MEDICAL MATTERS
- Medical Matters features questions asked by Members of the ME Association on health-related topics.
- Dr Charles Shepherd and the ME Association's other advisers answer these questions by sharing their expert knowledge.
- Medical Matters is based on the popular ‘Ask the Doctor’ series in ME Essential magazine.
- It is a free resource that supplements the detailed information contained in the full range of literature that can be found in the website shop.
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Questions in the Category: Autonomic Nervous System
Symptoms: Balance
I developed ME a few years ago and have all of the main symptoms including occasional problems with balance or unsteadiness, especially when I’m tired. Over the past few months my balance/ unsteadiness has become more persistent. I’ve also had a couple of episodes when I’ve come off an escalator (which I no longer do) and nearly fallen over. My GP has checked me over (nothing abnormal was found) and prescribed a drug called Stugeron/ cinnarizine, which hasn’t really helped.
What else can I do? Just put up with it?
Symptoms: Overactive Bladder (OAB)
I’m female, in my early forties, and have had moderate ME/CFS for about five years. More recently, I've been having a number of bladder symptoms – in particular a frequent and sudden urge to pass what are only quite small amounts of urine. I am also having to go to the bathroom on several occasions during the night.
My doctor thought I might have cystitis – even though I don’t have any pain. However, there were no signs of infection on repeated urine tests. My GP now says that I probably have an “overactive bladder”, and that while there are drugs that can definitely help to calm down an irritable bladder they can cause side-effects, including drowsiness.
Is having an overactive bladder more common in ME/CFS? And is there any other form of treatment – as this is causing me a lot of distress and restricting what I’m able to do outside the house.
Symptom: Mild heat stroke
Recently I went to the seaside for the day. It was very hot and I felt it was too much for me, so I went down to the sea to cool off – just paddling in the water (which was surprisingly cold – in fact, downright chilly). It was fine initially but then I started to feel off-balance and then ill, and had to get back to the car quickly (and I had to sit down on the way several times) and then lie down on the back seat of the car. What might have caused such a reaction?
Symptom: Palpitations
Like many people with ME I have occasional palpitations. Does this mean that I might have some form of underlying heart disease? Or is this just another part of having ME? And are there any drug treatments that might be helpful?
Dysautonomia: Orthostatic Intolerance (OI) and Postural Orthostatic Tachycardia Syndrome (PoTS)
I keep reading about orthostatic intolerance, PoTS and postural hypotension and how they can all be symptoms of ME/CFS. But what do all these medical terms mean? What is going wrong? And are all these symptoms and syndromes related to each other?
Blood Flow: Oxygenation
I know there has been some interesting research involving neuroimaging studies and that this has demonstrated defects in blood flow to certain key parts of the brain. But does this research mean that people with ME/CFS have low levels of oxygen entering the brain? If so, does it also explain some of the key brain symptoms – cognitive dysfunction in particular? And could it lead to new forms of drug treatment?
Symptom: Fainting
Like most people with ME I have problems with balance and find it difficult to sustain any sort of activity that involves prolonged standing. I sometimes feel faint when standing up but have never actually fainted until recently. This has now happened on three occasions – all for no apparent reason. Fortunately, someone has always been with me and I haven’t injured myself. I usually recover very quickly but don’t normally feel as though I’m ‘back to normal’ till the next day. My GP took my pulse and blood pressure (which was low) and decided it was probably ‘just anther part of having ME’. I have been given some self-help advice about keeping well hydrated with water and not standing up too quickly but I’m concerned that there may be something else going wrong in addition to my ME. What would you advise?
Dr Charles Shepherd
Dr Shepherd has been Trustee and Hon. Medical Adviser to the ME Association for more than 40 years. He is integral to the charity's activities and provides information and support based on his professional knowledge, personal experience as a doctor with ME/CFS, and the understanding gained from helping many thousands of people with the condition. He was a member of the comittee responsible for the 2021 NICE Clinical Guideline and is a recognised expert on ME/CFS in the UK. His knowledge extends to Post-Viral Fatigue Syndromes (PVFS), Myalgic Encephalopathy/Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS), and Post-Acute Sequelae of SARS-CoV-2 infection (PASC) or Long Covid.
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Medical Matters is based on the popular ‘Ask the Doctor‘ series featured in the highly-regarded member’s magazine, ME Essential, and in the healthcare professional magazine, ME Medical. Both are produced by the ME Association and published as hard-copy magazines every 3 months and sent to members and healthcare professionals by post to home or business addresses.
If you are an HCP you can sign-up here to receive ME Medical magazine (people with ME/CFS can also nominate their HCP by completing the sign-up form).
