Contents
- Requirements
- Presenting Problems (Hurdles)
- Chronic Fatigue Risk Assessment
- Acronyms
- Results Up Front – Protective Factors
- Risk Factors
- Poor Sleep
- Fatigue and Dementia
- CF 12 Items Screener
- Protective Factors Longitudinal
- Physical Fitness
- Anxiety and CF
- Riding in the car
- Drive Ability Evaluation
- Revisit – Riding in a car
- Hand Movement Disorders
- Lithium and Tremors
- Stimulants
Presenting Problems (Hurdles)
Anxiety while driving self
Caffeine
Do not need Abilify and Wellbutrin anymore
Fatigue and anxiety while riding in car with another driving
Gym and Exercise
Hands shake
Handwriting impaired
Legs shake while standing
Medication adverse reactions
Nicotine
Problems precision work on computers & Smartphones
Risk of Falling
Rule out Myalgic Encephalomyelitis (ME)
Sewing
Stimulants
Store number pads and card use
Weak in the knees
Writing
Commercial of the Shelf 12 Item Screener
– Calculations Not Here
CFS Chronic Fatigue Syndrome Risk Assessment Screen
ME/CFS Basics
Centers for Disease Control and Prevention | CDC (.gov)
https://www.cdc.gov/me-cfs/about/index.html
May 10, 2024
ME/CFS is a biological illness that affects many body parts. It causes
severe fatigue not
improved by rest, problems thinking and sleeping,
dizziness, pain,
CFS – Acronyms (Codes)
Results Up Front
Theme – Housing “Beds” & “GreatBeds” Sleep and Fatigue
Sleep Centered Protective
Factors - 17 Items
HSF = High Scores are Favorable
Self-scored by and for Keith “Buster” Torkelson MS
Shared with> Metadata >
05_HHL_Needs_Matters_20020202_Notes I
Sleep as a protective factor
Sleep acts as a powerful, biological "protective factor" against physical illness, mental health disorders, and cognitive decline. It serves an essential role in daily functioning, strengthening your immune system, regulating emotions, and mitigating the impact of stress.
Theme – Housing “Beds” & “GreatBeds” Sleep and Fatigue
Sleep Centered Risk
Factors – 15 Items
LSF = Low Scores are Favorable
Self-scored by and for Keith “Buster” Torkelson MS
Shared with> Metadata >
05_HHL_Needs_Matters_20020202_Notes I
Poor sleep as a risk factor
Chronic poor sleep (less than 7 hours per night or severely
disrupted sleep) is a major, modifiable risk factor for serious health
conditions. It significantly increases the likelihood of developing
cardiovascular disease, type 2 diabetes, obesity, depression, and cognitive
decline, while also weakening your immune system.
Immediate Consequences
Cognitive Impairment: Reduces judgment, memory retention, focus, and
learning ability, leading to higher risks of accidents.
Emotional Instability: Heightens stress responses, mood swings, and risk
of anxiety or irritability.
Long-Term Health Risks
Cardiovascular Disease: Short sleep alters heart rate variability and
blood pressure, elevating the risk of hypertension, heart attacks, and stroke.
Metabolic Issues: Disrupts hormones that regulate hunger (ghrelin and
leptin), increasing obesity risk and decreasing insulin sensitivity, which
paves the way for type 2 diabetes.
Immune Dysfunction: Prevents the body from producing infection-fighting
cytokines, leaving you more susceptible to illnesses and chronic inflammation.
Brain Health: Linked to the buildup of neurological markers associated
with long-term dementia and Alzheimer's disease.
Neurological Markers Associated with Dementia
Neurological markers for dementia include abnormal protein
accumulations (like amyloid-beta and tau), genetic predispositions, and
structural brain changes. These biomarkers—detectable through blood tests,
spinal fluid analysis, and imaging—allow clinicians to diagnose conditions like
Alzheimer’s disease years before clinical memory symptoms appear.
Fatigue and Dementia
Dementia fatigue is profound exhaustion or a lack of energy linked to
cognitive decline. It stems from physical changes in the brain that disrupt
sleep cycles, increased effort needed to process information, and
potential co-occurring medical conditions.
Causes
Brain Cell Damage:
Alzheimer's and other dementias can damage specific brain
cells responsible for wakefulness, disrupting the body's internal
clock (circadian rhythm).
High Mental Effort:
Simple daily tasks require intense concentration for someone with
cognitive impairment, which drains energy quickly.
Sleep Disturbances:
Insomnia, sleep apnea, or a reversed sleep cycle
(wandering at night, sleeping during the day).
