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What to ask and tell doc- dysautonomia

Husband of

Senior Member
Messages
318
To the point for the cognitively impaired:

new doc seems good, willing to help, open minded, but not an MECFS expert.

Meeting in a few days to discuss dysautonmia, but could discuss more.

want to tell him the things that will be most helpful in getting helpful treatment. Hoping forum members can help.

He is likely to run tests. Want to ensure
right tests are run,
and right conclusions made,
given the type of dysautonomia my wife has (considering types of dysautonomia pwme get, and what subset my wife might fall in)

but don't know how to work this out.
How to describe symptoms
What research results to highlight

longer story

Had a promising appointment with a different doc than usual for my wife. Her mental health had gone beyond the point of being able to manage without assistance so she has been prescribed mirtazapine. This is not the topic of this thread though.

To give doc context we also told him about the MECFS , sleep issues, and dysautonomia and described how it seemed there was a physical as well as psychological component to the mental health issues. He was very receptive, said I was very smart in how much I knew and how I had analysis how various things might be contributing etc, and said he enjoyed the conversation, which took an hour instead of the designated 15 minutes. So this was very positive, that he seemed already to know some stuff, didn't dismiss MECFS, was willing to discuss things.

We talked about how the pots like symptoms had been quite bad recently and would like to do something about it, how we had upped water and salt some time ago which helped but that the symptoms had gotten worse recently.

he ordered some blood tests.

he had said he had a long COVID patient who has pots like symtpoms and that he had ordered tests for them. He said he wanted to use the term dysautonomia rather than labeling it as pots for now.

so he is likely to run tests. But he is likely to want a good description of symptoms from my wife.

being cognitively impaired she won't be able to describe her symptoms easily, so we want to try and recall them slowly over the next few days.

i also think there is a great opportunity to point the doctor to research on the specific types of dysautonomia pwme experience. Of course this is tricky as it seems ME morphs and changes the longer you have it (and yes it's different for everyone, but my belief is a large part of this is because it changes depending on how long you've had it. As demonstrated with the natural killer cell research for instance. But also my wife, 3 months from having MECFS for two year, has had changing symptoms set even within her short timeframe of her illness.

I read one article talking about different subtypes, but I can't quite remember it - sympathetic versus parasympathetic dominant, combined with something else.

And I have read somewhere about low blood volume in pwme. Is this something you can test for?

i think he has already done electrolyte tests.

im pretty sure my wife's dizziness symptoms change a lot throughout her menstrual cycle. Are there clues in this? Is there anything she should be testing for in this regard? Should she do 34hr salivary cortisol tests?

any help would be appreciated
 
Last edited:

lenora

Senior Member
Messages
4,926
I also had what we now know is POTS during my early life. The odd thing is that I had a very early menopause and everything went to the other extreme....high blood pressure that can't be controlled, or so it seems.

How old is your wife, I don't believe we know? Also, how was she diagnosed?

I agree that the questions should be put together slowly and carefully....it takes a lot of thinking. This new doctor sounds like a young person who is interested in learning. Congratulations on finding him/her. I know how much it can mean.

An internist is also a good source of information if you should ever need one. Do doctors believe in ME? I would say that most are undecided or don't. It's a complex matter.

I would like to see both of you have better lives and do hope that this doctor will help provide you with good care. Sorry, I don't have answers to your nerve system questions. I used to keep very good notes, but then things change and it becomes a fulltime job....especially when meds are taken into account. Yours, Lenora
 

linusbert

Senior Member
Messages
1,156
To the point for the cognitively impaired:

new doc seems good, willing to help, open minded, but not an MECFS expert.

Meeting in a few days to discuss dysautonmia, but could discuss more.

want to tell him the things that will be most helpful in getting helpful treatment. Hoping forum members can help.

He is likely to run tests. Want to ensure
right tests are run,
and right conclusions made,
given the type of dysautonomia my wife has (considering types of dysautonomia pwme get, and what subset my wife might fall in)

but don't know how to work this out.
How to describe symptoms
What research results to highlight

longer story

Had a promising appointment with a different doc than usual for my wife. Her mental health had gone beyond the point of being able to manage without assistance so she has been prescribed mirtazapine. This is not the topic of this thread though.

