clarification on CCRP's current research focus(or lack thereof!)
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Guest: William Reeves, Director CDC Chronic Viral Diseases Branch
Show: Georgia Weekly, Georgia Public Broadcasting
Air date: Sunday December 30, 2007
Host: Susan Hoffman
http://link.brightcove.com/services/player/bcpid9113583001?bctid=3D13652101=
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mms://mediam1.gpb.org/gpb-tv/2007/GPB-TV_GaWeekly_317_558kbps.wmv
Host: We all feel tired sometimes but when the fatigue is beyond
description and won=92t subside with a good night=92s sleep and lasts for
months, something=92s wrong. Could be any number of disorders, it could
be Chronic Fatigue Syndrome. Experts say it is vastly under-reported
and costly for businesses and families. Here with the latest on this
public health threat, CDC chronic fatigue expert Dr. William Reeves.
Thank you for being here, I appreciate your time. It is official, it
is not a figment of somebody=92s imagination, this previously called
=91Yuppie Flu=92, it is for real- but can you tell me, what is it?
Dr. Reeves: CFS is a syndrome, it is an illness comprised of a group
of symptoms. At the bottom line, fatigue is central to Chronic Fatigue
Syndrome, and it isn=92t just being tired. It=92s being absolutely wiped
out physically and mentally.
Host: Hit the wall.
Dr. Reeves: It=92s kind of like what you=92re like about two or three days
into flu, or influenza, you can=92t think straight, your body hurts all
over, and it isn=92t made any better by rest.
Host: Ok.
Dr. Reeves: Now that=92s the fatigue- It=92s a mental fatigue, it=92s a
physical fatigue. CFS is also accompanied, because it=92s a syndrome,
with other symptoms.
Host: Like what?
Dr. Reeves: Like almost everybody that has CFS complains that they
can=92t think straight and they can=92t remember things.
Host: Kind of that fog?
Dr. Reeves: The fog, the mental fog, that=92s almost everybody. Almost
everybody with CFS complains that they have trouble sleeping, they
don=92t feel refreshed when they wake up, they can=92t sleep through the
night.
Host: Ok.
Dr. Reeves: They almost all complain that their fatigue, mental or
physical, is made much worse and lasts- basically they hit a bottom
and don=92t get back if they do any unusual, or usual, physical activity
like going to the store, if they have to do mental activity like
giving a television interview, they=92re wiped out for the next day.
Host: It=92s an entire 24 hours...
Dr. Reeves: It=92s an entire 24 hours. There are other symptoms, they
are less common than that, and CFS isn=92t a single thing- many people
have problems with headache, many people have problems with muscle and
joint pain.
Host: What about the swollen glands?
Dr. Reeves: Sore throat, swollen glands, headache.
Host: Ok.
Dr. Reeves: So there can be any combination of those, and fatigue
isn=92t always the biggest problem. Many people with Chronic Fatigue
Syndrome say =91yes, I=92m fatigued, but my problem is I can=92t sleep
through the night, my problem is I can=92t think straight, my problem is
I hurt.=92
Host: So it=92s a lot, it=92s a variety, and so really trying to define it
you really have to figure out ok it=92s not thyroid, you have to almost
figure out what it=92s not in order to qualify what it is. Correct?
Dr. Reeves: That=92s correct. The problem is that there are no
characteristic- what we call clinical signs. People have- complain of
swollen glands, but you can=92t feel them.
Host: What about cause?
Dr. Reeves: Cough is not part of it.
Host: I=92m sorry, cause. What causes it?
Dr. Reeves: The cause of Chronic Fatigue Syndrome is not completely known.
Host: But we know stress is linked.
Dr. Reeves: We know that Chronic Fatigue Syndrome seems to be a
problem of mind-body, coping with what happens every day- with
physical stressors, with mental stressors, with-
Host: And it can be good and bad stress, right?
Dr. Reeves: With good stressors, and bad stressors, the brain and the
body respond to those and that seems to be out of kilter in Chronic
Fatigue Syndrome.
