I went to see Cheney on Monday (1/15), for an eight hour visit and echocardiogram. I have been seeing Cheney since 2001. He has been very helpful to me and his protocol has allowed me to keep working full-time since I got sick with CFIDS in 1998. Basically, Cheney continues to focus on diastolic dysfunction that is universally seen in all of his patients. Briefly, this means that the expansion of the heart to fill with blood is compromised in CFIDS patients. His explanation is that diastole (the expansion of the heart to fill with blood) requires cellular energy and CFIDS patients have low energy at the cellular level. (Systole, the contraction of the heart to pump out blood, requires almost no energy.) Therefore, the cardiac issues are a manifestation of a deeper problem at the cellular level. He does not think CFIDS patients are suffering from heart failure. At the same time, he sees diastolic dysfunction as a mediating factor in the illness because reduced cardiac output (or stroke volume) results in reduced blood flow to major organ systems. Without adequate blood flow, these organ systems don't funcion properly. He was quite excited about a new trial he just completed. Basically, the trial protocol consisted of cardiac cell signalling factors from adolescent and fetal pigs. He gets this stuff from Atrium Biotech. Roughly seven of his patients improved enormously from this treatment, but five did not. He then found through echocardiograms that patients whose cardiac function responds positively to inhaled oxygen were the ones who improved from the protocol. The patients whose cardiac function worsened from inhaled oxygen were the non-responders in the trial. He had a few theories about the underlying dynamics, but I think he was just throwing out ideas without much hard evidence. Unfortunately, my cardiac function worsened on the echocardiagram when I was given inhaled oxygen. Therefore, he did not think the protocol would work for me. His protocol for me, therefore, remains unchanged. I will list them in descending order of importance to me. Basically, the first three items listed are "essential" to me. The rest offer more marginal benefits as far as I am concerned: 1. Daily intramuscular magnesium injections. This is mixed with taurine to dilute the magnesium, which is caustic and can burn. For a few years I did this at night (per Cheney's recommendation) but then decided to try it in the morning before work. This was a magical discovery for me, improving my energy level and cognitive function during the day enormously. The benefits in my case were enormous and worth the pain in my rear-end from giving myself a daily IM shot. 2. Hydroxycobalamine (B-12) injections daily in AM. In the early years, this was very helpful for cognitive function. Cheney prescribes a high dose (10mg per day), and believes it is both an immunomodulator and a detoxifier. I still do it every day, although it has lessened in importance as my cognitive symptoms have improved. 3. Klonopin/Doxepin/Neurontin "cocktail" one hour before bed. This is basically used to allow patients to sleep. Klonopin induces sleep, while Doxepin and Neurontin keep you asleep. Cheney believes Klonopin is neuroprotective and that all three medications are important for immune function. Personally, I just think it promotes regular sleep. 4. Nexavir by injection or transdermal gel. Nexavir is essentially a new version of Kutapressin. He believes Nexavir is more potent than Kutapressin was. I have been using the injection form, although Cheney wants me to switch to the transdermal gel. Not sure why. He believes Nexavir has anti-viral properties and improves cardiac function, as measured on echocardiograms of his patients. 5. A variety of "neutraceuticals". He advises patients to take an anti-oxidant that contains grape seed extract, turmeric, green tea extract, etc. He also advises patients to take NADH, Folic Acid (preferrably tetrahydrofolate since many patients have a genetic defect that prevents them from metabolozing folic acid), Selenium, Co-Enzyme Q10, and Silymarin. Obviously, he also recommends a multi-vitamin. 6. Isoprinosine. This is a prescription medication (tablet) that is not available in the US, but has been approved in 50 other countries, including Canada and Europe. He thinks it is an important therapy that acts as an immunomodulator, although I have never noticed a major benefit when I am on it. At the margins, it may reduce the frequency of infections, although that may be a placebo effect in my case. I hope this review is helpful. I am grateful to Cheney and wish other doctors were more willing to follow his protocol. It would benefit a lot of CFIDS patients who otherwise cannot afford to see Cheney. But, maybe some of you can convince your own doctors to try one or more items in the protocol.