Chronic fatigue in Ehlers-Danlos syndrome-hypermobile type
|
|
- Angelina Mitchell
- 2 years ago
- Views:
Transcription
1 Chronic fatigue in Ehlers-Danlos syndrome-hypermobile type By Dr Xiaoqi Chen Key Points 1. Chronic fatigue is a common presentation in those with Ehlers Danlos Syndrome hypermobile type (heds). 2. Assessment of chronic fatigue in heds involves exclusion of red flags and identification of the main drivers of fatigue. 3. Management of chronic fatigue in heds is multi-faceted and involves a multi-disciplinary team. 1
2 BACKGROUND AND OBJECTIVE This paper was a narrative review written by a pioneering group of experts in the field of Ehlers- Danlos Syndrome - hypermobile type (heds), also known as Joint Hypermobility Syndrome and Hypermobility Spectrum Disorders. In those with heds, fatigue could be the main presenting symptom, on top of other symptoms including pain, joint instability and dysautonomia. Chronic Fatigue Syndrome or Myalgic Encephalomyelitis (CFS/ME) is characterised by fatigue that is unexplained by other conditions, not substantially alleviated by rest, not the result of ongoing exertion, and significantly impacts daily activities and quality of life for more than six months (1). Due to the general lack of awareness in the medical and research community on heds, some patients are diagnosed with CFS/ME in the absence of a heds diagnosis. Additionally, it is unknown how many patients diagnosed with CFS/ME actually have heds. Due to the controversial existing diagnostic criteria of CFS/ME that excludes heds, the authors proposed to use the term chronic fatigue in the context of this paper. Fatigue could be the main presenting symptom in those with Ehlers-Danlos Syndrome - hypermobile type. ASSESSMENT OF FATIGUE A thorough patient assessment involves: (A) the exclusion of red flags, and (B) identification of the main drivers of chronic fatigue in heds. Red flags may include the following: Fevers and infections - chronic infections associated with fatigue include hepatitis, endocarditis and Lyme disease Endocrine disorders (e.g. diabetes, thyroid disease and adrenal insufficiency) Neurological and autoimmune disorders (e.g. myasthenia gravis and multiple sclerosis) Bronzing of the skin - related to Addison s disease The ongoing provision of a positive and encouraging clinical environment can go a long way for patients with heds. Nail clubbing Unexplained weight loss Red, swollen joints Cardiorespiratory disease (e.g. Chronic Obstructive Pulmonary Disease, Cardiomegaly and Congestive Heart Failure) 2
3 The main drivers of chronic fatigue may include the following: Physical deconditioning Poor sleep quality due to pain, nocturnal tachycardia and sleep disordered breathing Chronic pain due to recurrent musculoskeletal injuries Dysautonomia Chronic allergies Food intolerances and nutritional deficiencies Bladder/bowel dysfunction (e.g. nocturnal polyuria) Psychological disorders (e.g. anxiety and depression) As part of the fatigue assessment, the authors recommended four main types of fatigue questionnaires that were found to be reliable in detecting change over time. These were the Fatigue Severity Scale, Fatigue Impact Scale, Brief Fatigue Inventory, and Multidimensional Assessment of Fatigue. MANAGEMENT OF FATIGUE Fatigue management should involve an ongoing shared decision-making process with the patient. Management is directed at addressing the main drivers of fatigue and involves realistic goal setting, patient education, and the involvement of a multi-disciplinary team (2). Patients are encouraged to keep a diary of their daily activities and symptoms. Useful clinical information can be gained from the diaries to obtain patients baseline activity tolerance, set goals, and monitor progress over time. Assistive equipment such as the use of a walking stick and wheelchair could help patients gain more independence. Clinicians could offer advice on activity and equipment modifications that are energy conserving and pain relieving to help patients manage work, home and study demands. Good sleep hygiene should be encouraged and includes advice on avoiding stimulants and large meals close to bedtime, associating bed with sleep (i.e. avoid watching TV and working on bed), having routine sleep and wake times, and having a pleasant and relaxing sleep environment. Exercising, especially early in the day, can help maintain a healthy sleep-wake cycle as the exposure to natural light helps encourage wakefulness. Chronic pain can play a critical role in poor sleep quality and should be managed accordingly with strategies such as pacing, exercise, and medications. As part of pacing, the clinician could encourage activity planning to allow patients to maintain a good balance between rest and activity. Mental fatigue should also be addressed by encouraging patients to spread out challenging cognitive tasks over time. Continued monitoring, adjusting and planning using an activity symptom diary can help minimize the boom and bust cycle. Rest advice is important and may include limiting the length of rest periods to a set duration per day, undertaking low-energy type activities on bad days, using relaxation or breathing 3
