Blog Archives

INSOMNIA: WHAT WORKS?

10/29/2012

Of all my symptoms, insomnia is the one I hate the most. It is not the symptom that has sent me to the hospital, or kept me there. It is not life-threatening, but it is the only symptom that makes me weep. There is nothing worse than lying in the dark, hour after hour, feeling ill and exhausted and desperate for sleep, and not being able to fall unconscious. At the very least, one should have a few hours “off” from this illness.

Insomnia was my first symptom. On February 16, 1987 I suddenly stopped sleeping. I went to my doctor, who raised a knowing eyebrow and said, “What's on your mind?” It was useless trying to convince her that I wasn't anxious about anything – except for not sleeping. My husband advised vigorous exercise, which only made matters much worse – and gave me a sore throat, muscle weakness, and other symptoms as well. It would be years before I connected the dots. The dots, although they eventually connected to CFIDS, also connected to my digestive system.

Charles Dickens always comes to mind when I think about insomnia. When confronted with the ghost of his dead associate, Jacob Marley, Ebeneezer Scrooge exclaims, “You may be an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of an underdone potato. There's more of gravy than of grave about you ...” Poor sleep, we all know, can be caused by poor digestion. This, I believe, lies at the root of my insomnia. I cannot digest, therefore I cannot sleep.

The digestive impairments which have plagued me are clearly the villains here. They are also the reason that none of the prescribed remedies for sleep have worked. I have tried all of them. But finally, after 25 years of trial and error (mostly error) I have found something that works.

Unbelievably, it is Dr. Cheney's recommended sleep cocktail from way back in the 1980s – Sinequan and Klonopin. Dr. Cheney recommended 2 drops of liquid Sinequan on the tongue combined with .25 mg of Klonopin. I had tried this combo unsuccessfully several times. Although, of course, my insurance company substituted the generic equivalents. As it turns out, generic equivalents are not all created equal.

The generic “equivalent” of Sinequan, doxepin, only works if it is manufactured by Teva Pharmaceuticals, a company based in Israel. I discovered this interesting fact by accident. I had been taking up to 10 drops of doxepin manufactured by Morton Grove with minimal effect. But I was desperate enough to give doxepin another go, so when my prescription needed to be renewed I took a new scrip to the pharmacy. To my surprise, they gave me a glass bottle, not a plastic one, which is always a good sign. That night, I put one drop on my tongue, took 0.125 mg of clonazepam, and slept five hours straight. When I woke up, I repeated the dose – and, miraculously, slept again.

Apparently, CVS had switched to Teva as their source of doxepin, and through that happy accident of fate, I am now able to sleep better than I have in five years. I still don't sleep like a rock, but I am functioning at a higher capacity. I still believe that faulty digestion and sympathetic nervous system upregulation lie at the root of my insomnia. But the good news is that you don't need to have an iron constitution to get a decent night's sleep.

The moral to this story is: Recycle! Even if a treatment doesn't work for you now, it may, with a little tweaking, help you later.

Book Review: Adolescence and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Journeys with the Dragon

10/24/2012

3 1/2 Stars - Useful for Parents of Adolescents with ME/CFS

The author of this book, Naida Edgar Brotherston, is a Canadian whose daughter fell ill with a mysterious illness at the age of thirteen. Eventually, the girl was diagnosed with Myalgic Encephalomyelitis or, as it is currently known, ME/CFS. Inspired by her experience with her own daughter, Brotherston decided to pursue a degree in social work and to delve more deeply into the issue of how ME/CFS affects adolescents.

Brotherston begins her book by saying: "Every facet of our lives seemed to be saturated with the fallout from a chronic illness that was not acknowledged as real by many key persons in our lives--indeed, at times we questioned our own perceptions and doubted the evidence of our own eyes. Of course, this meant doubting our child and the reality of her pain. The anguish and divisiveness this caused in our family was heartrending, until we made the decision to trust in the evidence of our own experiences." This statement, in a nutshell, captures the dilemma faced by any parent whose child has ME/CFS. Does one trust the authorities, or does one trust one's own child? Brotherston's decision to trust her child was the correct one, but it took courage. Going against the doctrine of the times is never easy.

The strength of this book lies in the case studies of adolescents who explain how ME/CFS has affected their lives. In short, moving accounts, these young people describe the loss of their hopes and dreams, their abandonment by friends, and, sometimes, family, and the pain of being stigmatized. Brotherston adds her own commentary to these interviews, which, unfortunately, is sometimes too peppered with social work jargon to be useful. (The constant discussion of social work methods is quite off-putting.) In any case, an interpretation is not necessary. These young people can speak for themselves.

