Rosenheimer Str. 6-8, 83043 Bad Aibling, Germany · info@clinicum-stgeorg.de
Treatment
ME/CFS treatment at St. George Hospital is an inpatient program of two to three weeks written from your findings: blood purification where autoantibodies or microcirculation findings support it, therapies for the energy metabolism and the immune system, and a schedule paced so that the program itself does not trigger post-exertional malaise.
Graded exercise made it worse. The antidepressant did nothing for the exhaustion. The last doctor was kind and had nothing left to offer. Somewhere along the way "manage your symptoms" became the whole plan, and you stopped expecting anyone to look underneath them.
This page describes what the inpatient ME/CFS program at our hospital consists of, week by week, what each therapy targets, and what the evidence does and does not show.
There is no single drug for ME/CFS because ME/CFS has no single cause. It is a syndrome in which several measurable dysfunctions interact: an immune system that stays activated, autoantibodies against receptors of the autonomic nervous system in a subset of patients, cells that cannot burn fuel efficiently, and a circulation that does not deliver under load. Treatment has to address the ones your work-up found.
The plan is written from those findings. Elevated receptor autoantibodies lead to immunoadsorption; microclot and endothelial findings lead to HELP apheresis; a measured energy block leads to IHHT, NAD+ and cofactor infusions; a reactivated virus is treated before the immune system is stimulated. Most patients have several overlapping findings and get a combined protocol. The ME/CFS work-up that precedes all of this is described on its own page.
The program runs two to three weeks as an inpatient, with daily treatments spaced so that the stay itself does not trigger post-exertional malaise. Patients with ME/CFS have a small energy budget, and the ward schedule is written inside it: a morning check with the physician sets the pace of the day.
For patients with elevated autoantibodies against β2-adrenergic or muscarinic receptors, immunoadsorption passes the plasma over a column that binds those antibodies and returns the plasma. A series of sessions over the stay; antibody levels are measured before and after.
For patients whose findings point to microclots and impaired microcirculation, often after COVID-19, HELP apheresis filters fibrinogen, inflammatory proteins and lipoproteins from the plasma. About two to three hours in a reclining chair with a nurse present.
IHHT trains the cells' oxygen handling in seated sessions; NAD+, CoQ10, alpha-lipoic acid, B vitamins, magnesium and glutathione are given intravenously to supply the cofactors the electron transport chain needs. Which deficits are targeted is read from the mitochondrial findings.
Thymus peptides, low-dose immunomodulation and natural killer cell support through immune therapy. For patients with a measured viral reactivation, an antiviral protocol comes first.
Whole-body hyperthermia at the low range of 38.5–39.5 °C / 101.3–103.1 °F in selected patients, never in the first week, with the physician present. It is an individual treatment attempt in ME/CFS, decided with you after medical consultation.
Microbiome-guided probiotic therapy, intestinal permeability repair and anti-inflammatory nutrition; liver and lymphatic support, and chelation only when heavy-metal testing indicates it.
| When | What happens | Who you meet |
|---|---|---|
| Before you travel | Free initial inquiry; records requested by the International Office; medical review and video call; written treatment proposal and itemized cost overview in EUR | Your physician and the International Office |
| Days 1 to 2 | Admission, blood draw, orthostatic and heart-rate testing, admission interview; rest | Attending physician, nursing team |
| Days 3 to 7 | Results arrive from the in-house laboratory; first low-intensity therapies (infusions, IHHT at low setting); plan confirmed from the complete picture | Attending physician, infusion nurses |
| Week 2 | Immunoadsorption or HELP apheresis series where indicated; immune therapy; autonomic training; baseline measurements repeated | Apheresis unit physician and nurses |
| Week 3 (where planned) | Second apheresis block or consolidation; mild hyperthermia in selected patients; home protocol written | Attending physician |
| Discharge and after | Letter to your physician at home, written home protocol; follow-up questions via the International Office; second cycle after three to six months for some patients | Attending physician, International Office |
Two to three sessions a day with generous rest between them. The schedule is adjusted each morning from how you slept and how the previous day's sessions landed, and a delayed worsening slows the plan rather than being pushed through.
