Journal of IiME Volume 2 Issue 2 www.investinme.org R Reeaassoonnss wwhhyy MMEE DDooeess NNoott BBeelloonngg ttoo tthhee MMUUSS CCaatteeggoorryy (continued) read in its entirety on the Internet, and her review of the condition is not therefore referred to here: ”The clinical presentation...appears in immediate connection with an infection” (ibid.). ”Fatigue or exhaustion is the dominating symptom. Even light use of muscles brings on such a feeling of fatigue by the patient that he/she is unable to perform any type of work, often for several days. It is also characteristic that efforts and physical training worsens the fatigue. The physical fatigue has some similarities with myasthenia gravis and has led to the denomination neuromyasthenia.” (ibid., p. 3018) The same year Dr Harald J. Hamre published an article on ME which then was called Chronic Fatigue Syndrome. Here is reproduced some of what he wrote. ”After a thorough diagnostic clarification the patients need a stable, supportive primary care doctor contact, with intermittent diagnostic re evaluation. Support and adequate rest is crucial, based on experience. Many will be totally or partially unable to work for a long time. (Hamre, 1995:3043) Patients with Chronic Fatigue Syndrome "can have significant and long-term relapses if they are pressed for a too high level of activity, e.g. by declaring recovery prematurely ... They have a number of ... symptoms ... that the doctor should know and take seriously.” (ibid., p. 3044). In 1995, Dr Kreyberg also published an article about Chronic Fatigue Syndrome. It can be Invest in ME (Charity Nr. 1114035) http://www.med.uio.no/iasam/forepi/epidem iologi/me/artikler/Et_naergaaende_mote.pdf 5. Diagnosis and necessary investigations And So Forth It is noted in the directorate’s report (2007) that there are strict criteria for diagnosis. In the general practice medicine it is reported that a high proportion of patients present tiredness/fatigue. Extremely few of these get a confirmed diagnosis of ME (G93.3) after years of investigations. The general practice medicine has moreover their own coding system with various umbrella terms. The diagnostic code which is used most often in the general practice medicine is A04 (A, zero, four): ”The diagnosis is difficult because it cannot be confirmed by specific tests, laboratory tests or physical findings. The doctor has to build on the typical illness history and recognition of the clinical presentation. Fatigue is a non specific symptom in the line with fever and nausea and can be provoked by a number of factors. The aim for an operational definition must be a characterisation of this reaction so that it can be recognised clinically and can be limited against other conditions”. (Socialand Health Directorate, 2007:7) At the Ullevål University Hospital, Medical division, a diagnosis is given based on recognised criteria (Carruthers et al, 2003; Fukuda e al. 1994) and a specific diagnostic guide which was formulated by Dr Brubakk and Dr Baumgarten. Infectious disease specialist, previously head of department at (continued on page 71) Page 70/74

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