Pearls of Wisdom from a CFS Physician, part 3

Bateman-4webBy Lucinda Bateman, MD

In this 3-part blog series, Dr. Bateman brings you some of her pearls of wisdom on treatment of ME/CFS, honed in her many years of caring for thousands of ME/CFS patients…

Lucinda Bateman, MD, specializes in the diagnosis and management of unexplained chronic fatigue, ME/CFS and fibromyalgia. She is the cofounder of OFFER, the Organization for Fatigue and Fibromyalgia Education and Research and has served on the Solve ME/CFS Initiative’s Board of Directors in the past. In 2015, Dr. Bateman will be the lead clinical investigator on the $500,000 research study awarded to SMCI from the Falk Medical Research Trust.  This award gives us the opportunity to further grow the SolveCFS BioBank and to extend the exciting results generated by SMCI funded investigator Dr. Patrick McGowan.

Learn more about the grant awarded to SMCI to fund this study HERE

Learn more about Dr McGowan’s SMCI funded research HERE

And access the paper describing his exciting results HERE


In part 1, Dr. Bateman spoke about building emotional resilience and achieving the most restorative sleep possible. Read part 1 HERE

In part 2, Dr. Bateman discussed achieving reasonable pain control and balancing physical pacing with physical conditioning. Read part 2 HERE.

These pearls of wisdom aren’t listed in any particular order; each of them are helpful in managing ME/CFS patient care. Hopefully the information shared in these posts will help you identify areas you and your health care team can explore.


Pearl 5: Identify and treat comorbid conditions

There are a number of medical conditions, often subtle in presentation, that frequently overlap or occur in combination (are comorbid) with ME/CFS. These conditions have well known diagnostic and treatment plans that a medical professional can follow whether familiar with ME/CFS or not. Since each untreated condition may worsen ME/CFS symptoms, any improvement in symptoms of comorbid conditions is progress in reducing the severity of ME/CFS.

Here are some of the more common comorbid conditions present in people with ME/CFS:

  • Sleep disorders (such as obstructive or central sleep apnea; restless legs syndrome, periodic limb movement or myoclonus; excessive sleepiness)
  • Allergies, chronic sinusitis and reactive airway disease (asthma)
  • Irritable bowel syndrome (IBS), reflux and heartburn (GERD), lactose intolerance, celiac disease
  • Focal pain conditions such as osteoarthritis, cervical or lumbar disc disease
  • Primary or secondary mental health conditions (such as attention deficit disorders, depression, anxiety)
  • Metabolic syndrome (primary or secondary) and type II diabetes
  • Hormone imbalances or dysregulation (such as menopause, low testosterone, hypothyroidism, polycystic ovarian syndrome)
  • Chronic or recurrent infections (such as herpes or shingles outbreaks)
  • Vitamin D and vitamin B12 deficiency or “low normal” values People with ME/CFS should learn about their own comorbid conditions, and in partnership with a medical professional, see that they get the best supportive treatment available.

 * In the Institute of Medicine (IOM) report on ME/CFS, released earlier this week, one of the recommendations dealt with the issue of comorbid conditions, stating that physicians should diagnose ME/CFS if diagnostic criteria are met, following an appropriate history, physical examination, and medical work-up. The committee clearly called for the removal of the exclusionary rule; existing criteria specify that if fibromyalgia, Lyme disease or a host of other known co-morbid conditions are diagnosed, then ME/CFS cannot be diagnosed. Comorbid diseases frequently occur and the committee stated that it is incumbent upon the physician to make the ME/CFS diagnosis as well and then do all they can to treat it. In the past, the exclusionary rule for ME/CFS diagnosis has slowed research progress. This new recommendation should improve research effectiveness and progress in the future.

Read more about the IOM Report HERE


Wisdom applied

The relevance of these clinical pearls of wisdom depends on the features of each individual’s illness, but each of them benefit CFS patients by improving functionality and quality of life. With a chronic condition like ME/CFS, this can go a long way toward helping patients manage their illness while we search for targeted interventions and ultimately a cure.


