Managing medicines – carers’ experiences needed

Can you help Carers Trust Wales to develop standardised guidance/training specifically around medicines administration for unpaid carers?

Following the success of their booklet A Carers Guide to Medicine management they are asking carers to answer a questionnaire.  There is also the potential to get involved in UK wide work around patient/carer research into drug management.

Questionnaire                                Holiadur

A Carers Guide to Medicine management

Canllaw i Ofalwyr ar Reoli Meddyginiaeth

More info:
Carers Trust Wales are working with Community Pharmacy Wales to look at medicines management issues and solutions for carers.

This is an on-going opportunity to contribute. To register your interest please email Gill Winter mailto:gwinter@carers.org

 

 

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Chu says suicide in ME/CFS not always linked to depression and anxiety

Excerpt from article by Dr Lily Chu:

Another reason I wanted to write about this topic is to encourage professionals and others to think about reasons for suicide beyond depression and anxiety. This is especially important for ME/CFS since many mainstream providers still conflate depression or anxiety with ME/CFS or believe that the origins of ME/CFS are psychiatric or psychological.

It is also my personal experience, in taking care of elderly people, that thoughts of suicide can occur without depression or other mood disorders being involved.

Symptoms of chronic illness, especially uncontrolled pain, and secondary consequences
such as poverty, social isolation, job loss, disability, etc. also play a major role.

Surprisingly, there has been very little research examining the effects of chronic illness itself on suicide. Or perhaps not surprising, as suicide is still considered a delicate or taboo subject by many people. Therefore, the UK-based nonpartisan think tank Demos researched this issue in 2011 by exploring medical databases and interviewing key figures.

They concluded that, conservatively, at least 10% of suicides may be linked to chronic or terminal physical illness; sadly, in the health district they chose to further explore their findings (p. 66-67 of the report), 4 out of 25 health-related suicides were specifically linked to ME. Furthermore, even if depression and anxiety are involved, it could be argued that these conditions might not have arisen in an individual patient had they not become sick or severely ill with ME/CFS in the first place.

Consequently, while we should diagnose and treat mood disorders appropriately, I see them as only one stopgap measure in preventing suicide in ME/CFS. Other stopgap measures include managing symptoms to the best of our ability and addressing the unmet social needs of patients, whether they be concrete, like providing written support for food/ housing benefits, or more abstract, reinforcing the validity of patients’ experiences with their family present or referring them to a support group to decrease social isolation.

We can also work on increasing research funding and providing more accurate information to healthcare providers to give patients some degree of hope for a better future. Ultimately the best way to prevent suicide in ME/CFS will be to find effective disease-modifying treatments or cures for it.

Read the full article:

Suicide and ME/CFS , by Dr Lily Chu in IACFS/ME newsletter 9:1, May 2016, attachment 3

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ME Awareness blog posts 2016

Laura’s pen blog post, by Laura Chamberlain, 12 May 2016: The M.E. Adventures comic: energy and exertion #MEawareness   [Introduction:  Today is ME awareness day, and to make a change I thought I’d make a comic. When I decided to do this I didn’t quite realise just how long it would take and how many spoons, but hopefully it’s worth it.]

Sally just me blog post, by Sally Burch, 12 May 2016: #May12BlogBomb Link List for 2016 [a selection of awareness blogs from around the world]

Slightly alive blog post, by Mary Schweitzer, 12 May 2016: ME is not a mysterious disease.

Raindrops of sapphire blog post, by Lorna Burford, 12 May 2016: From nothing to something [As it’s ME awareness week right now, I wanted to touch base on… isolation.]

ohsopleasant blog post, by Rosie Fletcher, 12 May 2016: ME, alone [M.E. really is a very lonely illness. It is all consuming to the person with it, tightening the boundaries on every aspect of their life in a way that is invisible to other people]

jennyhelenmyspoonielife blog post 12 May 2016: The power of stigma: a campaign for change

the hill congress-blog post, by Maureen Hanson10 May 2016: When the hoofbeats are zebras [comment on the long road to getting an accurate diagnosis]

Seán óbriain, 13 May 2016: It’s not all in our head. The truth about ME/CFS [Irish pwme says: We need a complete overhaul of the system and change how we treat patients.]
A Path Of Emotional Growth

ProHealth blog post, 3 May, 2016, by Clarissa Shepherd: A path of emotional growth [May 12th is Awareness Day for ME/CFS and Fibromyalgia. I dedicate this to each of you living a daily battle within yourself. In this, you’re not alone.]

