It took me almost one hour to type this response.
Thanks so much for the effort you took. Which helps me to voice some suggestions.
What do I need to address?
That is the Million dollar Question
#1 Get over the chronic fatigue so I can live a productive life.
I asked this question, because in my case most former health issues from being born, actually became co-factors in the final conditions I fought. PEMs were a last pinnacle only. Also with me, it actually started with a much debilitating walking-disability from PAD and COPD, where comprehensive lifestyle changes and Orthomolecular supplementation couldn't bring quick improvements. As diseases, which are usually considered mercilessly progressing, and available standard interventions able to slow somewhat only.
Therefore, to get feedback for improvements or worsening through my interventions, I used as many lab-tests as possible. And there I saw the damage done long in the past since my birth: with difficulties with the heart, lung, liver, kidneys, spleen, androgens, thyroid, glucose metabolism, etc., - where it seemed intuitive to tackle even the slightest dysfunction of any body-system, to reverse the usually considered non-reversible main conditions.
I consider injuries or operations as not being sick .
I call it a life learning experience
Luckily, I miss this life experience, except one broken food joint as a child. But with my PAD at age 40 I was offered a vascular prothesis, instead of my abdominal aorta down to the legs. Recommending MDs couldn't give much advice on possible risk. Therefore, I found elsewhere, on the German Wikipedia:
The most frequent complications after the use of vascular prostheses are blockage (occlusion) due to excessive tissue formation in the neointima region (hyperplasia) or due to detachment of parts of the pseudointima, infections of the implant, problems with the material structure, as well as the development of aneurysms and pseudoaneurysms in the anastomosis region.
Five to ten years after implantation, around 90 percent of prostheses still function in the aorta area and the adjacent vessels, while prostheses with a diameter of less than six to eight millimeters have a success rate of less than 50 percent after five years. In general, the higher the flow resistance in the implant area, the lower the prospects for short-term and long-term function.
And declined this invasive procedure. All my organs were already damaged, I didn't need a further damage done. Especially where I probably would survive a further repair at age 60, but already a decade later probably wouldn't.
No question, in an accident where the aorta was torn apart, there isn't such considerate choice left, and I immediately would agree. But not in my situation, with the ability to weight risks with benefits.
I would in your place consider the possibility, beside all other conditions, that the surgeries - at the right arm, the kidney stone, multiple stitches, broken bones and tendon, but especially the hernia repair with mesh - could as well be maybe small, but significant co-factors to your final breakdown.
Never the big one cause, but small contributions.
#6 I think the mental strain played the largest part.
I can't help but immediately see similarity to the stress of a newborn being strangled. Again, not one big, but certainly one further small contributor. Therefore, I would also take care of improving emotional resilience and stress tolerance.
#7 Covid , other than being sick multiple times with it, I really dont know if it played any part in my CFS.
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#1 Get over the chronic fatigue so I can live a productive life.
I am open to suggestions and any specialty Dr. reccomendations.
Covids, or their not-long term tested vaccines, are of course the final straw which broke the camel's back. And needs to be primarily addressed.
For now, your productive life is in addressing your health difficulties as a whole. Since all your damages are, as in my case, reflected by regular lab-tests of organs functioning: I would monitor them for improvements or worsening together with trialed intervention. Don't rely on the immediately 'felt' only. Repair might take years, as in my case, and with nothing felt during the first years.
This is only a suggestion from my particular experience of this disease and remission of symptoms. Discard, if it disagrees with you in any way. Finding a specialty Dr., who treats you as a whole, would of course be ideal. But I didn't find one accessible to me. Therefore, I helped myself. Of course, with lots of gracious help on health forums.
If you decide to, would you like to share most common lab-tests results? Regular things, like kidney function, liver enzymes, lipid and blood glucose markers, androgens, CBC, etc.? So I could point out what to watch for?