4 techniques, and trying to avoid complete rest as the only management during a flare. Relaxation techniques such as massage, meditation, yoga, music and art therapy are encouraged. CLINICAL IMPLICATIONS As physiotherapists we are trained to manage pain, but not fatigue. In general, the core principles underpinning the management of chronic fatigue and chronic pain are not dissimilar it involves empathy, patient education, pacing, exercise training, activity/symptom diaries, and a multi-disciplinary approach. In heds, fatigue and pain have to be co-managed as these often involve complex, intermingling issues. It is good practice to assess for fatigue in conjunction with pain in the subjective assessment. Fatigue questionnaires like the ones mentioned in this article can be useful tools to quantify pre- and post-treatment functional outcomes. The main priority is to identify and manage the major drivers of fatigue in these patients once red flags have been ruled out. Observationally, the most common drivers of chronic fatigue in the heds population are poor sleep, dysautonomia, pain, gastroenterological, dietary and psychological factors. Management of chronic fatigue in heds is also about being sensitive to the changing mental and physical status of the patient due to recurrent injuries, poor healing, and their evolving medical conditions. It helps to prescribe bad day and good day exercise programs for these patients. Exercises prescribed should involve aspects of cardiovascular, strength, balance, and proprioception training. Overall, an open-minded approach to chronic fatigue management is useful as patients with heds may have large fluctuations in their condition over time. The ongoing provision of a positive and encouraging clinical environment can go a long way for patients with heds. + Study reference Hakim A, De Wandele I, O Callaghan C, Pocinki A, Rowe P (2017) Chronic fatigue in Ehlers- Danlos syndrome-hypermobile type. AM J Med Genet Part C Semin Med Genet, 175C, Dr Xiaoqi Chen SUPPORTING REFERENCES 1. Institute of Medicine, Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome; Board on the Health of Select Populations (2015). Beyond Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome: Redefining an illness. Institute of Medicine. Washington, D.C.: The National Academies Press, February Castori M, Morlino S, Celletti C, Celli M, Morrone A, Colombi M, Camerota F, Grammatico P (2012). Management of pain and fatigue in the joint hypermobility syndrome (a.k.a. Ehlers-Danlos syndrome, hypermobility type): Principles and proposal for a multidisciplinary approach. Am J Med Genet A 158A:
5 Having a hard time keeping up to date? You re not alone! Our members get all this in each monthly issue Plus, access to our entire library of research reviews (>400 studies) Save time and money keeping up to date by subscribing to our Research Reviews. LEARN MORE
Allied Conditions and rehabilitation
Allied Conditions and rehabilitation Dr Helen Cohen Consultant Rheumatology & Chronic Pain, Royal National Orthopaedic Hospital Cmglee, Radially-symmetrical five-set Venn diagram devised by Branko Grünbaum,
More informationInsomnia affects 1 in 3 adults every year in the U.S. and Canada.
Insomnia What is insomnia? Having insomnia means you often have trouble falling or staying asleep or going back to sleep if you awaken. Insomnia can be either a short-term or a long-term problem. Insomnia
More informationYoung Person s Guide to CFS/ME
Young Person s Guide to CFS/ME The Royal College of Paediatrics and Child Health This leaflet has been developed as part of the Evidence based guideline for management of CFS/ME (Chronic Fatigue Syndrome
More informationSLEEP DISTURBANCE AND PSYCHIATRIC DISORDERS
E-Resource December, 2013 SLEEP DISTURBANCE AND PSYCHIATRIC DISORDERS Between 10-18% of adults in the general population and up to 50% of adults in the primary care setting have difficulty sleeping. Sleep
More informationManage cancer related fatigue:
Manage cancer related fatigue: For People Affected by Cancer In this pamphlet: What can I do to manage fatigue? What is cancer related fatigue? What causes cancer related fatigue? How can my health care
More informationSleep Difficulties. Insomnia. By Thomas Freedom, MD and Johan Samanta, MD
Sleep Difficulties By Thomas Freedom, MD and Johan Samanta, MD For most people, night is a time of rest and renewal; however, for many people with Parkinson s disease nighttime is a struggle to get the
More informationChronic Fatigue Syndrome not just tired all the time Assessment & diagnosis
Chronic Fatigue Syndrome not just tired all the time Assessment & diagnosis Alastair Miller MA FRCP FRCP(Edin) DTM&H Consultant Physician Hon Senior Lecturer University of Liverpool Chair British Association
More informationFatigue Management in Neurology. Alison Nock MS Specialist Occupational Therapist
Fatigue Management in Neurology Alison Nock MS Specialist Occupational Therapist Overview of Fatigue Common disabling symptom Some people rate fatigue as the worst symptom of their disease. Predominant
More informationA Healthy Life RETT SYNDROME AND SLEEP. Exercise. Sleep. Diet 1. WHY SLEEP? 4. ARE SLEEP PROBLEMS A COMMON PARENT COMPLAINT?
