Thermoregulation and body temperature

[borko2100]

I have the opposite problem, namely feeling hot / overheating. This symptom only occurs at a certain time of day - usually around evening time (+- 10 hours after waking up). To describe it simply, around evening time I start feeling as if the room has suddenly become several degrees hotter, while in reality nothing has changed (I have checked with a room thermometer).

Finally, this symptom seems to be made much worse if I am in a crash / PEM. I remember, during a recent crash, feeling that way for the majority of the day and waking up feeling very hot and warmed up (interestingly without any signs of sweating at night).

As far as feeling cold is concerned, I do not notice such a feeling at normal room temperature, with the exception of my feet, those feel quite cold indeed. On the other hand if I am outside often times I can not tolerate the cold (5 C or below) and I do start shivering quite severely, while other people around me seem be doing just fine.

 

[ScottTriGuy]

Here's a short video (4 mins) by a doctor about "5 reasons for cold intolerance"

 

[HTester]

I sweat excessively when I go out in the sun for even a few minutes.

Your post is important to my thinking; thanks for investing the time to write it. Do I understand correctly that even though you sweat profusely, you do not flush? By flushing I mean that your skin changes color towards red, which is one of the normal physiological responses to high core body temperature. The mechanism of this response is autonomic vasodilation of skin arterioles with the teleological goal of radiating heat away from your body. It would be an important hint about ME/CFS if your body is sweating but not flushing.

 

[raghav]

@HTester Yes. You are correct. I sweat a lot yet no flushing. I need an external source of coolant to cool my body. I did not have this feeling of heat intolerance when I was on Deanxit (Flupentixol + Melitracen). Now I use only Flupentixol for my IBS. Melitracen was regulating body temperature. It is a tricyclic antidepressant. Not much literature is available in the western world since it was never approved in US. It is make by Lundbeck Pharma.

 

[JadeD]

@HTester - I’m the same as @raghav, I sweat excessively on a daily basis but do not flush/go red. The hot flush I described in an earlier post was actually me describing the sensation of feeling like I’m internally burning up/hot a bit like how you feel when you are feverish. But I don’t visibly flush, my extremities can still be vasoconstricted and ice cold throughout.

 

[HTester]

I sweat a lot yet no flushing.

I sweat excessively on a daily basis but do not flush/go red.

I remember another thread somewhere on PR in which patients describe freezing cold extremities while at the same time another part of their body is sweating. What you both describe is actually very closely related. All of these cases have one autonomic effector system responding as if to high temperature and another responding as if to low temperature, simultaneously. It seems unlikely that all the different afferent dorsal horn pathways are sending wrong signals to the hypothalamus. More likely is that some efferent pathways are being inappropriately inhibited and others not. In the rat, this control point is in the rostral medullary raphe. I'll have to find out where that control region is in the human brain. There's also the question of how you can sweat without flushing since both are mediated, at least in part, by vasodilation. I'll look into that too. This feels like a productive line of investigation. Thanks.

 

[perrier]

I remember another thread somewhere on PR in which patients describe freezing cold extremities while at the same time another part of their body is sweating. What you both describe is actually very closely related. All of these cases have one autonomic effector system responding as if to high temperature and another responding as if to low temperature, simultaneously. It seems unlikely that all the different afferent dorsal horn pathways are sending wrong signals to the hypothalamus. More likely is that some efferent pathways are being inappropriately inhibited and others not. In the rat, this control point is in the rostral medullary raphe. I'll have to find out where that control region is in the human brain. There's also the question of how you can sweat without flushing since both are mediated, at least in part, by vasodilation. I'll look into that too. This feels like a productive line of investigation. Thanks.

Interesting Dr Phair what you raise: simultaneously one part of the body cold and another part hot/sweating. This is exactly what happens to our family member. Her hands and feet and nose are ice cold virtually always, except in our brief Canadian summer. Yet, even in the middle of a Canadian winter in the house she wears sleeveless shirts or summer blouses because she says she sweats--while her feet and hands are ice cold. (I on the other hand always wear sweaters in the house in winter.). She never seems to feel a comfortable temperature, ever, except in the bath tub.

 

[Rufous McKinney]

She often complains that the cold is " inside", in her bones

I just thought I would comment that I experience- very deep "cold" that parks inside deep joints- it feels: well very cold.

I do chinese Traditional Medicine and that "cold" is "wind"....inside the joint. So when I go on wind reducing diet, or use herbs to reduce wind, this 'cold" phenomenon...goes away.

