Fatigue and Avoidance Recovery Planning for Keith Torkelson September 2024 by Keith Torkelson MS
Feature Photo – NOMJ – Fatal
Fatigue
20180314-W: Stressors
Our stressors aren’t anything unusual. How we manage our stressors is showing impairment. We have a monthly, must to do, lab test for managing one of our medications – Clozapine. It is stressful because if it isn’t done then we do not get this essential medication. From 2007 to 2024 we never missed a test. Since we were bedridden for 75 days things like this routine lab fatigue us. Walking and what used to be simple tasks also fatigue us. We have been avoiding things due to stress and fear. Also associated with fatigue we have a back log of work at our storage. This could be worse. Others had and have fatigue worse. Some suffer terminal fatigue.
Could Be Worse
Our stress could be worse. We could have an incurable illness. This is an example of New Old Man John. He fell ill and died in no time. He coughed and hacked spasmodically and
relentlessly. For us there is time to
turn things around. This report
discusses averting Avoidance Coping.
Metadata > GhlthFatigueEpisode2008081001
Back on August 10, 2008 we discussed bedriddening [SPELLED] fatigue. The report mainly deals with Clozapine. We were new to it and had much to learn in practice.
- Chronic Fatigue
- Anxiety
- PTSD
- Lack of Resilience
- Stress
- OCD
- Sleep Disorder
Results
Metadata > Assessment Instruments
Fatigue…Plan…V2024
2Anxiety
05_DA_Worry_What_If_Anxiety_23053004_Notes V2024
3PTSD
Too many traumas to apply
Assess_PTSD_14081604_Scorer v2024 10 Item
4BMBB_Anxiety_PTSD_Scales_11032304_TATC V2024
5Resilience
HHS_ResilienceScale_Wksht_10040701 V2024
6Specific Phobia [STAYED]
7Stress
Grief…Stress_Assess 2013…
Reco_Stress…Scaling_Adults…
8Profile of Mood Scale (STAYED]
Diagnosis
PTSD & OCD & Anxiety
& CFS & Sleep Disorder
Possibly the reason I still haven’t resolved my symptoms is that we are working with the wrong diagnoses. Since July 1, 2024 we have been on an effective treatment plan for sleep concerns. At the next doctor’s appointment we want to address daytime concerns of anxiety and fatigue.
Living Arrangements
We first moved into shared living back in 2007. Since 2008 we have had trouble with living arrangements. We had more periods of roommate problems and peace and harmony. Now in 2024 we have a chance to help our roommate enjoy a rewarding life in the face of addressing both our needs. Our current roommate is a very physically ill man. He would fit into the dying old man category. Next we address some of our wins.
Our Wins
Even though it was uncomfortable from 2012 to 2023 we found ourselves asking our landlady for help. We changed beds 3 times in around ten (10) years. It’s too bad that in the process we didn’t get a GoodBed. During our episode 2023-24 we found we were running low on resources yet we got through. Our family stepped up and helped us. Particularly our brother-in-law physically helped us move our property. Our oldest sister is our Significant Other. She arranged a good deal to get us our current bed. Samantha Santos, our social worker, arranged for us to pick living at Harvest Senior Living. We have a working laptop and smartphone with us. Our car was returned to us, which makes transportation easier. We partnered with Dr. Bera back on our case. Last, in our new room there is no bullying.
Mechanism – Sleep and Anxiety
Medication Management
Since 2007 we have kept the Clozapine constant because it addresses our sleep issues. We changed our dependency on Clozapine in 2024 and our sleep issues snowballed. We are on a mixture of meds for sleep that is 90% effective. Now we need medication to address our daytime medication needs. For example, we need to address fatigue and anxiety.
Needs & Neglect – Sleep &
Anxiety
Our needs are centered about survival needs. In particular, we need sleep each night and peace each day. Back at Leisure Circle we suffered several traumatic incidences about our sleep needs. On numerous occasions they failed to have our sleep medication. This caused us sleeplessness across some odd seven nights. One incidence, the last, was for two (2) nights in a row. Since July 1, 2024 our medication has been consistent. We still worry, what if and wonder what to do if there is a problem with our nightly medication. During the day the peace to solve anxiety and fatigue is not in place yet.
Protective Factors
https://www.dhs.wisconsin.gov/resilient/risk-protective-factors.htm
Important protective factors
Most Significant Support People -
Sister Support
During this episode (2024) our oldest sister has been our number one support person. She was open to calling at least once per day. During 2023 we talked with her once per week on Thursdays. It wasn’t so much support rather than conversation. Now she is leaning towards far less phone calls per week: Tuesdays, Thursdays, and Saturdays. We feel like we lost something for better or worse. She is important in my Prevention Network and Support System (PNSS).
