"Too tired to teen" in The Art of Paediatric Medicine Beyond the Evidence Base: Clinical Pearls from Experienced Clinicians, 2025, Lubitz

Dolphin

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Table of contents (89 chapters)

 
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Useful management strategies include:

[...]

Graded exercise with management of "burst and bust" cycle.

In summary, the approach to CFS management is:
  • recognise it early and start an intervention program.
  • believe the child/adolescent.
  • offer a clear explanation to the child and family.
  • use medications as needed.
  • assist with a rehabilitation approach with graduated return to activities in a very carefully controlled way.
  • always maintain optimism of recovery as the prognosis of CFS in childhood is good.
 
Wow. I had to double check that this was in fact published in 2025.

Beyond the evidence base? Undoubtedly. The art of medicine? Please, go draw some pictures of old-world hospitals or something. This here is incompetent nonsense.

Why always maintain optimism for recovery if the prognosis is good? What difference would it make?

The critical start to the management of the patient is to 'believe' them.

And there we have it, fully on display, with scare-quotes. Lie to your patient. Bullshit them and yourself. The art of medicine looks increasingly like the art of the deal.
 
Graded exercise with management of "burst and bust" cycle.

But graded exercise IS the burst preceding the bust. The point is explicitly to get the patient to push into the symptomatic zone and stay there to habituate themselves more and more to PEM, in the misguided idea that PEM is merely a state of distorted perception of bodily sensations that can be fixed through graded exposure.

The critical start to the management of the patient is to 'believe' them.
I suspect the believing would end as soon as the patient says GET is harmful or not working.

The demand by adults to push through the illness as adolescent is dangerous because of the power imbalance in the relationship. The adults will be in a position to force the adolescent to keep overexerting and crashing and to carry all the responsibility for failure while having little ability to make indipendent decisions. The end result of this can be devastating, and result in exactly the scenario that the guide here is trying to prevent.

The demand to keep overexerting and the resulting crashes will form a series of failures that teach the adolescent that any attempt to better their situation is futile. It is the result that teaches, not the intent behind it. If instead the limitations are acknowledged and accomodated for, and the adolescent has permission to be sick and do less, then they will be able to keep participating in life, although at reduced capacity.

The unwillingness to accept that there is a disability that cannot be controlled, only accomodated, is at at the root of many problems. It is this unwillingness that causes a significant portion of the disability because it consistently leads to attempting to do things in a way that cannot work. A sick person cannot behave like a normal person and gradually trying to behave more and more like a healthy person won't cure any illness. Presumably the misguided belief that it would is the result of confusing ongoing sickness and disability with habituation to a level of sickness and disability that are no longer present (the belief the patient has recovered and just needs to get used to normal life again).
 
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