You can download a single PDF with all of the information from this 3-part blog series HERE



Tags: , , , , , , , , , , February 13, 2015
  • mizlou

    I am new here but not new to ME/CFS. The specific exercise regimine is what I guess that I need to build a bit of endurance which I have virtually zero now. I recently read the two articles Manual Therapy in CFS Parts 1 and 2 by doctors Peter C. Rowe and others. I found the articles very interesting and would like to try this specific form of therapy. When I speak to my primary care doctor about exercise the immediate reaction is to put me into a conventional exercise program. That would not work at all. When seeking “Manual Therapy” what is one to ask for so that one gets a specific therapy that can perhaps help someone with ME/CFS?? What are the specialists in this field called?

    • female avatar would fit

      There are unfortunately very few “specialists” in most of the country. It also depends on where you live. About the exercise program, ask for a preliminary meeting with the physical therapist, or call ahead to find out if they have an exercise or physical therapist that is familiar with ME/CFS. If not, avoid the place and do what you can on your own. I wish you much luck.

      • Nikoli McCracken

        Way back when I first got ill, I participated in a research program at a hospital at UCLA. They had me ride a bicycle, on room air. I ran out of energy very quickly. I went home, recovered from that, and returned a month later. This time, I was on 100% oxygen, with a tube in my mouth furnishing that. It also measured my exhales as well as inhales. I lasted 45 minutes! Yet, I cannot find a doctor who will let me exercise on oxygen! It seems to me, that those test results infer that we are not getting enough oxygen to our tissues.

        • PeggyTree

          I totally agree with you about the oxygen supply. I have asthma which is aggravated by secondhand cigarette smoke. Also when tested for sleep apnea, I slept extremely well when the tester supplied oxygen. I was given a sleep apnea machine with no oxygen. The machine turned out to be more trouble than it was worth since it didn’t help at all without the oxygen. I understand what you are saying.

    • female avatar would fit

      If you live in Ohio, there is supposed to be a place called the Crystal Clinic that, I think is somewhere near Akron? Summit County, or I’m not quite sure where. They used to advertise online but I haven’t seen an ad online for several years now. They said they treated Fibromyalgia. Whether or not they treat ME/CFS, I have no idea. I rely on my own doctor who keeps himself up on what’s going on in that field of health.

  • Suella

    Hello, You might want to have a look at these sites for safe ways to improve activity and stamina. None of this can be rushed.


    Very useful to assess our ability to be active on any one day
    Early morning heart rate here:

    “The Key Measure – Perhaps the key activity
    management tool, however, is something called ‘resting heart rate’,
    which is measured after you get up in the morning. Your resting heart
    rate is measured by obtaining a cheap heart rate monitor (@$30 – getting up in the morning for a bit and then lying down and
    taking the reading (before taking any stimulants such as coffee).

    Pushing through fatigue only leads to more fatigue…You
    can’t beat it – but you can go around it. Dr. Connie Sol works with Dr.

    Doing this over 10 days or so and keeping a simple activity and
    symptom log should help you notice how changes in your morning resting
    heart rate are associated with your symptom and energy levels that day.
    If you engaged in too much activity/stress over the day or two before –
    it will probably result in an increased morning resting heart – and a
    more symptomatic day. Connie Sol stated that if your RHR rises as much
    as 8% above your baseline level then you need to cut back on your
    exercise/activities. If you ignore that warning, you’re going to crash.
    (This means you can use a heart rate monitor to manage your
    activity levels without doing the VO2 max testing. The VO2 max test can
    pinpoint the point at which exercise/activity level becomes dangerous
    but there are ways for the less well off of us to get some an idea of
    the maximum heart rate we should achieve during exercise/activity
    without doing the expensive testing…”

    For safe exercise and activity using Dr. Nancy Klimas’ VO2 test strictures generally the videos and discussion at
    Dan Moricoli on his low level exercise
    Seated Yoga can be rented or purchased:
    and look here as well


    • J Rae

      Thank you!!!

  • Tracey

    Interesting that D3 and B12 deficiencies existed. The Council on Vitamin D3 found that a 40K IU dosage daily was safe. Doctors used to give B12 shots too. Now they are cautious on both. Why is that?

  • Sarah Abbott

    I have suffered with ME since 09 it’s hard going but I did find that vitamin b12 did help and apart from a few exhaustion days I did manage to get back to work. But lately I’m exhausted everyday the sheer agony of my spinal arthritis is not helping the dr has now put me on vitamin D as that’s deficient but has anyone got any tips on what else I can do? Gp can only do so much and the hospital are worse than useless told me to lose weight and you will feel better 3 1/2 stone lighter and if anything I feel worse!