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Yesterday i had a good appointment with my specialist and he is writing me a report which will hopefully be thorough and supportive of my DLA claim and make it worth going to the appeal tribunal… he asked to see the DWP medical report in order to criticise it and correct any incorrect assumptions, so that is looking promising.

Then, this morning the tribunal papers came through in the post, so i have another little form to send back in the next few days, if i want to continue.

I am getting quite concerned now that it is getting closer and more real, that i have not got representation. I have been reading other people’s experiences, talking to people who know about these things, and the consensus seems to be that without representation it is a nightmare and they can rip your argument/statements to shreds in seconds… i was told by Welfare Right Service when they said they could not take my case on, that the tribunal panel will go easier on me because i am representing myself, but i am not convinced. Either i meet the criteria or i don’t, but the thought of having to be coherent and consistent for 45 mins to one hour about details of my condition, what i am capable of, what i can’t do etc, particularly with a fluctuating condition as mine, fills me with horror. Particularly after the experience of the DWP medical i had, where i just felt so ill from the effort and stress of going that i could hardly walk/speak or think clearly and it was so traumatic that i spent the next 8 days largly in bed recovering… the tribunal is certainly a more stressful thing and i think i need help.

I have emailed the benefits adviser who helped me with the form to ask if there is any chance Welfare Rights will change their minds, now that i have more evidence from the specialist, and where else to find a representative if not. Of course i will have to find these for myself, but no harm in asking. I think i can ask the Citizen’s Advice Bureau, and i think you can even take a solicitor, although i would have to pay for that i imagine…

So, still lots to sort out for DLA, and no sign of it being over any time soon! It would be nice to have it done before Christmas, as it has been hanging over me for so long.

Well, it seems as though i may have “POTS” (Postural Orthostatic Tachycardia Syndrome). There is a good website here that explains what it is, click on the links under “POTS place” on the left hand side…

I have been taking part in a research study about CFS/ME and Orthostatic Intolerance and have been to the hospital three times in the last month where i have been monitored (heart rate, blood flow, pressure etc) while lying down for ten minutes, then standing for two minutes. It seems that when i stand, my heart beats very fast to try to deal with becoming upright, which it seems my body does not do very well. The specialist asked me if i would be prepared to see her as a patient as there a number of drugs that she can try to manage the problem (it can’t be “fixed” as it is a problem of my autonomic nervous system, as CFS/ME is as well) and maybe (maybe) make me feel a bit better… which would be nice as i have been feeling pretty awful recently and it feels as if things have been just getting gradually worse and worse over the last couple of years or more that i have been off work.

I have been having problems with dizziness and feeling lightheaded and weak, particularly when i stand up, but at other times too (sometimes when sitting still), since i was still at work, and it has been a major problem for a long time. I find it very hard to stand for any length of time, which rules out things like waiting at a bus stop (even if there is a “seat” to perch on as you are still almost standing), i can’t queue in shops and even walking in general is pretty hard. If i bring on a “funny turn” in this way, i have to get home and to bed as soon as possible as i feel so awful, just lose all power and energy. Even when i don’t feel dizzy as such, i find it very tiring and hard work, and feel generally weak and lightheaded. I find it hard (and often impossible) to go anywhere or do anything much, basically. My doctor advised me to drink isotonic drinks and eat more salt, and said she didn’t think i needed to see a specialist as although my blood pressure drops a bit when i stand, she thought it was mild… “I just think your ME is quite bad at the moment”. Hmm yes… but why, Doc?

So that is partly why i signed up for the research study, and now i am glad i did, but i also feel that i should not have had to… apparently this condition is common in people with ME, so why has it taken so long for someone to notice? Maybe as it is difficult to treat and not life threatening they don’t bother… all the same it seems it can be very debilitating and any improvement that can be made would be most welcome. I don’t like taking medication and am a little concerned about what i will be taking, and if i will take it permanently, but life has been very limited and anything that can make everyday things a bit more possible or less exhausting would be nice. I am trying not to get my hopes up, of course…

In ten years of illness, this is the first time a physical test has come back as abnormal. I wish i had had this early on so that i would have had something to wave at the people who said it was all psychological (the insurance company, in particular, i am looking forward to telling them!). Maybe i am getting ahead of myself, i have no piece of paper to wave or even appointment with the specialist as yet! But in the couple of minutes she spent with me she seemed to be speaking as if she thinks i have it. Reading about it certainly rings true, especially now that i know what my heart is doing. She asked me if i ever noticed my heart beating fast when i stand up, i said no! It is not pounding away heavily or anything, just faster, and who knows what is normal without actually focussing on it. I have noticed it, but mostly when lying down, i think just because it is quiet, maybe the pressure on my pulse of the pillow etc etc. maybe it takes a while to calm down/recover to a normal rate after lying down…