The establishment blog post, 13 May 2016, by Naomi Chainey: The Hidden Battle For The Rights Of Chronic Fatigue Syndrome Sufferers   [In over 5000 peer-reviewed studies, researchers have identified physical abnormalities in the immune, cardiac, endocrine, and autonomic nervous systems of ME/CFS patients. Though an underlying cause has yet to be identified, the debilitating physical symptoms cannot be denied.

Despite this, the belief that ME/CFS is a “lifestyle disease” continues to influence public opinion, patient care, and availability of research funds on an international scale. Why?]

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ME Awareness videos

Living with M.E – Short Documentary [a first year University project ]

Aarogyamastu – Chronic fatigue Syndrome Awareness Day – 12th May 2016 – ఆరోగ్యమస్తు [Indian video]

Action for ME awareness videos:

What is ME? [Prof Julia Newton & Dr Gregor Purdie talk about ME]
ME and social care [about the complex care needs that ME can bring]
Don’t ignore me [ about the isolation of ME]

The caged bird ME awareness 2016: the first song…  [person with ME sings]

ME/CFS ghost [a series of videos about ME and awareness raising for ME Awareness month]

 

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Factors determining fatigue in CFS

Research abstract:

OBJECTIVES:

To explore the interrelationship of different dimensions (fatigue, neuroticism, sleep quality, global mental and physical health) in patients with chronic fatigue syndrome (CFS).

METHODS

Patients meeting the Fukuda criteria of CFS filled out two independent fatigue scales (Fatigue Questionnaire, FQ and Checklist Individual Strength, CIS), NEO-Five Factor Inventory (NEO-FFI), Pittsburgh Sleep Quality Index (PSQI) and Medical Outcomes Study 36-item Short Form Health Survey (SF36). Exploratory and confirmatory path analyses were performed.

RESULTS

Out of 226 eligible patients, 167 subjects were included (mean age 39.13 years, SD 10.14, 92% female). In a first exploratory path analysis, using FQ for assessment of fatigue, night-time PSQI sleep quality had a direct effect on SF36 physical quality of life (PQoL) and no effect on FQ fatigue. This was confirmed by a subsequent path analysis with CIS fatigue and by confirmatory path analyses in 81 patients. These unexpected results raised the question whether FQ or CIS fatigue sufficiently operationalizes fatigue in CFS patients.

CONCLUSIONS

Poor sleep quality seems to directly impact on mental quality of life (MQoL) and PQoL without mediation of fatigue assessed with FQ and CIS. A more cohesive framework needs to be developed with more comprehensive clinical tools for the different dimensions in the construct of CFS.

Factors determining fatigue in the chronic fatigue syndrome: a path analysis, by Els Tobback, Ignace Hanoulle, An Mariman, Liesbeth Delesie, Dirk Pevernagie, Dirk Vogelaers in Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine [published online on 3 May 2016]

 

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10 things people with ME want you to know

Huffington Post UK article, by  Natasha Hinde, 12 May 2016: ME awareness week: 10 important things people with ME want you to know

It’s estimated that around 250,000 people in Britain are affected by ME, yet many people are still unaware of what it actually is.

ME, or Chronic Fatigue Syndrome (CFS), is a debilitating illness which affects people of all ages. It can cause severe fatigue, painful muscles and joints, disrupted sleep and poor memory.

The condition can affect lives “drastically”. In young people, schooling and higher education can be severely disrupted. Meanwhile for those of a working age, employment can become virtually impossible.

The ME Association website notes that: “Social life and family life become restricted and in some cases severely strained. People may be housebound or confined to bed for months or years.”

me awareness

As part of ME Awareness Week, here are ten important things people with the condition want you to know.

1) It affects your day-to-day life, severely.

