What is the ETeam

 

Rationale

One of the most frustrating experiences for people with the above disorders (ME/CFS, FM & MCS) is the absence of objective findings validating the subjective illness experience.  Some of the symptoms such as pain and fatigue are internal experiences.  Other symptoms such as irritable bowel and sleep disorder are overlooked as benign by many practitioners because they are not progressive or lethal.  The lack of objective measures can lead to patients’ experiences not being believed by others.  The ETeam offers assessments which may validate patients’ experiences.  All of the assessments offered by the ETeam are evidence based, validated tests.

Our multidisciplinary team members work independently and then share information with each other to provide an integrated report outlining strengths and deficits in a broad range of areas relevant to ME/CFS, FM and MCS.  The medical/psychiatric and cognitive aspects form the core of the protocol.  The other components (vision, hearing, QEEG and exercise capacity) are optional and dependent on a client’s symptoms.

Protocol Components

The medical and psychiatric assessments will be completed by Eleanor Stein MD FRCP(C).  She will undertake a focused history of the presenting symptoms and a careful review of symptoms to rule out other causes of the problems.  This includes a psychiatric interview to establish whether psychological and/or psychiatric issues are a part of, secondary to or independent of the physical health problems.  She will make DSM-5 (psychiatric) diagnoses if appropriate and will rate the degree of disability using the WHODAS 2.0.  This assessment provides context to aid in the interpretation of the other assessments.  The detailed report may include: recommendations for further testing, general management suggestions and recommendations specific to each individual. The report will be sent to the patient and the referring physician.  Dr. Stein provides follow up to the referring physician by phone on request.

The psychological assessment including cognitive tests will be administered by Mr. Gerard Alberts M.Ed., R.Psych or Mr. Robert Hadden M.Ed. M.Sc., R.Psych both with extensive experience in psychometrics and other aspects of psychological evaluation.  Cognitive effects are among the most disabling symptoms of those suffering from ME/CFS, FM &MCS. Psychometric testing can provide valid and reliable data.  Well-established, standardized tests and procedures are used to provide objective measurement of: working memory, mental processing and other aspects of verbal and nonverbal performance. The cognitive assessment is the most time-intensive component of the multidisciplinary assessment. Testing sessions can be arranged to suit one’s schedule and energy level. A report of findings is provided with recommendations for improving workplace performance and/or quality of life.

Dr. Diana Monea (optometrist) will conduct a complete eye-health assessment. The effects of ME/CFS and FM on vision are frustrating and chronic. Since 80% of what we learn is through vision, visual impairments effect every waking moment and may impact work, study or parenting.  Visual symptoms may include: dry eyes, sensitivity to lights, fluctuating and fading of vision, eye pain, loss of vision or color vision changes.  The visual consultation involves digital documentation of the corneal map for dryness, retinal photos for signs of eye disease, refractive testing, and visual fields to determine any visual loss.  All assessment results are stored digitally and can be e-mailed if necessary to treating professionals.

Dr. Anne Woolliams (audiologist) offers hearing, auditory evoked potential testing and tinnitus assessments. The effects of ME/CFS and FM on the auditory-vestibular system can be subtle to severe.  ME/CFS, FM and MCS can affect balance, equilibrium, auditory processing and tinnitus (ringing in the ears).  She is one of few audiologists in Canada trained in assessment and treatment of tinnitus.

Stuart Donaldson PhD psych and Chris Rozell MC, R.Psych offer QEEG and Psychophysiologic Stress Testing.  QEEG is a form of assessment which measures the electrical activity of the brain in real time. The goal is to determine the type and level of activity at each brain location, and measure the connectivity between locations. Psychophysiology Stress Testing – Using the Thought Technology system monitors an individual’s heart rate, breathing rate, sweat response, muscle responses, and temperature while they complete a number of exercises that are designed to be challenging. The level of each physiological response provides objective evidence that may relate to symptoms and can provide clear goals to make treatment more efficient/effective.

