Transcript Module 7 - CFS and Oncology

460 ~ 6 April 2006
• Module VII – Integrative Approaches
re Common Health Issues:
~ chronic fatigue
~ oncology
Can you have Good without Evil ?
Is this an Optical Illusion ?
Learn is always reflected in Teach
How much difference is
there between You & Me ?
Chronic Fatigue Syndrome
• “This illness is to fatigue what a
nuclear bomb is to a match. It’s an
absurd mischaracterization."
~ Laura Hillenbrand, battling CFS,
bestselling author of book, Seabiscuit
Chronic
FATIGUE Syndrome
• the name chronic fatigue syndrome
itself has caused many of the
misconceptions and trivialization of it
• Fatigue is a symptom, not the illness
• Now often prefer Chronic Fatigue
Immune Dysfunction Syndrome
(CFIDS)
• No known cause, no definitive cure
Understanding Chronic Fatigue
Syndrome (CFS)
• CFS disproportionately affects
women, & has long been underrecognized & under-diagnosed
• now one of the most common
chronic illnesses of our time
• also one of the most misunderstood
• research is shattering many
misconceptions, showing CFS to be
major public health problem
Chronic Fatigue Syndrome – what
is it ?
• 1988 US Ctre for Disease Control (CDC)
formulated working defn that supported
notion of CFS as single entity with single
cause
• Thus, term used for any unexplained,
persistent fatigue from sleep disorders,
nutritional deficiencies, stress etc
• CDC defn no longer supported though it
still taints perception of CFS
Prevalence ?
• US prevalence rate for women with
CFS is higher than it is for AIDS (12
women per 100,000), breast cancer
(26 women per 100,000) and lung
cancer (33 women per 100,000)
• CFS not specific to any race, age, or
SES group
Canadian & Other Stats
• According to Statistics Canada, 341,126
Canadians have had a doctor diagnose them with
Chronic Fatigue Syndrome [ 2003 study, released
2006] ~ called 10% phenomenon
• Perspective re US stats: almost twice as
common as multiple sclerosis & five times
more common than AIDS
• Estimate that $100 billion lost annually in
N America due to CFS-related issues &
complications & side effects
ME / CFS
• Problem: what is fatigue, prolonged
fatigue, chronic fatigue, & chronic fatigue
syndrome ?
• the Canadian Expert Consensus Panel has
published a medical milestone, the first
clinical case definition for the disease
known as myalgic encephalomyelitis
/chronic fatigue syndrome
• ME more widely known as fibromyalgia
ME vs cfs
• Myalgic encephalomyelitis (ME) is a more specific and
appropriate diagnosis than CFS, as it describes a
specific condition with muscle and neurological
symptoms, not only the ubiquitous symptom of fatigue
• More specifically, the fatigue in ME is exertion related
(vs. "tired all the time"), with a significantly prolonged
recovery time, and all symptoms can be magnified by
levels of physical, cognitive, sensory or emotional stress
that would have been of no consequence prior to the
illness onset
• Currently both names/descriptions may be used, or
sometimes may be used interchangeably, which has led
to a great deal of confusion
• CFS is used more frequently in the US, while ME is still
preferred by most of Europe, Canada, and Australia
• Possible that all patients with ME have CFS but not
everyone with CFS has ME
More on ME
• Systemic disease but primarily
central nervous system dysfunction
• Often dysautonomia or abnormal
functioning of the autonomic nervous
system
• Also associated with emotional,
cognitive, & proprioceptive
dysfuntion
Myalgic encephalomyelitis = CFS –
Chronic Fatigue Syndrome
• the new clinical case definition makes it
compulsory that in order to be diagnosed with
ME/CFS, a patient must become symptomatically
ill after exercise and,
• must also have neurological, neurocognitive,
neuroendocrine, dysautonomic, and immune
manifestations [symptoms other than fatigue
must be present for a patient to meet the criteria
]
• This case definition, which incorporates some of
the current research on dysautonomia, cardiac,
and immune problems, was published in the
Journal of Chronic Fatigue Syndrome, Vol. 11 (1)
2003.