“I describe it as my body being like a dodgy phone battery,” says freelance writer, Kayleigh Bell.

“It drains a lot faster than everyone else’s, and even if I charge it multiple times a day it still ends up flat. No amount of sleep feels refreshing and on bad days I ache all over.

“I feel dizzy and light-headed, and struggle to even focus on watching TV. As a bookworm and freelance writer one of the most devastating effects on my life has been my inability to concentrate.”

She adds that her short-term memory is “worse than your Nan’s after a few brandies”.

“It’s a battle to pick even a commonplace word out of the alphabet spaghetti soup inside my brain.”

2) It’s relentless.

Imagine a hamster wheel of exhaustion – that’s ME.

Blogging on HuffPost UK, Penelope Friday writes: “On a bad day, it’s like when you wake up with full-blown flu: your entire body aches and there’s no way that you feel capable of doing anything at all.

“On a better day, it’s more like the day where you are just feeling a bit better after having flu, but by the time you get up and get dressed, you realise that this has made you so tired you need to go back to bed again.”

3) It can affect anyone.

Stephen Tudor was diagnosed with ME in 2000. He says that back then, it was a “woefully misunderstood condition that only seemed to strike middle-class teens called Rachel or Isabelle”. Additionally, its existence was “actively disbelieved by many”.

Blogging on HuffPost UK, he adds: “From being a normal lad who went out clubbing, drinking, watching City and failing hopelessly with girls, I now found myself waking each morning with red stinging eyes as if I’d been up for three days straight.

“My head would be swirling with a thick pea soup that Jack the Ripper could run amok in while my legs were aflame with agony.

“I barely had enough strength to lift a brew and generally felt like I’d gone ten rounds with Carl Froch after calling his girlfriend a minger. All this struck each and every day in the first few minutes of consciousness and it usually went downhill fast from there.”

4) It affects relationships and social life.

“These days I’m best mates with my dog,” writes Kayleigh Bell.

“I don’t get out much and try to reserve my energy to go to yoga classes a couple of times a week.”

5) No two cases are the same.

Kayleigh Bell writes: “I’m very aware that even my limited amount of activity is a luxury that many ME sufferers can only dream of.

“Every case of ME is different; no two people have the same experience. Some people recover completely, others deteriorate consistently, but most dance back and forth with relapses and periods of improvement for their whole lives.”

SEE ALSO: It’s ME Awareness Week: Here’s What Living With ME Is Actually Like

6) Like many other conditions, it fluctuates.

Penelope Friday writes that many people don’t understand that ME, like a number of other illnesses, fluctuates.

“You don’t have the same amount of energy every day,” she says. “Equally, maybe last week I decided that doing the supermarket shop would be my Big Thing for the week, and chose to use my energy on that.

“But this week, my son’s got a music exam, or I’ve got a doctor’s appointment so I have to deal with that instead.”

7) It’s not “nice” being unable to work.

“Some days the guilt is crippling,” writes Bell. “I feel like I’m a burden to my loved ones and not contributing anything to the world. I can see my life and my youth wasting away as I sit useless on the sofa.

“People comment on how it must be nice to not work. I have to resist the urge to cause them an injury.

“Enduring ME is mind-numbingly, scratch-out-your-eyes, scream-into-pillow boring. Having an ‘invisible’ illness means that even those closest to me often struggle to accept that I’m too exhausted to get out of bed some days.”

8) Even if someone with ME looks “fine”, they might not feel it.

“The hardest part of having ME at my level is that you feel dreadful but look fine,” writes Laura Roche in a blog on HuffPost UK.

“Unless you become a chronic illness bore and constantly regale people with tales of bodily woes, it’s difficult to explain to people why you can’t do everything you want and need to do. It’s even more difficult to explain why you can’t do everything THEY want and need you to do.”

9) There are small workarounds to help make life easier.

Blogging on HuffPost, Professor Norma Cook Everist reveals how she manages to hold down a job in lecturing while living with the illness, which she was diagnosed with 30 years ago: “Daily life requires discipline, structure, and organisation.

“For example, my best time of the day is 5 a.m. I would teach then, but students probably would not come, so I use that time for writing.

