Inquest Ruling: Young drama student Merryn Crofts killed by ME

ME Association blog post by John Siddle, 18 May 2018: Inquest Ruling: Young drama student Merryn Crofts killed by M.E. 

A devastating disease that some experts insist is all in the mind led to the death of a young drama student, a landmark inquest today ruled.

Merryn Crofts, 21, weighed less than six stone and had spent the last three years of her life totally bed-bound with severe ME – an incurable condition that affects 250,000 people in the UK.

The youngster was unable to take more than two teaspoons of food before suffering immense gut pain and vomiting, a coroner was told.

Merryn, from Rochdale, today became only the second person in the UK to have M.E. – myalgic encephalomyelitis – listed on a death certificate.

Despite being classed as a real neurological disease, many think the condition is not real – even within the medical profession.

Merryn’s mum, Clare Norton, sobbed as she told Rochdale Coroner’s Court how her “beautiful” and “energetic” daughter was left wheelchair-bound and reliant on tube feeding.

She said:  “As a child, she was a bundle of energy. She didn’t walk anywhere – she would hop, skip and jump.

“She was the kind of person that people gravitated towards. They wanted to be her friend.

“She was very social and loved drama. She was a total fashionista, a typical teenager. Her bedroom was a mess of clothes, hairspray and tan.

“But she was also stubborn, and I think that helped her cope with her illness in a lot of ways. She never gave up.”

In August 2011, Merryn, then 15, was diagnosed with hives and swelling shortly after coming back from a family holiday in Mallorca.

Tests in early 2012 revealed that at some point she had contracted glandular fever – a virus which can trigger M.E.

Despite dozens of medical appointments – including mental health checks for panic attacks – Merryn’s condition deteriorated as she suffered breathing problems, exhaustion and excruciating hypersensitivity to touch, light and sound.

She was eventually diagnosed with M.E. in the summer of 2012.

The would-be theatre star, who was forced to wear an eye mask, also suffered from severe migraines, brain fog, slurred speech and persistent infections.

Stomach problems, and problems swallowing, meant that her weight plummeted to just five-and-a-half stone.Coroner Katherine McKenna was told that Merryn could take on just 100 calories a day because her gut was in so much pain, and that, by 2015, even two teaspoons of nutrients were intolerable.

Merryn was eventually fitted with an intravenous nutrition line but suffered intestinal failure and was given a terminal diagnosis in 2016.

She died on May 23, 2017, just days after her 21st birthday.

Mrs McKenna today concluded her cause of death as starvation caused by a withdrawal of supportive nutrition, caused by M.E. She described Merryn as someone who “bore her suffering with dignity and good grace”.

She said: “Merryn had suffered with M.E. since 2012 which caused severe fatigue, gastrointestinal failure, chronic pain, global hypersensitivity, loss of mobility and function.

“Despite extensive investigations no reason for her gastrointestinal failure which led to her reliance on supportive nutrition was found and it most likely it was caused by her M.E.”

Mum Clare, who attended the inquest with daughter Amy Williams and Merryn’s stepdad Dave Norton, told of her long-standing belief that M.E. contributed to her death.

She said: “With M.E. the key symptom is post-exertional malaise. That means if someone’s energy is pushed beyond what they can tolerate, it will trigger all their symptoms.

“The best advice we were given was for Merryn to do just 50% of what she felt capable of.

“But Merryn didn’t even have 50% to give. She was always crashing, so everything that happened to her kept pushing her further behind.”

Pathologist Daniel DuPlessis said that a post-mortem showed low-grade inflammation of nerve roots. It was suggested that this inflammation could have made her bowel hypersensitive to processing nutrients.

Dr DuPlessis pointed out that Merryn had inflammation of the ganglia – gatekeepers to sensations in the brain. A post-mortem into the only other UK death attributed to ME, Sophia Mirza, 32, in 2006, also found ganglionitis.

M.E. expert at Salford Royal hospital, Dr Annice Mukherjee, said she was convinced that the illness was responsible for triggering Merryn’s intestinal failure.

Read more

NB  While it is possible that only 2 people have been recorded as dying of ME. Other people in the UK have had CFS listed as a cause of death on their death certificates, 1 known in Wales.

