Regarding Dr. Chaney

Discussion in 'Fibromyalgia Main Forum' started by louiesgirl2, Apr 28, 2009.

  1. louiesgirl2

    louiesgirl2 New Member

    Am I invisible. I must be. I replied to this post on his information. No one seemed to care that lay people might have trouble understanding all that information. You all just kept going on like some of us would really understand. Well I for one didn't and don't. So, if some kind person would take the time to explain it for us dummies I would appreciate it.
  2. ikathy

    ikathy New Member

    If you will google Dr. Cheney Basic Protocol it is all explained there. There is really too much information for one to give you a good explanation.

    Please do not think you are invisible. Sometimes it just takes some time before their are replies back to your message.

  3. AuntTammie

    AuntTammie New Member

    I see you : ) so, nope, not invisible.....just as others have said, asking questions that we don't necessarily know how to answer....or don't have the time and/or energy to explain

    and no, you are not dumb if you cannot understand this stuff - it's really complex and confusing....I sometimes understand most of it, but that's only if I am not feeling too foggy and exhausted, and that's also after having done a ton of my own research....if you don't have the basic info that he uses to build upon in explaining his theories, then the more advanced (for lack of a better term) his explanations get, the more easy it is to get confused....kind of like trying to do complex algebra if you don't know how to do simple addition....that doesn't mean that you are dumb - you might very well be able to understand exactly what he is saying in the latest report (his "algebra") if you familiarize yourself with a bit of his "basic addition" first

    I really hope that didn't come across as insulting, but I don't know how to explain it better - what I mean, though, is that you might not have encountered enough of his stuff before to be able to make sense of this - never seeing it doesn't mean that you are not capable of understanding it eventually

    that said, it IS pretty hard to grasp, and I don't quite get all of it either
  4. richvank

    richvank New Member

    Hi, louiesgirl2.

    I can't say that I totally understand Dr. Cheney's work and point of view on CFS myself, but I will give a try at explaining it. Please bear in mind that Dr. Cheney and I do not agree on some important issues, as he pointed out in response to a question about me from a person in the audience, but I will try not to let that color my interpretation of what he said, although that is difficult! Perhaps others here will correct me where I go wrong. I do think very highly of Dr. Cheney, have learned a lot from him, and enjoy our interactions.

    I was not at the talk, but I have interacted with Dr. Cheney quite a bit by email and also some in person, and I think I have a general idea about his thinking. I have also followed his talks since 1999.

    First, let me give you some background. A few years ago, Dr. Cheney himself had heart failure, and he received a transplanted heart from a 25-year old. He himself is in his fifties. By his own testimony, he actually died on the table, but was brought back. His new heart has done wonders for him, and as you can imagine, he became very interested in matters associated with the heart.

    He had been involved with chronic fatigue syndrome since the cluster of cases in Incline Village, Nevada, in the mid-80s. After his heart transplant, he ran across a paper by Arnold Peckerman et al., in which it was reported that people with CFS have low cardiac output. That is, the amount of blood their hearts pump out per minute is below the normal range.
    Dr. Cheney began testing patients with the technique Peckerman used, called impedance cardiography. This is a noninvasive approach in which electrodes are attached to the body, something like what is done with an electrocardiograph. The impedance cardiograph is able to measure the amount of blood pumped out per stroke of the heart (stroke volume), and by multiplying this by the heart rate, you get the cardiac output. It also measures some other parameters associated with the heart and the blood flow.

    Dr. Cheney found similar results on his patients to what Peckerman had reported. Dr. Cheney went on to use a modern echocardiograph machine on his patients, and with this device, he could evaluate many features of the heart's operation. These days, I think he pretty much focuses on using the echocardiograph.

    Now, I need to explain why the heart in CFS patients has low output. First of all, in general, this is called "heart failure." That doesn't mean that the heart has stopped working. It means that it is not putting out as much blood per minute as the body really needs to function normally.

    There are several types of heart failure. Some of them involve a weakened heart muscle, which can be caused by various things. In these types of heart failure, there is what is called a low ejection fraction. The ejection fraction is the fraction of blood that comes into the left ventricle (the "workhorse" part of the heart) during the socalled diastolic or relaxation phase of the heart muscle that is actually pumped out during the systolic phase, when the heart muscle tightens up. This type of heart failure has been commonly known and measured by cardiologists for a long time.

    However, as time went by, it was recognized that there were a lot of people who had low cardiac output, i.e. heart failure, but not a low ejection fraction. Eventually somebody figured out that there is another kind of heart failure. It is called diastolic dysfunction. In this type of heart failure, the ejection fraction is in the normal range, but the output of the heart is low, because not enough blood comes into the left ventricle during the relaxation phase of the heartbeat.

    The reason it doesn't is that the heart muscle does not relax fast enough to allow enough blood to come in before the next compression is going to occur. The reason the muscle doesn't relax fast enough is that the mitochondria (the little power plants in the cells that oxidize food to produce ATP) do not produce ATP fast enough.

    ATP is used to relax the heart muscle, and to sort of "cock" it like a gun, so that it is ready to squeeze when it gets the signal to do so. ATP is what supplies energy to operate the heart muscle as well as to drive a wide variety of biochemical reactions in the cells. This low rate of production of ATP in the heart muscle cell mitochondria is what Dr. Cheney means by "an energy-related cardiac problem."