If you have an adolescent with ME/CFS, this book will help you to understand the pain your child is experiencing. It may also help you to re-examine your own priorities.

SUPPLEMENTS: which ones are best?

10/21/2012

Nutritional supplements are an essential component of any CFS/ME treatment protocol. Research has shown that people with CFS/ME are routinely deficient in many important nutrients (notably zinc, magnesium, and carnitine). These deficiencies, in and of themselves, can decrease the degree to which the body can absorb and make use of other nutrients. Even when there are no clinical nutritional deficiencies, the physiological demands of a chronic illness make it necessary to provide additional nutritional support – especially in light of the numerous GI problems prevalent in the CFS/ME population, which may lead to malabsorption. For these reasons, most CFS/ME doctors recommend supplements.

My own experience with nutritional supplements is that recovery is virtually impossible without them. Sometimes, I did not notice immediate benefits, but when I stopped taking them I felt a decline in energy after a few weeks.

The ten supplements most frequently recommended by CFS/ME physicians are:

1) An all-round nutritional supplement (multi-vitamin and minerals)
2) Vitamin B-12
3) Magnesium
4) CoQ10
5) Carnitine
6) Fish Oil
7) Vitamin C
8) Essential Fatty Acids (EFAs)
9) Vitamin D3
10) Zinc

These are the standard supplements that nearly every CFS/ME physician will instruct you to take at one point or another. I have taken all of them, and each has provided some benefit. But there are a few that I cannot do without.

Here are the five supplements which have benefited me the most:

1) Fish oil - I take the enteric-coated form, Fisol. This was of immediate benefit to me, and I've taken it every day for five years.

2) B complex vitamins - I take these in liquid form.

3) Butyrate (ButyRen, Butyrex) - has helped with intestinal healing

4) Vitamin A - has improved my sleep

5) Vitamin C - immediate increase in energy, I take the powdered form

I also routinely take vitamin D3, vitamin E, magnesium and zinc (carnosine). I have never noticed any particular effect from taking these, but I know that I need them.

For specific symptoms, I also take the appropriate supplements. Carnitine, for example, was very useful for increasing muscle strength and appetite when I was severely ill. Ubiquinol (CoQ10) helped increase energy levels, as did D-Ribose. There have been many others.

Every person is a little different. With patience, perseverance, and a lot of trial-and-error, you will find your "top 5."

My best wishes for your speedy recovery!
Erica

Book Review: Chronic fatigue syndrome (The Facts) by Frankie campling and michael sharpe

10/20/2012

0 stars - Not useful to anybody

Chronic Fatigue Syndrome (The Facts) is a worthless little book that contains very few facts, in spite of being part of "The Facts" series. While it is imperative that with a disease as complex and poorly understood as CFS (CFIDS), authors muster as much data as possible, the authors of this book appear to have done very little scientific research. The sections on testing, causes, prevalence, and prognosis fail to cite a single study, ignoring the plethora of articles that have appeared in medical journals over the past three decades documenting immune system abnormalities, nervous system defects, cellular dysfunction, viral reactivation and hypoxia. Instead the authors rely on vague generalizations couched in language geared to an eight-year-old. The area of greatest concern to people with CFIDS--treatments--was positively skeletal, devoting as little as a single sentence to some of the more widely used medications. In sharp contrast, chapter after chapter was devoted to "psychosocial treatments" not one of which has ever been shown effective for treating CFIDS.

The underlying problem with this book is that the principal author is a psychologist. (If to a hammer everything is a nail, to a psychologist everything is a neurosis.) This is not to say that counseling is useless for people with CFIDS. This book devotes many pages to depression, anxiety, panic attacks, managing relationships, mood - all of which can be useful for those with emotional problems. However, to make counseling an essential component of treatment is to define CFIDS as a psychiatric illness. This is not a fact; it is a myth..

Rich Van Konynenburg

10/16/2012

Rich Van Konynenburg's untimely death on September 25, 2012 was a shock to the CFS/ME community. Rich was a true friend, and a true scientist. His efforts to unravel the underlying mechanism of CFS/ME, and to treat it, were unflagging. Rich gave many presentations, wrote many papers, and answered every single question that was put to him on CFS/ME forums and boards. He always had time for our community. His kindness and generosity were unstinting.

