By Carol Ann Ryser, M.D.
This is part of the presentation on February 15, 2002, at the American Academy of Environmental Medicine meeting in St. Louis, Missouri. The rest of the presentation is reserved for a book which will be coming out at the end of the year.
Evaluating the fatigue patient is a great challenge to the clinician researcher, health care professional. This requires a broad and interpretative view of disease and a psychosocial sensitivity and astuteness of mental health disorder as well as a good ongoing relationship with the patient with a capacity to listen to all the issues. The phenomenon of Chronic Fatigue Syndrome remains a major focus for researchers and clinicians. Statistics show this complex disease on the rise and has been observed for over a century.
Possible Causes of CFS/FMS
Understanding the inter-relatedness of Viral Infections, Bacterial Infections, Environmental Toxins, Chronic Infections, Fungal Infections, Nutritional Deficiencies, Trauma, Stress, Chronic Illness and a new kid on the block, Coagulation Defect, are key factors to diagnosis and treatment of CFS/FMS.
There are several kinds of viruses that can be a causal factor in CFS/FMS. These are:
• Virus Herpes Simplex virus-1 (HSV-1) – Oral Herpes (fever blisters)
• Herpes simplex virus-2 (HSV-2) – Genital Herpes
• Varicella-zoster virus-3 (VZV) – Chicken Pox, Shingles
• Epstein-Barr virus-4 (EBV) – Infectious mononucleosis
• virus-5 (CMV) – “Mono-like” illness, infections in immune compromised patients
• Human herpes virus-6 (HHV-6) – Roseola, “mono-like” illness, associated with MS & CFS
• Human herpes virus-7 (HHV-7) – “mono-like” illness, Pityriasis Rosea
• Human herpes virus-8 (HHV-8) Disease – Kaposi’s sarcoma
Coagulation in CFS/FMS
A further explanation of coagulation and the significant role it plays in Chronic Fatigue and Fibromyalgia Disease, is key not only to diagnosis but treatment as well.
A Coagulation Defect is:
1. A coagulation protein defect leads to a hypercoagulation state when the patient is subjected to a pathogen, trauma, toxins.
2. Excess thrombin (IIa) generation converts FIB to soluble fibrin monomer (SFM) causing fibrin(oid) deposition.
3. Accumulation of fibrin on EC (endothelial cell) surfaces block oxygen/nutrients from entering tissues and cells creating focal ischemia.
4. Blood viscosity increases (slows) blood flow resulting in endocrine (HPA Axis) sleep disorder, CNS (central nervous system) dysfunction, decreased blood volume, fatigue, decrease in heart stroke volume, lowered BP, and lowered immune stem function, and malfunction of the adrenal glands.
By definition, a Hypercoagulation State Infectious Disease State is:
1. Stress – The way we react, mentally, emotionally, and physically to demands of life. Stress creates: 1) physical symptoms, i.e. fatigue which requires more nutrients; (2) increases adrenaline-causing platelets to stick together decreasing oxygen to the medulla.
2. Deaths from infectious disease 1980-1992 are up 58% (the number 3 killer with heart disease and cancer being the number 1 and 2 killers).
Eliminate HIV and all other infectious diseases have risen by 22%. Immune System.
Etiologies of Activation: Any of the following can activate a coagulation defect:
SEPSIS: New Concepts in Research by Lilly
Supportive documentation as to the importance of coagulation in chronic illness can be found from the Lilly foundation and research they are conducting.
“Sepsis can be most simply defined as a spectrum of clinical conditions caused by the immune response of a host to infection or trauma and characterized by systemic inflammation and coagulation (Mesters, 1996a; Wheeler, 1999). It ranges from a systemic inflammatory response to organ dysfunction to multiple organ failure, and ultimately death for many patients.
Particularly in elderly, immunocompromised, and critically ill patients, sepsis is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide (Friedman, 1998; Balk, 2000). In the US, sepsis is the leading cause of death in noncoronary ICU patients (Sands, 1997), while recent 1998 data from the Centers for Disease Control (CDC) show that it is the 11th leading cause of death overall (National Vital Statistics Report, 2000).* (from Lilly’s website)
1. Increased procoagulant activity and reduced anticoagulant activity
2. Impaired fibrinolysis
3. System inflammation
4. Role of indigeous activated Protein C in Sepsis
The Immune System
A healthy immune system is a very important part of maintaining one’s health
and well-being. The immune system is important for protection against infections, cancer surveillance inside the body, and maintaining a healthy balance of most of our bodies’ functions. When the immune system is compromised or you have an inadequate immune response, it may lead to serious infections.
Overactive Immune System leads to the following disorders:
• Urticaria (hives)
An Overactive Auto Immune System leads to the following diseases:
• Multiple Sclerosis
• Type I Diabetes
• Lupus Erythematosus
• Rheumatoid Arthritis
• Juvenile Diabetes
• Alzheimer’s Disease
• Lou Gehrig’s Disease
• Rheumatoid Arthritis
• Epileptic Seizures
• Atopic Dermatitis
The following are Inflammatory Diseases caused by an overactive immune system:
• Crohn’s Disease
• Celiac Disease
• Irritable Bowel
• Ulcerative Colitis Under active Immune System
When you have an underactive immune system you may have the following disorders:
• Infections: parasites, fungal, bacterial, viral
• HIV, Hepatitis B/C , Shingles, Sinusitus
• Cancer, CMV, Tuberculosis
• Other viruses
The following are common conditions which are affected by viral infections:
• Heart Disease
• Diminished water quality
• Day care
• International Travel
• Many chronic illnesses
Viruses Links to Cancer
A growing concern in both Allopathic and Alternative Medicine in that a link exists between viruses and cancer.
• HHV-8 Kaposa Sarcoma
• HPV Cervical, vulva, and Vaginal Cancer
• EBV Nasopharyndeal Carcinoma, Burketts Lymphoma, B Cell
lymphoma Hodgkins Disease Breast Cancer
• Hepatitis B Hepatocarcinoma
Criteria as defined by the American College of Rheumatology:
1. Wide spread pain which lasts 3 months: Pain in trigger points: neck, back, chest, arms and legs, bilateral pain, spine, cervical, thorasic, lumbar, and chest walls.
2. Trigger points: stimulation of points that create shooting pain.
3. Recurrent use of nonspecific antibiotics.
Daniel Wallace, MD, UCLA, found abnormalities Of 3 cytokines, IL-1, IL-8, IL-6, cause severe Widespread pain, fatigue and disturbed sleep. Cytokines are small signaling materials produced by immune system to alter functions of other cells. Toxin released from infection activity causes liver cells to produce IL-1, Il-6 and other cytokines. Cytokines interact with nerves that travel to the brain which signals down the spinal cord, causing amplified pain signals. IL-6 is related to fatigue and impaired concentration.
TREATMENT CONSIDERATIONS OF CFS/FMS
I will be coming out with a book by the end of the year. Treatment considerations and protocols will be available at that time. You can also attend any of the workshops or seminars I conduct with various groups such as A4M, ACAM, Hemex Labs, and many other local medical groups. For a listing of upcoming presentations, please refer to my website:
www.carolannrysermd.net or go directly to the Special Events section:
NO REPRINTING OR REPRODUCING WITHOUT THE EXPRESSED, WRITTEN CONSENT OF CAROL ANN RYSER, M.D.
This information is (c) 2002 Dr. Carol Ann Ryser. All rights reserved.
Carol Ann Ryser, M.D.
5308 East 115th Street
Kansas City, MO 64137