|TESTING FOR A CIRCULATORY
Just recently, medical doctors have been advised to take blood pressure reading and heart rates while the patient is in an upright position. Orthostatic hypotention was described as early as 1925, but Dr. David Streeten published the first book for medical professionals that was devoted to problems that the body had trying to adjust to different postures.
While it is known that changes in the body's posture form lying down to sitting and standing involve neurological, endocrine and cardiovascular adjustments to maintain normal circulation in the body, there are several orthostatic disorders that have gotten little attention because they are not felt to be life threatening. Using grants from the U.S. Public Health Service, Dr. Streeten described many of these resulting problems in previous publications. He had no idea, however, that while he was writing his book, an entity inappropriately named Chronic Epstein Barr Virus by the NIH was actually the same mechanism he had been studying. To detect the low volume, Dr. Streeten ran several lab tests. Only the final blood volume test, done correctly and using the right radioactive isotope, will be needed to prove this in all PWCs. A clinical trial, however, needs more data for proof.
First the patient was in a reclining position with an automatic blood pressure mechanism attached to their arm. Every two minutes, the pressure would automatically print out results. The patient was then asked to sit and stand. As in the tilt-table test, this Emeritus Professor of Medicine was looking for a plunge in blood pressure, but was also taking careful notes on all reactions by the patient. Why not use a tilt-table test for this?" People don't tilt!" exclaimed Dr. Streeten, "they sit , they lie down, they stand, but they don't tilt." Further testing is done with a Mast suit which is also called "shock pants". This is like a giant blood pressure cuff the envelopes the lower body and looks like a huge pair of rubber pants. The blood in the body, instead of going to the heart when a person stands, pools in the extremities, especially the legs. When the "suit" is inflated, most patients feel enormous relief from the pain they were experiencing when they had to stand in one place without shifting their feet or weight. A physical examination follows this test.
The final phase of the testing in this clinical trial involved a blood volume test. Three total volumes are sought: red blood cell (RBC) volume, plasma volume and total volume. The is the only test necessary for most PWCs to prove that low circulating volume is the problem. A radioactive dye using Chromium 51 is injected. It is about the same amount of radiation one would get having a lung x-ray. The blood is then drawn at intervals to read the volumes.
Treatment for the volume reduction depends on the outcome of the test. Some patients have found florinef effective while others have found mitodrine works best for them. Florinef is a corticosteroid while mitodrine is an alpha adreneric agonist the was approved by the FDA in 1996, although it was used in other countries for many years. Unfortunately, a mechanism for totally reversing this abnormality has not yet been found, although one is being tried now in a clinical trial. More information will be included in the January issue of The Journal of Chronic Fatigue Syndrome. There is still another piece of the puzzle that still is elusive. However, low circulating blood volume disorders can account for the many diverse symptoms seen in CIFDS including menstrual problems, intracranial symptoms, cardiovascular problems, fluid accumulation, fatigue, musculoskelatal pain, severe thirst, glucose intolerance, tachycardia, etc... At least two symptoms were new to Dr. Streeten: hyperflexia and thermal control. It is possible that the patients he treated earlier were not as severe because they were not sick as long.
PWCs with severe hypertension cannot be treated by the methods now being tested, although borderline hypertension could be "predominantly or exclusively orthostatic," according to Dr. Streeten. Nearly all the symptoms of CFIDS can be contributed to reduced cerebral blood flow caused by the lowered volume and in the inadequate autoregulation in the brain. Dull chest pain, mitral valve prolapes, even impotence and incontinence can be attributed to this disorder. Other common symptoms such as syncope (faintness), flushing, excessive sweating, nausea, and impaired cognition are explainable. Indeed, even the exercise debate that is raging throughout CFIDS community can be answered by this enormous step forward: walking will help mild patients, but NOT severe patients. In 1941, Sead and Ebert wrote that strenuous activity aggravate the sympoms to a great degree! In 1925, Barabury and Eggleston noted that seizures can occur with orthostatsis, although they are NOT grand mal! There are even orthostatic disorders that explain the weight gain seen in CFIDS. Although this mechanism needs much more study, merely discovering it brings us closer to a day when treatment will be possible. Indeed, if nothing else is gained, the clinical trial proved that no damage is permanent with this illness. When the right treatment is found, CFIDS can be totally reversible!
The National CFIDS Foundation * 103 Aletha Rd, Needham Ma 02492 * (781) 449-3535 Fax (781) 449-8606