Hi Bob,
Given that you are still playing catch up and have not read my posts, you might like to do so and then reconsider what you have posted here, as this statement of yous is, I believe incorrect:
The impression given on this thread was that fatigue is not a predominant feature of historic ME. The Ramsay literature totally contradicts that.
I know your still playing catch up on reading my posts, but when you do so - you will see that the statement you made here is not correct.
As for the impression given on this thread, that ME is always a life long condition I have addressed that also in my previous posts which I am sure you will get to.
Ramsay in that *one article *circa 1986*suggests-* that it might not always be life long. Agreed.
There is support in the literature that some people if given complete rest during the acute phase of the illness (first couple of months after illness onset) can and have recovered.
How much support for that in the literature I dont know - I would have to sit down and do an analysis on this.
However, the second part to that is this.
The literature and even Ramsays own subsequent research findings in 1990 which you cite (Dowsett and Ramsay1990) calls into question the idea of ''complete recovery'', as well as raising the question of what ''recovery'' might be regarded as for the purposes of ME - a condition known in part, for ''remission's'(of various durations) and relapses (also of various durations). So keep that in mind.
There is some suggestion (as I said, how much would require me to sit down and look at it carefully) in the literature that if ''recovery'' does occur at all- then it may be in the acute phase (shortly after illness onset with complete rest).
However, I believe that this represents the exception and not the rule.
"'Complete rest'' at illness onset today is rare though and being rendered unconscious (like the three patients he refers to as recovered) or put into an induced coma is unlikely to occur.
In the good old days, irca 1934 -when medicine recognised the value of bed rest for most ill patients, this might explain why there were indeed reported cases of recovery during the acute phase of the illness. It is less likely today I would suggest, and for the problems I have suggested (re failure to detect outbreaks, the delays in conducting enteroviral testing after illness onset and limitations with those tests).
But Dowsett and Ramsay both did and Dowsett continued to emphasize- the importance of complete rest - especially during the early stages of the illness.
One example from the historic ME literature
Dr Albert Marinacci, was a doctor at the LA County General Hospital at the time of not only the well known 1934 ME outbreak there, but also subsequent ones. He went on to write a book in which he described the features of ME and in a subsequent interview on this matter with Dr Karl Von Hagen, reported that patients from the 1934 outbreak seen 50 years later,
had not recovered. Those that he followed for a long time, were disabled and
very few made a complete recover.
In addition to treating and following epidemic cases, both Marinacci and Von Hagen saw a number of sporadic (non 1934 epidemic(s)) ME cases and they followed these cases for 16 years.
They report that the findings in those patients (who progressed to the chronic phase of the illness) and who were chronically affected, were consistent with those seen in the epidemics.
In this group they did note though, some recovery of patients in the acute phase (just after illness onset 3-6 months). In the next phase the chronic phase they said that patients could have the illness for years with periods of improvement for short durations as in the 1934 epidemics.
So findings re recovery - if and when -were consistent in both epidemic and sporadic groups.
However, from my reading it seems to me that those that recover just after illness onset in the acute phase -seem to represent the exception than the rule.
These reports though, are consistent with what is known about the nature of enteroviral infections generally.
Studies have shown that there is an association between hormones (progesterone and cortisone in particular) and certain strains of coxsackie enteroviral activity. A study Gatmaitan et al showed for instance, that a certain strain of the coxsackie virus stimulated by hormones produced by activity induced stress, increases viral load of coxsackie B3, 530 fold in mice.
So complete rest at illness onset, may assist in seeing the recovery of some people in the very early stages of illness. That though is subject to the caveat that this will also be dependant on viral strain, virulence, age and individual susceptibility and their immune health.
However, enteroviruses are also known as presenting long term infections in ME patients who progress to the chronic phase (which I would say is the general rule rather than the exception). Ramsay and Dowsetts study showed persistent enteroviral infection in their study co hort of 402 patients by finding evidence of coxsackie enteroviral infection in persons who had ME for many years. Chia and Mowbray et al have also shown this.
As enteroviruses go to the tissues and hide there, they behave in a fashion similar to the hidden repositories reported in HIV patients (hidden repositories associated with latent infections) and proliferate under certain circumstances. Hence the remission and relapsing nature of the illness. Consider here, what I also said previously on the finding of the Gatmaitan study with hormones, and activity.
The findings of Ramsays study in 1990 show that 69% of patients in their co hort who had reported having the illness over a collective period of 60 years, were not improving and 25% had never experienced a remission or worse.
What happened to the other 31% reporting improvements is not known. Did this continue? How many did so or did not?
Even though this does not relate to historic ME, in the Hanson Bell XMRV study they also questioned what recovery meant in the context of CFS, with patients reports of recovery, not meeting generally accepted objective medical standards of such. It was suggested that those patients in that study that reported recovery, had not. It was thought that the patients reported such, because compared to where they had been previously (in terms of disability) the improvement felt like a recovery.
So to summarize -a small group of ME patients might recover on complete rest, within a short time after illness onset - though opportunities for this today are rare, I would suggest. Further, most of those seen as ME patients today, I would suggest are not those that recover but, are those that reach the chronic stages and in such patients the literature suggests that complete recovery is not the norm.
I will leave it there for now.