The evidence that the illness has a biology to treat is moderate: post-exertional symptoms distinguish patients from healthy controls under controlled conditions (Mateo et al., 2020), and metabolic profiling has shown impaired pyruvate dehydrogenase function, a block in how cells burn fuel (Fluge et al., 2016).
The evidence for immunoadsorption is emerging. A pilot study removed β2-adrenergic receptor antibodies with immunoadsorption in ME/CFS (Scheibenbogen et al., 2018); a follow-up study examined repeat immunoadsorption (Tölle et al., 2020); an observational study and then a 2025 trial examined repeated immunoadsorption in post-COVID ME/CFS patients with elevated β2-adrenergic autoantibodies (Stein et al., 2023; Stein et al., 2025). For IHHT, NAD+ infusions and mild hyperthermia in ME/CFS the evidence is limited to mechanism and small series. None of these is standard care for ME/CFS; in our program they are individual treatment attempts, decided with you after medical consultation.
What the evidence does not show is which patient will respond, or for how long. We handle that limit by measuring: antibody levels, immune and autonomic markers before the first session and again in week two, and a laboratory schedule for your physician at home. For patients traveling from abroad, the stay from the first email to the flight home is described on the Long COVID and ME/CFS apheresis program page.
"We write our ME/CFS protocols around one rule: do not trigger post-exertional malaise. Every therapy, every schedule and every rehabilitation step is set inside the patient's energy budget, and the budget is measured, not assumed."
Medical team, St. George Hospital
Two to three weeks for the initial program. Severe ME/CFS can need a longer stay, which the physician says before you travel. A second cycle can be arranged after three to six months.
Two to three treatments a day with rest between them. A companion can stay, Munich Airport is 60 minutes by car, and the ward runs in English and German.
A written, itemized cost overview before anything is booked; see costs and insurance. You leave with a written home protocol and a letter to your physician, and follow-up questions go to the International Office; see how a stay runs.
There is no approved drug that treats ME/CFS itself. Treatment targets the mechanisms measured in each patient: autoantibodies and microcirculation findings with immunoadsorption or HELP apheresis, the energy metabolism with IHHT and NAD+ infusions, the immune system with immune therapy and antiviral protocols, the autonomic nervous system with pacing, vagus nerve stimulation and orthostatic training. The combination is decided after the work-up.
The schedule is built to avoid it: two to three sessions a day with rest between them, no exertion testing on arrival, mild hyperthermia only in selected patients and never in the first week, and a morning check with the physician in which the day's pace is set. If you notice a delayed worsening we slow the plan rather than push through it.
A series, spaced over the stay, and the number depends on the findings and on how you tolerate the first sessions. The published pilot and follow-up studies used repeated sessions over several days; your physician sets the rhythm with you and measures the antibody levels before and after.
You leave with a written home protocol: supplements, pacing rules, nutrition, and the laboratory schedule for your physician at home. A letter goes to that physician; follow-up questions, from you or from that physician, go to the International Office. Some patients return for a second cycle after three to six months.
Treatment is self-pay. After a physician has reviewed your findings you receive a written, itemized cost overview; the invoice is itemized so it can be submitted to a US insurer for out-of-network review. Details are on the costs and insurance page.
Removes receptor autoantibodies from the plasma over a series of sessions in our apheresis unit.
What immunoadsorption involves →Seated sessions of alternating low and high oxygen that train the cells' oxygen handling.
What IHHT training involves →Intravenous NAD+ given slowly over several hours for the energy metabolism.
What NAD+ infusion involves →Blood filtration for microclot and microcirculation findings.
What HELP apheresis involves →Thymus peptides and low-dose immunomodulation for the immune findings in the work-up.
What immune therapy involves →Correction of thyroid, adrenal and sex-hormone deficits that compound the fatigue.
What hormone therapy involves →The initial inquiry is free of charge. The International Office reviews your message and your case directly and gets back to you.
Munich Airport (MUC), about 60 minutes by car.
