What is the right treatment for your patient?


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Choosing the right treatment for CFS/ME can be complicated. This presentation can help guide you in the right direction.

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What is the right treatment for your patient?

  1. 1. Nathan Butler<br />Active Health Clinic<br />What is the right treatment for your patient?<br />
  2. 2. “There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don't know. But there are also unknown unknowns. There are things we don't know we don't know” Donald Rumsfeld<br />
  3. 3. What is the cause?<br />Origin unknown<br />Viral, neurological, immune dysfunction, deconditioning, psychological, leaky gut...<br />CFS/ME is a diagnosis of exclusion and an umbrella term<br />It could be all the above or none at the same time<br />Multi-factorial as in any chronic condition<br />
  4. 4. Physical fatigue<br />Mental fatigue<br />Concentration difficulties<br />Sore throat<br />Tender Glands<br />Joint pain<br />Myalgia<br />Headaches<br />Photophobia<br />Bowel problems<br />Sleep disturbance<br />Temperature regulation<br />Dizziness<br />Anxiety<br />Depression<br />Symptoms<br />
  5. 5. How do we treat something without knowing the cause?<br />
  6. 6. Patient Pathway<br />
  7. 7. “To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is to not go to sea at all” Osler, 1901<br />
  8. 8. How does your patient present?<br />What are their primary symptoms?<br />Physical, cognitive, pain, anxiety, headache, etc.<br />What are their illness beliefs?<br />Medical illness, deconditioning, emotional, unsure<br />If we don’t listen then how can we recommend and appropriate course of action?<br />
  9. 9. Assessing your patient<br />CFS/ME is a medical diagnosis and should not be trivialised<br />Malingerers<br />Complainers<br />“Your are just depressed, get on with it”<br />“We all get tired”<br />“It would be great to rest all day”<br />Patients are generally high achievers academically, professionally and/or physically<br />
  10. 10. Patient Advice<br />Belief and empathy<br />Vicious cycles<br />Deconditioning, sleep, social, emotional<br />
  11. 11.
  12. 12. Patient Advice<br />Belief and empathy<br />Vicious cycles<br />Deconditioning, sleep, social, emotional<br />Don’t force ideals or models<br />Psychological support ≠ ‘it’s all in my mind’<br />Exercise ≠ ‘it’s just deconditioning’<br />Flexibility<br />Discuss the ‘three P’s’<br />Predisposing, precipitating and perpetuating factors<br />
  13. 13. The three P’s<br />Predisposing<br />Genetic<br />Environmental<br />Personality<br />Perfectionism, anxiety, high achiever<br />Lifestyle<br />Imbalance in work, rest and play<br />Food intolerances<br />
  14. 14. The three P’s<br />Precipitating<br />Physical<br />Infection, injury<br />Psychological<br />Life events, prolonged stress<br />
  15. 15. The three P’s<br />Perpetuating<br />Physical deconditioning<br />Sleep disturbance<br />Psychological<br />Anxiety, depression, loss, self worth, financial<br />Personality<br />Social<br />Food intolerances<br />
  16. 16. Treatments<br />Evidence based<br />Graded Exercise Therapy<br />Exercise that doesn’t exacerbate fatigue, pacing, goals, sleep and setback planning<br />Cognitive Behavioural Therapy<br />Promising treatments<br />Pacing<br />Food intolerances and nutritional interventions<br />Gluten, lactose and fructose<br />
  17. 17. The team<br />GP - ‘The Pitcher’<br />Initial contact, assessment, treatment<br />Specialist – ‘The catcher’<br />Confirmation of diagnosis, medications, treatment<br />Therapists – ‘Basemen’<br />Exercise Physiologists, Physiotherapists, Psychologists, Dieticians<br />Treatment<br />
  18. 18. Which treatment?<br />Medical, GET, CBT, Nutritional or a combination?<br />Listen to your patient<br />Initial focus on management and not cure<br />By addressing the three P’s it can lead to better management and recovery<br />Early intervention<br />Team work<br />Message of hope<br />Belief<br />
  19. 19. There is no one ‘right treatment’ but hopefully there are now more known knowns and less known unknowns but there still are and always will be unknown unknowns…<br />Nathan Butler: info@activehealthclinic.com.au<br />