I have posted the methylation protocol on this website exactly as he submitted it to me in May 2012. It is not his final protocol - I believe that for Rich there never would have been a final protocol - but it contains all the treatments Rich believed would best help the CFS/ME community.

We will miss him.

Rich VanK's obituary: http://www.legacy.com/obituaries/modestobee/obituary.aspx?pid=160243735#fbLoggedOut

Getting well: the philosophy

10/14/2012

There are many CFS/ME treatment approaches, countless protocols, and a lot of what I can only call “stances” that go along with them. Some practitioners maintain that you can only get well if you purge your body of its accumulated toxins. Many insist on a completely natural approach, while most conventional doctors will prescribe pharmaceuticals and merely smile vaguely when you bring up the topic of supplements. Every practitioner has his or her own bias. Unless you are fortunate enough to see a CFS/ME doctor with considerable experience, chances are good that you will be subjected to dogma.

You are not a practitioner, you are a patient, so you don't have to be limited by the confines of prejudice. There is only one philosophy that truly works for CFS/ME patients: if it works, do it. When you have the mother of all multi-system illnesses, this is not a time to cross treatments off your list simply because you don't believe in them.

As a good case in point, I offer myself. Before falling ill, I was an all-natural kind of person. I fed my family organic food, much of which I grew myself (and still do). I used herbal remedies for the most part, and I even wrote a book, The Supermarket Survival Handbook (never published), about safe, non-toxic products.

I still espouse the use of safe, non-toxic products, but during my long experience with CFS/ME I have learned that there is a place for everything. I take a small amount of clonazepam and a drop or two of doxepin to help me sleep, because no herbal remedy or complementary modality has been able to touch my insomnia. I also take a slew of vitamins, all of them in fact, and other supplements: fish oil, magnesium, zinc, NAG, enzymes, butyrates, and many more. The single treatment that has helped me the most was a cortisol injection. I take hormones (estrogen and progesterone), and I also visit acupuncturists. I meditate.

All of these things help, some quite dramatically. They are my bag of tricks – treatments that I pull out of my hat as needed.

My advice to people with CFS/ME is to develop your bag of tricks, and not stand too much on principle. The most productive approach is a pragmatic one. Do what works - for you.

BOOK REVIEW: Chronic fatigue syndrome: Critical Reviews and clinical advances

10/13/2012

4 stars - Recommended for Researchers

This slim paperback represents a survey of the most significant research compiled on CFS during the late 1990s as well as research reviews and clinical articles on the causes and mechanisms of the disease. Although the information is somewhat dated, the research approach during this decade was more varied and wide-ranging than research performed in subsequent years, making this book an essential tool for anyone interested in serious medical investigations of CFS.

The first section, written by Rosamund Vallings, is a report on the Second World Congress on CFS and Related Disorders, held in Brussels in September 1999. This is, by far, the most valuable section of the volume as it summarizes the bulk of the research performed over the previous decade. All of the major figures in CFS research were present: Neil McGregor, Byron Hyde, G. Moorkens, and Tim Roberts, who spoke on the biochemistry of the illness, as well as Kuratsune and Dunstan, who spoke about cortisol production, endocrine function, cytokine activity and acetylcarnitine metabolism. Suhadolnik and De Meirleir presented papers on RNase L pathway disruptions in CFS, an area of investigation which holds enormous potential for developing a definitive test for CFS. Reports on clinical immunology and concurrent allergy were made by Brostoff, Hyde, Lambrecht and Regland. Garth Nicolson discussed the presence of mycoplasma infections in CFS and Gulf War veterans, and proposed a course of antibiotic treatment which has been successful in this subgroup. Moorkens and his team reported on pituitary function, noting a significant decrease of growth hormone in CFS patients. Bastien, Nix, Hyde and Cabane reported on clinical findings, including motor abnormalities, memory impairment, altered perception, and reduced exercise capacity. Treatment discussions centered largely around Ampligen, an immune modulator, which was about to enter Phase III trials.

The second and third sections of this volume were devoted, respectively, to research and clinical reports:

1) Role of Mycoplasmal Infection in Fatigue Illnesses: Chronic Fatigue and Fibromyalgia Syndrome, Gulf War Illness and Rheumatoid Arthritis by G. Nicolson et al. Nicolson presents compelling evidence of simultaneous infection with mycoplasma infections, but whether the infection is opportunistic or causative is something that remains to be proven. Nicolson's assertions that CFS and GWS symptoms can be reversed through long-term antibiotic therapy have been effective in only a small number of cases. However, for those patients in whom the mycoplasmal infection is causative, antibiotics may be highly beneficial.