Host: Alright now it can also be tipped off, you had said prior to the
taping, that things like Q-fever, mononucleosis, can appear- bona fide
illness, and they never get better. So there are some links there.
That=92s not the cause of it, but they=92re linked.
Dr. Reeves: The link there, we think, is the stress of mononucleosis,
the stress on the immune system, the stress on the body, the virus
that caused it goes away but the body=92s reaction to that stress- or
the maladaptive reaction to that stress continues.
There are other things, infectious diseases like mononucleosis,
stresses like a divorce, a death in the family, someone who is treated
for cancer with the chemotherapy, the cancer is cured- they don=92t feel
any better, they have been knocked over the edge as far as how their
body is responding to this.
Host: Alright, who is most susceptible, cause I know that sometimes
childhood tragedy, illness, potentially neglect or abuse can make
people somewhat predisposed or susceptible, correct?
Dr. Reeves: Ok the predisposition and susceptibility- 3 to 1 the cases
involve women. So women are at much higher risk. Now why that is we
don=92t know. Adults between 30 and 50 are at high risk- kids get it,
men get it, but women seem to have a very high risk of it. We know-
Host: Pregnancy seems to be tied in for some too.
Dr. Reeves: Say again?
Host: Pregnancy, or recovery from a pregnancy.
Dr. Reeves: Recovery from a pregnancy, again the stress of going
through that, not getting better. Now, as far as susceptibility-
women, people who have had a lot of stressors throughout their
childhood, that can be infections, that can be surgeries, seem to be
at risk. There are genetic predispositions- there=92s not a genetic
cause, but there are certain genetic predispositions, all associated
with the mind and body stress response that put one at a higher risk.
All of those interacting together we think are what lead to the final
illness.
Host: Why do you think this is a public health threat?
Dr. Reeves: This is a public health threat for a variety of reasons.
First of all, CDC studies have shown that at least 4 million Americans
suffer from Chronic Fatigue Syndrome, bona fide as classic as it can
be. At least 7 million report symptoms of Chronic Fatigue Syndrome.
That=92s a body count. The people with Chronic Fatigue Syndrome are in
fact profoundly ill. They are as disabled as anyone with AIDS, with
breast cancer, with coronary artery disease.
Host: Can you qualify for disability if you have to stop working because of=
it?
Dr. Reeves: That is difficult to do and that=92s one of the problems
that health care providers and the patients have. Now the disability
goes more than that. A quarter of the people that have CFS in the
population are either out of work or on disability because of CFS.
Host: So lost productivity,
Dr. Reeves: Lost productivity.
Host: Lost income for the family,
Dr. Reeves: Lost in- it doesn=92t just affect the person that has it.
The average family in which someone has CFS foregoes- loses $20,000 a
year in family earnings and income. That=92s half the median household
income in the United States.
Host: That=92s a lot.
Dr. Reeves: That=92s a lot.
Host: It=92s a lot. Ok, Emory and CDC are teaming up to do a study. Tell
me what you=92re doing and what you hope to accomplish.
Dr. Reeves: We are very interested- you asked the question what causes
Chronic Fatigue Syndrome. We=92ve teamed up with Emory University to do
a three day inpatient study trying to look at what is happening to the
body with Chronic Fatigue Syndrome.
Host: Are all these bona-fide patients?
Dr. Reeves: These are all bona-fide patients, we=92re doing a study
currently in Georgia in which we have surveyed the population of
Atlanta, Macon and the rural counties around it, we have identified
people not from physician practices who have Chronic Fatigue Syndrome
as bona-fide as it can be-
Host: Sidenote, you said that there=92s higher numbers in the rural
areas than you expected.
Dr. Reeves: There were- actually not higher numbers in the rural
areas, we asked the question about women.
Host: Ok.
Dr. Reeves: Ok women are very high risk.
Host: Ok.
Dr. Reeves: And women are women because of their sex.
Host: Right.
Dr. Reeves: Women are treated differently in society than men are.
