Investigating and managing chronic fatigue syndrome.

Chronic Fatigue Syndrome (CFS) is a complex and poorly understood condition characterized by debilitating fatigue and a worsening of symptoms after doing too much (post exertional malaise).

CFS patients often struggle with:

• Brain fog
• Feeling worse when upright (and better when lying down)
• Unrefreshing sleep
• Reduced ability to tolerate stress
• Frequent and prolonged viral infections
• Trouble staying hydrated
• Chronic pain
• Sensory sensitivities
• And more

The symptoms of CFS usually follow a “push-crash” cycle where the patient does too much, symptoms flare for days to weeks, and then they begin to feel better until they once again do too much. Symptoms usually worsen slowly over time as this push-crash cycle continues. There may also be a sudden and severe worsening of symptoms after an acute stressor such as a viral infection.

• You’ll reserve a 45-minute slot on my calendar for your consultation. We’ll use Google Meet or phone, your choice, during which you tell me about your battle.
• I will give a personalized assessment of your symptoms, letting you know if you meet criteria for CFS or not.
• A curated list of other conditions that need to be ruled out before a diagnosis of CFS can be confirmed.
• A personalized letter which you can bring to your treatment team which communicates what CFS is and why I believe you have it (given that the above conditions are ruled out). Or, if you do not meet criteria for CFS, a letter with whatever other helpful suggestions I may be able to provide.
• An initial list of recommendations for lifestyle changes and treatments.
• If you already have a diagnosis of CFS, I will focus less on diagnosis and more on treatment recommendations.
• If, after this initial consult, you are interested in working with me further, I will provide you with information on becoming a patient in my CFS clinic and what that would entail.
  
• Within 7 days of the consult call, I will email you your personalized assessment as well as an invitation to joint the clinic as a patient if I feel that you would be a good fit. Invitations are valid for 12 months from the date they are sent. After that, the initial consult would need to be repeated in order to confirm that I would still be a helpful resource for you.

Within 24 hours of scheduling your appointment, you will receive a relatively brief questionnaire in your email. This must be submitted at least 24 hours before the start of your appointment so that I have time to review it.

• Make sure to submit your Consult Questionnaire. 
• I recommend drinking lots of water as well as resting (laying down with eyes closed) before and after the appointment to reduce chances of PEM if you have any suspicion that the consult may be draining for you.
• I encourage you to make yourself completely comfortable during the appointment, such as taking the call lying down. You may leave your camera off during some or all of the appointment if that gives you greater freedom to relax.
• If there is anything I can do to reduce the stress of the appointment, please email me at [email protected] and let me know what accommodations I can make for you. I welcome the presence of support persons and/or recordings of the appointment if that would be helpful for you.

If you flare or crash before the appointment and would like to reschedule, email me at [email protected] and let me know. I would rather you reschedule than keep the appointment when you are not able to participate fully and safely. There is no penalty for rescheduling. I am unable to offer refunds at this time.

The initial consult will not include any treatment, including prescription medication. The purpose of the consult is to confirm that your symptoms are consistent with CFS and give you the opportunity to learn more about becoming a patient in the CFS Doc Clinic.