The Concept of ME/CFS

Discussion in 'Diagnostic Criteria and Naming Discussions' started by Jonathan Edwards, Oct 15, 2024.

  1. Kitty

    Kitty Senior Member (Voting Rights)

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    Made a PDF with added spacing for folk who struggle with dense text.

    Content is the same, but the text is left-justified in a san-serif typeface, and the heads and subheads are bolded.
     

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  2. Sasha

    Sasha Senior Member (Voting Rights)

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    Not quite, I am now turning my attention to the references section! :)
     
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  3. bobbler

    bobbler Senior Member (Voting Rights)

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    Yes anything that infers a ‘feeling’ rather than what it is which is that deterioration

    the big issue we battle with is that we can only ‘prove’ someone wrong by yielding to what they force on us and it deteriorating us. Eventually it affects your ability to speak or move out the way to keep yourself safe even in emergency moments and it becomes a terrifying trap.

    because by then you realise it doesn’t matter how much iller it makes you and how much it takes from you this ‘belief’ people are allowed to have that ‘we only think we feel and if we moved it would be better’ actually just gets worse the iller and more disabled we get. I don’t know whether it’s a human instinct in too many of how they emotionally react to and treat ‘the vulnerable’ and suspect that plays into it (as I see people’s contempt then I have to be on the receiving end of people justifying that contempt to me as also being ‘get fed up with doddery old blokes too’ and the like) - so that is very real snd something we are also having to deal with here, and easily given fodder.
     
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  4. Sasha

    Sasha Senior Member (Voting Rights)

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    @Jonathan Edwards - Done my best with the editing of the references in the absence of any style rules that I could find on Qeios's website - I've just gone for internal consistency, and when in doubt, I've checked the article webpages themselves for how some of the unusual refs should be cited.

    Hope this is helpful! :)
     

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  5. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    I sent it off after going over it again and making a few more tweaks. I did look at the references but may have missed a few gaps. Fortunately the software usually handles that.

    It can always be edited online.
     

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  6. Sasha

    Sasha Senior Member (Voting Rights)

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    Exciting! Let's hope it gets a lot of attention. Huge thanks again for all the work and insight that you've put into this.
     
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  7. Hutan

    Hutan Moderator Staff Member

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    Very nice, thank you Jonathan.
    Some comments:

    I still don't understand how the ME/CFS acronym transcends the insights of people with ME/CFS.


    Second use of 'obscures', and I'm not sure that it is the best word to use here. You could just say ''Complex' tends to tacitly imply unspecified psychological factors, which was not intended'.


    I and others have found the 'unpleasant' a bit jarring, as the symptoms can be a good deal worse than unpleasant. Also, how many symptoms are not unpleasant? Not many I think. I think 'unpleasant' could just be deleted, without any loss of sense. I agree with others that malaise, the feeling of being unwell, is different to nausea, OI and pain, and is not the sum total of those. Just to confuse matters, I rarely feel nauseous.

    I don't think that 'difficulty organising thought processes' is quite right. I don't have problems organising my thought processes, apart from when I have more global problems with my thought processes. Organising thought processes seems specific and almost implies a mechanism. I think it might be better to just say 'difficulty with cognition' or 'difficulty with cognitive processes'.

    There is no mention of muscle weakness and fatiguability in this initial listing of symptoms. I think it is an important aspect of the illness and potentially an important clue. I think we saw it in the intramural study, people with ME/CFS could not sustain muscle use in the way that the healthy controls could. I think there was a hand grip study that found it too. It's not related to fitness, as some days the weakness and rapid fatiguability is there, and other days it is not. There is mention of fatiguability later in the report, but it does not make it clear that fatiguability is a characteristic of ME/CFS.


    I really don't like 'weaned off'. It makes it sound as though the person has needed help to give up something that they wanted, and implies something of moving the person towards an adult state. I know it wasn't meant that way, but it does have connotations. You could just say 'Others have had parenteral and enteral feeding support and later have been able to return to oral feeding.'


    This would be better slightly reworded:
    "... with there being no evidence for any reduction in the prevalence of the illness and with people still dying of avoidable dehydration and starvation."


    I don't think there is a well-established epidemiology - we desperately need better data. Also, not knowing about the illness is not the only or even the best reason for people to turn their attention to it. It is also quite common, and life-disrupting. I'd write that sentence as
    " ...that implies a reasonably well-delineated and relatively common debilitating illness that we understand very little about. For precisely that reason, we need to turn our attention to it."


    I don't think you need 'type of'


    I think that sentence reads better as
    "Until then, there is a need to make the clinical concept as clear as possible so that research studies have the very best chance of finding clues to the underlying pathology."

    Thanks again for your effort on this.
     
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  8. bobbler

    bobbler Senior Member (Voting Rights)

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    I think in particular your first few points are really important

    I’ve been to ill due to other commitments to properly attend to this

    but these points miss the issue of it being about a ‘ratchet’ illness where treating us badly and ignoring these things we flag makes us deteriorate and reduces our envelope further.

    and to the wrong ears who are behaviourist would be used like we just need a strong hand to force us to through a bit of unpleasantness we are being ninnies about and after all think of how many horrid things eg cancer patients have to endure whilst being cured/treated with hope of it helping.

    The balance with me/cfs is different because yes we deserve support to survive but it needs to be aware that deterioration caused by it is deterioration so cherry-picking and doing things without adjustments etc isn’t them ‘just’ short-cutting then wondering why we are still bad and ‘won’t get better’. but is the START of a careful, long journey which will be made longer and us more ill the more that we are out through that deteriorates us - because we don’t have some helpful treatment other than time in restful circumstances giving us a chance.
     
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