Underlying Factors:
Medications, depression, dehydration, or infections like
Urinary Tract Infections (UTIs).
Management Tips
Establish a Routine:
Maintain consistent wake-up and bedtime schedules to reset their internal
clock.
Limit Naps:
Restrict daytime napping to short periods so they build "sleep
pressure" for the night.
Encourage Activity:
Light stretching or gentle
walks can improve circulation
and energy.
Simplify the Environment: Reduce background noise and clutter to lower
cognitive load.
Monitor Medications & Health: Review medications with a doctor and
screen for depression, pain, or infections.
Caregivers supporting a loved one can access educational tools, support
groups, and resources through the Alzheimer's Association to better
manage fatigue and daily care needs. If you are experiencing fatigue
yourself, you can find local resources and support options via the Eldercare
Locator.
Chronic Fatigue 12 Items Screener
Metadata >XLS - Assess_CFS_17081002_Scorer 12 Item V2025
Scored by and for Keith “Buster” Torkelson, MS
LSF = Low Scores are Favorable
Protective Factors
Buster rates Self (SS)
Fatigue Protective Factors Score – 17 Items
Positive Scoring –
Protective Factors - Good Things
HSF = High Scores are Favorable
Protective Factors
Buster rates Self (SS)
Fatigue Protective Factors Score (HSF) – 17 Items
Positive Scoring – Protective Factors - Good Things
Signs of Fatigue Deficits Evaluation (SFDE 15 Item)
Risk Factors
Impact of others on Buster
Fatigue Risk Factors Score (LSF) (FRFS) =
Negative Score – Risk Factors - Unfavorable Things
Signs of Fatigue Deficits Evaluation (SFDE 15 Item)
Risk Factors
Impact of others on Buster
Fatigue Risk Factors Score (LSF) (FRFS)
Negative Score – Risk Factors - Unfavorable Things
Tandem with behavior change (Gym
Subsidy)
Tandem, or paired, gym subsidies and behavior change interventions are
designed to boost physical activity by adding social accountability to
financial incentives. Research indicates that requiring friends to attend the
gym together to receive a reward (a "tandem-reward condition") is
more effective at fostering attendance than individual incentives alone, increasing
visits by approximately 35% more
frequently than standard rewards.
Planet Fitness without Classes
Planet Fitness offers a "Judgement Free Zone" focused on
self-guided workouts using extensive cardio and strength equipment, rather than
traditional
group classes. Memberships (starting around
$15/month) include free, on-demand training in the Planet Fitness App, QR-coded
machine tutorials, and optional, small-group "PE@PF" training
sessions led by certified trainers.
Aside - Fitness As Measured By (AMB)
- Gym
- Yoga
- Machines
- Not having to use walker or wheelchair
- Running
- Swimming
- Weight
- Walking
Does the gym help with chronic fatigue?
“Our studies clearly show that dynamic exercise like walking or jogging
exacerbates symptoms associated with Myalgic Encephalomyelitis/CFS.” ~J. Mark
VanNess, Ph.D.
Exercise
The best exercises for Chronic Fatigue Syndrome (CFS/ME) are gentle,
low-intensity activities that focus on pacing to avoid post-exertional malaise
(PEM), including gentle
walking, restorative yoga, stretching, swimming, or light water exercise. Crucially,
exercise must remain within your energy budget to prevent relapses, starting
with as little as 1–5 minutes a day.
MSG CFS Assessment Tools
MSG-CFS-17-Item (Protections) & MSG-CFS-15 Item (Risk Factors)
Databases > Metadata >
Assess_CFS_Exam_16082803_Scorer (XLS)
Assess_CFS_Exam_16082803_KET (XLS)
Assess_CFS_Exam_17013003_KET (XLS)
Goes with Diagnostic Assessments
Fatigue Factors
Chronic fatigue (ME/CFS) stems from various factors like infections
(COVID-19, Mono), immune issues, genetics, extreme stress, and energy metabolism problems, but also can stem
from common conditions like anemia, thyroid issues, depression, sleep apnea,
diabetes, or medication side effects, requiring medical evaluation to rule out
other causes.
Anxiety and Fatigue
Anxiety fatigue is extreme physical and mental exhaustion caused by chronic stress, hyper-alertness, and high cortisol/adrenaline levels. It often
results in muscle weakness, sleep issues, and low energy, sometimes described
as an "anxiety hangover". Managing it involves treating the
underlying anxiety through relaxation techniques,
therapy, regular routines, and improving sleep hygiene. Constant
Fight-or-Flight: Anxiety keeps the body on high alert, causing the nervous
system to burn through energy, leading to a crash once adrenaline wears off.
