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Transcript of Dr William Reeves on Georgia Public TV
Saturday 26 September 2009
The episode can be seen here.
Although the episode is from December 2007, a transcript has only recently been made available:
Transcriber note: This is for archival purposes as well as clarification on CCRP's current research focus (or lack thereof!)
Guest: William Reeves, Director CDC Chronic Viral Diseases Branch Show: Georgia Weekly, Georgia Public Broadcasting Air date: Sunday December 30, 2007 Host: Susan Hoffman
Host: We all feel tired sometimes but when the fatigue is beyond description and won’t subside with a good night’s sleep and lasts for months, something’s wrong. Could be any number of disorders, it could be Chronic Fatigue Syndrome. Experts say it is vastly under-reported and costly for businesses and families. Here with the latest on this public health threat, CDC chronic fatigue expert Dr. William Reeves. Thank you for being here, I appreciate your time. It is official, it is not a figment of somebody’s imagination, this previously called ‘Yuppie Flu’, it is for real- but can you tell me, what is it?
Dr. Reeves: CFS is a syndrome, it is an illness comprised of a group of symptoms. At the bottom line, fatigue is central to Chronic Fatigue Syndrome, and it isn’t just being tired. It’s being absolutely wiped out physically and mentally.
Host: Hit the wall.
Dr. Reeves: It’s kind of like what you’re like about two or three days into flu, or influenza, you can’t think straight, your body hurts all over, and it isn’t made any better by rest.
Dr. Reeves: Now that’s the fatigue- It’s a mental fatigue, it’s a physical fatigue. CFS is also accompanied, because it’s a syndrome, with other symptoms.
Host: Like what?
Dr. Reeves: Like almost everybody that has CFS complains that they can’t think straight and they can’t remember things.
Host: Kind of that fog?
Dr. Reeves: The fog, the mental fog, that’s almost everybody. Almost everybody with CFS complains that they have trouble sleeping, they don’t feel refreshed when they wake up, they can’t sleep through the night.
Dr. Reeves: They almost all complain that their fatigue, mental or physical, is made much worse and lasts- basically they hit a bottom and don’t get back if they do any unusual, or usual, physical activity like going to the store, if they have to do mental activity like giving a television interview, they’re wiped out for the next day.
Host: It’s an entire 24 hours...
Dr. Reeves: It’s an entire 24 hours. There are other symptoms, they are less common than that, and CFS isn’t a single thing- many people have problems with headache, many people have problems with muscle and joint pain.
Host: What about the swollen glands?
Dr. Reeves: Sore throat, swollen glands, headache.
Dr. Reeves: So there can be any combination of those, and fatigue isn’t always the biggest problem. Many people with Chronic Fatigue Syndrome say ‘yes, I’m fatigued, but my problem is I can’t sleep through the night, my problem is I can’t think straight, my problem is I hurt.’
Host: So it’s a lot, it’s a variety, and so really trying to define it you really have to figure out ok it’s not thyroid, you have to almost figure out what it’s not in order to qualify what it is. Correct?
Dr. Reeves: That’s correct. The problem is that there are no characteristic- what we call clinical signs. People have- complain of swollen glands, but you can’t feel them.
Host: What about cause?
Dr. Reeves: Cough is not part of it.
Host: I’m sorry, cause. What causes it?
Dr. Reeves: The cause of Chronic Fatigue Syndrome is not completely known.
Host: But we know stress is linked.
Dr. Reeves: We know that Chronic Fatigue Syndrome seems to be a problem of mind-body, coping with what happens every day- with physical stressors, with mental stressors, with-
Host: And it can be good and bad stress, right?
Dr. Reeves: With good stressors, and bad stressors, the brain and the body respond to those and that seems to be out of kilter in Chronic Fatigue Syndrome.
Host: Alright now it can also be tipped off, you had said prior to the taping, that things like Q-fever, mononucleosis, can appear- bona fide illness, and they never get better. So there are some links there. That’s not the cause of it, but they’re linked.
Dr. Reeves: The link there, we think, is the stress of mononucleosis, the stress on the immune system, the stress on the body, the virus that caused it goes away but the body’s reaction to that stress- or the maladaptive reaction to that stress continues. There are other things, infectious diseases like mononucleosis, stresses like a divorce, a death in the family, someone who is treated for cancer with the chemotherapy, the cancer is cured- they don’t feel any better, they have been knocked over the edge as far as how their body is responding to this.
Host: Alright, who is most susceptible, cause I know that sometimes childhood tragedy, illness, potentially neglect or abuse can make people somewhat predisposed or susceptible, correct?
Dr. Reeves: Ok the predisposition and susceptibility- 3 to 1 the cases involve women. So women are at much higher risk. Now why that is we don’t know. Adults between 30 and 50 are at high risk- kids get it, men get it, but women seem to have a very high risk of it. We know-
Host: Pregnancy seems to be tied in for some too.
Dr. Reeves: Say again?
Host: Pregnancy, or recovery from a pregnancy.
Dr. Reeves: Recovery from a pregnancy, again the stress of going through that, not getting better. Now, as far as susceptibility- women, people who have had a lot of stressors throughout their childhood, that can be infections, that can be surgeries, seem to be at risk. There are genetic predispositions- there’s not a genetic cause, but there are certain genetic predispositions, all associated with the mind and body stress response that put one at a higher risk. All of those interacting together we think are what lead to the final illness.
Host: Why do you think this is a public health threat?
Dr. Reeves: This is a public health threat for a variety of reasons. First of all, CDC studies have shown that at least 4 million Americans suffer from Chronic Fatigue Syndrome, bona fide as classic as it can be. At least 7 million report symptoms of Chronic Fatigue Syndrome. That’s a body count. The people with Chronic Fatigue Syndrome are in fact profoundly ill. They are as disabled as anyone with AIDS, with breast cancer, with coronary artery disease.