Diet Sleep Exercise RETT SYNDROME AND SLEEP DR. DANIEL GLAZE, MEDICAL DIRECTOR THE BLUE BIRD CIRCLE RETT CENTER A good night s sleep promotes learning, improved mood, general good health, and a better
More informationSelf-help guide to recovery for Chronic Fatigue Syndrome and Fibromyalgia
Self-help guide to recovery for Chronic Fatigue Syndrome and Fibromyalgia This brief guide is written in an attempt to explain the process of recovery in chronic fatigue syndrome (CFS) and fibromyalgia.
More informationDr Sarah Blunden s Adolescent Sleep Facts Sheet
Dr Sarah Blunden s Adolescent Sleep Facts Sheet I am Sleep Researcher and a Psychologist. As a Sleep Researcher, I investigate the effects of poor sleep on young children and adolescents. I also diagnose
More informationLincolnshire CFS/ME Service. CFS/ME When is it more than just tiredness? Presenter: Lynsey Woodman Specialist Occupational Therapist
Lincolnshire CFS/ME Service CFS/ME When is it more than just tiredness? Presenter: Lynsey Woodman Specialist Occupational Therapist CFS/ME Team Anne Abey: Head of Physical Health Specialty Lynsey Woodman,
More informationNew Jersey Chronic Fatigue Syndrome Association Medical Student Scholarship/Medical School Loan Repayment Program Application/Applicant Requirements
New Jersey Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Association Medical Student Scholarship/Medical Student Loan Repayment Program Spring, 2015 Dear Applicant: Thank-you for your interest in
More informationHow To Find Out If The Gulf War And Health Effects Of Serving In The Gulf Wars Are Linked To Health Outcomes
Gulf War and Health: Update of Health Effects of Serving in the Gulf War Statement of Stephen L. Hauser, M.D. Professor and Chair of Neurology University of California, San Francisco, School of Medicine
More informationMellen Center for Multiple Sclerosis
Mellen Center Cleveland Clinic Marie Namey, RN, MSN, MSCN Mellen Center Cleveland Clinic Cleveland, OH Home of. Mellen Center for Multiple Sclerosis Mellen Center Mission The Mellen Center remains committed
More informationTinnitus & Hyperacusis Questionnaire
Tinnitus & Hyperacusis Questionnaire Please answer the following questions and return to our office. If you need more space for an answer, write it on a separate sheet of paper and indicate the question
More informationSleep History Questionnaire
Sleep History Questionnaire Name Address Daytime Phone Height Evening Phone Weight Weight 5yrs ago Describe your sleep problem: 1. What time do you go to bed? 2. What time do you wake up? 3. What time
More informationPain is a common symptom reported
MULTIPLE SCLEROSIS FACT SHEET MANAGING YOUR PAIN Pain is a common symptom reported by people with multiple sclerosis (MS). Approximately 50-60% of people with MS experience acute or chronic pain at some
More informationMillions of Americans suffer from abdominal pain, bloating, constipation and diarrhea. Now new treatments can relieve your pain and discomfort.
3888-IBS Consumer Bro 5/8/03 10:38 AM Page 1 TAKE THE IBS TEST Do you have recurrent abdominal pain or discomfort? YES NO UNDERSTANDING IRRITABLE BOWEL SYNDROME A Consumer Education Brochure Do you often
More informationIt s A Gut Feeling: Abdominal Pain in Children. David Deutsch, MD Pediatric Gastroenterology Rockford Health Physicians
It s A Gut Feeling: Abdominal Pain in Children David Deutsch, MD Pediatric Gastroenterology Rockford Health Physicians Introduction Common Symptom Affects 10-15% of school-aged children Definition (Dr.