Since i got home from the hospital, i stood up against the wall and took my pulse for 15 seconds after one minute of standing: 31 beats (124 beats/min), then i took it after 5 minutes and it was still 29 beats (116), so it obviously does not just happen when i first stand, but continues for a while… i rarely can stand for much longer than that anyway! Over 120 beats per minute is tachycardic apparently, so when i initially stand it is over that, over 100 beats per minute is still seen as abnormal.  Even though i knew there was something wrong, it was quite a shock to know that my heart is doing that. Now i know it is, it seems so obvious and i notice it a lot, although i am trying to ignore it!

I am a little confused about the diagnosis, as the symptoms, likely causes etc are so similar to ME, that there must be connections. Do i even have CFS/ME? I think so, as i am not sure that i have had POTS for the last ten years… it has maybe just developed over time or become bad enough to qualify as “POTS” but maybe have had issues in this department throughout the illness? Who knows. The lightheadedness and dizziness i think has never been as bad before as in the last couple of years, but has been present at times. This website speaks a bit about the connection…

Chronic Fatigue Syndrome (CFS), also known as Chronic Fatigue Immune Dysfunction Syndrome (CFIDS), is somewhat related to POTS, at least in terms of a similarity of many of the secondary symptoms. In Europe CFS is called myalgic encephalomyelitis (ME). Orthostatic intolerance, a broad title for blood pressure abnormalities such as neurally mediated hypotension (NMH) and POTS, is a common symptom of some types of CFS. Neurally mediated hypotension refers to patients who get lightheaded when standing due to a defect in their nervous system’s regulation of blood pressure. Patients do not need to develop tachycardia to qualify for a diagnosis of NMH. The Center for Disease Control now estimates that over 1,000,000. Americans have CFS. Various studies suggest that more than one 100,000. Americans have POTS. Some percentage of patients have both POTS and CFS. The Center for Disease Control has found at least four distinct forms of CFS, and that some forms of CFS cause abnormal heart rate and blood pressure issues (POTS and NMH) while others do not.

Well, who knows… i look forward to having some questions answered when i get my appointment through. I hope it is soon.

Maybe this “new evidence” will help my DLA appeal as well… fingers crossed!

Well, bad news is that the benefits service who could have helped me have refused to take my case on for appeal… so if i want to carry on to appeal i have to go it alone… I am not sure what they would have done for me, but they would have come with me and helped me prepare for it, and possibly “represented” me in some way. Anyway going alone (with my partner) is a bit daunting. The reason they are not taking me on is that I do not have good medical support/evidence, and as my case stands it does not look very strong, as without medical backup they (DWP) have every reason not to believe me it seems. The service have limited resources so can’t take on someone in this situation. I have an appointment with my specialist in october so i am hoping that he will be very supportive so that i have a basis on which to continue to appeal (and to challenge what has already been said about me), but i am having real second thoughts about continuing. It is stressing me out! I know that if i don’t i will always be thinking, “what if i had carried on…” but i am left doubting how strong a case i have and my chances of success after this latest development, and it is a lot to put myself through for nothing. I suppose i will just carry on until i have seen the specialist and give up if he is not overly enthusiastic/supportive/articulate but i am so sick of all this now. I could rant on and on about it but i really can’t be bothered to waste my breath today!

Today was a day of such contrasts… i spent most of the day’s energy writing an email to my benefit’s adviser person about the DLA medical evidence they used to reject my claim, see below. No need to read it all but it gives a good idea of how much work/stress is involved in the Appeal, if i actually get that far…. and i got fairly stressed thinking about it all… on the other hand i have spent some lovely time in the back yard with my partner, the sky was so blue, it was so warm and sunny, i lay on my back and watched all different birds (starlings, gulls, pigeons, rooks, an unidentified possible bird of prey, swifts, a butterfly and some bees), several strange planes and a few familiar package holiday planes, a helium balloon (which floated about for ages from a tiny glinting speck to a large blob and from side to side), my plants were looking lovely and cobwebs shimmered in the heat. We played cards a bit and listened to some music and it made everything seem better.

