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Dysautonomia article
Posted by faith v.
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faith v.
Dysautonomia article July 31, 2007 02:19PM |
A Quick Fix for Fatigue
By Mary Roach
Health Magazine, October 1998
In May 1983 I was told something was wrong with my heart. The diagnosis was mitral valve prolapse. In July 1997 I was told nothing is wrong with my heart It's my autonomic nervous system that's amiss. This is the new theory on MVP, and cardiologist Phillip Watkins, who runs the Mitral Valve Prolapse Center in Birmingham, Alabama, says it may help explain why millions of women -- including me -- feel tired all the time.
The mitral valve is an anatomical saloon door between two chambers of the heart. Prolapse means the door doesn't close snugly and a little of what's passing through sometimes slips back. The cowboy's hat gets left behind. This structural oddity left me at risk for a heart infection, my doctor told me when I was first diagnosed, but one so rare that I didn't need to worry.
Yet Watkins says the floppy mitral valve is a red herring. It's just another symptom that can be traced to a glitch, called dysautonomia, in the autonomic nervous system, the body's control center for monitoring and adjusting your vital signs. The end result is low blood volume -- meaning the body has 80 - 85 percent of the fluid it's supposed to -- which can lead to dizziness, heartbeat irregularities, chest pain, panic attacks, and most commonly, fatigue. It's like being in a state of chronic dehydration.
According to Watkins, mitral valve prolapse affects up to 12 percent of the population and is three times more common in women than in men. Many people have no symptoms. But if even 10 percent of them do -- a conservative estimate, Watkins reckons we're talking about more than 2 million women who may be walking around feeling light-headed, dizzy, and panicky, suffering from a syndrome they don't even know they have.
This may sound ominous. But it turns out, having an off-kilter autonomic nervous system is better than having a heart problem because it's easily fixed. Not only that, the treatment may help more than just those with MVP. Over the past few years researchers have been assembling evidence that some cases of chronic fatigue syndrome may stem from dysautonomia as well. If they're right, that adds to the mix perhaps 500,000 more individuals who stand to benefit.
The cluster of symptoms Watkins and others now call mitral valve prolapse syndrome has been puzzling doctors for decades. Around the time of World War II a physician observed a tendency among tall, thin female patients to feel tired and to be prone to dizzy spells and racing hearts. He called the phenomenon anxiety neurosis. In the 1960s another doctor noted the characteristic click and murmur that can be heard in these people's hearts (the click is the sound of the prolapsing valve; the murmur is the backflow). Then in the early 1970s sonograms arrived on the scene, allowing doctors a direct view of the heart. "We found all these people who had funny-looking valves," says Dr. Watkins, "so we started calling the condition mitral valve prolapse." The assumption was that the structural irregularity was causing the weariness, panic, and skipped heartbeats: correlation mistaken for causation.
But about 15 years ago Watkins and a fellow cardiologist separately discovered something very interesting. In studies of patients with MVPS, Andrew Gaffney, a Houston practitioner, noticed that they all had unusually low blood volume. Gaffney was also a consultant to NASA, and he observed that when astronauts return from space, their blood volume takes a nosedive and they experience effects similar to those of MVPS.
Meanwhile, during a study of women with MVPS, Watkins saw that when they became pregnant and their blood volume increased, their symptoms disappeared. The clincher came when he elevated the blood volume of the nonpregnant women and they got some relief.
Watkins is a soft-spoken man of perhaps 55 who sounds a little like Bill Clinton and looks a little like Charleton Heston. I decide to test his theory by letting him diagnose me. He grasps my left hand as though he has something upsetting to tell me. He doesn't. He wants to see if my hands feel cold. They do, as they almost always do. Ditto my feet. Watkins nods knowingly.
"Do you ever get light-headed when you stand up?" Sometimes. "Dry eyes?" Constantly. "Feel run down, easily fatigues?" Yup.
Watkins explains what he thinks is wrong with me. "Your fluid is low." Watkins is one of those doctors partial to automobile analogies. I blink my headlamps. "Meaning"
"If you take a patient with prolapse, turn her upside down, dump out all the fluid from her arteries and veins, it's only about 80 percent of what it should be. You're down to a quart." He theorizes that a faulty feedback mechanism in the brain fails to signal the body that it needs more water. "It thinks the tank is full when it isn't."
