Conditions
Chronic fatigue and ME/CFS
Exhaustion that sleep does not fix, and that most people around you underestimate. By the time patients reach me they have usually been told their tests are normal and offered very little else.
Normal tests are not the end of it
A standard blood panel excludes a handful of causes. It does not investigate mitochondrial function, sleep quality, hormonal rhythm, chronic infection, or the metabolic and inflammatory picture that often sits behind persistent fatigue.
The work is to look at the things that were not looked at, methodically, and to treat what is found.
Post-viral fatigue
A large proportion of what I see now follows an infection, and COVID-19 has increased that substantially. Recovery is usually possible but often slow, non-linear, and easily set back by pushing too hard.
Where post-exertional malaise is present, meaning you feel markedly worse a day or two after exertion, that changes the approach fundamentally. Graded exercise applied indiscriminately to this group has caused real harm, and I do not use it that way.
What treatment looks like
Sleep first, almost always, because nothing else works well while sleep is disordered. Then correction of any deficiency found, support for whatever the testing shows to be dysfunctional, and careful pacing rather than pushing.
This is slow work. I would rather set that expectation now than have you disappointed at three months.
Common questions
Is ME/CFS a real illness?
Yes. It is a recognised condition with real physiological features, and the historical framing of it as primarily psychological has caused a great deal of harm. I take it seriously as a physical illness.
Will you tell me to exercise more?
Not indiscriminately, and not where post-exertional malaise is present. Activity has a place, but pacing within your limits is the priority, and increasing load too early is one of the commonest ways people go backwards.
How long does it take?
Months rather than weeks, usually, and progress tends to be uneven. Anyone offering a rapid fix for chronic fatigue is overselling.
Related
Discuss your case with Dr Greenland
A short discovery call is the usual starting point. It costs nothing, and it is the fastest way to find out whether this approach fits your situation.