Key symptoms of CFS/ME include:
• profound exhaustion
• extreme joint/muscle pain and
headaches
• severe thinking and memory
dysfunctions
• a depressed immune system
It’s all in their minds!
• there is substantial objective, welldocumented evidence of central
nervous system, (CNS), immune,
endocrine, cardiovascular, and
autonomic nervous system
abnormalities which indicate that
CFS is biologically, not
psychologically, determined
It’s all in their minds!
• The leading model of CFS
pathogenesis is rooted in
scientifically identified
abnormalities in the brain (central
nervous system) and the immune
system, both of which affect and
alter the function of the other
At least 4 of these key symptoms are
concurrently present for 6 months or longer:
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substantial impairment in short-term
memory or concentration (attention
deficit, memory lapses, frequently using
the wrong word, spatial disorientation)
sore throat
extreme joint and muscle pain without
swelling or redness
headaches of a new type, pattern or
severity
Un-refreshing sleep (hypersomnia or
insomnia, nightmares)
painful lymph nodes
post-exertional malaise lasting more than
24 hours
CFS Research
• In broadly-defined CFS, the research is
equivocal and confusing
• there is some evidence for a persistent
viral infection in a subgroup of patients,
while in others, there are clear signs of
immune system activation, muscle
damage and other changes suggesting
ongoing disease
• presence of certain pathogens
(bacteria, parasites) in the gut play a
significant role in some CFS
Is there a psychological factor
identified by research ?
• research suggests that among broadlydefined populations, there is a subgroup
whose ongoing fatigue may be the direct
result of excessive inactivity and
maladaptive (irrational, unrealistic)
beliefs
• Majority of CFS sufferers do not have
psychological predisposition to CFS
Treatment/s
• Depends on the subgroup:
• patients with signs of ongoing infection
have responded to the appropriate antiviral or immunity-boosting drugs
• where there is a lack of certain vitamins
(D, B12) or food sensitivities,
supplementation and dietary modification
have had impressive results
Treatment/s
• In the UK, researchers have found
that lifestyle advice e.g. about
expenditure of energy, diet etc. plus
stress management and counseling,
can significantly reduce disability and
distress
Text re Treatment-Conventional:
• Conventional or allopathic includes
medical, social, psychological support
• Conventional drug therapies [antidepressants] work for some symptom
relief; just as often, they produce other
symptoms or reactions ex: NSAIDs create
GI problems
• Role of exercise is controversial and
equivocal in effect
Text re TreatmentIntegrative:
• Limited research or practice here
that comes down to decision-making,
experience, individual considerations
• Issue seems to be making sure there
are options and being open
• What forms? Massage, osteopathy,
chiropractic are all prelim studies
Text re TreatmentIntegrative:
• Mind-body interventions such as
relaxation, meditation ~ note the RCTs in
this area ~ goal in these is to help patient
live functionally, not cure CFS
• One good RT study on +tive effect of
homeopathic remedies
• Others in text: dietary, herbal,
acupuncture, Ayurveda
• See the case study page 427 re text
conclusions on CFS treatments
What about exercise ?
• those who do not engage in 'excessive
rest' or who tend to operate at their own
activity ceilings should learn to pace
themselves through the day
• for people whose fatigue appears to be
maintained by unhelpful beliefs and
behaviours, cognitive-behaviour therapy
(CBT) plus graded activity is the treatment
of choice
• Issue is not whether to exercise, but how
much and when
New advice for CFS patients ~
‘Pace & Switch’
• Pace in everday activities
• Switch mental and/or physical
activities before exhaustion
• Commitment to rest
• Relatively new coping mechanism
that’s kind of an CFS interval training
approach
What is needed ?
• we need better criteria to separate
the different fatigue syndromes –
otherwise, inconsistent & confusing
findings
• doctors must begin to trust people
with CFS ~ it has had some very bad
press and is tarnished by prejudice ~
public needs greater awareness too
The name "Co-Cure" stands for
"Cooperate and Communicate for a Cure."