Watkins shifts metaphors. Now I'm an underfilled water balloon. Stand me up on end and the fluid pools in my lower half, unlike a fully plumped water balloon, wherein the water stays put. When the blood pools in my legs, my head doesn't quite get enough -- hence the wooziness when I stand up suddenly. To compensate, the brain shunts blood away from the extremities -- hence the cold hands and feet.
And my prolapsing valve? How does that fit in? Watkins cups his hands loosely in front of him like a priest saying mass. "Let's say this is your heart. If you've got a heart this size, and the heart shrinks down because the blood volume is less but the valve stays the same size, now it's too big for the heart." As a result, it flops around a bit.
By way of demonstration, Watkins takes me into an examination room and puts his stethoscope into my ears and onto my rib cage. "Hear the click?" I hear a sound that neither lub nor dub, a small muffled sharpness like fingers being snapped deep inside my chest. That's my loose mitral valve. Then Watkins has me lie down. With the blood in my body more evenly distributed, the click is gone.
Watkins asks if my heart ever races for no apparent reason and if I'm plagued by unexplained panic attacks. I have neither of these symptoms of MVPS, though my heartbeat sometimes seems to get off track.
Watkins pins this, too, on low blood volume. As with light-headedness, one of the body's compensating mechanisms is to blame. When fluid levels drop, adrenaline is called into service to rev heart rate. The less blood there is circulating, the faster the body needs to have oxygen, nutrients, and waste shuttled to and from its cells. The result is that people with low blood volume suffer a chronic excess of adrenaline.
"If you've got all this adrenaline going all the time, you can get awfully anxious," Watkins notes. Which could explain why 70 percent of his patients have had panic attacks at one time or another. The hammering heart itself is the source of the panic, he says. It starts pounding, and you don't know why. You panic, which makes it pound harder, and you panic more. "I asked a psychiatrist friend of mine, "How many of your panic patients have prolapse?" He said "All of them."
More solid proof comes from endocrinologist Al Davies of the Baylor College of Medicine in Houston. Davies has found biochemical evidence that MVPS sufferers not only have an excess of adrenaline but are excessively sensitive to it. Even a normal amount of adrenaline, in other words, would have a stronger effect. This may also explain why so many MVPS patients feel tired (92 percent of Watkins's patients say they regularly lack energy,) If you're going through life on overdrive, you're bound to feel the strain.
Watkins leads me down to a room full of intimidating equipment for the definitive blood volume test. Technician Laura Ousley directs me to lie down on something called a tilt table, then straps me to it. As it tips me to an upright position, she will observe changes in my blood pressure. People with low blood volume register a significant drop as the blood pools in their feet.
Ousley takes a baseline reading, then pushes a handheld button. The head of the table rises slowly and noisily. It's like lying in the back of a dump truck as it prepares to release its load. Mid-dump, my blood pressure plummets.
So I guess I'm one of them. Which means I might be in line for a simple cure: topping up the tank.
Watkins tells patients to drink eight to ten glasses of water a day and get more salt, which makes the body hold onto water, (You don't need to worry about driving up your blood pressure too high since it's already so low to begin with,) He also instructs them to cut out caffeine, which stimulates adrenaline production and prevents the body from hanging on to water, and to exercise, which keeps heart rate and blood pressure in check. If these lifestyle measures aren't enough, he moves on to one of two medicinal remedies: a beta-blocker, which curbs the response to adrenaline, or Florinef, a drug that has the same water-conserving effect as salt, only more so.
Patients with MVPS aren't the only tired people who may benefit from the humble first-resort cures. A recent study at Johns Hopkins University suggests that some cases of chronic fatigue syndrome may derive from the same autonomic nervous system disorder that lies behind MVPS. People with chronic fatigue don't necessarily have low blood volume, but their bodies act as if they do.
"We've tilted about 800 CFS patients," says Peter Rowe, the study's leader. Up to 95 percent showed that the same precipitous blood pressure drop that MVPS patients experience. And Rowe had cured these patients with the same treatment Watkins recommends for MVPS.
Becky Ayers certainly go a major lift from the regimen. At age 47 she began to experience classic symptoms of MVPS: dizziness, heart palpitations, panic attacks., terrible fatigue. She visited 12 doctors in six months, but no one was able to figure out what was wrong. She even saw a cardiologist who heard a click in her heart and diagnosed MVP, but he didn't think her symptoms had anything to do with the heart defect.