Situational Anxiety and Fatigue - Uncomfortable
Riding in the Car
Anxious riding in the car, known as amaxophobia, involves fear or panic while being a passenger or driving, often triggered
by fear
of accidents, loss of control, or feeling
trapped. Symptoms include rapid heart rate, sweating, and dizziness. Coping
strategies include exposure therapy, deep breathing, calming music, and seeking
professional help.
Amaxophobia
Amaxophobia is an intense, irrational fear of driving or being a passenger in a vehicle, often
referred to as traffic phobia or vehophobia. Symptoms include panic attacks, rapid heart rate, sweating, and nausea, causing
many to avoid cars. Common causes include past accidents, traumatic events,
or anxiety over losing control. Treatments include Cognitive Behavioral Therapy (CBT) and exposure
therapy.
Exposure Therapy
Exposure therapy is a highly effective form of cognitive behavioral
therapy (CBT) that helps individuals safely confront the objects, situations, or memories they fear. By
repeatedly facing these triggers in a controlled environment, patients learn to
overcome the avoidance
patterns that typically make anxiety
worse over time.
Response to Speeding
When riding in a speeding car, prioritize safety by calmly asking the
driver to slow down. If they refuse, use phrases
like "I feel uncomfortable" or "I need you to slow down," set boundaries, or ask to be let out. Avoid creating drama, keep
your seatbelt on, and report dangerous, reckless, or impaired drivers to the
police.
Boundaries while riding in a car
Setting boundaries while riding in a car involves both physical safety
(lane
positioning) and interpersonal behavior
(passenger conduct). Key practices include maintaining lane center using
reference points, keeping at least a 3-second following distance, and ensuring
passengers avoid distractions, such as loud noises or sudden movements. Effective
communication is essential for managing passenger behavior, especially with
children or teens.
Are speeding, excessive lane changes, and tailgating dangerous?
Yes, speeding, excessive lane changes, and tailgating are highly dangerous behaviors, classified as aggressive driving that significantly increases the risk of accidents. These actions cause roughly 90% of vehicle crashes, often resulting in severe injuries or fatalities.
Describe Aggressive Driving
Aggressive driving is the operation of a motor vehicle in a manner that endangers or is likely to endanger people or property, often involving deliberate, unsafe behaviors. Common acts include speeding, tailgating, weaving through traffic, failing to yield, and ignoring traffic signals. It is distinct from, but can escalate to, road rage.
Close calls while driving
A driving close call—or near miss—is a terrifying incident that avoids a collision but highlights potential dangers like distracted driving, bad weather, or other drivers' mistakes. These moments often leave drivers shaken, with common reactions including adrenaline surges, fear, and anxiety. It is crucial to pull over, breathe, and reflect on the experience to improve safety.
Close calls while a passenger in a car
Close calls as a passenger often stem from driver distraction, including heated conversations, texting, or navigating, which can lead to near-misses like running red lights, drifting lanes, or abrupt braking. Passengers can mitigate risks by encouraging focus, assisting with navigation/phone tasks, or bracing during sudden maneuvers.
Abrupt Braking
Abrupt braking is a sudden, forceful deceleration of a vehicle. It frequently causes rear-end collisions, damages brake rotors, flattens tires, and wears down your drivetrain. It can be triggered manually by the driver (slamming on the pedals or brake checking) or automatically by a vehicle's malfunctioning collision sensors, known as "phantom braking"
Driving considering the safety of the passengers
Ensuring passenger safety requires drivers to buckle everyone up, follow proper car seat regulations, and maintain focused driving. Key measures include keeping kids in the back seat until age 13, avoiding distractions, and managing speed, as unbelted passengers can cause fatal injuries to themselves and others. Passengers can assist by navigating and avoiding distracting behaviors.
Riding with…
Special Presenting Problem – Worry While
Driving
Safe Driving Assessment
Rate Driving Performance
Every time you get behind the wheel of a car, you must decide how
to react to other vehicles and drivers,
traffic signs and signals, highway conditions and your vehicle’s performance –
and often take quick action. Would you like to know your driving performance?
Drivers 65 Plus
Drivers 65 Plus is a brochure that features a 15-question
self-rating driving assessment exercise designed to help you examine your driving performance. After
answering the questions, follow the instructions to calculate your score and
get information about your driving performance. The driving assessment will
list your
strengths and weaknesses, along
with suggestions for how to improve your driving.
https://exchange.aaa.com/wp-content/uploads/2021/03/Driver-65-Plus.pdf
Scored by and for Keith “Buster” Torkelson age 67
Notes
20260419-SU-Redondo
I stopped at the wrong limit line in a complex intersection.