2) Human Herpes Virus 6 Infection in Patients with Chronic Fatigue Syndrome and Its Relationship to Activation-Induced Cell Death, by A. Cocchetto et al. HHV-6 has long been associated with CFS, and has been implicated in increased apoptosis observed in CFS patients. HHV-6 is a highly destructive virus whose proliferation in immunocompromised patients has long been documented as the basis for a wide range of symptoms. The authors propose that immune modulators such as NDGA and N-acetyl cysteine might be useful for downregulating the harmful effects of HHV-6 proliferation.

3) Neurological Dysfunction in Chronic Fatigue Syndrome by A Chaudhuri et al. This article presents a useful summary of some of the more significant neurological effects of CFS: vertigo, movement disorders, mental and physical fatigue, sleep disorder, sensory symptoms, autonomic symptoms, and neuroendocrine abnormalities, as well as proposing a mechanism for neurological dysfunction. Chaudhuri also discusses the history of CFS, from epidemic form to sporadic outbreaks. While the claim that evidence for CFS has been found on an ancient Egyptian papyrus must be taken with a grain (or, perhaps, a pound) of salt, there is substantial evidence for the more recent epidemic form.

4) Immunology of Chronic Fatigue Syndrome by Patarco-Montera et al. This is a concise and valuable review of the literature on immune system abnormalities found in CFS grouped according to type. The authors propose that the interplay of cytokine activation, poor cellular function and pro-inflammatory cytokines play an important role in the waxing and waning pattern of CFS symptoms.

5) The Biorhythm of Fatigue in Chronic Fatigue Syndrome, by Carbane et al. This study failed to show any consistent patterns of fatigue in CFS patients.

6) Divalent Cations, Hormones, Psyche and Soma: Four Case Reports by Hock. Four patients with psychiatric diagnoses of depression, secondary depression, CFS and somatoform disorder were tested for vitamin D deficiencies caused by calcium depletion. All four patients were successfully treated with vitamin D and trace minerals. While this study is far from conclusive it reveals that psychiatric diagnoses can hide underlying biological disorders.

7) Common Clinical and Biological Windows on CFS and Rickettsial Diseases, by Jadin. Rickettsial diseases, such as Lyme disease, were found to be underlying causes of 500 patients previously diagnosed with CFS, FM, MS, depression, heart disease, and psychosis. After treatment with tetracyline symptoms were reversed. While this was a fascinating study, it left many questions unanswered. How were the original diagnoses made? While the idea that CFS may be caused by bacterial infections, the study does not explore the possibility that the overlap in diagnoses in these cases may have been due to sheer medical incompetence.

8) Role of Rickettsiae and Chlamydiae in the Psychopathology of CFS Patients, by Bottero. This was an open study conducted by Bottero after he observed that ALL of his CFS patients tested positive for bacterial infections. An impressive 78.5% of Bottero's 98 CFS patients improved significantly after treatment with antibiotics. A second smaller group, composed of patients diagnosed with ADHD, schizophrenia and autism also showed a similar rate of improvement.

9) Chronic Psychopathologies Associated with Persistant Rickettesiae and/or Similar Germs (Chlamydiae) Phillipe Bottero. Due to the long survival of rickettsiae in reticuloendothelial tissues and vascular linings, persistent infection may result in vascular encephalitis, which, in turn, produces numerous psychiatric symptoms. Sixty patients with psychiatric diagnoses, including schizophrenia, delirium, bi-polar disorder, and depression tested positive for the presence of Rickettsial and Chlamydial infections. Fifty-five of the sixty cases were treated with good to excellent results. It is a pity this article was so poorly written, because it clearly demonstrates how psychiatric opinions have superseded medical diagnoses. If Bottero could cure his group of "schizophrenics" with tetracycline, just imagine how many other patients with treatable organic illnesses have been subjected to years of harmful psychoactive drugs, useless therapy and destructive psychiatric interventions because they were dismissed as "mentally ill."

Find this book on Amazon: http://www.amazon.com/gp/product/0789009994/

DIET: Organic vs conventionally grown food

10/12/2012

One of the questions that repeatedly arises in the CFS/ME community concerns the use of organic as opposed to conventional food sources. Should people with CFS/ME eat organic foods? The answer is yes. Will eating organic food cure CFS/ME? The answer is no.