Fatigue Factors – Behaviors –
Goals
Moving past Avoidance Coping
Behavior Changes and
Modifications
Car Example
SMART is a well-established tool that you can use to plan and achieve your goals. While there are a number of interpretations of the acronym's meaning, the most common one is that goals should be Specific, Measurable, Achievable, Relevant, and Time-bound.
FYI > https://www.forbes.com/advisor/business/smart-goals/
Driving Stressor - Contingencies
One of our biggest stressors is driving our car. Yes, we have had some major car accidents in our past. Yet, we have many safe miles driven. Just at times we feel at risk. Another feature about driving is how to handle a break down. We don’t have the roadside supports of family anymore. We used to drive hundreds of miles in a day without concern. Now if we break down we wonder if we could handle the process. We need to make a contingency breakdown plan. Next we cover avoidance or avoidance coping.
FYI - Avoidance
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9629285/
Fatigue severity and avoidance among individuals with chronic disease: a meta-analysis
Objective:
Fatigue is a common, debilitating symptom experienced by individuals with chronic disease. Avoidance, or the act of evading unwanted experiences, is associated with fatigue across chronic disease samples. The current study sought to determine the strength of association between fatigue severity and avoidance in individuals with chronic disease.
Avoidance coping
Experiential Avoidance
In psychology, avoidance coping is a coping mechanism and form of experiential avoidance. It is characterized by a person's efforts, conscious or unconscious, to avoid dealing with a stressor in order to protect oneself from the difficulties the stressor presents. Wikipedia
Avoidance - June 20, 2024 (TH)
Start of avoidance primarily was due to using bus as transportation. Then it was fears of being isolated with no backup. Eventually, avoiding things related to walking and fears of falling down.
Traumas and Fears and Losses
FYI – Defining Fatigue
Summary: Fatigue can be caused by various factors working in combination such as… Fatigue is a known risk factor in motor vehicle and workplace accidents.
Fatigue – Goals
CBT - Goals
What is Cognitive Behavioral Therapy?
American Psychological
Association (APA)
https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
What is Cognitive Behavioral Therapy? Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness.
Remedies/Treatment
We are hoping that doctor Bera finds a good fitting daytime medication that addresses anxiety, fatigue, thoughts, feelings and behaviors. We would like the nighttime medication changed only slightly by adding 50mg of Clozapine PRN.
Risk/Risks
https://www.dhs.wisconsin.gov/resilient/risk-protective-factors.htm
A risk factor is something that increases a person’s risk of illness, injury, or harm. Experiences like abuse or violence in the home are risk factors. These can lead to…
Outcomes
Risk - Areas to Address
For us our greatest risk factors for hospitalization are: Lack of daytime peace and harmony, sleeplessness and cigarette smoking. Socioeconomic level (SEL) is also a risk factor. We are in the high risk range for SEL.
Socioeconomic Level
At just over 1800 per month we live near poverty level. The 2024 Federal Poverty Guidelines are as follows. Persons in Family (1), Household $15,060, Poverty Guideline MAGI* Medi-Cal <138% Federal Poverty Level (FPL) $20,783
Symptoms
We have been working on our symptoms since 1989. It is hard to believe we still have so many symptoms. It’s during the day our fear related symptoms that are the most bothersome for us.
Diagnoses
We show or have shown signs of:
Complaints
The primary means we manage
fatigue is by using the computer and world-wide-web. We are a survivor of Gal on Dude domestic violence. We are not ready to discuss abuses on us at
this time. We are getting passed them
though. Back in 2011 we were the victim
of emotional abuse and bullying. Things
we were addressing in 2017 were: Attention Deficit Disorder (ADD), Bum Soo
Lee’s Retirement, Clozapine Side Effects, Payee Accounting, Risk of
Homelessness and problems with Sleep. Again
in 2023 we were a victim of bullying. These,
some more than others, caused / cause us stress.
CFS Checklist
http://chronicfatigue.about.com/od/whatischronicfatigue/a/cfs_symptoms.htm
Knowing all of the possible symptoms can help you in a few different ways:
It can help your doctor diagnose you properly
Tracking them can help you identify symptom triggers
It can help you see that you're not the only one experiencing these problems
Diagnosis/Diagnoses
What do we have?
HSF = High scores are favorable
HSP = High scores are problematic
Plan - What to do about it?
What we plan to do has already been addressed earlier in this paper
Chronic Fatigue Syndrome
Brief Physical
Symptoms Screener (8 Items) –Not
Used in Summary
CFS Checklist (Material Used to Create MSG Checklist – Results Included in This Document)
http://chronicfatigue.about.com/od/whatischronicfatigue/a/cfs_symptoms.htm
Knowing all of the possible symptoms can help you in a few different ways:
It can help your doctor diagnose you properly;
Tracking them can help you identify symptom triggers;
It can help you see that you're not the only one experiencing these problems.