“I have a hard time walking or talking in the evenings. Time with energy is precious, so I measure it carefully. While most people can go over their limits, I simply cannot or will have a relapse for a week or six months.”

10) You can still have fun with ME.

Laura Roche says that while life is different after being diagnosed with the illness, you can still have fun with it.

“It’s not as easy and you might have to re-define what fun means, but fun is out there if you look for it,” she writes.

“My pre-ME methods of fun included dance, long walks and endless socialising. Now I enjoy watching dance clips on YouTube and chat with friends online or through emails.”

Roche adds that while she might not be able to walk in the park and look at nature every day, she can “grow plants and look at those instead”.

“I’m currently having a lot of fun trying to get my new Amaryllis plant to grow in a perfectly straight vertical line,” she says.

“ME might consume my body, but it doesn’t consume my mind or my life!”

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Case study of immune disturbance following biotoxin exposures

Research abstract:

BACKGROUND:

Patients with multisymptom chronic conditions, such as refractory ulcerative colitis (RUC) and chronic fatigue syndrome (CFS), present diagnostic and management challenges for clinicians, as well as the opportunity to recognize and treat emerging disease entities. In the current case we report reversal of co-existing RUC and CFS symptoms arising from biotoxin exposures in a genetically susceptible individual.

CASE REPORT

A 25-year-old previously healthy male with new-onset refractory ulcerative colitis (RUC) and chronic fatigue syndrome (CFS) tested negative for autoimmune disease biomarkers. However, urine mycotoxin panel testing was positive for trichothecene group and air filter testing from the patient’s water-damaged rental house identified the toxic mold Stachybotrys chartarum. HLA-DR/DQ testing revealed a multisusceptible haplotype for development of chronic inflammation, and serum chronic inflammatory response syndrome (CIRS) biomarker testing was positive for highly elevated TGF-beta and a clinically undetectable level of vasoactive intestinal peptide (VIP). Following elimination of biotoxin exposures, VIP replacement therapy, dental extractions, and implementation of a mind body intervention-relaxation response (MBI-RR) program, the patient’s symptoms resolved. He is off medications, back to work, and resuming normal exercise.

CONCLUSIONS

This constellation of RUC and CFS symptoms in an HLA-DR/DQ genetically susceptible individual with biotoxin exposures is consistent with the recently described CIRS disease pathophysiology. Chronic immune disturbance (turbatio immuno) can be identified with clinically available CIRS biomarkers and may represent a treatable underlying disease etiology in a subset of genetically susceptible patients with RUC, CFS, and other immune disorders.

Reversal of Refractory Ulcerative Colitis and Severe Chronic Fatigue Syndrome Symptoms Arising from Immune Disturbance in an HLA-DR/DQ Genetically Susceptible Individual with Multiple Biotoxin Exposures, by SR Gunn, GG GUnn, FW Mueller in American Journal of Case Reports, 11 May 2016.

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5 things people with ME need doctors to know

Daily life article by Naomi Chainey, 12 May 2016: 5 things people with chronic fatigue syndrome need doctors to understand

No one likes having to visit the doctor, but for people with ME/CFS, the experience can be downright traumatic.

Today is ME/CFS Awareness Day, and boy do we need better awareness around this illness. If I had a dollar for every misconception voiced in my presence since being diagnosed in 2006, I might be a millennial with a housing deposit.

Also known as Myalgic Encephalomyelitis or Chronic Fatigue Syndrome, ME/CFS is classified by the World Health Organisation as a disorder of the central nervous system. It affects up to 242,000 Australians, the majority of whom are women, and can cause profound disability. An estimated 25 per cent of sufferers are housebound and 6 per cent are unable to leave their beds. Sufferers experience fatigue, pain, cognitive dysfunction and sensory overload that can leave them incapacitated for months, even years, on end.

None of this is fun, but adding insult to injury is the lack of any formal training for Australian GPs, nurses and allied health professions on ME/CFS management. Consequently, inappropriate recommendations can be given, compounding what is already a wretched experience for most patients.