Organic food has much to recommend it. First and foremost, if you eat organic food you are not ingesting all the chemicals that are routinely sprayed on conventionally grown food. It doesn't do anybody any good to be consuming petrochemical derivatives, much less people who have chemical sensitivities, as so many people with CFS/ME do. For people with CFS/ME it makes inherent sense to avoid putting harmful chemicals in our bodies. We are already struggling with an illness. Why add to the burden? From other standpoints – the geophysical ramifications of continued spraying of pesticides and herbicides – it is also a good idea to eat organic. In short, it can help you to eat organic, and it certainly won't harm you.

A second point to remember is that even organic food contains petrochemical and inorganic contaminants. The heavy metals that the soil has accumulated after decades of farming techniques that used arsenic and lead are all still there. (The only way to get rid of them is to remove the soil.) There are pollutants in the air that get washed into the soil with every rainstorm. And, of course, there are the breakdown products of chemicals that may have been previously used. Even strictly organic food contains the legacy of many years of conventional farming.

Personally, I prefer organic to conventional produce. It hasmore flavor. There is simply no comparison between one of those round, red things your supermarket calls a tomato and what comes out of an organic garden. Green beans, broccoli, potatoes and carrots - especially carrots - all taste sweeter, fresher ... more vegetal. There is no doubt that pesticide-free food is better for you and better for the planet, but beware of practitioners who proclaim that a change of diet will cure you.

The reason organic food won't cure you is that eating conventionally grown food is not how you got sick. True, some people become ill after being exposed to pesticides, but in those cases the exposure was direct. Even if you remove the pesticide residues on your food, you will still have to deal with the actual cause of the illness.

BOOK REVIEW: CELLULAR HYPOXIA AND NEURO-IMMUNE FATIGUE

10/8/2012

5 Stars - Highly Recommended

Cellular Hypoxia and Neuro-Immune Fatigue by Dr. David S. Bell is one of the most concise explanations for the mechanisms of CFS/ME that you will ever find. Dr. Bell was one of the first doctors in the U.S. to identify, diagnose and treat patients with CFS, therefore his views on CFS/ME/FM are based on a wealth of experience.

Essentially, Dr. Bell proposes that people with CFS/ME have a slow, chronic form of septic shock. The sequence of events in septic shock is: 1) a serious infection, 2) production of cytokines, 3) increased nitric oxide, and 4) interference with the production of cellular energy. In acute septic shock, the loss of cellular energy is so profound that it can be fatal. In CFS/ME the process is gradual, resulting in vascular problems, neuropathies, and autoimmune processes.

Dr. Bell's theory is that there is a whole spectrum of neuro-immune illnesses which produce cellular hypoxia (oxygen starvation). These illnesses can be triggered by a variety of factors – viral, bacterial, environmental, or CNS trauma. No matter what the trigger, they all lead to a condition in which the body continues to produce inflammatory chemicals, notably nitric oxide. The end result is a hyper-aroused immune response that interferes with the cellular production of ATP, the body's source of energy. This, Dr. Bell believes, is the root cause of the myriad symptoms common to these conditions.

There is a lot of research to support Dr. Bell's position, the most significant of which Bell cites at the end of each chapter. The notion that impaired mitochondrial production of ATP leads to the chronic phase of the illness is not a new one. The first doctor to have pointed out that patients with this disorder might have a mitochondrial defect was Dr. Ramsay, the British doctor who investigated Royal Free Disease in the 1950s. (As Dr. Bell points out, CFS/ME is indeed the disease of a thousand names.) Since that time Dr. Cheney and a host of researchers have amply demonstrated that patients suffering from this illness show defects in the Krebs cycle, the biological process that transforms vitamin C into ATP. Now that we understand the process, the question remains: What does one do about it? For, as Dr. Bell points out "a little bit of vitamin C" is not going to solve the problem.

Dr. Bell, while excellent at explanation, tends to get vague when it comes to practical suggestions that might put his theory to good use. (To give him his fair due, he does state right at the beginning of this book that he will not delve into treatment.) As a consequence, this book might prove frustrating for those who have this illness. But for those who simply wish to understand CFS/ME, Dr. Bell's simple and straightforward explanation will prove invaluable.