To give doc context we also told him about the MECFS , sleep issues, and dysautonomia and described how it seemed there was a physical as well as psychological component to the mental health issues. He was very receptive, said I was very smart in how much I knew and how I had analysis how various things might be contributing etc, and said he enjoyed the conversation, which took an hour instead of the designated 15 minutes. So this was very positive, that he seemed already to know some stuff, didn't dismiss MECFS, was willing to discuss things.

We talked about how the pots like symptoms had been quite bad recently and would like to do something about it, how we had upped water and salt some time ago which helped but that the symptoms had gotten worse recently.

he ordered some blood tests.

he had said he had a long COVID patient who has pots like symtpoms and that he had ordered tests for them. He said he wanted to use the term dysautonomia rather than labeling it as pots for now.

so he is likely to run tests. But he is likely to want a good description of symptoms from my wife.

being cognitively impaired she won't be able to describe her symptoms easily, so we want to try and recall them slowly over the next few days.

i also think there is a great opportunity to point the doctor to research on the specific types of dysautonomia pwme experience. Of course this is tricky as it seems ME morphs and changes the longer you have it (and yes it's different for everyone, but my belief is a large part of this is because it changes depending on how long you've had it. As demonstrated with the natural killer cell research for instance. But also my wife, 3 months from having MECFS for two year, has had changing symptoms set even within her short timeframe of her illness.

I read one article talking about different subtypes, but I can't quite remember it - sympathetic versus parasympathetic dominant, combined with something else.

And I have read somewhere about low blood volume in pwme. Is this something you can test for?

i think he has already done electrolyte tests.

im pretty sure my wife's dizziness symptoms change a lot throughout her menstrual cycle. Are there clues in this? Is there anything she should be testing for in this regard? Should she do 34hr salivary cortisol tests?

any help would be appreciated

i would go for a checklist or list format. no full sentences or explanations until he asks for it. give him copy of the list later.
he should be engaged ... actually leading, give him breadcrumbs to he asks the right questions.

clever said, never figured this out. :O)
 

Husband of

Senior Member
Messages
318
.

How old is your wife, I don't believe we know? Also, how was she diagnosed?
Thanks for your post Lenora . My wife is only 33.

She was diagnosed with cfs be a neurologist who believes it's psychological . Before that the previous doc thought she had a post viral condition, possibly long COVID ( though that seems unlikely given timing and no known COVID in the community at the time).

She hasn't been diagnosed with pots. I told the neurologist we had significant , but nowhere near complete, improvement in pots symptoms by increasing salts and water. I asked them if it was worth doing tests or if there was no point because we'd just be told to increase salt and water. She said no point in getting tests. This was before I learned they thought MECFS was psychological. Perhaps she thinks pots is psychological too. She also downplayed my wife's illness in her write up including by blatantly lying about test results ( she told my wife a name and address and asked her to repeat it, then told her again, asked her ti repeat it and so on. The test was ti see how many times it took my wife before she could accurately repeat it. It took four goes but the neurologist wrote down two. I could see at the time she thought my wife was pretending. )
 

linusbert

Senior Member
Messages
1,156
She was diagnosed with cfs be a neurologist who believes it's psychological .

there is no psychological cfs/me!
this is just a unknowingly ignorant stupid diagnose, like saying a broken leg is psychological.
maybe switch doctors? if the doc once is on the psycho train, he never gets back from it. this is a life sentence.

Perhaps she thinks pots is psychological too
100%

blatantly lying about test results
100% get a different doctor. and this behaviour is borderline criminal. there are institutions which oversight doctors, i would report her!
i had this as well, neurologists playing down and lieing about results. the exercising doctor who did tests said there is a clear myopathic change and response in my muscles, the muscle also did atrophy unusually for somebody my age. but the chef of the clinic who did the treatment just said there was no atrophy at all.. i should make more sport to fix muscle weakness, visit psychiatric hospital.
and even the muscle biopsy which according to the pathologist showed signs of metabolic myopathy... the doctor still did deny and ignore those results at all.
at one point they agreed to do specific urine tests for metabolic myopathy.. i gave them urine, they took the bottle... and guess what, they told me urine tests were fine. my girlfriend who worked at the same clinic at that time asked the laboraty about the urine tests.. the laboratory told her they never got the sample, but the neurology did request the specific tests.
it turned out the neurology doctor did bring the urine sample into the wrong laboratory and did just standard tests for glucose, protein, infections... which you could do at home with test stripes. they tried to cover it up.
btw, this was considered one of the best hospitals in germany, a university clinic.
i switched clinic, they ran the same tests again, and suddenly everything which was negative before somehow now got positive results and i got diagnosed with myopathy.


if a doctor does bollocks one time, it wont get better. usually the first impression is correct.
i had patience too long with different doctors.. usually after first conversation i could tell its not worth it.
from my experience its like 9 out of 10 doctors are not worth the time. there is a chance that 1 of 20 actually does help.
 