Host: Ok, so wait, I was wrong though about the rural, I thought you said-
Dr. Reeves: It=92s gender. What was different in metropolitan and rural
is 5 times as many women than men in metropolitan areas have it, twice
as many men as women have it in the rural areas.
Host: Huh.
Dr. Reeves: And that is beginning to get us to look at is there
something different in the stress patterns of men and women in those
areas that account for that difference. Rather than it=92s women sex;
women or men=92s roles and how they=92re functioning in their different
parts of society.
Host: Alright so they come in and what exactly are you going to do?
Dr. Reeves: What we=92re going to do in this study is they will come
into Emory hospital for three days. The first day we=92re interested in
memory and concentration.
Host: How do you measure...
Dr. Reeves: There are tests that you can do, the test we do is called
the CANTAB, it=92s about an hour long test that measures every aspect of
your memory and concentration, and we will do that in conjunction with
what are called functional magnetic resonance imaging, we will look at
how the brain is functioning as they do that test.
Host: So they have electrodes, and they=92re all hooked up.
Dr. Reeves: They sit in a big huge machine that actually looks at
their brain functioning.
Host: Alright you=92re also able to look at the cumulative stress in their =
life.
Dr. Reeves: Ok we=92ve looked at that with questionnaires and we=92ve
looked at the cumulative stress with a measure called allostatic load.
Host: What=92s that in layman=92s terms?
Dr. Reeves: In layman=92s terms when you react to stress, every time you
react your body reacts chemically. And that accrues, it builds up over
time.
Host: And you can actually look at blood work that shows you how much
has built up?
Dr. Reeves: You can look at blood work that shows you how much that
builds up. Now allostatic load, that build up, is a big risk factor
for cancer. It=92s a big risk factor for coronary artery disease. It
appear- is a big risk factor for diabetes. And it appears also to be a
big risk factor for Chronic Fatigue Syndrome. So we will be looking at
that in the Emory study as related to how one is thinking, as related
to how one=92s brain is functioning.
Now the next day gives a cognitive challenge and does functional
magnetic resonance imaging, the last day measures how they respond to
a psychologic stress, like giving an interview on tv-
Host: Ok then, what-
Dr. Reeves: We have them speak, public speaking, and we measure their
response to that- their endocrine response, their immune response, one
of the things we=92re doing is we look at their genes and we look at how
active every single gene is. So it is a study that has never been done
before, and it couples CDC=92s ability to get people from the community
with Emory University=92s high technology of imaging and clinical
studies.
Host: Which is great, now- this is a syndrome, and it basically is
something you will have to manage the rest of your life. How can we
best treat it? Because there=92s no pill.
Dr. Reeves: There=92s no pill, there=92s no overnight treatment. The best
way to treat- the most pivotal thing to treatment is this just isn=92t
the person, it=92s the person, the person=92s family and their provider.
One thing is to learn about it. CDC operates an excellent website just
for Chronic Fatigue Syndrome at cdc.gov-
Host: What are some of the suggestions?
Dr. Reeves: The suggestions are that you get to a good health care provider=
.
Host: Ok.
Dr. Reeves: That you realize you=92re not going to get better overnight.
This is a chronic illness, and no chronic illness gets better
overnight.
Host: What advice to you give on say, moderation or diet?
Dr. Reeves: What we give is that the first thing is to try to take
care of your symptoms. If there are problems sleeping, talk to a
physician, learn how to get better sleep hygiene. Things like diet.
Look at your diet. Consult with your doctor. Modify it for this. If
you are having trouble with pain, take- under your doctor=92s advice,
medication for pain. Remember that people with CFS are often more
sensitive to drugs, so you may take less.
Host: Gotcha.
Dr. Reeves: It is important to stay under the care of a provider.
Because one has CFS doesn=92t mean they can=92t have something else.
Host: Gotcha, alright. With that I have to say thank you very much Dr.
Reeves, keep up the good work and you have to come back and see me, I
appreciate it.
Dr. Reeves: Thank you for having us.
Host: Of course. That was our broadcast, thanks for joining us and
thanks for watching Georgia Public Broadcasting.
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