POTS & CFS affects blood volume in exercise for adolescents

Posted on 09/04/2014 by wames

Abstract

Postural orthostatic tachycardia syndrome (POTS) is characterized by chronic fatigue and dizziness and affected individuals by definition have orthostatic intolerance and tachycardia.

There is considerable overlap of symptoms in patients with POTS and chronic fatigue syndrome (CFS), prompting speculation that POTS is akin to a deconditioned state. We previously showed that adolescents with postural orthostatic tachycardia syndrome (POTS) have excessive heart rate (HR) during, and slower HR recovery after, exercise – hallmarks of deconditioning.

We also noted exaggerated cardiac output during exercise which led us to hypothesize that tachycardia could be a manifestation of a high output state rather than a consequence of deconditioning.

We audited records of adolescents presenting with long-standing history of any mix of fatigue, dizziness, nausea, who underwent both head-up tilt table test and maximal exercise testing with measurement of cardiac output at rest plus 2-3 levels of exercise, and determined the cardiac output (Q) versus oxygen uptake (VO2) relationship.

Subjects with chronic fatigue were diagnosed with POTS if their HR rose ≥40 beat•min(-1) with head-up tilt. Among 107 POTS patients the distribution of slopes for the , relationship was skewed toward higher slopes but showed two peaks with a split at ~7.0 L•min(-1) per L•min(-1), designated as normal (5.08 ± 1.17, N = 66) and hyperkinetic (8.99 ± 1.31, N = 41) subgroups.

In contrast, cardiac output rose appropriately with in 141 patients with chronic fatigue but without POTS, exhibiting a normal distribution and an average slope of 6.10 ± 2.09 L•min(-1) per L•min(-1). Mean arterial blood pressure and pulse pressure from rest to exercise rose similarly in both groups.

We conclude that 40% of POTS adolescents demonstrate a hyperkinetic circulation during exercise. We attribute this to failure of normal regional vasoconstriction during exercise, such that patients must increase flow through an inappropriately vasodilated systemic circulation to maintain perfusion pressure.

High flow variant postural orthostatic tachycardia syndrome amplifies the cardiac output response to exercise in adolescents by PT Pianosi et al in Physiol Rep. 2014 Aug 28;2(8). pii: e12122. Print 2014 Aug 1.

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Poor blood flow leads to cognitive problems in FM

Posted on 09/03/2014 by wames

Abstract

Objective:

There is ample evidence for cognitive deficits in fibromyalgia syndrome (FMS).

The present study investigated cerebral blood flow responses during arithmetic processing in FMS patients and its relationship with performance.

The influence of clinical factors on performance and blood flow responses were also analyzed.

Method:

Forty-five FMS patients and 32 matched healthy controls completed a mental arithmetic task while cerebral blood flow velocities in the middle (MCA) and anterior (ACA) cerebral arteries were measured bilaterally using functional transcranial Doppler sonography (fTCD).

Results:

Patients’ cognitive processing speeds were slower versus healthy controls. In contrast to patients, healthy controls showed a pronounced early blood flow response (during seconds 4-6 after the warning signal) in all assessed arteries.

MCA blood flow modulation during this period was correlated with task performance.

This early blood flow response component was markedly less pronounced in FMS patients in both MCAs. Furthermore, patients displayed an aberrant pattern of lateralization, with right hemispheric dominance especially observed in the ACA.

Severity of clinical pain in FMS patients was correlated with cognitive performance and cerebral blood flow responses.

Conclusions:

Cognitive impairment in FMS is associated with alterations in cerebral blood flow responses during cognitive processing. These results suggest a potential physiological pathway through which psychosocial and clinical factors may affect cognition.

Aberrant Cerebral Blood Flow Responses During Cognition: Implications for the Understanding of Cognitive Deficits in Fibromyalgia, by Montoro CI Duschek S, Muñoz Ladrón de Guevara C, Fernández-Serrano MJ, Reyes Del Paso GA in Neuropsychology 2014 Aug 25. [Epub ahead of print]

 

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Prolonged fatigue [CFS] & cytokines post-West Nile Virus infection in USA

Posted on 09/03/2014 by wames

Simon McGrath comments on a research paper: Evaluation of Prolonged Fatigue Post–West Nile Virus Infection and Association of Fatigue with Elevated Antiviral and Proinflammatory Cytokines

Extract:
31% of the cohort were fatigued at follow-up (44/140) and “Of those with fatigue postinfection, 28 (64%) met the CDC’s case definition of chronic fatigue syndrome (Fukuda)”.

Unfortunately, the rest of the data is for all fatigued patients, not only those who met Fukuda. Also note there were no lab tests or medical/psychiatric exam to confirm CFS diagnosis. So this study is only indicative of CFS post West Nile Virus, but is, I think, still of interest. Note that for all fatigued patients combined, 82% had cognitive problems, 75% had PEM and 75% sleep problems.

