460 ~ 6 April 2006

1
460 6 April 2006

• Module VII Integrative Approaches re Common
  Health Issues
• chronic fatigue
  oncology

2
(No Transcript)
3
(No Transcript)
4
Can you have Good without Evil ?
5
Is this an Optical Illusion ?
6
Learn is always reflected in Teach
7
How much difference is there between You Me ?
8
Chronic Fatigue Syndrome

• This illness is to fatigue what a nuclear bomb
  is to a match. Its an absurd mischaracterization.
  " Laura Hillenbrand, battling CFS,
  bestselling author of book, Seabiscuit

9
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

10
Understanding Chronic Fatigue Syndrome (CFS)

• CFS disproportionately affects women, has long
  been under-recognized 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

11
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

12
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

13
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

14
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

15
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

16
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

17
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.

18
Key symptoms of CFS/ME include

• profound exhaustion
• extreme joint/muscle pain and headaches
• severe thinking and memory dysfunctions
• a depressed immune system

19
Its all in their minds!

• there is substantial objective, well-documented
  evidence of central nervous system, (CNS),
  immune, endocrine, cardiovascular, and autonomic
  nervous system abnormalities which indicate that
  CFS is biologically, not psychologically,
  determined

20
Its 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

21
At least 4 of these key symptoms are concurrently
present for 6 months or longer

• 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

22
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

23
Is there a psychological factor identified by
research ?

• research suggests that among broadly-defined
  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

24
Treatment/s

• Depends on the subgroup
• patients with signs of ongoing infection have
  responded to the appropriate anti-viral 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

25
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

26
Text re Treatment-Conventional

• Conventional or allopathic includes medical,
  social, psychological support
• Conventional drug therapies anti-depressants
  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

27
Text re Treatment-Integrative

• 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

28
Text re Treatment-Integrative

• 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

29
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

30
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 thats kind of an
  CFS interval training approach

31
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

32
(No Transcript)
33
The name "Co-Cure" stands for "Cooperate and
Communicate for a Cure." Our Focus Myalgic
Encephalomyelitis / Chronic Fatigue Syndrome
(ME/CFS) Fibromyalgia
34
(No Transcript)
35
(No Transcript)
36
O n c o l o g y
37
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

38
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 . . .

39
(No Transcript)
40
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 dont die of
  embarrassment

41
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

42
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

43
Cancer Prevention Modifiable Risk Factors ?

• Tobacco use
• Unhealthy eating
• Excess body weight
• Physical inactivity
• Over-exposure to suns ultraviolet rays

44
Treatments Conventional

• Surgery
• Chemotherapy
• Radiation
• Hormonal therapy
• Biological therapy plus managing pain,
  managing side effects like
  destruction of healthy cells , managing
  stress

45
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

46
(No Transcript)
47
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

48
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

49
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

50
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

51
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

52
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, evidence-based decision-making
  imperative

53
Next Day

• Last Class Synthesis and Wrap-up
• Exam info