Finally, a friend of hers recognized her problem and lent her a book on MVPS, which contained advice similar to what Watkins gives. "I went cold turkey on caffeine, drank more water and ate more salt, and started exercising for the first time in my life," Ayers says. By the time she found a doctor who understood MVPS she was already starting to feel like her old self again. Ayers eventually founded a support group for MVPS sufferers. "I don't want anyone else to get the treatment I got -- or didn't get."
By Mary Roach
Health Magazine, October 1998
In May 1983 I was told something was wrong with my heart. The diagnosis was mitral valve prolapse. In July 1997 I was told nothing is wrong with my heart It's my autonomic nervous system that's amiss. This is the new theory on MVP, and cardiologist Phillip Watkins, who runs the Mitral Valve Prolapse Center in Birmingham, Alabama, says it may help explain why millions of women -- including me -- feel tired all the time.
The mitral valve is an anatomical saloon door between two chambers of the heart. Prolapse means the door doesn't close snugly and a little of what's passing through sometimes slips back. The cowboy's hat gets left behind. This structural oddity left me at risk for a heart infection, my doctor told me when I was first diagnosed, but one so rare that I didn't need to worry.
Yet Watkins says the floppy mitral valve is a red herring. It's just another symptom that can be traced to a glitch, called dysautonomia, in the autonomic nervous system, the body's control center for monitoring and adjusting your vital signs. The end result is low blood volume -- meaning the body has 80 - 85 percent of the fluid it's supposed to -- which can lead to dizziness, heartbeat irregularities, chest pain, panic attacks, and most commonly, fatigue. It's like being in a state of chronic dehydration.
According to Watkins, mitral valve prolapse affects up to 12 percent of the population and is three times more common in women than in men. Many people have no symptoms. But if even 10 percent of them do -- a conservative estimate, Watkins reckons we're talking about more than 2 million women who may be walking around feeling light-headed, dizzy, and panicky, suffering from a syndrome they don't even know they have.
This may sound ominous. But it turns out, having an off-kilter autonomic nervous system is better than having a heart problem because it's easily fixed. Not only that, the treatment may help more than just those with MVP. Over the past few years researchers have been assembling evidence that some cases of chronic fatigue syndrome may stem from dysautonomia as well. If they're right, that adds to the mix perhaps 500,000 more individuals who stand to benefit.
The cluster of symptoms Watkins and others now call mitral valve prolapse syndrome has been puzzling doctors for decades. Around the time of World War II a physician observed a tendency among tall, thin female patients to feel tired and to be prone to dizzy spells and racing hearts. He called the phenomenon anxiety neurosis. In the 1960s another doctor noted the characteristic click and murmur that can be heard in these people's hearts (the click is the sound of the prolapsing valve; the murmur is the backflow). Then in the early 1970s sonograms arrived on the scene, allowing doctors a direct view of the heart. "We found all these people who had funny-looking valves," says Dr. Watkins, "so we started calling the condition mitral valve prolapse." The assumption was that the structural irregularity was causing the weariness, panic, and skipped heartbeats: correlation mistaken for causation.
But about 15 years ago Watkins and a fellow cardiologist separately discovered something very interesting. In studies of patients with MVPS, Andrew Gaffney, a Houston practitioner, noticed that they all had unusually low blood volume. Gaffney was also a consultant to NASA, and he observed that when astronauts return from space, their blood volume takes a nosedive and they experience effects similar to those of MVPS.
Meanwhile, during a study of women with MVPS, Watkins saw that when they became pregnant and their blood volume increased, their symptoms disappeared. The clincher came when he elevated the blood volume of the nonpregnant women and they got some relief.
Watkins is a soft-spoken man of perhaps 55 who sounds a little like Bill Clinton and looks a little like Charleton Heston. I decide to test his theory by letting him diagnose me. He grasps my left hand as though he has something upsetting to tell me. He doesn't. He wants to see if my hands feel cold. They do, as they almost always do. Ditto my feet. Watkins nods knowingly.
"Do you ever get light-headed when you stand up?" Sometimes. "Dry eyes?" Constantly. "Feel run down, easily fatigues?" Yup.