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The high costs of low-grade inflammation

Review abstract:

The High Costs of Low-Grade Inflammation: Persistent Fatigue as a Consequence of Reduced Cellular-Energy Availability and Non-adaptive Energy Expenditure. by Tamara E. Lacourt, Elisabeth G. Vichaya, Gabriel S. Chiu, Robert Dantzer and Cobi J. Heijnen in Front Behav Neurosci. 2018 Apr 26;12:78.

Chronic or persistent fatigue is a common, debilitating symptom of several diseases. Persistent fatigue has been associated with low-grade inflammation in several models of fatigue, including cancer-related fatigue and chronic fatigue syndrome. However, it is unclear how low-grade inflammation leads to the experience of fatigue. We here propose a model of an imbalance in energy availability and energy expenditure as a consequence of low-grade inflammation.

In this narrative review, we discuss how chronic low-grade inflammation can lead to reduced cellular-energy availability. Low-grade inflammation induces a metabolic switch from energy-efficient oxidative phosphorylation to fast-acting, but less efficient, aerobic glycolytic energy production; increases reactive oxygen species; and reduces insulin sensitivity.  These effects result in reduced glucose availability and, thereby, reduced cellular energy. In addition, emerging evidence suggests that chronic low-grade inflammation is associated with increased willingness to exert effort under specific circumstances.

Circadian-rhythm changes and sleep disturbances might mediate the effects of inflammation on cellular-energy availability and non-adaptive energy expenditure.

In the second part of the review, we present evidence for these metabolic pathways in models of persistent fatigue, focusing on chronic fatigue syndrome and cancer-related fatigue. Most evidence for reduced cellular-energy availability in relation to fatigue comes from studies on chronic fatigue syndrome. While the mechanistic evidence from the cancer-related fatigue literature is still limited, the sparse results point to reduced cellular-energy availability as well.

There is also mounting evidence that behavioral-energy expenditure exceeds the reduced cellular-energy availability in patients with persistent fatigue. This suggests that an inability to adjust energy expenditure to available resources might be one mechanism underlying persistent fatigue.

Major Research Group Highlights Inflammation Energy Production Connection in ME/CFS, by Cort Johnson, 30 June 2018

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Brain function characteristics of CFS

Research abstract:

Brain function characteristics of chronic fatigue syndrome: A task fMRI study, by
Zack Y Shan, Kevin Finegan, Sandeep Bhutab, Timothy Ireland, Donald R Staines, Sonya M.Marshall-Gradisnik, Leighton R.Barnden in NeuroImage: Clinical
Vol 19, 2018, Pages 279-286

Highlights

  • CFS patients recruit larger BOLD activation areas for the Stroop task.
  • BOLD signal complexities in CFS are lower in ten activated regions.
  • The BOLD signal complexity is correlated with the SF-36 health score across all subjects.
  • The BOLD signal complexity explains more than 40% of variance in the health score across all subjects.

Abstract

The mechanism underlying neurological dysfunction in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is yet to be established. This study investigated the temporal complexity of blood oxygenation level dependent (BOLD) changes in response to the Stroop task in CFS patients.

43 CFS patients (47.4 ± 11.8 yrs) and 26 normal controls (NCs, 43.4 ± 13.9 yrs) were included in this study. Their mental component summary (MCS) and physical component summary (PCS) from the 36-item Short Form Health Survey (SF-36) questionnaire were recorded. Their Stroop colour-word task performance was measured by accuracy and response time (RT). The BOLD changes associated with the Stroop task were evaluated using a 2-level general linear model approach. The temporal complexity of the BOLD responses, a measure of information capacity and thus adaptability to a challenging environment, in each activated region was measured by sample entropy (SampEn).

The CFS patients showed significantly longer RTs than the NCs (P < 0.05) but no significant difference in accuracy. One sample t-tests for the two groups (Family wise error adjusted PFWE < 0.05) showed more BOLD activation regions in the CFS, although a two sample group comparison did not show significant difference. BOLD SampEns in ten regions were significantly lower (FDR-q < 0.05) in CFS patients. BOLD SampEns in 15 regions were significantly associated with PCS (FDR-q < 0.05) and in 9 regions were associated with MCS (FDR-q < 0.05) across all subjects. SampEn of the BOLD signal in the medioventral occipital cortex could explain 40% and 31% of the variance in the SF-36 PCS and MCS scores, and those in the precentral gyrus could explain an additional 16% and 7% across all subjects.