20260606-SA and 20260607-SU-Redondo
Got everything correct.
CFS & Sleep Issues > Metadata >
Aside - Problem Solving – Coping
Tool – SMART
SMART is a mnemonic acronym, giving criteria to guide in the setting of
objectives, for example in project management, employee-performance management
and personal development. The letters S and M usually mean specific and
measurable. Possibly the most common
version has the remaining letters referring to achievable,
relevant and time-bound.
However, the term's inventor had a slightly different version and the letters
have meant different things to different authors, as described below.
Additional letters have been added by some authors.
20260620-SA-Plan
- Mindful caffeine
- Mindful nicotine
- Gym
- Avoid riding with aggressive (reckless) drivers
- Let medication ride for now [20260729-W-Lithium Discontinued by Doctor]
- Less OTCs
- Walking
- Vitamins
Special Content – Riding with an overly aggressive driver
Riding with an overly aggressive driver is highly dangerous. To protect yourself, stay calm, avoid reacting to others on the road, and focus on de-escalating the situation. If you feel unsafe, clearly communicate your fear, ask them to pull over, or request to get out of the vehicle at the next safe opportunity.
Avoiding riding with a reckless driver
To avoid riding with a reckless driver, never get into the vehicle if you suspect unsafe behavior, and establish clear boundaries. Protecting your physical safety always takes precedence over polite social conventions or temporary awkwardness. According to safety resources like AAA and legal experts Norton & Spencer, passengers account for nearly a quarter of all traffic fatalities. Taking proactive measures can save your life.
What is a reckless driver?
A reckless driver operates a vehicle with a willful or wanton disregard for the safety of people or property. It goes beyond simple negligence or a careless mistake, representing a conscious choice to engage in dangerous behaviors that put everyone on the road at serious risk.
Common Behaviors
A driver is typically considered reckless if they exhibit one or more of the following actions:
Excessive Speeding: Driving significantly over the posted speed limit (often 15 to 20 mph or more) or driving at speeds that are unsafe for current weather and traffic conditions.
Aggressive Maneuvering: Weaving aggressively through traffic, swerving between lanes, or failing to signal.
Tailgating: Following the vehicle in front too closely, preventing adequate reaction time.
Disregarding Signals:
Running red lights, stop signs, or ignoring railroad warnings.
Street Racing:
Participating in unauthorized speed contests on public roads.
Impaired Driving:
Operating a vehicle while under the influence of drugs or alcohol.
Aside - Riding in Car with Aggressive (Reckless)
Driver
I have been telling KTL no to riding with him. It is his preference to drive aggressively
and I tire of reminding him. He speeds, tailgates, brakes hard, and makes
frequent lane changes. These actions
make my adrenaline go up and down. So rather
than fighting I am fleeing.
Hand Movement Disorders
Hand movement disorders are neurological or muscular conditions that cause uncontrollable, involuntary, or poorly coordinated movements in the hands and fingers. They range from common rhythmic shaking and spasms to erratic jerks, often signaling underlying brain or nerve issues.
Common types of hand movement disorders include:
1. Tremors
The most common type of movement disorder, tremors involve involuntary, rhythmic, and oscillatory shaking of the hands.
Essential Tremor:
Shaking that typically becomes most noticeable when the hands are actively being used (e.g., writing or holding utensils).
Parkinsonian Tremor: A "resting tremor" that looks like pill-rolling between the thumb and forefinger; it occurs when the hands are relaxed and often lessens with movement.
Intention Tremor:
A coarse shaking that becomes worse as the hand gets closer to a targeted object (e.g., reaching for a glass).
2. Dystonia
Neurological conditions causing involuntary muscle contractions that force the hands or fingers into repetitive, twisting movements or abnormal, sometimes painful postures.
Focal Hand Dystonia: A task-specific dystonia (often called "writer's cramp" or "musician's cramp") where the fingers curl or lock when performing a highly practiced movement.
3. Chorea
A disorder that causes brief, erratic, and unpredictable jerking movements that migrate from one muscle to the next, often appearing like a dance or excessive fidgeting. It is a hallmark of progressive conditions like Huntington's Disease.
4. Myoclonus
Characterized by sudden, rapid, brief, shock-like contractions of a muscle or muscle group in the hand or fingers. They often result in sudden involuntary flexion or extension of the hands.