Find this book at: http://www.amazon.com/Cellular-Hypoxia-Neuro-Immune-Fatigue-David/dp/1595941797/

GETTING WELL: THE METHOD

10/6/2012

When you are ill, everyone offers you advice about how to get well - take this supplement or that, get your fillings removed, move to Sedona, pray. In too many cases these people are selling something, a "miracle cure" or a program that is guaranteed to make you well again. The awful thing about CFS/ME is that there are no guarantees, no sure-fire cures, As far as treatment is concerned, it's all terra incognita. And so we spend thousands of dollars in a desperate attempt to get our lives back - only, in many cases, to get worse.

When I first fell ill I didn't know what was happening to me.Within a few short weeks I had lost any resemblance to the human being I had comfortably inhabited for 39 years. I'd become completely alien to myself. My doctor didn't know what was happening any more than I did. So, he prescribed antidepressants - the all-purpose anodyne for doctors who haven't a clue. When I got worse, I went to an alternative clinic in Mexico that had "the cure." I was chelated for weeks, given daily enemas, enzymes, mysterious IVs, live cells, and lots of pills. I got much,much worse.

I came home emaciated, bedridden, fading away, and even more desperate. I took everything that anybody recommended - and I did it all, from laying on of hands, to narcotics. And slowly, inexorably, I slid into the abyss. The doctors washed their hands, told my family I was dying, and sent me off to my fate. I resigned myself and lay in bed, waiting for what I thought was the end.

To my surprise, I didn't die. As soon as I stopped trying to fix my body it began to heal. I realized I had gone about things all wrong: I had dumped too much into my ailing body, and it couldn't handle everything being thrown at it.

Don't do what I did.

If you want to get better - it will take time and patience. This is how you do it:

1) Start with the small guns. That is to say, find the things that will make your body work the least - suggestions rather than commands. For example, when you put an antidepressant into your body, it is a command that your body must obey. It will obey that command even if the result is to do itself harm. On the other hand, if you put vitamin C in your body, it will take what it needs and discard the rest. In most cases (and there are exceptions) a vitamin is a suggestion, not a command. You can work up to the "big guns" when your body has stabilized.

2) Start with low doses. Always begin at the lowest possible dose of anything, whether it's a supplement or a pharmaceutical. To test for tolerance, do the "toothpick test." Crush the tablet with the bottom of a glass. Lick the end of a toothpick, dip it into the crushed tablet, and put the toothpick under your tongue. Wait for a day. If nothing bad happens, then try a greater amount the next day. Don't work up to the full recommended dose, work up to a quarter (or less) and keep it at that level for a week before you increase it. If you can, buy supplements and pharmaceuticals in liquid form. You can take a single drop to start.

3) One at a time. Even if several supplements are recommended, only take one. Wait four days before you add a second supplement (or drug). Wait again. This will give your body time to adjust. It will also allow you time to accurately judge if the treatment is having a harmful effect. (Beneficial effects often take longer to notice.) If you take too many treatments at once, you will never be able to judge which ones have helped and which ones have not. Worse, you may throw the baby out with the bathwater and ditch them all if you have a bad reaction.

4) Recycle. What doesn't work at one stage of the illness may work at another. If you've spent your good money on something that is "neutral," that is, if it doesn't seem to be helping, don't throw it away. Put it in the fridge and save it for later. Even medications and supplements that may make you worse at one point can actually help at another stage of the illness. (Be sure to check for expiration dates if you've put something away for later use.)

5) Take with food. Unless the medication requires being taken on an empty stomach (such as levothyroxine), always take medications and supplements with food. This is how you do it: Eat a little, take the medication or supplement, eat a little more. Your stomach will move the medication along with your food. If you take a pill before or after you eat, it will simply float up to the top of your stomach where it will irritate your esophagus.

6) Make a plan. You may feel too exhausted, too ill, and too desperate to think about making a treatment plan. But this will save your life. Make a list of things you would like to try, put them in order - "small guns" (usually supplements) to "big guns" (usually pharmaceuticals). Then follow the plan. You will discard the plan every time it fails, every time your symptoms flare, and every time you feel hopeless. Don't quit! Make another plan.

How do you know what to put in your plan? Well, I have organized all the treatments used for CFS/ME for you very neatly in Chronic Fatigue Syndrome: A Treatment Guide, 2nd Edition.

And no, I am not just selling you a "cure" - I am giving you a tool. Use it properly and you will feel better.

All my best wishes for your speedy recovery,

Erica

Picture credit: Sleeping Women by artist Yao Wu Zhang