Saturday 15 December 2018

Dear Dr Nina: How can we help our sister who has chronic fatigue?

Stock photo
Stock photo

Nina Burns

My 40-year-old sister has a diagnosis of ME, or chronic fatigue. I will admit that none of us have been very supportive in the past as we didn't fully understand the condition and my sister, as a result, is very reluctant to communicate with us and keep us updated on her condition. I understand that there are a lot of conflicting views among the medical community on the condition. Could you explain what the condition is? Also, have you any advice on how we can support our sister?

Dr Nina replies: Chronic fatigue or ME (myalgic encephalopathy) is an illness that is recognised on symptoms alone. There is a broad range of symptoms that vary from person to person. No identifying cause is known and there is no test available to diagnose it. The course and duration of the condition is also very variable. Due to these factors, the condition can be difficult to recognise and diagnose and it can also be hard for patients to explain, and for friends and relatives to understand.

Core symptoms include fatigue that is persistent or recurrent and started at a specific time. This fatigue results in a substantial reduction in activity and may get worse after periods of exertion. One or more of the following symptoms should also be present: sleep problems, muscle or joint pain, headaches, tender lymph glands, a sore throat, cognitive changes ('mental fog'), flu-like illness, nausea and dizziness.

There are many illnesses that can have similar symptoms, so typically ME can take a while to diagnose. Those afflicted may end up having extensive blood tests, scans and physical investigations in order to rule out other significant illness. In order for ME to be diagnosed, symptoms must be present for more than four months in adults or three in children.

There is no treatment or cure for ME, but it is important to note that the majority of people improve over time. A healthy lifestyle can really help. It is important to eat well and nourish the body. Eating regularly throughout the day is best for energy levels. Good sleep hygiene and sleep management can help. Make sure to have a wind down time, and a comfortable and relaxing sleeping environment.

Rest periods during the day may be important, though these should be short lasting no longer than 30 minutes at a time. These rest periods could also be used to incorporate rest or breathing techniques and mindfulness that can aid relaxation. Many people with ME seek out alternative therapies. There is little evidence to support the majority of these in ME, but some find them helpful and so use them for symptom control. There is no evidence to support the use of vitamin and mineral supplements. If these are taken it is also important to ensure that extra high doses are not taken.

Prescription medicine doesn't help ME per se, however amitriptyline may help those with sleep problems or nerve pain. Cognitive behavioural therapies can help. They allow a greater understanding of the condition and the limitations it causes. Graded exercise can also help. This involves incorporating smaller short amounts of exercise into the daily routine and gradually increasing this as tolerated

There is little you can do to help your sister with the condition, as symptoms are really quite personal and varied. The most important thing is to leave the door open for communication, validate her symptoms and listen to her concerns. Most of those who suffer with ME aren't looking for family members to solve the problem and offers of "getting out" or "going to the gym" although well intended will not help.

Let your sister know you care, that you are there to support her and listen to her concerns and encourage her to seek medical support.

Q. My 11-year-old daughter’s knee sometimes clicks out of joint, which is very painful. The pain goes when she manages to straighten her leg. What could this be?

Dr Nina replies: The patella (or kneecap) is a disc of bone that protects the knee joint and helps the thigh muscles move the knee. The patella is one of three bones in the knee. The others are the tibia (lower leg) and femur (thigh). The quadriceps tendon connects the upper leg through the knee to the lower leg. If the patella sits in an unbalanced way, it can slip out of the joint, putting pressure on the femur and structures of the knee. All of these can cause pain.

Tight thigh muscles can also lead to knee and kneecap pain. Knee pain is most common during periods of rapid growth and front-of-knee pain is more common in girls than boys.

Causes include joint inflammation, pain radiating from the hip, a misaligned patella or ligament bone, or tendon damage. Recurrent dislocation of the patella may be due to loose ligaments surrounding the joint. This is more common in young girls. When the patella is in place it can glide smoothly over the surface of the femur on knee movement. If it clicks out of place, friction is created, leading to pain in the joint.

It is important to start with a check up at the GP. Your doctor can fully examine the lower limbs to try and narrow down the cause of knee pain or the joint dislocation. An x-ray may be advised. MRIs are rarely needed. If initial tests are normal, then physiotherapy will be advised.

A physio can fully assess the joints, muscle and surrounding structure and can prescribe exercises to help improve muscle tone surrounding the knee, which will improve strength and joint stability. For recurrent dislocation, a brace may be prescribed for a few weeks. This would usually allow healing of any injury that has occurred. Surgery is only very occasionally recommended.

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