You would be hard put to find a better ally in the fight against CFS than Dr. Nancy Klimas. She is the principal investigator at one of three government established and funded CFS Cooperative Research Centers in the nation. Her center is located at the University of Miami School of Medicine where she is director of the Department of Immunology. Dr. Klimas is also a professor of Medicine, Psychology, Microbiology, and Immunology.
Among her distinctions, Dr. Klimas is also the founding editor of the Journal of Chronic Fatigue Syndrome and co-editor of a 1993 book dealing exclusively with this ailment. But perhaps the greatest kudos are due for her membership in the U.S. government’s Department of Health and Human Services CFS Coordinating Committee. In that role she fiercely advocates government support and financing of CFS research.
Immune System Problems
Through her research Dr. Klimas has come to the conclusion that there are four primary causes of CFS symptoms. She explains these causes as “a state of immune activation …, [a] nervous system problem, orthostatic intolerance [difficulties standing], and nonrestorative sleep.”
Of the four areas, a prime focus of Dr. Klimas’s has been immune system abnormalities. She explains, “with regard to the immune system, we have a system that is hyperactive but not working properly.” As part of this hyperactive state, Dr. Klimas has seen unusually high amounts of cytokines, a substance that promotes inflammation. She feels that the hormonal imbalances also found in CFS patients may result from this elevated cytokine level.
Dr. Klimas has observed that the greater the immune problems found in CFS patients means the greater the severity of their symptoms. Particularly, immune problems seem to result in increased frequency and severity of lymph node tenderness, greater memory and concentration problems, and more headaches. Immune difficulties apparently also result in the greater likelihood of sleeping problems and fatigue.
Chronic immune problems found with CFS reduce the body’s ability to ward off attacks from infections and pathogens. Reduced immunity means latent herpes viruses can be reactivated. The viruses in turn can result in, or perpetuate immune problems and CFS symptoms.
This year Klimas and her associates reported in the journal Applied Neuropsychology that stressful events can account for worsening of these immune problems. Supporting this research is a study Dr. Klimas was involved with on the effects of Hurricane Andrew on CFS patients. The stress of that storm apparently adversely affected the immune function of patients in the hurricane exposure area. This was seen in greater immune activation after the storm. Increased fatigue and inability to work resulted. Cognitive symptoms, muscle weakness and pain also increased in storm victims. This is in contrast with CFS patients who, although living nearby, were not in the storm’s path and did not suffer adversely.
Dr. Klimas reported potential treatments of immune problems at the American Association of CFS Fifth International Conference in Seattle. Eleven CFS patients successfully completed a study involving the removal of a lymph node. Cells from the lymph node were then treated to improve immune function. After the cells were reinfused, the patients were monitored for 24 weeks.
The greatest benefits to the patients were improved mental abilities. However, patients also reported less pain and sore throats and increased physical stamina. Dr. Klimas reported that patients “had more restorative sleep and woke up rested, and their activity levels improved.” Dr. Klimas realizes more studies will need to be done before this immunity enhancing treatment can be widely recommended.
This significant study showed that treatments that improve immunity also relieve cognitive problems. Klimas indicates this small study supports a theory she and her colleagues propose. This theory states that immune abnormalities cause or perpetuate the neurological and psychological problems associated with CFS.
Aside from her research into the causes of CFS, Dr. Klimas has provided clinical care for CFS patients. From her own research, and through association with other CFS specialists, she has come up with effective therapies. These therapies are useful in alleviating CFS symptoms.
Regarding sleep aids, Dr. Klimas discourages the use of short acting mediations like Ambien and Restoril. While these help you fall asleep, she feels that they may prevent you from reaching needed deeper levels of sleep. Instead she recommends tricyclic medications such as Elavil and Doxepin. Dr. Klimas explains that Doxepin “gives patients 8 hours of sleep and simultaneously reduces pain.”
Doxepin also has the advantage of being available in a liquid, which enables patients to better control dosage. This can be crucial since CFS patients may react differently than others to medications. For many with CFS, less is more. In other words, smaller dosage can be just as effective as normal dosages. Klimas explains that “CFS patients are drug intolerant, and it is important to begin with small doses and slowly increase the amount until symptom relief is achieved.”
Dr. Klimas does not recommend strong, short acting pain medications because of their side effects. As a dose of these drugs dissipates from one’s system panic attacks can result. “If this is the case, I first wean the patient from her current regimen and then look for nonpharmalogical alternatives, such as massage, stretching, and physical therapy (whirlpool, hot tubs). … For the few who require pain medication, I choose the long-acting, 24 hour opiates at a low dose to control the pain.”
Klimas feels that exercise is crucial in the treatment of CFS. One reason is because of its benefits when one has blood pressure difficulties. But because many patients tolerate exertion so poorly, Klimas recommends a particular exercise regime.
Begin with the amount of aerobic exercise (walking, bicycling, or preferably swimming) you can tolerate daily without causing fatigue. Do only this amount of exercise each day for two weeks. Then for the next two weeks add seven minutes of exercise at a different time of the day. After another two weeks do another 7 minutes at yet a third time of the day. Only increase the amount of time in each session when you are certain you can tolerate it.
The goal of this exercise is to prevent deconditioning by gradually increasing strength. If you relapse, simply cut back to what you can handle and gradually build from there as outlined above. With this program, many CFS patients can work up to several 15 minute exercise sessions per day within 6 months.
Any good fighter will tell you that the key to success is knowing your opponent well. Dr. Nancy Klimas has facilitated just that, understanding CFS better. With her assistance a therapeutic arsenal is developing that can help individuals make headway against this enemy. And perhaps one day Dr. Klimas will help us decimate this foe once for all.
Toward Optimal Health: The Experts Discuss Chronic Fatigue, J. of Women’s Health & Gender-Based Medicine, 9(5);477-482 (2000)
Pathogenesis of Chronic Fatigue Syndrome and Fibromyalgia, Growth Hormone & IGF Research, 8;123-126 (1998)
Cytokine and Other Immunologic Markers in Chronic Fatigue Syndrome and Their Relation to Neuropsychological Factors, Applied Neuropsychology, 8(1);51-64 (2001)
Physical Symptoms of Chronic Fatigue Syndrome are Exacerbated by the Stress of Hurricane Andrew, Psychosom. Med. 57(4);310-323 (1995)
Dr. Klimas Lecture (June 27, 1999)
CDC to Restore Chronic Fatigue Syndrome Funding, Reuters Health (July 28, 1999)
NIAID Funds Three Chronic Fatigue Syndrome Research Centers, NIAID News (Oct. 20, 1999)
The E.M. Papper Laboratory of Clinical Immunology website