This is "different" from- your body temperature overall- it feels like a dense pit of cold deep inside a specific spot.

I fell and turned by ankle sideways quite severely. After a few days, that shifted and this incredible cold parked in my ankle- I used herbs to dissipate it. (soaking).

 

[Albert Donnay]

When Hot and Cold sensitivity occur with other sensitivities as part of Multi-Sensory Sensitivity or MUSES Syndrome, they are caused by CO poisoning.

When bilirubin and ferritin also are high, as they are in some CFS studies, the source of that CO is endogenous, as all three are produced together from the catabolism of heme by heme oxygenase enzymes.

 

[wabi-sabi]

they are caused by CO poisoning.

No.

Carbon monoxide poisoning is an emergency and quickly causes death when untreated.

https://www.poison.org/articles/carbon-monoxide

 

[Albert Donnay]

No.

Carbon monoxide poisoning is an emergency and quickly causes death when untreated.

https://www.poison.org/articles/carbon-monoxide

Hi Wab-Sabi.

Carbon monoxide poisoning is only SOMETIMES an acute high-level emergency that causes death if untreated. Risk of death depends on the level and duration of exposure.

What I suggest is causing CFS/ME is chronic low level CO poisoning, in which blood and breath CO levels are lower than the acutely lethal range but still higher than normal, and enough to warrant treatment. Chronic CO poisoning has been a thing in medical literature dating back over 100 years to when CO in illuminating gas was first identified as the most likely cause of neurasthenia in the late 19th century.

COHb levels are not typically fatal until arterial OR venous is over 10% and their sum over 20%, but US CDC recommends that doctors diagnose CO poisoning in non-smokers--and treat it--when either arterial or venous COHb is above just 2%.

Critically, people with CFS who have been tested per my protocol usually have over 2% COHb.

See for example the 2.7% COHb reported by @Emootje back in 2011:
https://forums.phoenixrising.me/threads/mechanism-for-normal-sp02-when-short-of-breath.10955/post-191146

As my protocol predicts for CO survivors, he also had low oxygen delivery to tissues (= arterial minus venous oxygen), as evidenced by higher than normal venous PO2 and venous SO2.

Please also consider this peer-reviewed report from 1999 by Knobeloch and Jackson of the Wisconsin Health Department online at https://pubmed.ncbi.nlm.nih.gov/10605352/

The authors review the cases of 3 families whose members were independently diagnosed with CFS in separate incidents. The physicians involved were competent enough to make these diagnoses but did not first consider and rule out carbon monoxide poisoning, which was later discovered to be the cause.

While some might say these were not actually CFS cases but just misdiagnosed cases of CO poisoning (since most CFS case definitions rule out the diagnosis if any cause can be found), I think it is more helpful to think of CFS as the correct diagnosis, since the patients all met the required criteria, while CO poisoning was the missed diagnosis of the cause.

Just as headaches can have different causes, so too may CFS. Doctors using ICD-10 coding systems are supposed to diagnose diseases separately from toxic exposures, for which there is a separate list of E codes that includes several for carbon monoxide.

These well-documented cases are enough to prove that repeated exposures to low levels of CO (less-than-lethal) from inadequately vented home appliances are sufficient to cause CFS/ME in SOME males and females, from young children to adults. Given how common CO exposures still are in the US-- where CO is the leading cause of both non-lethal and lethal unintentional toxic poisonings according to CDC -- it is reasonable to assume that CO poisoning is still causing some unknown percentage of new CFS cases.

If there are CFS researchers who do not think CO should be considered as a cause of CFS and who do not want to study this possibility (I know a few...), I recommend they exclude such cases from their studies so as not "pollute" the others.

To do this, however, they will have to test all their prospective cases and controls for CO poisoning, using either invasive tests of COHb in arteries and veins, or faster non-invasive tests of exhaled CO or transcutaneous SpCO, and exclude all those who meet the CDC definition for poisoning with COHb>2%, which is equivalent to exhaled CO >12 ppm.

But if they diagnose any previously unrecognized cases of CO poisoning by these methods, they also are going to have to immediately treat them until both their arterial and venous CO fall below the poisoning threshold, as it would be malpractice not to.

My hope is that CFS researchers will not exclude cases with CO poisoning like @Emootje had in 2011 but will include them and report their results separately from those of CFS cases without CO poisoning.

My bet is that the first CFS study that tries screening for CO will find more than half of its CFS cases are already poisoned.

 

[Judee]

since the patients all met the required criteria

Do you know which criteria was used to determine that?
Fukada? ICC? CCC? Chalders?