After much consideration I drafted the following letter to my doctor. I'd welcome any thoughts on it, before I send it. Thank you again for our appointment on the 19th of February. As you requested I have been considering your advice to try Celexa to reduce symptoms of fibromyalgia and chronic fatigue syndrome. I am concerned about this medication’s tendency to cause nausea as a side effect. I am already experiencing some nausea; more would decrease my already compromised ability to care for my children and myself. My reactions to very low doses of medications tried already indicates some sensitivity, and therefore the advisability of proceeding with the utmost caution. I do want to proceed with treatment, and am impatient to find anything that would bring relief both to myself and to my 16-year-old son who is suffering from CFS and Firbomyalgia to the extent that he’s mostly bedridden. In such sensitive and painful condition, however, I would repeat that our treatment must follow a path of caution. To me, “proceed with caution” would mean to avoid the style of prescription that I have so far met with for this condition: X medicine has helped a percentage of patients, so let’s try it and see if it helps you, and if the side-effects are intolerable we’ll stop. Trial and error, along with stress, have already worsened my condition since it was first diagnosed. In a positive sense, to “proceed with caution” suggests a more science-based approach. Specialists who have seen hundreds of patients over decades have created a consensus on diagnosis and treatment which includes suggested testing specific to the systems effected by chronic fatigue syndrome. I enclose for your consideration a copy of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Clinical Case Definition and Guidelines for Medical Practitioners. If you would kindly pay particular attention to pages 8-9 and page 18, you will see the broad range and specificity of tests suggested. Running as many of these tests as possible on both myself and my son would provide us with a fair picture of the specific systems that are effected in our two cases, and treatment plans could then be devised which would address exact deficiencies, weaknesses, needs. I am seeking appointments with a specialist, Dr. Dan Peterson in Incline Village, who has experience running these types of tests on many ME/CFS and fibromyalgia patients and familiarity with patterns of presentation and responses to treatment. I don’t know if or when I will be able to get appointments with Dr. Peterson for myself and my son. Whether or not we are seen by Dr. Peterson, I would be grateful for your involvement in our ongoing care locally, particularly if you have time to familiarize yourself with the document enclosed.