More informationProvidence Alliance for Catholic Teachers (PACT)
Providence Alliance for Catholic Teachers (PACT) Health and Wellness History Please place this form in a separate sealed envelope, marked with your name and Health and Wellness History. Submit to PACT
More informationLakeview Endocrinology and Diabetes Consultants. 2719 N Halsted St C-1. Chicago IL 60614 P: 773 388 5685 F: 773 388 5687. www.lakeviewendocrinolgy.
Lakeview Endocrinology and Diabetes Consultants 2719 N Halsted St C-1 Chicago IL 60614 P: 773 388 5685 F: 773 388 5687 www.lakeviewendocrinolgy.com Patient information: Early menopause (premature ovarian
More informationPolymyalgia Rheumatica www.arthritis.org.nz
Polymyalgia Rheumatica www.arthritis.org.nz Did you know? Arthritis affects one in six New Zealanders over the age of 15 years. Polymyalgia rheumatica is a common rheumatic condition. It affects more women
More informationCorCap Cardiac Support Device Patient Information Booklet
What is Heart Failure? CorCap Cardiac Support Device Patient Information Booklet Heart failure is a condition in which the heart is unable to pump enough blood to meet the needs of the body. To compensate
More informationNEURO-OPHTHALMIC QUESTIONNAIRE NAME: AGE: DATE OF EXAM: CHART #: (Office Use Only)
PAGE 1 NEURO-OPHTHALMIC QUESTIONNAIRE NAME: AGE: DATE OF EXAM: CHART #: (Office Use Only) 1. What is the main problem that you are having? (If additional space is required, please use the back of this
More informationMarilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL
Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL www.goldcopd.com GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR DIAGNOSIS, MANAGEMENT
More informationBetter Choices, Better Health
PROGRAM BROCHURE Fall 2015 and Winter 2016 October 2015 March 2016 Education Classes Better Choices, Better Health Exercise Classes D isease-specific and general topics are offered in different formats
More informationCOPD - Education for Patients and Carers Integrated Care Pathway
Patient NHS COPD - Education for Patients and Carers Integrated Care Pathway Date ICP completed:. Is the patient following another Integrated Care Pathway[s].. / If yes, record which other Integrated Care
More informationCancellation/No Show Policy
Cancellation/No Show Policy If you are unable to keep your scheduled appointment we require a 24 hour advance notice. Failure to provide this notice will result in a $50.00 cancellation/no show fee. You
More informationPalliative Care for Children. Support for the Whole Family When Your Child Is Living with a Serious Illness
Palliative Care for Children Support for the Whole Family When Your Child Is Living with a Serious Illness Palliative care provides comfort and support to your child and family. When a child is seriously
More informationDisability Evaluation Under Social Security
Disability Evaluation Under Social Security Revised Medical Criteria for Evaluating Endocrine Disorders Effective June 7, 2011 Why a Revision? Social Security revisions reflect: SSA s adjudicative experience.
More informationJAMES PETROS, M.D., INC. PHONE: (408) 528-8833 FAX: (408) 528-8557
FIGHTING PAIN. TOUCHING LIVES. JAMES PETROS, M.D., INC. PHONE: (408) 528-8833 FAX: (408) 528-8557 Personal Information Emergency Contact Today s Date: Name: Patient: Realtionship: Birth Date: Age: Sex:
More informationPCORI Workshop on Treatment for Multiple Sclerosis. Breakout Group Topics and Questions Draft 3-27-15
PCORI Workshop on Treatment for Multiple Sclerosis Breakout Group Topics and Questions Draft 3-27-15 Group 1 - Comparison across DMTs, including differential effects in subgroups Consolidated straw man
More informationObjectives: Perform thorough assessment, and design and implement care plans on 12 or more seriously mentally ill addicted persons.
Addiction Psychiatry Program Site Specific Goals and Objectives Addiction Psychiatry (ADTU) Goal: By the end of the rotation fellow will acquire the knowledge, skills and attitudes required to recognize
More informationNeuroendocrine Evaluation
Neuroendocrine Evaluation When women have health concerns they usually prefer to discuss them with another woman. Dr. Vliet is a national expert on hormone-related problems and specializes in neuroendocrine
More informationSpinal cord stimulation
Spinal cord stimulation This leaflet aims to answer your questions about having spinal cord stimulation. It explains the benefits, risks and alternatives, as well as what you can expect when you come to
More informationSLEEP AND PARKINSON S DISEASE
A Practical Guide on SLEEP AND PARKINSON S DISEASE MICHAELJFOX.ORG Introduction Many people with Parkinson s disease (PD) have trouble falling asleep or staying asleep at night. Some sleep problems are
More informationDelirium. The signs of delirium are managed by treating the underlying cause of the medical condition causing the delirium.