So, this ME/CFS Awareness Day, I’d like to address the Australian medical establishment. This is what we, your patients, would like you to remember about ME/CFS:

1. It’s not in our heads.

Given the gendered nature of ME/CFS, perhaps it should surprise no one that it was mischaracterised by psychiatrists as “hysteria” in the ’70s, and that this mischaracterisation has stuck around like a bad smell. People with ME/CFS still encounter doctors who assume a psychological basis, despite solid evidence to the contrary.

If you had a broken leg, you wouldn’t be treated for “broken leg beliefs”, and you would lose faith in any doctor who tried. Yet ME/CFS patients encounter this regularly. Mental healthcare is useful for people coping with a loss of function of course, but implying that ME/CFS is a wrongheaded perception of illness is akin to the emotionally abusive practice of gaslighting.

2. Exercise can be harmful.

ME/CFS is characterised by “post-exertional malaise” – a completely naff description of the increased impairment that follows even minimal activity. For me it’s nausea, sore throat, heavy limbs and a cotton wool brain. It can last days after overdoing things. Researchers have found gene expression, maximal oxygen uptake and cognitive function differs between ME/CFS patients and controls after exercise, so objective measurements of the phenomenon are floating around.

This makes the often-recommended treatment of GET (Graded Exercise Therapy) very controversial. The therapy was originally devised to help patients overcome an irrational fear of exercise (hysteria!), the plan being to slowly increase activity back to normal levels. However, surveys find that 74 per cent of patients who have tried GET actually experience a worsening of their condition, and though the largest study conducted on GET reportedly found it to be mildly helpful, reviews of that study have found quite the opposite.

3. We’re more ill than we look.

“No wonder doctors think we’re less ill than we are, they only see us when we’re well enough to get to the clinic.”

This comment recently appeared in an online support group I frequent, and it’s on the money. People with ME/CFS look deceptively healthy when we’re out. But we spend inordinate amounts of time recovering from our infrequent jaunts into public space. Someone who looks perfectly well at an appointment might still be physically limited to an hour or so of activity a day.

4. It’s okay to admit that you don’t know how to fix us.

There’s no cure for ME/CFS. Most people improve a little with lifestyle adjustments, and approximately five per cent mysteriously recover, but the vast majority of us are stuck with this until the research improves (right now it’s barely funded).

Despite this, many with ME/CFS find their doctors expect recovery and become frustrated when it doesn’t happen. This is very hard on patients who, in addition to still feeling awful, end up feeling they’ve failed themselves. It amounts to victim blaming.

5. Your support is essential to our wellbeing.

There’s an oddly common belief that a diagnosis of ME/CFS enables a “disabled lifestyle” (whatever that means), but frankly, having these symptoms with no explanation is freaking scary (I honestly believed I was dying). We need our doctors to be familiar with the diagnostic criteria and willing to make the call.

We’re also much more likely to be supported by employers, friends and family (who we may be dependent on for care) if the condition is explained by a doctor. There are extraordinary levels antipathy directed at people with invisible illness – those who look able are judged for inactivity in a culture that values productivity over all – but doctors can facilitate management of expectations. This may include going to bat for us with social security. Too many with ME/CFS are financially supported by family because they can’t work and DSP (Disability Support Pension) has been denied or revoked. Those without supportive family are at risk of homelessness if they can’t make rent. A solid report from a doctor can make all the difference.

We need you. Be on our side.

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ME Awareness Q&A 10

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Q. What is ME?

A. ME is so debilitating that most people need help with everyday personal care at some time during their illness. Around 25% are so severely affected they need help daily from carers or care workers.

ME Awareness week: 11-17 May

Awareness and fundraising activities are taking place around the world during the month of May.

Tell us what you are doing and how you would answer the question: What is ME?

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ME Awareness Q&A 9

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ME Awareness day 12 May

Q. What is ME?

A. ME is much misunderstood and maligned, even by some in the medical profession. Many people with ME are still not believed and given the support and care they need. There is no widely accepted diagnostic test yet, but it is possible to diagnose by recognising the pattern of symptoms.

WAMES is working with the Welsh Government and Health Boards to improve understanding of ME and to improve services in Wales.

For ME awareness day 2016 WAMES information about ME has been posted on the Welsh GP website and distributed to Health Boards.

 

 

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