Watkins explains what he thinks is wrong with me. "Your fluid is low." Watkins is one of those doctors partial to automobile analogies. I blink my headlamps. "Meaning"
"If you take a patient with prolapse, turn her upside down, dump out all the fluid from her arteries and veins, it's only about 80 percent of what it should be. You're down to a quart." He theorizes that a faulty feedback mechanism in the brain fails to signal the body that it needs more water. "It thinks the tank is full when it isn't."
Watkins shifts metaphors. Now I'm an underfilled water balloon. Stand me up on end and the fluid pools in my lower half, unlike a fully plumped water balloon, wherein the water stays put. When the blood pools in my legs, my head doesn't quite get enough -- hence the wooziness when I stand up suddenly. To compensate, the brain shunts blood away from the extremities -- hence the cold hands and feet.
And my prolapsing valve? How does that fit in? Watkins cups his hands loosely in front of him like a priest saying mass. "Let's say this is your heart. If you've got a heart this size, and the heart shrinks down because the blood volume is less but the valve stays the same size, now it's too big for the heart." As a result, it flops around a bit.
By way of demonstration, Watkins takes me into an examination room and puts his stethoscope into my ears and onto my rib cage. "Hear the click?" I hear a sound that neither lub nor dub, a small muffled sharpness like fingers being snapped deep inside my chest. That's my loose mitral valve. Then Watkins has me lie down. With the blood in my body more evenly distributed, the click is gone.
Watkins asks if my heart ever races for no apparent reason and if I'm plagued by unexplained panic attacks. I have neither of these symptoms of MVPS, though my heartbeat sometimes seems to get off track.
Watkins pins this, too, on low blood volume. As with light-headedness, one of the body's compensating mechanisms is to blame. When fluid levels drop, adrenaline is called into service to rev heart rate. The less blood there is circulating, the faster the body needs to have oxygen, nutrients, and waste shuttled to and from its cells. The result is that people with low blood volume suffer a chronic excess of adrenaline.
"If you've got all this adrenaline going all the time, you can get awfully anxious," Watkins notes. Which could explain why 70 percent of his patients have had panic attacks at one time or another. The hammering heart itself is the source of the panic, he says. It starts pounding, and you don't know why. You panic, which makes it pound harder, and you panic more. "I asked a psychiatrist friend of mine, "How many of your panic patients have prolapse?" He said "All of them."
More solid proof comes from endocrinologist Al Davies of the Baylor College of Medicine in Houston. Davies has found biochemical evidence that MVPS sufferers not only have an excess of adrenaline but are excessively sensitive to it. Even a normal amount of adrenaline, in other words, would have a stronger effect. This may also explain why so many MVPS patients feel tired (92 percent of Watkins's patients say they regularly lack energy,) If you're going through life on overdrive, you're bound to feel the strain.
Watkins leads me down to a room full of intimidating equipment for the definitive blood volume test. Technician Laura Ousley directs me to lie down on something called a tilt table, then straps me to it. As it tips me to an upright position, she will observe changes in my blood pressure. People with low blood volume register a significant drop as the blood pools in their feet.
Ousley takes a baseline reading, then pushes a handheld button. The head of the table rises slowly and noisily. It's like lying in the back of a dump truck as it prepares to release its load. Mid-dump, my blood pressure plummets.
So I guess I'm one of them. Which means I might be in line for a simple cure: topping up the tank.
Watkins tells patients to drink eight to ten glasses of water a day and get more salt, which makes the body hold onto water, (You don't need to worry about driving up your blood pressure too high since it's already so low to begin with,) He also instructs them to cut out caffeine, which stimulates adrenaline production and prevents the body from hanging on to water, and to exercise, which keeps heart rate and blood pressure in check. If these lifestyle measures aren't enough, he moves on to one of two medicinal remedies: a beta-blocker, which curbs the response to adrenaline, or Florinef, a drug that has the same water-conserving effect as salt, only more so.
Patients with MVPS aren't the only tired people who may benefit from the humble first-resort cures. A recent study at Johns Hopkins University suggests that some cases of chronic fatigue syndrome may derive from the same autonomic nervous system disorder that lies behind MVPS. People with chronic fatigue don't necessarily have low blood volume, but their bodies act as if they do.
"We've tilted about 800 CFS patients," says Peter Rowe, the study's leader. Up to 95 percent showed that the same precipitous blood pressure drop that MVPS patients experience. And Rowe had cured these patients with the same treatment Watkins recommends for MVPS.