Delirium Introduction Delirium is a complex symptom where a person becomes confused and shows significant changes in behavior and mental state. Signs of delirium include problems with attention and awareness,
More informationMarkham Stouffville Hospital
Markham Stouffville Hospital Adult Diabetes Education Frequently Asked Questions What is diabetes? Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is turned
More informationNational Football League Head, Neck and Spine Committee s Protocols Regarding Return to Participation Following Concussion
National Football League Head, Neck and Spine Committee s Protocols Regarding Return to Participation Following Concussion Introduction The management of concussion is important to football players, healthcare
More informationFibromyalgia: The Information and the Care You Deserve PATIENT HANDBOOK
Fibromyalgia: The Information and the Care You Deserve PATIENT HANDBOOK Fibromyalgia: You Need the Facts Fibromyalgia (fi bro-mi-al je- ) affects more than 6 million people in the United States. e Most
More informationPatient Guide. Important information for patients starting therapy with LEMTRADA (alemtuzumab)
Patient Guide Important information for patients starting therapy with LEMTRADA (alemtuzumab) This medicinal product is subject to additional monitoring. This will allow quick identification of new safety
More informationMore than just fatigue a UK perspective
More than just fatigue a UK perspective Julia Newton Julia Newton Professor of Ageing and Medicine & Consultant Physician, Fatigue Interest Group / Falls and Syncope Service University of Newcastle What
More informationStress can become a problem when you are not sure how to handle it. Worry sets in, and you feel stressed.
Stress Reduction Patient Education Improving Health Through Education What is Stress? Stress is a normal emotional and physical reaction to the demands of life. Stress comes from both the good and bad
More informationALL ABOUT SPASTICITY. www.almirall.com. Solutions with you in mind
ALL ABOUT SPASTICITY www.almirall.com Solutions with you in mind WHAT IS SPASTICITY? The muscles of the body maintain what is called normal muscle tone, a level of muscle tension that allows us to hold
More informationNew England Pain Management Consultants At New England Baptist Hospital
New England Pain Management Consultants At New England Baptist Hospital Pain Management Center Health Assessment Dear New Pain Management Patient, Welcome to the New England Pain Management Consultants
More informationUnderstanding. Peripheral Neuropathy. Lois, diagnosed in 1998, with her husband, Myron.
Understanding Peripheral Neuropathy Lois, diagnosed in 1998, with her husband, Myron. What Is Peripheral Neuropathy? Peripheral neuropathy is a nerve disorder. It may cause numbness, tingling, and weakness.
More informationREGISTRATION FORM PATIENT NAME: ADDRESS (STREET, CITY, STATE, ZIP): HOME PHONE: WORK PHONE: CELL PHONE: DATE OF BIRTH: / / AGE: SEX:
REGISTRATION FORM PATIENT NAME: ADDRESS (STREET, CITY, STATE, ZIP): HOME PHONE: WORK PHONE: CELL PHONE: E-MAIL ADDRESS: OCCUPATION: DATE OF BIRTH: / / AGE: SEX: SOCIAL SECURITY NUMBER: MARITAL STATUS:
More informationPAIN MANAGEMENT. Patient s name: IF YOUR INSURANCE REQUIRES A PRE AUTHORIZATION / REFERRAL FORM, PLEASE OBTAIN PRIOR TO YOUR VISIT.