Symptoms with an asterisk are
included in the CDC diagnostic criteria.
The assessment used here was derived by stratifying it to about 100
items. The table includes summary information.
High scores are problematic
Table – CSF Symptom Screener
Derived from: https://en.wikipedia.org/wiki/Chronic_fatigue_syndrome
DF=Direct Fill
HSP = High Scores are problematic
L15D=Last Fifteen Days
R=Retroactive
Overall Index for MSG-Chronic
Fatigue (CFS) Affects / Effects (2013-2016)
Overall Fatigue Assessment
High scores are problematic
Overall Index for MSG-Chronic
Fatigue (CFS) Effects Exhaustive (2013-2018)
Some of the data is repeated
High scores are problematic
CSF Assessment in Development
https://en.wikipedia.org/wiki/Chronic_fatigue_syndrome
Symptoms of CFS include
We have conquered several of these
…and other
characteristic symptoms in a previously healthy and active person.
Additional symptoms may be reported, including
Symptoms
The most commonly used diagnostic criteria and definition of CFS for research and clinical purposes were published by the United States Centers for Disease Control and Prevention (CDC). The CDC recommends the following three criteria be fulfilled:
- A new onset
(not lifelong) of severe fatigue for six consecutive months or greater
duration which is unrelated to exertion, is not substantially relieved by
rest, and is not a result of other medical conditions.
- The fatigue
causes a significant reduction of previous activity levels.
- Four or more of the following symptoms that last six months or longer: Impaired memory or concentration
Assess_CFS_Physical_Brief (8
Items) Used In Summary
CFS – Physical Focus
HSP = High Scores are problematic
Assess_CFS_Physical_Brief (8
Items) Used In Summary
CFS – Physical Focus
HSP = High Scores are problematic
Other common symptoms include:
CFS – Physical Focus – Extended
(13 - Item)
Other common symptoms include:
HSP = High scores are problematic
Other symptoms are:
Visual disturbances (blurring, sensitivity to light, eye pain or dry
eyes). Allergies or sensitivities to
foods, alcohol, odors, chemicals, medications or noise. Difficulty maintaining upright position
(orthostatic instability, irregular heartbeat, dizziness, balance problems or
fainting)
Other common symptoms include:
CFS – Physical Focus – Extended
(13 - Item)
Other common symptoms include:
HSP = High scores are problematic
Other symptoms are:
Visual disturbances (blurring, sensitivity to light, eye pain or dry eyes). Allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise. Difficulty maintaining upright position (orthostatic instability, irregular heartbeat, dizziness, balance problems or fainting)
CFS – Psychological Focus
(2013-2016)
HSP = Higher scores are
problematic
CFS – Psychological Focus
(Includes 2014)
HSP = Higher scores are
problematic
Treatment: Chronic fatigue syndrome treatment
Management
Many people do not fully recover from CFS even with treatment. Cognitive behavioural therapy (CBT) and graded exercise therapy (GET) have shown moderate effectiveness for many people in multiple randomized controlled trials. As many of the CBT and GET studies required visits to a clinic, those severely affected may not have been included.
Two large surveys of patients indicated that pacing is the most helpful intervention, or is considered useful by 96% of participants.[59][dead link][60] Medication plays a minor role in management.[61] No intervention has been proven effective in restoring the ability to work.[56]
http://www.cdc.gov/cfs/causes/index.html
Conditions that have been studied to determine if they cause or trigger the development of CFS include
Trigger CFS
Pacing
CFS affects patients in different ways, and the treatment plan should
be tailored to address symptoms that are most disruptive or disabling for each
patient. Helping the patient get relief from symptoms is the main goal of
treatment. However, expecting a patient to return to usual activities should
not be the immediate goal because the physical and mental exertion needed to try
to reach that goal may aggravate the illness.
Assess_CFS_Coping
Difficulties of Living with CFS – Apply to Bera Profile
Living with chronic fatigue syndrome can be difficult. Like other debilitating chronic illnesses, CFS can have a devastating impact on patients' daily lives and require them to make major lifestyle changes to adapt to many new limitations.
CFS – Cognitive Focus (2013-2016)
Coping with Fatigue Problems (History)
Common difficulties for CFS
patients include problems coping with:
HSP = Higher scores are
problematic
Complications
Feelings of anger, guilt, anxiety, isolation and abandonment are common
in CFS patients. While it's OK to have such feelings, unresolved emotions and
stress can make symptoms worse, interfere with prescription drug therapies, and
make recovery harder.