Jyoti

Senior Member
Messages
3,379
I asked them if it was worth doing tests or if there was no point because we'd just be told to increase salt and water. She said no point in getting tests.
This is outrageous. There are many medicines that can help with POTS, as well as other interventions that go a long way, particularly if you know more about the specifics of your wife's particular autonomic dysfunction.

As well, there are a suite of conditions often linked to dysautonomia that can each be addressed and thus lessen the load. But ....those have to be tested for. If you haven't already, do check out https://dysautonomiainternational.org/ and www.dinet.org.

I finally found a neurologist who understands dysautonomia. However, he dismisses ME/CFS as nonsense, so I have to listen to parts of what he advises. Still, he did a ton of testing on me--both autonomic testing and lab testing, trialed a handful of meds and one of them actually has made a difference. Dysautonomia International has a list of doctors: https://dysautonomiainternational.org/page.php?ID=14 and I see three in Australia, which I seem to recall is where you are. But you can as well go on the DINET forum and ask more specifically. Your wife (and you) deserve better care than this!
 

lenora

Senior Member
Messages
4,926
Hello again! First off, you're a great husband and helpmate to your wife. Mine is also, and there isn't a day that goes by that I don't appreciate him for it.

Second: Yes, your wife should have as many tests as possible to rule out any possibly known condition. I didn't even know that you were in Australia. Depending upon where you are there, it's possible that a clinic may be closer than you think.

I personally believe that a mental condition can co-exist (but not be the reason for) ME/CFS/FM....call it what you will. Thus a psychiatrist should also be involved if that is the case. I specify psychiatrist because here in the U.S. certain drugs can only be prescribed by a psychiatrist. If needed, therapists and psychologist also have their places and can be helpful.

Your wife is very young and it must leave you in an in-between life. I encourage my husband to partake of as much as possible as I want him to have a life of his own. He does, but is also with me a lot. I'm not planning to take a trip to CA with him when he visits my daughter just outside of San Francisco. I can't negotiate all of those stairs, but it's my loss. He's retired but still takes contracts, and is heavily involved in volunteer activities and now pickle ball. He spends one hour/day on exercise. I hope you're making time for yourself. It's tough....I know.

I hope you are near a clinic....that would be just great. Yours, Lenora
 

Husband of

Senior Member
Messages
318
there is no psychological cfs/me!
this is just a unknowingly ignorant stupid diagnose, like saying a broken leg is psychological.
maybe switch doctors?
Well, this was just from a specialist appointment with a neurologist who we don't plan to see on the regular. Except she did agree to do an mri for chiari etc despite dismissing it aggressively at first. That was a while ago now and I haven't booked the appointment so hopefully I t hasn't expired.

the doctor we are seeing tomorrow is a different doctor, just a GP, but a new GP. They seem promising so far

i would report her!
I fantasise about this. But I imagine they'd throw it out. Her word against mine, who they gonna believe? Plus have to wait til after we do the mri haha.
There are many medicines that can help with POTS, as well as other interventions that go a long way, particularly if you know more about the specifics of your wife's particular autonomic dysfunction
Good to hear, and yes trying to work out the specifics of my wife's autonomic dysfunction is what i am trying to do. I'll take a look at the resource you provided. Thanks for that.
I didn't even know that you were in Australia.
New Zealand actually.
I personally believe that a mental condition can co-exist (but not be the reason for) ME/CFS/FM....call it what you will
Well my wife is seeing a psychologist too, who specializes in helping cancer patients deal with the fact they are sick
 

Husband of

Senior Member
Messages
318
Update: went to see the doc, he is going to order a tilt test, a salt test, and a cortisol test.

he was very validating. It is very promising.

He also tested her blood pressure when lying down - was 100 over 60, then after standing up - was 90 over 50. And he said her heart rate was very high when she stood up but he didn't say what it was.