This is the first study to investigate BOLD signal SampEn in response to tasks in CFS. The results suggest the brain responds differently to a cognitive challenge in patients with CFS, with recruitment of wider regions to compensate for lower information capacity.

Graphical abstract

The sample entropy (a measure of amount of information encoded in a temporal signal) of BOLD response to Stroop tasks in seven areas are significantly lower in patients with chronic fatigue syndrome (CFS) and significantly correlated health scores across all subjects, suggesting that the brain operates differently in CFS patients.

 

 

 

 

 

 

 

Brain differences shown in chronic fatigue syndrome (Fukuda) study: comment by Sasha Nimmo

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Association of T & NK cell phenotype with the diagnosis of ME/CFS

Research abstract:

Association of T and NK cell phenotype with the diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), by Jose Luis Rivas, Teresa Palencia, Guerau Fernández, Milagros Garcia in Front. Immunol., 09 May 2018

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a pathological condition characterized by incapacitating fatigue and a combination of neurologic, immunologic, and endocrine symptoms.  At present its diagnosis is based exclusively on clinical criteria.

Several studies have described altered immunologic profiles; therefore, we proposed to further examine the more significant differences, particularly T and NK cell subpopulations that could be conditioned by viral infections, to discern their utility in improving the diagnosis and characterization of the patients.

The study included 76 patients that fulfilled the revised Canadian Consensus Criteria (CCC 2010) for ME/CFS and 73 healthy controls, matched for age and gender.

Immunophenotyping of different T cell and natural killer cell subpopulations in peripheral blood was determined by flow cytometry.

ME/CFS patients showed significantly lower values of T regulatory cells (CD4+CD25++(high)FOXP3+) and higher NKT-like cells (CD3+CD16+/−CD56+) than the healthy individuals. Regarding NK phenotypes, NKG2C was significantly lower and NKCD69 and NKCD56 bright were significantly higher in the patients group. A classification model was generated using the more relevant cell phenotype differences (NKG2C and T regulatory cells) that was able to classify the individuals as ME/CFS patients or healthy in a 70% of cases.

The observed differences in some of the subpopulations of T and NK cells between patients and healthy controls could define a distinct immunological profile that can help in the diagnostic process of ME/CFS patients, contribute to the recognition of the disease and to the search of more specific treatments. However, more studies are needed to corroborate these findings and to contribute to establish a consensus in diagnosis.

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Music 4 ME: an album of songs & poetry to raise money for ME education & research

Music 4 ME – raising funds for education & research

Music 4 M.E is an album of original songs and poetry composed and performed by people with M.E and their Carers or family about their experiences of living with M.E.

The ME illness seriously limits what sufferers can do but a group of talented artists with ME have come together to show the world that although they may be missing from their lives, they are not lost.

The aim is to raise funds for education and research into the devastating illness ME (Myalgic Encephalomyelitis).

The songs for this album have been recorded in their homes, in studios if they had enough energy, and even from their beds andrelease for sale on May 12th, International ME Awareness Day.

Preview on the Website.   Available for download for £10.

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#TimeForUnrestWales – funding from the Oakdale Trust

A big thank you to the Oakdale Trust

The Oakdale Trust has given WAMES a grant of £1,000 to help us represent people with ME as we campaign for recognition and better services.

This will enable us to continue travelling to meetings, distributing information etc. beyond 2018 ME Awareness week.                    #TimeForUnrestWales

Find out how you can contribute to campaigning in Wales.

 

 

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#TimeForUnrestWales – #StopIgnoringME campaign

MESiG’s #StopIgnoringME campaign aims to visually display symptoms that go ignored as a result of the invisible aspect of the illness e.g. dizziness, depression, insomnia, clumsiness, cognitive symptoms…

ME/CFS is under recognised and massively underfunded, and through the campaign #StopIgnoringME the goal is for people to do just that, to stop ignoring the 250,000 people suffering from ME in the UK.

MESiG invites you follow the campaign on their blog, Instagram, Facebook and Twitter. Let’s get people to #StopIgnoringME!