    Dr. Cheney believes that the low cardiac output as a result of diastolic dysfunction is what causes PWCs to have orthostatic intolerance, i.e. difficulty in standing up without having problems with tending to faint or having a very rapid heart rate.

    There are certain parameters that one can measure using an echocardiograph machine (which is basically an ultrasonic or sound wave type of machine that is used to study the size and shape of parts of the heart and their motion during the heartbeat) that will tell you how bad the diastolic dysfunction is. One of these is a relaxation time called the IVRT. This is what Dr. Cheney focuses a lot of his attention on. He observes the heart of a patient using the echocardiograph machine, and he can measure the IVRT value as it changes over time, depending on various things he gives the patient.

    Dr. Cheney likes to make up his own jargon to describe what he does, and the term he uses for these IVRT measurements is the "Echo terrain map." The word "terrain" goes back to arguments that the early biomedical researchers like Pasteur used to have. Some emphasized the importance of the bacteria, and others emphasized the importance of the condition of the body, which they called the "terrain." I think this actually goes back to military terminology, in which battles are fought on terrain, and in the body there is a battle between the bacteria and the immune system.

    What Dr. Cheney does is to measure the IVRT repeatedly while he gives the patients various substances. Most of them are given by putting them on the skin in a gel, i.e. transdermally. He gives oxygen with a breathing mask. He observes the change in IVRT within a few seconds or minutes after he applies these various substances. He refers to changes in the IVRT as "energy response." When the IVRT value worsens, he refers to it as "backflash."

    Now here's one of the places where he and I part company. He believes that if the IVRT value improves, showing less diastolic dysfunction a short time after he gives a certain substance, that that substance is beneficial for the patient. On the other hand, if the diastolic dysfunction becomes worse shortly after applying the substance, he concludes that that substance is bad for the patient. I might mention here that as far as I know, he is the only one doing this and interpreting it this way, and that this is unproven. It is very innovative, and I do think it's meaningful if interpreted properly, but I'm not convinced that his way of interpreting these changes is correct, because of the short times involved. Something that might look harmful in the short term may turn out to be beneficial in the longer term, and vice versa, in my opinion, because so many things in the biochemistry change over the course of time. The body is a very complex biochemical system. So when he says something is good or bad for patients, bear in mind that it is based on this unproven interpretation. But anyway, back to Dr. Cheney's talk:

    One thing that Dr. Cheney has found is that when he gives oxygen to his CFS patients, the diastolic dysfunction becomes worse over the short term. As a result, he says the patients are "oxygen toxic" or "toxic to oxygen." This response is different from what he sees when he tests healthy people. He concludes that CFS patients have a problem with "oxygen handling."
    I don't think he is totally clear on how to interpret this observation. At various times he has invoked a left shift of the hemoglobin oxygen absorption curve in the red blood cells, but it has not been clear to me that this makes sense. Apparently in this talk he suggested that damage to red blood cells is involved. I don't know of any evidence for this.

    I don't think Dr. Cheney has a clear explanation from a biochemical standpoint for why the mitochondria are not able to produce ATP at a high enough rate to sustain normal cardiac output. I think his view is that something like a virus has disrupted the antioxidant enzymes, so that there is a condition of oxidative stress, and this is limiting the ability of the mitochondria to produce ATP at a normal rate.

    I think he believes that once this has occurred, the body does various things to compensate for this problem in order to keep the person alive. He believes that the symptoms of CFS result from this adaptation.

    The "PFO" that is referred to stands for "patent foramen ovale." The foramen ovale is a hole that we all have between two chambers of our hearts while we are in the womb. The reason for this is that we don't need to pump blood through our lungs before we are born, because they can't get any oxygen until we start breathing after we are born. In most people, this hole is covered with a flap of tissue after we are born. In some people, it isn't sealed shut, and in that case, it's called "patent." Dr. Cheney can look for this using the echocardiograph, and he finds it to be patent on quite a few CFS patients. This is caused by the condition of diastolic dysfunction, which produces a higher than normal pressure in one of the chambers of the heart, which can push this flap open.

    The P450 that was mentioned refers to the cytochrome P450 enzymes. These are used for detoxication in the cells, and they produce some oxidizing free radicals during their operation. The mitochondrial also produce oxidizing free radicals. Oxidizing free radicals are the source of oxidative stress. Normally, the antioxidant system is able to take care of the oxidizing free radicals so as to prevent oxidative stress. However, in CFS, it has been shown in many measurements that there is oxidative stress. The question is, why? I have my own hypothesis for this, as does Prof. Martin Pall, and Dr. Cheney grapples with this question as well. Part of the reason it's difficult to understand what Dr. Cheney says is that he doesn't have this totally worked out yet.

    I think I'll stop here. I may not have covered everything, but hopefully what I've written will help you to better understand what Chris has reported about Dr. Cheney's talk.

    Best regards,


    [This Message was Edited on 04/28/2009]
  5. louiesgirl2

    louiesgirl2 New Member

    Thanks Rich for your explanation. Still a little foggy but have a better understanding to a degree. I will do some research myself and hopefully by going back to go forward as it were, I will understand more.