5. Dyskinesia & Tics
Dyskinesia: Diminished voluntary movements paired with involuntary muscle activity. A common type is Tardive Dyskinesia, which causes repetitive, uncontrollable jerking movements of the hands, fingers, or face, frequently as a side effect of long-term medication use.
Tics: Sudden, repetitive, and brief movements (or vocalizations), primarily seen in Tourette Syndrome, which can cause sporadic twitches or purposeless hand gestures.
6. Ataxia
A lack of voluntary coordination in muscle movements, leading to clumsy, unsteady hands and poor fine motor control.
7. Alien Hand Syndrome
A rare neurological disorder where a hand operates completely independently of the person's own will, sometimes performing complex tasks or even acting in opposition to the other hand.
FAQs
What specific triggers make the hand movement worse?
Is it affecting one hand or both?
What does the uncontrolled movement look like? (e.g., shaking, twisting, or jerking)
Generative AI - If you describe the specific type of movement and when it occurs, I can help you find more targeted information or resources for management.
Does Cogentin help with tremors and dyskinesia?
Cogentin (benztropine) is highly effective for treating tremors and general muscle rigidity caused by Parkinson’s disease or medication-induced movement disorders (like pseudo-Parkinsonism). However, it does not help with true tardive dyskinesia and can actually worsen its symptoms.
Lithium and Tremors
Lithium tremors are a very common, often benign side effect of lithium therapy, typically presenting as a fine, symmetrical shaking of the hands. While often mild, they can worsen with voluntary movement, stress, or caffeine. In some cases, they are an early warning sign of lithium toxicity.
Why They Happen
Therapeutic Effects:
Tremors occur in 4% to 65% of patients, often appearing when initiating treatment or adjusting the dosage, and usually improve as the body adjusts.
Toxicity:
If tremors appear suddenly after a long period without them, or if they are severe, they may indicate elevated or toxic lithium levels.
Managing the Tremors
If tremors are bothersome, the following strategies are commonly utilized:
Dosage Adjustment:
Doctors may lower the dosage or switch the medication to a once-daily extended-release version.
Lifestyle Changes:
Reducing caffeine intake and ensuring you stay well-hydrated can significantly decrease the intensity of the shaking.
Medical Intervention:
If conservative measures fail, prescribers frequently manage the side effect with beta-blockers (like propranolol).
Tremor management – Eliminate Lithium or add cogentin
When managing lithium-induced tremors, neither eliminating lithium on your own nor adding Cogentin (benztropine) are generally recommended first steps. Abruptly stopping lithium can trigger withdrawal or mood instability, while Cogentin is specifically for antipsychotic-induced parkinsonism and can worsen lithium tremors or cause cognitive side effects.
What causes shaky legs?
Leg shaking is usually a harmless response to stress, an excess of stimulants like caffeine, or a habitual physical outlet for nervousness. However, when persistent or uncontrollable, it can signal an underlying medical issue such as Restless Legs Syndrome (RLS), a nutritional deficiency, or a neurological disorder.
Common Causes & Triggers
Anxiety and Stress: The body’s "fight or flight" response releases adrenaline, causing muscles to tense up and potentially triggering involuntary tremors or shaking.
Stimulants:
Excessive caffeine or the use of certain medications (such as asthma inhalers, decongestants, or some antidepressants) can induce a temporary tremor.
Restless Legs Syndrome (RLS):
This condition causes an irresistible urge to move the legs, often accompanied by tingling or crawling sensations. Symptoms typically worsen at night or during periods of inactivity.
Nutritional Deficiencies:
Low levels of magnesium, potassium, or iron can lead to muscle twitches and tremors. (e.g., Shaky-leg syndrome and vitamin B12 deficiency).
Is nicotine a stimulant?
Yes, nicotine is classified as a powerful central nervous system stimulant. When it enters the body, it causes a rapid surge of adrenaline and dopamine. This triggers several immediate physical and mental effects.
Steady state nicotine
Steady-state nicotine refers to the point where the amount of nicotine entering your bloodstream equals the amount your body clears or metabolizes, creating stable, consistent plasma levels. Because nicotine has a short half-life of about 2 to 3 hours, achieving a steady-state usually requires continuous or very frequent dosing, typically seen with transdermal patches.
How come the patch does not substitute for smoking?
Nicotine patches do not fully substitute for smoking because they only address the physical addiction by slowly releasing nicotine through the skin. They fail to replicate the behavioral rituals, immediate brain satisfaction, and psychological coping mechanisms associated with the habit.
