following lecture:
Monday, April 23, 2007
OB/GYN Grand Rounds
'Chronic Fatigue Syndrome in Women'
James F. Jones, MD, CDC
speaking at the Univ. of Arizona Health Sciences
[ [?] indicates difficulty transcribing]
http://streaming.biocom.arizona.edu/people/?id=11525
The transcript is at:
http://tinyurl.com/jamesjonesoncfs
i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0909A&L=CO-CURE&P=R3247&I=-3
For anyone who is put off by the length (8103 words), I've taken out some
extracts (1073 words) which give an idea about Dr Jones' views on the
illness and where he sees the (CDC's) research going. The first part of the
talk in particular, he doesn't really give his views.
Dr. Jones is Dr. Bill Reeves' number 2 in the CFS program in the CDC, which
has a budget of millions of dollars each year. The CDC CFS program also
extra importance because of the CDC's status: what the CDC says on the
illness is taken more seriously than what a random individual clinician or
researcher says on the illness. It might seem a bit old but it is about the
last talk we have access to I believe.
Tom Kindlon
============================
"So the gender issue goes back- this goes back to the stress study by
Christine Heim based on our Wichita data, and it demonstrates that
both sexual abuse and emotional neglect are really critical in
childhood in developing later on the Chronic Fatigue Syndrome. So
gender probably is terribly important."
--
"So coming up with values above this when we looked at our patients in
our population study, it turned out that the odds ratio for CFS was
quite different between females and males, particularly with high
allostatic load variables. The odds ratio was 5 ½ if the allostatic
index was greater than 6 in females, it was 2.3 in males, but- in
other words when we do our population studies and we look for illness
and Chronic Fatigue Syndrome, are we really measuring a syndrome or
are we simply measuring- studying individuals who have had marked
accumulated life stress and are developing the illnesses that one
develops when you're 50 years of age or more?"
--
[Slide: Comorbid conditions: Fibromyalgia, Gulf War Illness, Irritable Bowel
Syndrome, Orthostatic Instability, Multiple Chemical Sensitivity, TMJ,
Somatoform disorders, Anxiety disorders]
"and there are a variety of co-morbid conditions that are not excluded.
Fibromyalgia is not exclusionary and as this list goes on. And one can
also wonder whether these illnesses also have to do with alterations-
cumulative alterations in monitoring bodily processes and that this is
really an illness of interoception, or an alteration in your
self-perception."
--
"The two most common effective, documented therapies are graded
exercise and some type of cognitive behavioral therapy- CBT. Graded
exercise means that if you're not doing anything, you start doing
something in a very low level. You don't automatically go to the PT
and get put into an hour program. You start walking for 5 minutes, and
when you can walk for 5 minutes every day for a week and not feel
tired, you go to 7 minutes. So it's really an extraordinarily slow
program. But in essence you're training the individual and they're
training themself that being physically active is ok and that lying on
the couch is not ok. And likewise the formal Cognitive Behavioral
Therapy teaches them about the illness, teaches them how they need to
alter their behavior, and it has been shown to be very helpful."
"And I think here
are some management resources that will be made available regarding
the Cognitive Behavioral Therapy, this was a meta-analysis in JAMA in
2001 which was very good, and then the efficacy of graded exercise."
--
Case History (TK: other case history wasn't CFS - she just needed more
iron):
Now this is another lady who was post-menopausal who had three
children and her husband was a post office employment, ten months
prior to that he was a manager at a fast-food job and he lost his job.
The complaints were fatigue, headache, unrefreshing sleep, muscle
aches, more malaise- malaise means both fatigue and feeling sick after
physical and mental activity, and the complaints had been present for
8 months and had interfered with her activity.
So she'd be an ideal candidate.
The history [?] identify any potential underlying medical
illnesses. Her BMI was 29, which was high, her glucose was 135, blood
pressure was high and a psychiatric screener did not identify any
primary psychiatric diagnosis.
And so one could work with her and make a working diagnosis of Chronic
Fatigue Syndrome versus a situational reaction which would be very readibly
understood. And the query is whether she might be developing diabetes
or have diabetes type II.
Course a
A counseling program for the family was
initiated along with sleep hygiene recommended to the patient, a
graded exercise program and a diet was started and the patient
gradually improved.
Course b
Another way of looking at this same lady was if she was told it was
all in her head and she was depressed. She was given medication for
sleep and anxiety, she was not on hormone replacement therapies so
that was a consideration, and that sleep problems became worse and her
other symptoms did not improve, the medications were changed and
increased in number.
Course c
The last course was that she was told she had
Chronic Fatigue Syndrome and she was to go to bed. Her children were
left to their own devices, her husband took a second job, her oldest
daughter who was 16 began with similar symptoms and then she comes to
see you. So you are the proud recipient of all the mishandling of this
lady that has taken place in the prior months.
[TK: So he is giving the impression that one giving a diagnosis all sorts of
problems - course c]
---
[Question] I wondered if anybody ever looked at- took a small section
of these population of the chronic fatiguers and looked at PET
scanning?
[Dr. Jones]- They have. And they're all over the map, just as they are
with SPECT scanning.
[TK: I presume what he is saying is the results aren't consistent]
---
So the fMRI study we're going to be doing- one is
associated with cognition and we'll be using a variety of learned
memory tests, and the second part which we're involved with
particularly is doing a challenge, a mentation challenge that induces
stress. And by doing that we should be able to determine if areas of
the brain, particularly associated with this interoceptive process
that I alluded to, is altered in these patients.
--
So we're going to do something called an N-BACK test which
you have to remember sequences of numbers that you were given, it's a
very highly stressful test. The other thing we're going to be doing is
having them read symptoms and complaints that are associated with
illness. And we know from studies with diabetes, we know from other
studies that when people do that they activate certain areas of the
brain.
--
[Question]- I also, this is the first time I've really heard that-
allostatic load, and I can't help but think about the obesity epidemic
in the United States and relationship to the fact [?] many of us are
sleep deprived and there's interference with our society center and
serving more and we have greater loads, and I'm wondering- it seems
like I'm oversimplifying this but just cut down on your calories and
everything will be good.
[Dr. Jones]- Well I think you're right (etc)
--
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