PAIN MANAGEMENT Please fill out the following questionnaire and bring it with you to your appointment. In addition, bring your medication list and Reports of any X- rays, MRI or Cat scans. Patient s name:
More informationPreoperative Laboratory and Diagnostic Studies
Preoperative Laboratory and Diagnostic Studies Preoperative Labratorey and Diagnostic Studies The concept of standardized testing in all presurgical patients regardless of age or medical condition is no
More informationRelease: 1. HLTEN515B Implement and monitor nursing care for older clients
Release: 1 HLTEN515B Implement and monitor nursing care for older clients HLTEN515B Implement and monitor nursing care for older clients Modification History Not Applicable Unit Descriptor Descriptor This
More informationPAIN MANAGEMENT AT UM/SYLVESTER
PAIN MANAGEMENT AT UM/SYLVESTER W HAT IS THE PURPOSE OF THIS BROCHURE? We created this brochure for patients receiving care from the University of Miami Sylvester Comprehensive Cancer Center and their
More informationDIABETES MELLITUS. By Tracey Steenkamp Biokineticist at the Institute for Sport Research, University of Pretoria
DIABETES MELLITUS By Tracey Steenkamp Biokineticist at the Institute for Sport Research, University of Pretoria What is Diabetes Diabetes Mellitus (commonly referred to as diabetes ) is a chronic medical
More informationDMSRU Education Series 2012
DMSRU Education Series 2012 Why Am I So Tired?? Fatigue is one of the most commonly reported symptoms of MS Affects 70-90% of those living with MS and many report it as their most disabling symptom Experienced
More informationFatigue in MS: 2005 update B. Colombo University of Milan - HSR
Fatigue in MS: 2005 update B. Colombo University of Milan - HSR Fatigue in MS One of the more disabling symptoms Affects about 75/90 % of the patients May be the onset symptom Transient or chronic May
More informationORTHOPAEDIC SPINE PAIN QUESTIONNAIRE
ORTHOPAEDIC SPINE PAIN QUESTIONNAIRE NAME: DATE: ADDRESS: AGE: TELEPHONE#: RELIGION: OCCUPATION: REFERRED BY WHOM: NEAREST FRIEND/RELATIVE: TELEPHONE#: ADDRESS: PLEASE EXPLAIN WHY YOU HAVE COME TO SEE
More informationChemobrain. Halle C.F. Moore, MD The Cleveland Clinic October 3, 2015
Chemobrain Halle C.F. Moore, MD The Cleveland Clinic October 3, 2015 Terminology Chemotherapy-associated cognitive dysfunction Post-chemotherapy cognitive impairment Cancer treatment-associated cognitive
More informationWhat is PD? Dr Catherine Dotchin MD MRCP Consultant Geriatrician
What is PD? Dr Catherine Dotchin MD MRCP Consultant Geriatrician Overview of presentation Case history Video example pre and post treatment Historical review PD in the UK Epidemiology and aetiology Making
More informationCHRONIC PAIN AND RECOVERY CENTER
CHRONIC PAIN AND RECOVERY CENTER Exceptional Care in an Exceptional Setting Silver Hill Hospital is an academic affiliate of Yale University School of Medicine, Department of Psychiatry. SILVER HILL HOSPITAL
More informationDartmouth Medical School Curricular Content in Addiction Medicine for Medical Students (DCAMMS) Keyed to LCME Core Competency Domains ***Draft***
Dartmouth Medical School Curricular Content in Addiction Medicine for Medical Students (DCAMMS) Keyed to LCME Core Competency Domains ***Draft*** This content, sorted by LCME competencies is intended to
More informationCosting statement: Depression: the treatment and management of depression in adults. (update) and
Costing statement: Depression: the treatment and management of depression in adults (update) and Depression in adults with a chronic physical health problem: treatment and management Summary It has not
More informationLong Term Use of Antacid Medications Can Cause an Increased Risk for Osteoporosis and Much More
Long Term Use of Antacid Medications Can Cause an Increased Risk for Osteoporosis and Much More By: Jeremie Pederson D.C., C.S.C.S. Many people are concerned about the FDA news release dated May 25, 2010
More informationTreatment of Chronic Pain: Our Approach
Treatment of Chronic Pain: Our Approach Today s webinar was coordinated by the National Association of Community Health Centers, a partner with the SAMHSA-HRSA Center for Integrated Health Solutions SAMHSA
More information7/1/2014 REGISTERED NURSE CONSULTATION PURPOSE & KEY TERMS OBJECTIVES
REGISTERED NURSE CONSULTATION June 2012 DHS Office of Licensing and Regulatory Oversight 1 PURPOSE & KEY TERMS The purpose of this section is to assist the learner in understanding the role of a Registered
More informationContents. Overview Treatments Inpatient Services Day Programs The Clinic What are the Costs? How to Get Started How to Find Us
Lakeside Clinic Contents Overview Treatments Inpatient Services Day Programs The Clinic What are the Costs? How to Get Started How to Find Us Overview At some point in their lives, as many as one-in-five
More informationTable of Contents. Preface...xv. Part I: Introduction to Mental Health Disorders and Depression
Table of Contents Visit www.healthreferenceseries.com to view A Contents Guide to the Health Reference Series, a listing of more than 16,000 topics and the volumes in which they are covered. Preface...xv
More informationMaster of Physician Assistant Studies Course Descriptions for Year I
FALL TERM COURSES: Master of Physician Assistant Studies Course Descriptions for Year I PHAC 7230 Fundamentals in Pharmacology for Health Care I Credit Hrs: 3 This course will build on foundational knowledge
More informationPO 477 Florham Park NJ 07632 Helpdesk@njcfsa.org * http://njmecfsa.org * njmecfsa@njmecfsa.org
January 6, 2015 Dear Guidance Counselor: The New Jersey ME/CFS Association, Inc. (NJME/CFSA) is pleased to sponsor a scholarship in the amount of $1,000 to be awarded to a graduating senior in the class
More informationDisability Evaluation Under Social Security
Disability Evaluation Under Social Security *14.09 Inflammatory arthritis. As described in 14.00D6. With: A. Persistent inflammation or persistent deformity of: 1. One or more major peripheral weight-bearing
More informationTreating symptoms. An introduction to. Everyone diagnosed with MS can get treatment for their symptoms. The symptoms of MS. Who can get treatment?