So here follows the email, names edited…

…There are substantial differences between what the EMP had recorded about how i was/appeared and said to what actually was the case. I will briefly summarise these as it may be useful in justifying if we have a viable case. I will take  a note of obviously incorrect statements with me to Dr S too so that he will hopefully overrule them and assert that they are incorrect… no word from him as to an appointment date yet.
 
The report from my GP is not good, she has not even answered all the questions but maybe i should just wait and see if Dr S will be thorough and supportive, rather than go back for another couple of sentences from her? She has not even answered the question as to the severity, which the EMP describes as mild, which is ridiculous… I don’t know what to do about my doctor’s part.
 
OK:
Firstly, i did not get to answer all the questions fully as he did keep interrupting and moving on to new questions, so it is not a full picture, despite the meeting taking an hour, most time was taken up with repetition, him recording info on computer v slowly…
 
The summary in section 1, under Chronic Fatigue Syndrome J’s notes show that i talked about sensory overload as a main symptom (sensitivity to light, noise, movement in visual field). This affects me a lot and can affect my ability to sit in room with noise (TV/music) and often i have to lie in darkened room (i think i mentioned that to the EMP). Even when not severe this symptom can lead to me finding a taxi ride very draining and stressful, dealing with the momentum, radio, listening to chatty driver, etc and these symptoms do prevent me from going out and contribute to physical stress & fatigue/feeling unwell.
 
In medication i explained to him that i take Boots Tension headache tablets with codeine and muscle relaxant and at the time he said “paracetamol?” and i corrected him, saying that they did contain paracetamol but also codeine etc and he has recorded it as simply paracetamol… J’s notes also show here that i talked about my sharp nerve pains in my forehead that flare up sometimes, where i had Tri-geminal Neuralgia. he has not noted this anywhere.
 
on page 3 – client’s reported impairments and functional restrictions incl response to current treatment
J’s notes show that i stated that walking is VERY draining and that i need to lie down before and afterwards. He also asked me if i have good days and i said that they have greatly reduced as time has gone on, this is not in report.
He report states that “current treatment for CFS slightly improves the condition” I have no idea what this refers to as i am not receiving treatment. He asked me at one point if the painkillers i take work and i said to some extent, but this does not improve my functional abilities, I still have all the major symptoms/problems!
 
In the summary of typical day: again he had omitted that i have to spend a large proportion of the day in bed resting between tasks in order to get through the day without major flare up and effects in following days. He again asked me about my typical day but before i could answer he just asked lots more questions about my day rather than allowing me to explain. I became dizzy and very lightheaded while trying to answer these questions and asked for a pause at this point, as i was finding it hard to assert myself, be listened to, project my voice and felt quite weak and distressed. I explained that i do not get up, get washed, dressed, etc all at once and that i do the bare minimum (pj’s and teeth) before breakfast, then may deal with washing (bath etc) later if i feel well enough, which i often do not, or it takes a huge proportion of daily energy. After trying to explain about hair washing and being cut off within the first few words i started to cry, and although j’s notes do not show this i explained to him that i was finding it very hard to explain clearly as it was talking a huge amount of effort to speak and every time he interrupts is making it even harder as he did not seem to let me speak/listen to me. He did apologise but from this point on i was feeling very ill and was visibly shaking through the exertion/effort of being there. I also explained to him that my back was causing me a lot of discomfort /pain and i kept having to sit forward/shift position as the chair was not supportive.
 
(On page 5 it says that i sat still through 45 minutes… this is very incorrect.)

Still on p3 it says i can use a computer without difficulty – i did not say this, i said that i can use it for limited time, that i get blurred vision and limited concentration when reading, and that i can get sensory overload symptoms when using it. I also said here that i often just sit quietly, and am not always able to be doing something. None of this was recorded by EMP.
 
It also says i do not fall. I explained that i sink down to the ground, or have to sit/lie down on the ground but do not fall suddenly or in a way that could hurt me (a controlled fall)
 
Page 5:
hands not shaking (my body was so i think my hands probably were a bit as well – my legs were trembling through most of interview)
does not look tired – felt absolutely awful and cannot believe that i looked ok
 
mental state:
here is says i sat still – i was not sitting still at all – but this seems to be the mental assessment and my reasons were physical.
 
