Over the last decade we have seen many patients with Chronic Fatigue Syndrome and unexplained fatigue and have developed a particular interest in the management of the condition. The programme we have developed is aimed at giving the patient the tools in order to get well. It is not aimed at maintaining the 'status quo', but progress towards health. It consists of the following:
1. Re-assessment of medical, social and psychological factors contributing towards their illness.
2. Medical review which may include assessment of endocrine function with particular reference to the Hypothalamic-Pituitary-Adrenal Axis and review evidence of any chronic inflammatory conditions which may present with fatigue.
3. A pacing programme designed with them by the physiotherapist and the physician. This to enable control to be given back to the patient, and to provide a platform on which to build.
4. Basic Chronic Fatigue Syndrome management concepts to be learnt would include understanding:
- How in a fatigue state the peaks and troughs of ability lead to a spiralling of symptoms and deterioration of illness.
- The importance of having a structured daily routine balancing rest and activity throughout the day in order to even out the peaks of activity and troughs of exhausted inactivity, manage the illness and move forward.
- The meaning of true rest for mind and body using various relaxation techniques.
- How to re-introduce activity in a gradual and systematic way over time.
- The importance of goal planning and of breaking down activities into manageable stages.
- How to set realistic and achievable goals in order to achieve personal aims.
5. A graded exercise programme based on a daily aerobic exercise bringing the pulse up to 50% maximal heart rate. The ultimate aim is 30 minutes a day at this rate; however, the starting level is different for every patient. Some may start with 10-15 seconds a day, another may start at 10 minutes a day. Step by step increases from baseline are reviewed on a weekly basis.
6. Sessions with our counsellor using a combination of cognitive, psychodynamic or a person centered approach as appropriate for them. Counselling would address:
- Losses associated with Chronic Fatigue Syndrome, working towards acceptance and new coping mechanisms.
- The effect of illness on relationships with family and friends.
- The management of emotion: anger, anxiety, guilt etc.
- Negative thought patterns.
- Unresolved prior life events and difficulties.
- Any psychological blocks to progressing their individual pacing programme.
7. An opportunity to look at the role of spirituality in moving towards health.
8. The opportunity for a broader social integration within the Burrswood Community, which may have been lacking due to the isolation of their illness.
9. Finally a discharge plan would be made which could include:
- Telephone review of goal setting.
- Outpatients attendance with different members of the team.
- Joining a Chronic Fatigue Syndrome group based at Burrswood, jointly led by our physiotherapist and counsellors.
For further information about Burrswood's Hospital please telephone our Admissions Department on 01892 863818.