Everyone diagnosed with MS can get treatment for their symptoms This resource is an introduction to the treatments that are available. The symbol will point you to further resources. An introduction to
More informationDENVER CHIROPRACTIC CENTER GLENN D. HYMAN, DC, CSCS
DENVER CHIROPRACTIC CENTER GLENN D. HYMAN, DC, CSCS Are you in the right place? Please read this before proceeding with paperwork: At Denver Chiropractic Center, we specialize in treating muscles with
More informationHealth Assessment Toolkit GuidanceResources
Health Assessment Toolkit GuidanceResources Health Assessment ToolKit Table of Contents 1. The Healthy You: The Importance of Taking Care of Your Health 2. Introduction to the HealthyGuidance program 3.
More informationDepression. Introduction Depression is a common condition that affects millions of people every year.
Depression Introduction Depression is a common condition that affects millions of people every year. Depression has an impact on most aspects of everyday life. It affects eating and sleeping routines,
More informationPersonal Health Assessment
Personal Health Assessment The purpose of this assessment is to determine your risk of developing the degenerative diseases common among Americans. Although diagnostic testing can sometimes be important,
More informationPresently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1
What is bipolar disorder? There are two main types of bipolar illness: bipolar I and bipolar II. In bipolar I, the symptoms include at least one lifetime episode of mania a period of unusually elevated
More informationPulmonary Associates of Richmond
Pulmonary Associates of Richmond Name: Address One: City: Home Phone#: Work Phone#: Cell Phone#: State: Zip: Sex: Social Security Number: Referring Doctor: of Birth: Employer: Primary Care Doctor: Employment
More informationThe University of Hong Kong Department of Surgery Division of Esophageal and Upper Gastrointestinal Surgery
Program Overview The University of Hong Kong Department of Surgery Division of Esophageal and Upper Gastrointestinal Surgery Weight Control and Metabolic Surgery Program The Weight Control and Metabolic
More informationCancer-Related Brain Fog
Cancer-Related Brain Fog Information for Cancer Patients and Caregivers about Cancer-Related Brain Fog Princess Margaret Also called Chemo-Fog, Chemo-Brain, or Cancer-Related Cognitive Dysfunction Please
More informationCoping With Stress and Anxiety
Coping With Stress and Anxiety Stress and anxiety are the fight-and-flight instincts that are your body s way of responding to emergencies. An intruder crawling through your bedroom window in the dark
More informationFact Sheet. Queensland Spinal Cord Injuries Service. Pain Management Following Spinal Cord Injury for Health Professionals
Pain Management Following Injury for Health Professionals and Introduction Pain is a common problem following SCI. In the case where a person with SCI does have pain, there are treatments available that
More informationAddiction Medical Clinic LLC
Chief Complaint and Symptom: Substance Abused: Current amount per use and Frequency/day used: Last use: Date & Time: Route: Current and in the past: Duration of Use: Both Current and Lifetime: Have you
More informationBackground Information & Medical History Form
Background Information & Medical History Form To ensure you receive a complete and thorough evaluation, please provide us with information regarding your health status found on this form. If you do not
More informationQuality Measures for Long-stay Residents Percent of residents whose need for help with daily activities has increased.
Quality Measures for Long-stay Residents Percent of residents whose need for help with daily activities has increased. This graph shows the percent of residents whose need for help doing basic daily tasks
More informationDocument Author: Frances Hunt Date 03/03/2008. 1. Purpose of this document To standardise the treatment of whiplash associated disorder.
