Notes from Cheney's presentation Dr Cheney said that he would discuss oxygen toxicity, diastolic dysfunction, free energy, redox sates and stem cell treatments. He described the 'Symptom Triad': energy (the push-crash dynamic which is lost in the word ‘fatigue’); brain (issues with complex processing); and pain. Cognitive disturbances are reported in 99% of cases and it can be the number one complaint. Mood disturbance is reported in 60% of cases although depression per se is rarely severe. At the start of the illness, symptoms are generally worse but activity levels are normal. As the illness progresses, the patient learns to ‘control’ the symptoms but they lose functionality as a compensatory measure. The phases of illness development: 1. Onset 2. Triad 3. Dynamic dysfunction 4. DNA phenotype adaptation (i.e. the body does not recover but complex ways are found to adapt) Cheney measured the percentage of predicted VO2 max achieved by ME patients and controls. The latter’s mean was 100%; the former’s mean was 67%. Even ‘normal’ couch potatoes achieve 75%. Brain lactate has the highest levels in ME. Only those with specific genetic mitochondrial defects have higher levels. Severely affected patients lose their fingerprints which is a function of immune dysfunction and oxidative stress. The scar ridges that arise on the finger pads are caused by collagen being laid down underneath the skin. ME has the highest RNA activity in any cell in any activity at any one time. In January 2010, XMRV testing of patients showed significant positives within family groups suggesting easy transmission within families. In ME, the systolic ejection fraction is normal. It is diastolic dysfunction which is the key symptom and which causes orthostatic intolerance. Test methods include: 1. Fick 2. Dilution (which is invasive) 3. Impedance 4. Doppler 5. Brute force approximation The problem is with cardiac output. The left ventricle is normal, the valve size is normal and the valve function is normal but there is abnormal diastolic function. Diastolic dysfunction is a relatively new term which had no mention in medical literature prior to 1995. Measurement instruments started to be developed in 2001 and it has only “hit the literature” in the last few years. Cheney contacted a heart surgeon he knows to ask about diastolic dysfunction. The surgeon said: “It’s what the heart looks like when there’s no energy in it.” Cheney uses an Echocardiography Pulse Wave Doppler to measure blood throughput. For example, normal throughput is 8.3 litres per minute. This throughput is then divided by body mass index (to correct for size) to produce a cardiac index. At the higher end of the cardiac index scale is hyperthyroidism and hypertension. ME patients are at the very low end: 2.36. Anything less than 2 should be in a transplant ward. Cheney then discussed E/A and e/a ratios, notes for which I have to unravel. The key conclusion from this was that there is E/A and e/a reversal in ME. EDIT starts These ratios apply to different forms of cardiac velocities which I cannot decipher. Cheney uses three methods to calculate them. The first, I believe, is the Pulse Wave Doppler. The second uses an Echocardiography Diastolic Tissue Doppler. The third uses an Echocardiography PV In Flow Doppler. I have figures for these if anyone can interpret. Cheney said that there are two types of diastolic dysfunction and most ME patients have Type I. 75% of those who progress to Type II will die within five years of daignosis. EDIT ends Pulmonary vein monitoring (using a very high spec machine) will show atrial cavitation in ME. This is where the left atrium collapses and is something that doesn’t happen in healthy people. When an ME patient goes from supine to 70 degrees, you can see the atrium flattening like a pancake. There is significant pressure on the left ventricle resulting in up to 70% thickening of the ventricular wall. Ejection fraction can go up to 86%. There can be left ventricular asynchronicity to 500 milliseconds with the one part of the ventricle still filling whilst the other part is trying to eject. Cheney says that magnesium corrects this (but only IV or sub-lingually, not orally). Patent Foramen Ovale (PFO) can be seen in some patients where the ventricular pressure forces open a hole in the heart. He has found PFO in 88.7% of patients (n=60) versus 16-20% in the general population. He said that PFO leads to an increased incidence of stroke, severe headaches and migraine. ME people are moving to keep oxygen out and are adapting to a low energy state to prevent….(slide taken down). Sadly, Cheney did not have time to discuss the stem cell treatments which he is trialling.