Assess_CFS_Coping
Difficulties of Living with CFS – Apply to Bera Profile
Living with chronic fatigue syndrome can be difficult. Like other debilitating chronic illnesses, CFS can have a devastating impact on patients' daily lives and require them to make major lifestyle changes to adapt to many new limitations.
CFS – Cognitive Focus (Includes 2014)
Fatigue Coping Efficacy
Common difficulties for CFS
patients include problems coping with:
HSP = High scores are problematic
Resolution and Processing
CFS – Feelings Evaluation
Feelings common in CFS Patients
Ditto - While it's ok to have such feelings, unresolved emotions,
unresolved stress, can make symptoms worse, interfere with prescription drug
therapies make recovery harder.
Introduction to Resolving Stress
Ways to Manage Stress
https://www.webmd.com/balance/stress-management/stress-management
Good News
Disruptive Fatigue Screener – 5 –
Item (2012-2014)
Options for Treating and Managing CFS
The good news is there are many options to help patients manage CFS and improve their quality of life:
Treating the Most Disruptive
Symptoms First
HSP = High Scores are problematic
Disruptive Fatigue Score
(Includes 2024)
Treating the Most Disruptive
Symptoms First
HSP = High scores problematic
FYI - Assess_CFS_Management
Options for Treating and Managing CFS (Continued)
- Monitoring the
Use of All Medicines and Supplements
- Over-the-counter
and prescription medicines
- Nutritional and
herbal supplements
- Managing
Activities and Exercise
- Avoiding
extremes
- Developing an
activity program
- Modifying
exercises for extremely ill patients
- Improving
Health and Quality of Life
- Cognitive
behavioral therapy (CBT)
- Support groups
- Professional counseling
CFS Program Score
First addressed: 20180314-W:
Options for Treating and Managing
CFS (Continued)
HSF = High scores are favorable
Last Reviewed: 20240913-F:
HSF = High Scores are Favorable
20151208 – Results - Diagnostic
Criteria (Calm Clinic)
[20160114 – Link Check = Link Broken]
http://www.calmclinic.com/anxiety/symptoms/extreme-fatigue
Anxiety and Extreme Fatigue
Anxiety symptoms are as much physical as they are mental, and all of them tend to disrupt a person's quality of life. But for many, it's not necessarily the symptoms themselves that are the problem. It is the extreme fatigue that occurs once the symptoms are over. Many people with anxiety suffer from terrible bouts of fatigue, making it more and more difficult to complete everyday tasks.
Fatigue = Anxiety?
Fatigue is one of the first signs of any problem. Only a doctor can diagnose the cause of
your extreme fatigue. Take my anxiety test now to find out more about your
anxiety, so that ultimately you can cure your anxiety once and for all.
Appendix - Assessment Not
available
Lost Assessment
Back in 2015 we accessed an online assessment tool. Since this time the assessment at Calmclinic has become inaccessible. This is always a risk with online assessments particularly ones that self-score.
Anxiety Test - Find if your
anxiety is within normal ranges
FYI - http://www.calmclinic.com/anxiety-test/#
Retaking test
20151208-TU:
Your diagnosis is almost ready — where should we send it? A
confirmation message will be sent to you with a link you must click on in order
to receive your free Anxiety Diagnosis profile - Get Your Results
Your level of affectedness by anxiety and panic is not severe but strong enough to affect your life and your person on a regular basis.
FYI – Appendix
Generalized Anxiety Disorder
What is generalized anxiety disorder? Occasional anxiety is a normal part of life. Many people may worry about things such as health, money, or family problems. But people with GAD feel extremely worried or nervous more frequently about these and other things—even when there is little or no reason to worry about them.
OCD
Obsessive-compulsive disorder (OCD) is a long-lasting disorder in which a person experiences uncontrollable and recurring thoughts (obsessions), engages in repetitive behaviors (compulsions), or both. People with OCD have time-consuming symptoms that can cause significant distress or interfere with daily life.
Panic
…sudden uncontrollable fear or anxiety, often causing wildly unthinking behavior.
Social Anxiety Disorder
A person with social anxiety disorder feels symptoms of anxiety or fear in situations where they may be scrutinized, evaluated, or judged by others, such as speaking in public, meeting new people, dating, being on a job interview, answering a question in class, or having to talk to a cashier in a store.
Agoraphobia
Agoraphobia involves fearing and avoiding places or situations that
might cause panic and feelings of being trapped, helpless or embarrassed. You
may fear an actual or upcoming situation. For example, you may fear using
public transportation, being in open or enclosed spaces, standing in line, or
being in a crowd.Jan 7, 2023
Photos of bedridden people – Fatigue