Host: Can you qualify for disability if you have to stop working because of it?
Dr. Reeves: That is difficult to do and that’s one of the problems that health care providers and the patients have. Now the disability goes more than that. A quarter of the people that have CFS in the population are either out of work or on disability because of CFS.
Host: So lost productivity,
Dr. Reeves: Lost productivity.
Host: Lost income for the family,
Dr. Reeves: Lost in- it doesn’t just affect the person that has it. The average family in which someone has CFS foregoes- loses $20,000 a year in family earnings and income. That’s half the median household income in the United States.
Host: That’s a lot.
Dr. Reeves: That’s a lot.
Host: It’s a lot. Ok, Emory and CDC are teaming up to do a study. Tell me what you’re doing and what you hope to accomplish.
Dr. Reeves: We are very interested- you asked the question what causes Chronic Fatigue Syndrome. We’ve teamed up with Emory University to do a three day inpatient study trying to look at what is happening to the body with Chronic Fatigue Syndrome.
Host: Are all these bona-fide patients?
Dr. Reeves: These are all bona-fide patients, we’re doing a study currently in Georgia in which we have surveyed the population of Atlanta, Macon and the rural counties around it, we have identified people not from physician practices who have Chronic Fatigue Syndrome as bona-fide as it can be-
Host: Sidenote, you said that there’s higher numbers in the rural areas than you expected.
Dr. Reeves: There were- actually not higher numbers in the rural areas, we asked the question about women.
Dr. Reeves: Ok women are very high risk.
Dr. Reeves: And women are women because of their sex.
Dr. Reeves: Women are treated differently in society than men are.
Host: Ok, so wait, I was wrong though about the rural, I thought you said-
Dr. Reeves: It’s gender. What was different in metropolitan and rural is 5 times as many women than men in metropolitan areas have it, twice as many men as women have it in the rural areas.
Dr. Reeves: And that is beginning to get us to look at is there something different in the stress patterns of men and women in those areas that account for that difference. Rather than it’s women sex; women or men’s roles and how they’re functioning in their different parts of society.
Host: Alright so they come in and what exactly are you going to do?
Dr. Reeves: What we’re going to do in this study is they will come into Emory hospital for three days. The first day we’re interested in memory and concentration.
Host: How do you measure...
Dr. Reeves: There are tests that you can do, the test we do is called the CANTAB, it’s about an hour long test that measures every aspect of your memory and concentration, and we will do that in conjunction with what are called functional magnetic resonance imaging, we will look at how the brain is functioning as they do that test.
Host: So they have electrodes, and they’re all hooked up.
Dr. Reeves: They sit in a big huge machine that actually looks at their brain functioning.
Host: Alright you’re also able to look at the cumulative stress in their life.
Dr. Reeves: Ok we’ve looked at that with questionnaires and we’ve looked at the cumulative stress with a measure called allostatic load.
Host: What’s that in layman’s terms?
Dr. Reeves: In layman’s terms when you react to stress, every time you react your body reacts chemically. And that accrues, it builds up over time.
Host: And you can actually look at blood work that shows you how much has built up?
Dr. Reeves: You can look at blood work that shows you how much that builds up. Now allostatic load, that build up, is a big risk factor for cancer. It’s a big risk factor for coronary artery disease. It appear- is a big risk factor for diabetes. And it appears also to be a big risk factor for Chronic Fatigue Syndrome. So we will be looking at that in the Emory study as related to how one is thinking, as related to how one’s brain is functioning. Now the next day gives a cognitive challenge and does functional magnetic resonance imaging, the last day measures how they respond to a psychologic stress, like giving an interview on tv-
Host: Ok then, what-
Dr. Reeves: We have them speak, public speaking, and we measure their response to that- their endocrine response, their immune response, one of the things we’re doing is we look at their genes and we look at how active every single gene is. So it is a study that has never been done before, and it couples CDC’s ability to get people from the community with Emory University’s high technology of imaging and clinical studies.
Host: Which is great, now- this is a syndrome, and it basically is something you will have to manage the rest of your life. How can we best treat it? Because there’s no pill.
Dr. Reeves: There’s no pill, there’s no overnight treatment. The best way to treat- the most pivotal thing to treatment is this just isn’t the person, it’s the person, the person’s family and their provider. One thing is to learn about it. CDC operates an excellent website just for Chronic Fatigue Syndrome at cdc.gov-
Host: What are some of the suggestions?
Dr. Reeves: The suggestions are that you get to a good health care provider.
Dr. Reeves: That you realize you’re not going to get better overnight. This is a chronic illness, and no chronic illness gets better overnight.
Host: What advice to you give on say, moderation or diet?
Dr. Reeves: What we give is that the first thing is to try to take care of your symptoms. If there are problems sleeping, talk to a physician, learn how to get better sleep hygiene. Things like diet. Look at your diet. Consult with your doctor. Modify it for this. If you are having trouble with pain, take- under your doctor’s advice, medication for pain. Remember that people with CFS are often more sensitive to drugs, so you may take less.
Dr. Reeves: It is important to stay under the care of a provider. Because one has CFS doesn’t mean they can’t have something else.
Host: Gotcha, alright. With that I have to say thank you very much Dr. Reeves, keep up the good work and you have to come back and see me, I appreciate it.
Dr. Reeves: Thank you for having us.
Host: Of course. That was our broadcast, thanks for joining us and thanks for watching Georgia Public Broadcasting.
The above transcript originally appeared on the Co-Cure Archives here.
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