The biggest predictor of developing fatigue after WNV infection was having a symptomatic infection (most infections produce no symptoms), and 42/44 or 95% of those fatigued at follow-up had symptoms on infection. The other predictors were being female and being younger (under 50 at infection).

Prolonged Fatigue [CFS] & cytokines post-West Nile Virus Infection, in USA

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Microbial Diagnostics and Discovery in ME/CFS – transcript of Lipkin talk

Posted on 09/02/2014 by wames

Transcript of Ian Lipkin MD’s talk at the Stanford ME/CFS Symposium in March, prepared by Patricia Carter of ME/CFS Forums is online:

Microbial Diagnostics and Discovery in ME/CFS

Dr. Ian Lipkin.  is the John Snow Professor of Epidemiology and Professor at the Center for Infection and Immunity at the Mailman School of Public Health at Columbia University. He is known as a microbe hunter, and his group is doing pathogen discovery work.

a video recording of the talk is also available online: Video 5 (56:00)

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How people with CFS and asthma perceive their health and physical future

Posted on 09/01/2014 by wames

Abstract

INTRODUCTION

Most people perceive their own future as more positive than the average person’s. This optimistic bias may be a concern if it leads to people misjudging health threats and therefore the need for taking preventative steps.

OBJECTIVES

To investigate the generality of recent observations of a reverse, pessimistic bias (i.e., perceiving oneself to be more at risk) in people with Irritable E.

AIMS

The aims are to discover if a pessimistic bias is also found in another psychosomatic condition (CFS/ME) or in another chronic illness (Asthma).

METHODS

CFS/ME and Asthma patients were compared with healthy controls (matched in age and sex) for their perceived risks of health threats (e.g., arthritis) and threats (e.g., being burgled), for self and for others.

RESULTS

The results for the 3 groups are shown in the graph.

PIIS092493381478232X.fx1.lrg

CONCLUSIONS

People with CFS/ME tend towards the possession of a pessimistic bias with regard to health threat, but towards an optimistic bias with regard to physical Asthma group tend towards a pessimistic bias with regard to health threat, but tend to be neither optimistic nor pessimistic with regard to physical threat. control group tend towards an optimistic bias with regard to both health and physical threats. Thus, it appears that people with a chronic condition tend toward pessimistic bias, as opposed to the optimistic bias found in the healthy. Materials devised to promote appropriate health-related behaviour may need to be the two different populations.

EPA-0907 – Perceived illness risk in chronic fatigue syndrome (CFS/ME) and asthma, by M. Martin, I. Alexeeva,  C.N.G. Dawes, from European Psychiatry, 1 August 2014. Abstract presented to the 22nd European Congress of Psychiatry in Munich, 1-4 March 2014.

 

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Florence Nightingale letters brought together online

Posted on 09/01/2014 by wames

A vast archive of letters from Florence Nightingale, many intensely personal and revealing about the woman usually seen as the shadowy Lady with the Lamp, is being brought together online and made freely accessible for the first time.

The originals of thousands of letters in which she discusses her life’s work of medical reform, nursing training and hospital design – and also her anxieties, exhaustion, and the mysterious illness that kept her bedbound for years – are scattered in different institutions around the world, including the Florence Nightingale Museum, the Wellcome Collection in London, and the Howard Gotlieb Centre at Boston University, which have now brought their collections together online.

Read more in Guardian article: Florence Nightingale letters brought together online

May 12th was chosen for International ME day because it is the birth date of Florence Nightingale, the nurse who inspired the founding of the International Red Cross. She is understood to have become ill in her mid-thirties, with an unknown debilitating condition. Despite her illness and being largely bedridden, she founded the first School of Nursing. Her example inspires people with ME to persevere and work for change.

 

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The importance of understanding how our genes change

Posted on 08/28/2014 by wames

Extract from article by Cort Johnson:

Epigenetics refers to the changes in sites in our DNA that are susceptible to change over time which can modify the expression of our genes.  Our genetic heritage, it turns out, only sets the tableau for how our genes express themselves. Just because you’re borne with a genetic  makeup that suggests, say, your immune system will immediately jump on and take out any pathogen that dares disturb you, that doesn’t mean it’s going to stay that way.

Epigenetics has provided an entirely new slant on genetics and gene expression. Things happen as you age that will change how your genes respond to events. Epigenetics isn’t so much an ‘if’ as it is a ‘how much’.  These processes occur in our body all the time. The older we get the less we are our mother’s and father’s sons and daughters and the more our genetic makeup takes on an identity of its own.

Twin studies indicating identical twins are epigenetically indistinguishable at first but diverge widely over time indicate how malleable our patterns of gene expression are. How this change in gene expression over time occurs and the implications it has for health and disease is what epigenetics is all about.  In a short time it’s become an enormous field. There’s no question epigenetic modifications play a role in  disease – the only question is how much of a role.

A couple of years ago the National Institutes of Health was interested enough in the possible effects of epigenetic changes on aging, heart disease, and mental illness to devote 190 million dollars to its study. Some researchers think epigenetics will end up having a greater impact on disease than genetics.