Becky Ayers certainly go a major lift from the regimen. At age 47 she began to experience classic symptoms of MVPS: dizziness, heart palpitations, panic attacks., terrible fatigue. She visited 12 doctors in six months, but no one was able to figure out what was wrong. She even saw a cardiologist who heard a click in her heart and diagnosed MVP, but he didn't think her symptoms had anything to do with the heart defect.
Finally, a friend of hers recognized her problem and lent her a book on MVPS, which contained advice similar to what Watkins gives. "I went cold turkey on caffeine, drank more water and ate more salt, and started exercising for the first time in my life," Ayers says. By the time she found a doctor who understood MVPS she was already starting to feel like her old self again. Ayers eventually founded a support group for MVPS sufferers. "I don't want anyone else to get the treatment I got -- or didn't get."
|
PeggyM
Re: Dysautonomia article July 31, 2007 09:25PM |
"... Watkins tells patients to drink eight to ten glasses of water a day and get more salt, which makes the body hold onto water, (You don't need to worry about driving up your blood pressure too high since it's already so low to begin with,) He also instructs them to cut out caffeine, which stimulates adrenaline production and prevents the body from hanging on to water, and to exercise, which keeps heart rate and blood pressure in check. If these lifestyle measures aren't enough, he moves on to one of two medicinal remedies: a beta-blocker, which curbs the response to adrenaline, or Florinef, a drug that has the same water-conserving effect as salt, only more so. ...
...Becky Ayers certainly go a major lift from the regimen. At age 47 she began to experience classic symptoms of MVPS: dizziness, heart palpitations, panic attacks., terrible fatigue. She visited 12 doctors in six months, but no one was able to figure out what was wrong. She even saw a cardiologist who heard a click in her heart and diagnosed MVP, but he didn't think her symptoms had anything to do with the heart defect.
Finally, a friend of hers recognized her problem and lent her a book on MVPS, which contained advice similar to what Watkins gives. "I went cold turkey on caffeine, drank more water and ate more salt, and started exercising for the first time in my life," Ayers says. By the time she found a doctor who understood MVPS she was already starting to feel like her old self again. Ayers eventually founded a support group for MVPS sufferers. "I don't want anyone else to get the treatment I got -- or didn't get.""
............................................................................................................
Personally i do not fit this profile, being short and fat rather than tall and thin, and having mild high bp rather than low. But many respondents here do fit this profile like it was a professionally drawn silhouette. You couldn't tell it from their shadow. I sure would like those people to try these simple measures and report back to us.
DGM, you out there? Can we get some comment from you, please?
PeggyM
...Becky Ayers certainly go a major lift from the regimen. At age 47 she began to experience classic symptoms of MVPS: dizziness, heart palpitations, panic attacks., terrible fatigue. She visited 12 doctors in six months, but no one was able to figure out what was wrong. She even saw a cardiologist who heard a click in her heart and diagnosed MVP, but he didn't think her symptoms had anything to do with the heart defect.
Finally, a friend of hers recognized her problem and lent her a book on MVPS, which contained advice similar to what Watkins gives. "I went cold turkey on caffeine, drank more water and ate more salt, and started exercising for the first time in my life," Ayers says. By the time she found a doctor who understood MVPS she was already starting to feel like her old self again. Ayers eventually founded a support group for MVPS sufferers. "I don't want anyone else to get the treatment I got -- or didn't get.""
............................................................................................................
Personally i do not fit this profile, being short and fat rather than tall and thin, and having mild high bp rather than low. But many respondents here do fit this profile like it was a professionally drawn silhouette. You couldn't tell it from their shadow. I sure would like those people to try these simple measures and report back to us.
DGM, you out there? Can we get some comment from you, please?
PeggyM
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Re: Dysautonomia article August 01, 2007 01:00AM |
Registered: 6 years ago Posts: 18,881 |
|
PC
Re: Dysautonomia article August 01, 2007 07:29AM |
Hi Faith,
You and/or others may not have read the Dysautonomia discussion in the CR
[www.afibbers.org]
PC
|
Pam
Re: Dysautonomia article August 02, 2007 03:41AM |
Making the link between vaso vagal syncope (neurocardiogenic syncope), dysautonomia and atrial fibrillation:
[www.afibfacts.com]
Pam
[www.afibfacts.com]
Pam
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