Introducing #StopIgnoringME

#TimeForUnrestWales

 

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International #MillionsMissing Visibility action in Geneva, May 12 2018

#MillionsMissing on May 12th

a day of global action that calls for health equality for everyone with ME

On Saturday 12 May, representatives from around the world will gather at Place des Nations in Geneva at 12pm, at the Broken Chair monument.

The Place des Nations in Geneva is the location of the United Nations and World Health Organisation.

Some of those who have not been able to attend in person have sent shoes.

Share the event on social media

 

 

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CFS treatment ‘should be withdrawn’

BBC newsbeat report, 8 May 2019: Chronic fatigue syndrome treatment ‘should be withdrawn’

A common treatment for chronic fatigue syndrome should be scrapped immediately, according to one of the UK’s leading experts in the illness.

Dr Charles Shepherd says graded exercise therapy (GET) can actually be harmful to some people.

He argues the idea of getting patients to do increasing amounts of exercise can lead to serious relapses.

The long-term illness affects around 250,000 people in the UK. It’s more common in women and the NHS says it tends to develop between your mid-20s and mid-40s. It can develop in your teens.

The effects can be totally devastating, leaving people bedbound for years. Despite its severity, the illness is still not well understood.

As well as fatigue, it can affect your brain and digestion as well as leading to extreme allergies.

Chronic fatigue: ‘Held hostage by ME’
Chronic fatigue trial results ‘not robust’, new study says

At the moment, the health watchdog NICE is updating its guidelines for treatment in England.

Wales, Northern Ireland and Scotland are all waiting to see what the recommendations are.

Other health experts disagree and say GET is both proven and a safe method of treatment.

Chronic fatigue syndrome (CFS) is also known as myalgic encephalomyelitis, or ME.

But they won’t be published until 2020 and Dr Shepherd – who’s the medical advisor to the ME Association – believes that’s too long to wait before GET is withdrawn.

GET is a treatment that encourages patients to do increasing amounts of physical activity day by day, month by month. The idea is to get the person used to being active again.

But Dr Shepherd argues it can actually do serious harm.

“Some people’s muscles are not capable of doing this type of exercise programme,” he tells Newsbeat.

“If they try and do too much physically, they make themselves more weak, more fatigued and can plunge themselves back into a relapse of all their symptoms.”

Those relapses can last for months.

In March this year, fresh questions were raised about the effectiveness of GET – after new analysis of the study that suggested it back in 2007.

Dr Shepherd says the problem with GET is that it’s too rigid and pushes patients too far.

“You can’t just exercise your way back to health.

“If graded exercise was a drug treatment doing this much harm, it would be withdrawn. But because it’s a physical activity intervention, it seems to have a different status with NICE.”

Read the full article

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BBC Newsbeat documentary: M.E. and me

BBC Newsbeat film: M.E. And Me

Presenter Emma Donohoe was diagnosed with M.E. when she was 19, an illness which many doctors don’t understand and people still talk about as “yuppy flu” – thinking sufferers are being lazy or too depressed to get out of bed.

Now at 24, Emma has been able to reduce some of her symptoms and wants to find out in a new BBC Newsbeat documentary if anything has improved since she first got sick and what life is like now for other young sufferers who are living with severe M.E.

An estimated 250,000 people in the UK are living with the illness, many bed bound and completely dependent on care. But change is coming as the way the illness is treated is being reviewed by NICE – the organisation which sets best medical practice. This follows consistent fears that the standard NHS treatments may be making people worse.

During the film, Emma meets sufferers and family members of those living with the debilitating condition such as young mum, Sophie, whose severe M.E. means her body is so sensitive she can only tolerate to be around her toddler for five minutes a day. She also meets Hannah whose condition means that when all of her symptoms flare, she can’t even drink water without vomiting.

And finally, Emma is left in tears after meeting the family of Merryn Crofts who lived with severe M.E. for six years and passed away in May 2017 just 10 days after her 21st birthday. Emma hears about the excruciating pain Merryn’s condition caused her, the struggle to find doctors who believed that her condition was physical and the shame she felt having an illness that is often doubted and widely misinterpreted.

In the film, Emma visits the latest research efforts to find new treatments and a better understanding of M.E.

Will she end with hope or despair?

Watch the documentary until 7 May 2019

See also: Chronic fatigue: I was ‘held hostage by ME’

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