Erasmus and Kinkajou
Dr Xxxxx
:.What follows is the CDC (Centre for Disease Control) definition of Chronic Fatigue Syndrome. (Actually this is an old definition that existed about a decade ago, not that the new version is any more enlightening or useful).
For a positive diagnosis of Chronic Fatigue Syndrome, both of the major criteria + at least six symptoms + two physical signs must be present.
Dr Xxxxx :. Major Criteria:
- New onset of persistent or relapsing, debilitating fatigue that is severe enough to impair average daily activity below 50% of "normal" for a period of six months or more.
- Exclusion of other diseases through clinical history, clinical examination, or other pathology investigations.
Dr Xxxxx :. Minor Criteria: Symptoms
- Mild fever (less than 38.6 degrees Celsius, normal is 37 degrees Celsius).
- Sore Throat.
- Painful cervical or axillary lymph nodes.
- Unexplained general muscle weakness.
- Myalgia or muscle discomfort.
- Generalized fatigue after exercise lasting 24 hours, that is not normal.
- Generalized headaches.
- Migratory arthralgia (joint aches) without swelling or redness.
- Neuropsychological complaints: any of: photophobia, transient visual scotoma (visual field missing patches), forgetfulness, irritability, confusion, poor concentration, difficulty thinking, depression.
- Sleep disturbance (including sleeping too much).
- Acute illness onset over hours to days.
the CDC
CDC Definition: Overview of Inclusions: New Definition
Fatigue + 4 out of 8 case-defining symptoms:
PEM lasting more than 24 hours
Unrefreshing sleep
Significant impairment of short-term memory or concentration
Muscle pain
Pain in the joints without swelling or redness
Headaches of a new type, pattern, or severity
Tender lymph nodes in the neck or armpit
A sore throat that is frequent or recurring
Duration
? 6 months (clinical evaluation starts at one month – prolonged fatigue)
Fatigue
? 6 months new onset severe persistent or relapsing fatigue
Unexplained after clinical evaluation
Not explained by ongoing exertion
Not substantially relieved by rest
Results in substantial reduction in occupational, educational, social, or personal activities
Post-exertional malaise
Not required but one of the 8 case defining symptoms
Minimum number of symptoms—5
Exclusions
Active medical condition that explains chronic fatigue – untreated hypothyroidism, sleep apnoea, narcolepsy, medication side effects
Previous diagnosis not unequivocally resolved – chronic hepatitis, malignancy
Past or current major depressive disorder with psychotic or melancholic features, bipolar disorder, schizophrenia, delusional disorders, dementias, anorexia nervosa, bulimia nervosa
Alcohol or substance abuse within 2 years of illness onset or any time after
Severe obesity (BMI > 45)
Accepted co-morbidities
Fibromyalgia, anxiety disorders, somatoform disorders, non-psychotic or melancholic depression, neurasthenia, multiple chemical sensitivity disorder, treated Lyme disease or syphilis before chronic sequelae, isolated unexplained lab or physical abnormality insufficient to suggest exclusionary diagnosis
Note : no mention of neuropsychiatric symptoms in the new definition of the disease.
2003 Canadian Consensus : Overview of Inclusions
Fatigue, post-exertional malaise ±fatigue, sleep dysfunction, and pain; have 2 or more neurological/cognitive manifestations and 1or more from 2 categories of autonomic, neuroendocrine and immune manifestations
Duration
? 6 months (preliminary diagnosis can be earlier)
Fatigue
Significant new onset persistent or recurrent physical or mental fatigue
Unexplained after clinical evaluation
Substantially reduces activity level
Post-exertional malaise
Required
Minimum number of symptoms—8
Exclusions
Active disease processes that explain symptoms, specifies:
Addison’s disease, Cushing syndrome, hypo- or hyperthyroidism, iron deficiency, anaemia, iron overload, diabetes mellitus, cancer, sleep apnoea, rheumatoid arthritis, lupus, polymyositis, polymyalgia rheumatic, AIDS, multiple sclerosis, tuberculosis, chronic hepatitis, Lyme disease, primary psychiatric disorders, substance abuse
Accepted co-morbidities
Fibromyalgia, myofascial pain, temporomandibular joint syndrome, irritable bowel syndrome, interstitial cystitis, irritable bladder syndrome, Raynaud’s phenomenon, mitral valve prolapse, migraines, allergies, multiple chemical sensitivities, Hashimoto’s thyroiditis, sicca syndrome, depression
2011 ME International Consensus: Overview of Inclusions
Post-exertional neuroimmune exhaustion, ?1 symptom from 3 neurological impairment categories, ? 1 symptom from the immune/gastrointestinal/genitourinary impairment categories, ? 1 symptom from energy metabolism/transport impairments
Duration
Not included
Fatigue
Not included
Post-exertional malaise
Required, renamed post-exertional neuroimmune exhaustion (PENE)
Minimum number of symptoms—8
Exclusions
Alternative explanatory diagnoses (untreated), primary psychiatric disorders, somatoform disorder, substance abuse
Accepted co-morbidities
Fibromyalgia, myofascial pain, temporomandibular joint syndrome, irritable bowel syndrome, interstitial cystitis, Raynaud’s phenomenon, mitral valve prolapse, migraines, allergies, multiple chemical sensitivities, Hashimoto’s thyroiditis, sicca syndrome, reactive depression
The Team: Erasmus met Dr Xxxxx and over a number of years grew to develop a belief in the problems of our world.
Erasmus is an old dog, but he reckons he still can do new tricks. He’s been around, and up and down a few dry creek beds in his lifetime .Born into servitude at the Daisy Hill Puppy Farm, Erasmus quickly realised the world could be a hostile and dangerous place. Puppies disappeared daily, never to be seen again.
Kinkajou: Features in our web sites as an adventurer but he is equally accomplished in the art of reasoning and has often followed the comments of Erasmus to their logical conclusion. His belief in the truth leads him to always "tell it true". This is the world as it can be seen and this is the real world.
Dr Xxxxx. This good doctor actually represents a diversity of opinions held by a small cabal of medically aware people.
Dr AXxxxx. Simply best described as a cold inhuman bastard, Erasmus says we are indeed lucky to have this paranoid psychopath on our side. In spite of his antecedents, his perspective is valuable for us to use to understand our world. Dr AXxxxx’s past background is in taking charge and being master at the helm of the ship of destiny. Control is the ultimate goal. Nothing must stand in the way of control. Domination not cooperation. Suspect your enemies and kill them first, preferably after extracting all useful information. Your destiny is yours to make and to take. Vengeance is a heady mix to this paranoic murderer.
The Commandant: Head of our security detail, the Commandant believes in doing the right thing and always considering safe options. However, his view of what is right is coloured by association with Erasmus, Kinkajou and the doctors Xxxxx.
Frobisher & Beethoven: These guys are our bullywot "security mooks", Frobisher is the literate one while Beethoven provides just more raw muscle power. While Officious and Intolerant of transgressions, they none the less have a sensitive and fragile side to their natures, an aspect their personality totally at odds with their aggressive and fierce appearance.
Goo is a simple and humble mammal.(Actually a marsupial numbat really). His ability to change the world is limited by his meagre intellect and his short life span. Furthermore, as a member of an endangered species, he has to face the prospect of personal death as well as species extinction. He could one day be the last of his kind.