Dr. Stuart Donaldson is a recognized expert in QEEG and Brain Biofeedback. Dr. Donaldson has published research on using Electromyography (EMG) in Fibromyalgia. His interest in Chronic Pain goes back many years. Chris Rozell is a provisional psychologist training with Dr. Donaldson with a keen interest in interpretation of QEEGs and helping people function better.

Cory Fagan M.Sc. offers the Two Day CPET (Stevens) protocol for ME/CFS and incremental blood lactate testing.  Mr. Fagan is a kinesiologist and owner of TCR Sport Laboratory in Calgary. Although TCR’s primary clientele are athletes, Mr. Fagan has a background and interest in chronic illness including cancer survivors and patients with ME/CFS and FM. Incremental Blood Lactate testing determines anaerobic threshold and exercise capacity.  Cardiopulmonary Exercise testing is the gold standard to determine exercise capacity.  It includes objectives measures of effort.  Clients can attend for a traditional one-day test or the specialized two-day exercise test protocol (Stevens Protocol). The two-day protocol, if positive, offers confirmation of post exertional malaise the core symptom of ME/CFS. Mr. Fagan provides a detailed report including recommendations for incremental training based on individual capacity.

Referrals

You can contact the ETeam yourself but you will need a physician’s referral before proceeding with the evaluation.  For medico-legal assessments, the referral must come from your Legal representative.  Our equipment and test selection is designed specifically to assess function related to ME/CFS, FM & MCS.  We do not accept referrals for neuropsychology or for other unrelated disorders affecting cognition such as head injuries or neurological disorders.  In most cases we will be able to confirm whether you have objective findings consistent with ME/CFS, FM or MCS.  However, cognitive testing cannot prove the cause of your condition nor can it predict whether your symptoms will improve with time.  We don’t find objective evidence of dysfunction in everyone.

The Procedure

For most clients, the first step will be an appointment (in person or by phone) with Gerard Alberts or Robert Hadden to discuss your objectives and decide whether an ETeam assessment could help you meet those objectives.   Please let us know up front if there is a chance your test results may be used in any legal action.  Next Dr. Eleanor Stein will talk to you and/or your physician by phone to help you select the tests which may be most helpful to answer the clinical questions you have.  If after this screening you decide to go ahead, you will be sent a package of questionnaires.  When these are returned we will book your assessment.  For those from out of town, you will need to be in Calgary for a full week.  The ETeam protocol requires approximately 12 – 15 hours of in person assessment time with the various team professionals.  After you have completed the entire assessment, the team members will exchange information and meet to discuss their findings with respect to you.  Please allow up to two months for this process especially if your assessment is before a holiday.

Outcome

You and your referring physician will receive a copy of our comprehensive report with diagnoses, test findings and management recommendations.  The information you receive may validate what you already know about yourself but have been unable to quantify or describe in objective terms.  In some cases, we will recommend further testing which may include further medical tests or neuropsychological testing.  The report will also include suggestions to manage and compensate for your symptoms.  Our group expertise and experience is diverse and we have liaisons with other practitioners who offer both conventional and complementary treatment options.  You may contact any team member (except Dr. Stein) for clinical follow up if you wish.  Dr. Stein is available to your referring physician for follow up.

Payment

The medical and psychiatric assessment (Dr. Stein) is covered by Canadian provincial health care plans.  The other assessments are not covered.  Most private insurance plans will pay a portion of these costs.  Upon request, we can provide you with a list of the test procedures to submit to your insurer.  In most cases there will be a substantial outstanding fee that will be billed directly to you, the client.  Half of the total fee is payable at the time you sign the informed consent to undertake the ETeam protocol and half is payable when you receive the final report.

Location

The ETeam is located in Calgary, Alberta though two of our members have offices in other cities as well (Anne Woolliams in Edmonton and Diana Monea in Regina).  If you will be coming from out of town to participate, Please allow at least one full week in Calgary.  You will need to book at least a month ahead to aid scheduling.  Other contact such as answering your questions about the protocol, informed consent and follow up questions can be done by phone and email.

We are very excited to be offering this much-needed service and look forward to hearing from you.