Epigenetic modifications of immune genes have been implicated in autoimmune and other inflammatory diseases as well as neurodegenerative diseases. Researchers are now arguing which factor – genes, the environment, or epigenetics – plays the biggest role in autoimmunity.  A recent review paper described probable epigenetic effects on neuroinflammation…

Cort goes on to discuss research findings for changes in gene expression in CFS (referring to Patrick McGowan’s research), FM and Rheumatic diseases, and the issues for future research: Epigenetics Study Highlights Immune Issues in Chronic Fatigue Syndrome 

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How Corinne built a house without harmful chemicals

Posted on 08/28/2014 by wames

Flame retardants, formaldehyde and volatile organic compounds shouldn’t be in any of our houses, but for those with Multiple Chemical Sensitivities (MCS), they are a disaster. The tiny house concept has been a godsend for not a few people suffering from MCS, Chronic Fatigue Syndrome (CFS/ME), Fibromyalgia and other auto-immune illnesses; it gives them a chance to live in a home that is built without any of the paints, glues, plastics and chemicals that they react to, usually in a place far away from pollution and other irritants.

It’s not easy to do. Corinne suffers from severe reactions to chemicals, and built her own tiny house out of carefully selected and tested materials. It is a lovely modern design, but it is also really healthy. She not only researched all the materials, tested them, and built a house out of them, but she has created a terrific blog documenting it, with extensive resources for others suffering from the same sensitivities. None of this was easy.

Read more: Woman builds herself a gorgeous, tiny, healthy, “chemical free” house

 

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DNA methylation modifications in CFS

Posted on 08/27/2014 by wames

Abstract

Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis, is a complex multifactorial disease that is characterized by the persistent presence of fatigue and other particular symptoms for a minimum of 6 months.

Symptoms fail to dissipate after sufficient rest and have major effects on the daily functioning of CFS sufferers. CFS is a multi-system disease with a heterogeneous patient population showing a wide variety of functional disabilities and its biological basis remains poorly understood.

Stable alterations in gene function in the immune system have been reported in several studies of CFS. Epigenetic modifications have been implicated in long-term effects on gene function, however, to our knowledge, genome-wide epigenetic modifications associated with CFS have not been explored.

We examined the DNA methylome in peripheral blood mononuclear cells isolated from CFS patients and healthy controls using the Illumina HumanMethylation450 BeadChip array, controlling for invariant probes and probes overlapping polymorphic sequences. Gene ontology (GO) and network analysis of differentially methylated genes was performed to determine potential biological pathways showing changes in DNA methylation in CFS.

We found an increased abundance of differentially methylated genes related to the immune response, cellular metabolism, and kinase activity. Genes associated with immune cell regulation, the largest coordinated enrichment of differentially methylated pathways, showed hypomethylation within promoters and other gene regulatory elements in CFS. These data are consistent with evidence of multisystem dysregulation in CFS and implicate the involvement of DNA modifications in CFS pathology.

DNA Methylation Modifications associated with Chronic Fatigue Syndrome by Wilfred C. de Vega, Suzanne D. Vernon, Patrick O. McGowan in PLOS ONE August 11, 2014

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The role of sleep in CFS

Posted on 08/27/2014 by wames

Review abstract:

Background: Chronic Fatigue Syndrome (CFS) affects 0.23–2.6% of the adult population. Sleep-related complaints are amongst the most frequently reported symptoms in these patients. Although a biopsychosocial model of CFS offers a plausible framework for understanding the condition, the role of sleep and how it functions within this model remains unclear.

Purpose: This narrative review describes the findings of studies of sleep in CFS and considers the reasons behind the diversity of results. The review also discusses the difficulties that exist in establishing relationships between sleep, behaviour, cognition, physiology, and the physical symptoms of CFS.

Methods: A search of Medline for the terms “CFS,” “chronic fatigue syndrome,” AND “sleep” was performed to identify articles concerning sleep and CFS from 1988 to the present.

Results: Subjective sleep dysfunction was frequently reported in the CFS sleep studies. However, objective sleep research in CFS has shown no consistent picture of sleep disturbance, particularly with regard to polysomnography. This may be attributable to the heterogeneity of sleep phenotypes in the CFS population as well as the variability in sleep assessment protocols, case definitions, and exclusion criteria used across studies.

Conclusions: Given the high prevalence of disturbed sleep in this population in combination with inconsistent findings, exploration of new protocols for the objective assessment of sleep in CFS (e.g., three-night PSG protocol) is recommended. Understanding the distinct sleep characteristics in this population could serve to improve insight into perpetuating factors of CFS symptoms which is relevant for diagnosis and therapy.

The role of sleep in chronic fatigue syndrome: a narrative by Zoe M. Gotts, Jason G. Ellis, Julia L. Newton & Vincent Deary  in Fatigue: Biomedicine, Health & Behavior Volume 2, Issue 3, 2014 pages 163-184

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