

    Sidereal Senior Member

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    In the next paragraph there is a poll with options like somatisation disorder and depression. :rolleyes:
     
  7. Sidereal

    Sidereal Senior Member

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    They did however make sure to inform us that pain in ME/CFS is mild, opiates are not indicated, prolonged rest is harmful and that the majority of patients have major depression. I must be occupying some alternate reality then.
     
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  8. WillowJ

    WillowJ คภภเє ɠรค๓թєl

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    is this, by any chance, part of an orchestrated campaign to discredit the IOM report?
     
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  9. SDSue

    SDSue Southeast

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    If this is "mild", "moderate" must be death. What would "severe" be?
     
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  10. Snow Leopard

    Snow Leopard Hibernating

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    Spontaneous nuclear fission explosion. ;)
     
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  11. SDSue

    SDSue Southeast

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  12. Never Give Up

    Never Give Up Collecting improvements, until there's a cure.

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    I know, right!? What a mess of an article! When I went through the article earlier today I actually voted for sleep apnea.

    Just checked back on the comments, someone wrote a great, lengthy critique. Thank you, whoever you are.

    At least 24% of the poll respondents voted for the CFS diagnosis. That means some are thinking about it. Now the readers will think to look for dirty, overweight, middle aged, depressed, tired, previously unprotectedly promiscuous women and treat them with CBT and GET because there is nothing else. Great take home message!
     
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  13. SDSue

    SDSue Southeast

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    It'd be interesting to know what percentage of us were obese when diagnosed. Most stories I've heard are from people who were fit and active - like typical over-achieving under-methylators. Who knows, but I didn't like that they threw in the obese thing.
     
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  14. Gingergrrl

    Gingergrrl Senior Member

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    Once again, I cannot read this article because I know I will be too annoyed and it will ruin my night. This stuff makes me too angry to read any more :mad::mad::mad:.
     
  15. Valentijn

    Valentijn The Diabolic Logic

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    It wasn't completely horrible. Mostly just ignorant due to relying on Fukuda and the old information on the CDC site.

    There were only a few comments that made me want to (verbally) eviscerate the author. And there weren't any really bad comments from the audience, just some clueless, and a couple quite good ones.
     
  16. Sidereal

    Sidereal Senior Member

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    Oh the irony, it burns my retinas. The article states that CBT helped her adapt to limitations imposed by her illness. I guess the author didn't get the memo that successful CBT for CFS patients - British psychiatry's only "gift" to the world - entails convincing the patient not to adapt to their illness but to act as though they're not ill.
     
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  17. chipmunk1

    chipmunk1 Senior Member

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    it seems that CBT is mainly a tool that helps the physician make the patient accept the fact that there is no real treatment available. No wonder it is so popular.
     
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  18. Kina

    Kina Admin Support Staff

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    They also are missing that she is on a cholesterol lowering medication which she started a few months before the onset of her symptoms. From what I have read about these meds, some of the side-effects include joint pain, muscle pain, fatigue, and cognitive issues.
     
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  19. Valentijn

    Valentijn The Diabolic Logic

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    Additionally, I don't think I've heard of any ME/SEID having a good or even neutral experience with statins after disease onset. And there are even some anecdotal reports of people developing ME/SEID shortly after starting on statins.

    Generally the description was just way too vague to draw any conclusions, the proposed treatments were crap, and the suggestion that rest is harmful was outrageous.
     
  20. beaker

    beaker ME/cfs 1986

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    What was the onset of her symptoms like ? Was she overweight at onset ? Did she gain weight after becoming sick ? Did she have poor hygiene b/c she was too exhausted and /or sick to shower prior to her appointment or to do both in one day ?
    I picked out sleep apnea as first to investigate. ( snoring and sleep disruption) There was certainly nothing to make a positive dx of anything w/ what was given.
    Also Kina brings up a good point on statins. ( was that your comment ? : ) )
    What about PEM ? I guess they didn't really read the IOM. Just a glance to see the new name. :bang-head:

    Perhaps they ignored the low positive/borderline ANA based on the normal SED , CRP, and PE (no swelling), but it should of been retested and watched over time at the very least. Family history, onset of symptoms and other lacking information ( PEM question answered and poor man's tilt, Romberg and other neuro eval that could of been done in office) would determine to me whether I would aggressively pursue that angle at this time. Or wait until
    sleep testing was done and if any necessary treatment of any sleep issue did not resolve symptoms. Unless, of course, repeat testing showed further elevation.

    And yes, a full thyroid panel should of been done w/ TSH of 4. They used they old range.

    I am shocked at how much was missed. And I know I'm not even listing it all.

    I can't even dignify the whole CBT/GET thing IF they magically somehow did have dx right. In fact the one treatment choice that was most reasonable -- rest ( don't push is my interpret of that)-- was dissed.

    This was a big Fail on so many many levels.

    PS on pg 3 of article :
    WRONG. They should of said the tests were done because of the symptoms that presented including chronic fatigue. BUT "other causes of CFS " ??????? another example of what is so wrong for so many reasons.
    ok I have to stop or I'll rip out all my hair.
     
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