Spoke at normal rate/volume – i was having great difficulty speaking and getting through the questions. it was using a huge effort/amount of energy and making me lightheaded.
 
page 7:
no neck tenderness – very precursory feel about neck was done – i always have neck tenderness and can feel “grating” when i turn my head.
 
page 11: sat in upright chair for 45 mins without obvious discomfort  not only was i frequently changing sitting position, often leaning forward as no support for upper back on chair, i stated more than once that i was in discomfort. he asked me straight out if my back was painful during physical exam and i said yes.
 
walked 30 m very slowly to examination room. However this was inconsistent with other available evidence
balance observed as unsteady, However this was inconsistent with other available evidence
I felt very weak and was finding it very hard to walk, particularly by the end of the visit, where J was supporting me on one side and i had stick on other side as i left the examination room. I had refused to stand for physical exam as i felt unable and was feeling very weak and dizzy by this point. What other evidence?
 
I had no difficulty understanding the customer’s speech 
I had to repeat myself and correct him over and over again and still at the end when he summarised he had recorded things wrongly that had been repeated earlier. He misheard me several times due to my lack of ability to project my voice, j had to repeat things i had said for me.
 
page 12:
physical summary completely disagree with. My condition is not mild.
Medication does not improve level of function at all.
i have more than mild disability and there is not way i could cook and care for myself on a daily basis.
 
the degree of variability described by the client is unlikely  it took me a full week to recover back to any level i consider to be “normal” for me after that examination, which i found to be so stressful and drained me of all energy reserves. My level of functioning went down so that i was basically bed-bound for most of the day, managing only to get up to use the toilet and to sit downstairs for meals. I felt very ill and found it very hard to concentrate on anything, think straight, stand or move around the house. My whole body ached and felt very heavy and cumbersome. I have very sensitive points on my scalp and tension type muscular headache for several days. I was not able to bath etc as much as i would have like to, and the couple of times i had to take the dog out i almost crawled across the road, sat on the bench opposite while she did her stuff, then crossed back over and it was a major trauma. I felt very unsteady and dizzy.
 
How can i ever prove it though? If i have been asked to go to the medical in the days after i would not have been able to go AT ALL. If i had to do everything for myself just getting through most days would be overdoing it and would result in flare-up after flare-up. This is why i think i do meet the criteria. I have no control or say in having to go to appointments etc which make me overdo it in this way. Sometimes i have a flareups due to viruses, hormonal changes etc that again i have no control over. These flareups happen regularly and are part of the condition. even when not in this emergency situation i still cannot go out much or for long, have to plan any walking or to avoid it where possible, have quiet places to rest planned etc just to make normal things possible, which largely they are not.
 
Small rant there, but unless i say, how can it be used as evidence?
 
Page 13: discomfort, pain, breathlessness on walking: they say not enough to significantly restrict my mobility… my mobility IS significantly restricted If i want to go to the shop and i know i have to take the dog out i have to combine the two tasks, and it is a very short walk… how bad do i have to be? even that short walk is a struggle. Standing to pay for something in shop is very hard and if more than one person ahead in queue i have to leave and not get the item.
 
Does the client need to halt? If i stop and rest on a bench this helps a lot but if i stand still, it is worse than walking slowly due to symptoms of orthostatic intolerance. Often i sit on bench and feel so lifeless and heavy in limbs i really struggle to get up and get home. Saying no contradicts that i told them i do need to stop often when walking.
 
Page 15 – Risk of falls
i have already told them i am at risk of falls due to dizziness and that i do HAVE to sit/lie on occasion or feel so weak that i feel faint.
 
Attention needs:
Peel/chop – i would find this very difficult on bad days when feeling weak
hot pans –  same as above
i always sit if doing any kitchen prep and do find it very draining – i do it very rarely.
take bath/shower – i cannot shower as cannot stand well. I am not always able to have a bath when needed as major effort. always lie down afterwards.
 
page 17 – communicated without difficulty during examination – not true – i directly said i was finding it hard and was visibly distressed by effort and voice was quiet.
 
If i can get something supportive out of Dr S i will carry on, but i can see your point about the appeal without more medical evidence/support. How can i demonstrate how bad things can be? The more articulate i am the more people think i am ok, but i need to be because people do not seem to get it/listen/understand.
 
I am totally exhausted now but had to write this to give you something else to go on with welfare rights people… This is really stressing me. Tried to leave it and rest but could not stop thinking about it so maybe now that i have written this i can sleep a bit. trying to rest up for wednesday but not feeling too good now!
 
Is any of this inconsistency useful for our case? Please GOD!

ME/CFS Awareness

ME/CFS Awareness

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