Guideline Title: WHIPLASH ASSOCIATED DISORDER Document Author: Frances Hunt Date 03/03/2008 Ratified by: Frances Hunt, Head of Physiotherapy Date: 16.09.15 Review date: 16.09.17 Links to policies: All
More informationDon t just dream of higher-quality sleep. How health care should be
Don t just dream of higher-quality sleep. How health care should be Many of our patients with sleep disorders don t realize there s another way of life, a better way, until they are treated. Robert Israel,
More informationHEALTH AND SOCIAL CARE
2016 Suite Cambridge TECHNICALS LEVEL 3 HEALTH AND SOCIAL CARE Unit 22 Psychology for health and social care J/507/4443 Guided learning hours: 60 Version 2 Revised content March 2016 ocr.org.uk/healthandsocialcare
More informationBACK PAIN MEASURES GROUP OVERVIEW
2014 PQRS OPTIONS F MEASURES GROUPS: BACK PAIN MEASURES GROUP OVERVIEW 2014 PQRS MEASURES IN BACK PAIN MEASURES GROUP: #148. Back Pain: Initial Visit #149. Back Pain: Physical Exam #150. Back Pain: Advice
More informationNew York State Workers' Comp Board. Mid and Lower Back Treatment Guidelines. Summary From 1st Edition, June 30, 2010. Effective December 1, 2010
New York State Workers' Comp Board Mid and Lower Back Treatment Guidelines Summary From 1st Edition, June 30, 2010 Effective December 1, 2010 General Principles Treatment should be focused on restoring
More informationDallas Neurosurgical and Spine Associates, P.A Patient Health History
Dallas Neurosurgical and Spine Associates, P.A Patient Health History DOB: Date: Reason for your visit (Chief complaint): Past Medical History Please check corresponding box if you have ever had any of
More informationUnderstanding The Unique Aspects And Challenges Of Living With MS
Connecticut Resident Services Coordinator Training Understanding The Unique Aspects And Challenges Of Living With MS July 23, 2009 Susan Raimondo, Senior Director, Advocacy & Programs National Multiple
More informationEducating the Dysautonomia Student: Dysautonomia In The College Setting
Awareness Series DYNA, Inc. 1301 Greengate Court Waldorf, MD 20601 Phone: 301-705-6995 Awareness Series Educating the Dysautonomia Student: Dysautonomia In The College Setting Email: info@dynakids.org
More informationBIPOLAR DISORDER IN PRIMARY CARE
E-Resource January, 2014 BIPOLAR DISORDER IN PRIMARY CARE Mood Disorder Questionnaire Common Comorbidities Evaluation of Patients with BPD Management of BPD in Primary Care Patient resource Patients with
More informationWomen s. Sports Medicine Program
Women s Sports Medicine Program The Froedtert & The Medical College of Wisconsin Sports Medicine Center The Sports Medicine Center is a leading provider of comprehensive sports-based programs to treat
More informationDepression & Multiple Sclerosis. Managing Specific Issues
Depression & Multiple Sclerosis Managing Specific Issues Feeling blue The words depressed and depression are used so casually in everyday conversation that their meaning has become murky. True depression
More informationNIM. Corporate Health Programs
NIM Corporate Health Programs 360 integrated healthcare solutions Nordic Integrative Medicine Corporations who invest in the health and wellbeing of employees receive longterm economic benefits. Workplace
More informationMassage Therapy Helps Back Pain By Susan Jackson Grubb, NCMT, CNMT
1 By Susan Jackson Grubb, NCMT, CNMT Absenteeism, lost wages and reduced productivity due to low back pain are costly to people, companies, and corporations. It is estimated that eighty percent of Americans
More informationTreating Depression to Remission in the Primary Care Setting. James M. Slayton, M.D., M.B.A. Medical Director United Behavioral Health
Treating Depression to Remission in the Primary Care Setting James M. Slayton, M.D., M.B.A. Medical Director United Behavioral Health 2007 United Behavioral Health 1 2007 United Behavioral Health Goals
More informationEUROPEAN LUNG FOUNDATION
PULMONARY REHABILITATION understanding the professional guidelines This guide includes information on what the European Respiratory Society and the American Thoracic Society have said about pulmonary rehabilitation.
More informationTest Request Tip Sheet
With/Without Contrast CT, MRI Studies should NOT be ordered simultaneously as dual studies (i.e., with and without contrast). Radiation exposure is doubled and both views are rarely necessary. The study
More information