Our Focus: Myalgic Encephalomyelitis / Chronic
Fatigue Syndrome (ME/CFS) & Fibromyalgia
Cancers
• Rogue cells that form lump or mass
that is either benign (non-cancerous)
or malignant (cancerous)
• Named for body area of origin, ex.
colon cancer; if it moves or
metastasizes to liver, then colon
cancer with liver metastases
Cancer complexity
• Complexity of CFS is one type of
complexity
• Complexity of cancer as health issue
is whole different matter
• Consider real case decision on
maternal cancer genetics . . .
Cdn Cancer Statistics
• In 2005, 149,000 new cases of and
69,500 deaths from cancers
• Lung cancer is leading cause of death
from cancer, more than breast &
prostate combined
• 2nd leading is colorectal – new TV ads
with bums with asterisk over rectal
area [ ‘don’t die of embarrassment’ ]
Cdn Cancer Statistics
• Incidence and mortality from all cancers &
lung cancer hier in eastern, lower in
western provs
• Increased number of new cases due to
aging population
• 44% of new cases and 60% of deaths
occur in 70+ age group
• Cancer rates hier for females during
reproductive years; males hier rates at all
other stages of life
Probability Stats
• 38% of Cdn women, 44% Cdn men
will develop cancer
• 1 out of every 4 Cdns will die from
cancer
• Lung cancer by far the leading cause
of premature death (life years lost)
• Some 1300 cases of cancer in kids;
only 20% likely to die
Cancer Prevention – Modifiable
Risk Factors ?
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Tobacco use
Unhealthy eating
Excess body weight
Physical inactivity
Over-exposure to sun’s ultraviolet
rays
Treatments ~ Conventional
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Surgery
Chemotherapy
Radiation
Hormonal therapy
Biological therapy
[ plus managing pain, managing
side effects like destruction of
healthy cells ], managing stress
Treatment & Canadian Cancer
Society:
• Seems to be very progressive, albeit
cautiously in its inclusiveness of both
allopathic and alternative treatment
approaches
• Directive and user-friendly, public
approach to understanding clinical
trials…
Treatment & Canadian Cancer
Society: re conventional
• “Conventional treatment for cancer, which
usually consists of surgery, radiation
therapy and/or chemotherapy aims to
attack or remove the cancer”
• “These methods have been scientifically
tested, and are constantly being improved,
in well-designed clinical trials”
Treatment & Canadian Cancer
Society: re Alternative
• Advocate that this is personal decision
and should consider/know:
~ diffs betw conventional &
CAM therapies
~ all the info you can get on
CAM forms
~ consulting with healthcare
team re use and interaction of CAM
forms with conventional
Treatment & Canadian Cancer
Society: re Alternative
• Distinguish betw complementary re
using, say meditation with
conventional therapies to relieve
pain etc
• Vs alternative, meaning ‘instead of’
with such forms as massage,
meditation, therapeutic touch,
herbal remedies, special diets, new
& un-tested treatment discoveries
Text & Integrative medicine
• Focuses mainly on CAM modalities in
cancer treatment re
• Minimal evidence for nutrient or
micronutrient (ex. Vitamins)
products having any real impact
• Palliation (alleviation) of symptoms
show some support re use of
acupuncture in reducing
nausea/vomiting with chemo
Text & Integrative medicine
• Underscores importance of “quality
survival”
• Goes thru good discussion of CAM
approaches like dietary, micronutrients
and nutraceuticals, botanicals, mind-body,
acupuncture and some others – for you,
note the evidence for each
• Note and study the extensive case study
author uses and conclusions re this
integrative approach
Conclusions re CFS and Cancer re
Integrative Medicine
• Both stunning, complex health issues
• Both have greater potential for
integrative medicine approach
• Keys: personal & professional
responsibility; informed, evidencebased decision-making imperative
Next Day
• Last Class – Synthesis and Wrap-up
• Exam info