Hi All,

More pieces of the puzzle are fitting together; And it all makes
sense. At least it makes sense to me and I hope that it will to you
as well.

Back in February Roberto posted the following in the yahoogroup
cfs_research (msg#19251): (he posted it somewhere in this group too)

Hi:
Does anyone knows what the following results mean?
It's from a venous blood gases test (not arterial).

pH = 7.4 ranges (7.31-7.41)
pCO2 (mm/Hg) = 43.6 ranges (40-52)
pO2 (mm/Hg) = 18 ranges (30-50)
HCO3 (mmol/L) = 28 ranges (22-28)
tCO2 (mmol/L) = 29 no ranges defined
EBvT (mmol/L) = 3 no ranges defined
O2 SAT (%) = 28 ranges (60-85)

Serum Lactic Acid 1.9 mmol/L ranges (0.6-2.2)

Any help is greatly appreciated.

Thanks,
Roberto
------ end of msg ----------

At that time some of the values did not make sense to me, as they
tended to conflict with some conceptions of CFS-FMS and physiology
that I had at the time; Conceptions that I now see did not correctly
pertain to ME/CFS/FMS.

A few days ago I received an email from Joyce in which she shared
the results of her blood gas tests:

Subject: Latest testing results on venous and arterial gases COOX
test after exercise.

Dr. chu the pulmonologist said that my o2 saturation is 33% and it
should be at least 95%. The arterial blood gas are ph 7.5 High, pco2
27.3 low po2 107 high, Hco3 low-21. I have a catherization for both
sides of my heart done Friday afternoon. Dr. Chu is the only Dr. I
have been to who won't stop until he finds out why I am so tired and
what is wrong with my heart. Other basic echograms and ekgs were ok
which is why he has proceeded to more invasive testing. I am
grateful for such a good Dr. I might know more Friday after test
with Dr. Mccrisken mom's heart Dr. Thanks for your interest. joyce
--------- end of email -------------

Doing a bit of reading in "Human Physiology and Mechanism of
Disease" by Guyton, things became much more clear. I'll write more
on this in another article.
(Everyone should own a copy of this book. Don't waste any more
money on fibro/cfs books. Learn how the body is designed to
operate.)

In the latest issue of "The Lyndonville News", Dr. David S. Bell's
newsletter at http://www.davidsbell.com/index.htm
Is the following:

Question and Answer

Can you tell me if orthostatic intolerance causes breathlessness on
standing and is there any mechanism through which diazepam could
help this?

Good question. Orthostatic intolerance certainly causes
breathlessness, and this symptom is often mistaken for asthma in
patients with ME/CFS. One easy way to tell the difference is that
the asthma medicines do not work. The cause of the breathlessness is
probably a reduction in blood flow through the heart and lungs, but
this may be different for every "type" of CFS. I have definitely
noticed benzodiazepines (Valium® or Xanax®) help this symptom but do
not know why. The usual answer is that it reduces the respiratory
rate by reducing anxiety, and the reduced respiratory rate improves
carbon dioxide balance. But I have my doubts that this is correct.
It is related to the observation that patients with ME/CFS cannot
hold their breath as long as healthy people. This was first noted by
Dr. Paul Cheney, but I have never been happy with the explanations I
have heard to attempt to explain it.
----- end of newletter excerpt ------------------

I'll explain more of my thinking on Orthostatic intolerance in
another article. For now I want to try to explain why people with
ME/CFS cannot hold their breath as long as healthy people. Maybe
some of you are already ahead of me, given the blood gas results
shown above for Roberto and Joyce.
Anyway here goes...

A healthy person has about 5 liters of blood in their body. The
heart of a healthy person (at rest) pumps about 5 liters of blood
per minute. (This makes it convenient to do the math.) Each
minute, all the blood in the body has passed through the lungs where
hemoglobin in the blood becomes oxygenated, so that the blood is
about 97 percent saturated with O2.

Fully saturated arterial blood will therefore contain about 20 ml of
oxygen per 100 cc.
(from information at http://www.madsci.com/manu/indexgas.htm)

Doing some conversion we can calculate that one liter of O2
saturated blood contains about 200 ml of oxygen. Multiply this by 5
liters, the amount of blood in the healthy person, and we find that
the blood supply of the healthy person is transporting 1000 ml (1
liter) of oxygen.

Each pass through the body (every minute in a resting person),
the blood delivers about 20 percent of the oxygen load that it
carries. Therefore the body of the healthy person at rest is being
delivered and consuming about 200 ml of oxygen.

After the first minute of holding their breath, the body of the
healthy person has consumed about 200 ml, leaving about 800 ml of
oxygen in the blood that it can still use. This is why brain cells
start to die after about 4 minutes of the body not being able to get
oxygen. It takes that long to completely deplete the blood of its
oxygen store, assuming the person is not active and expending oxygen
at a greater rate and they are a "healthy" person.

Now lets compare that with what is likely happening in the person
with ME/CFS (and I would include FMS).

Many people with ME/CFS have diminished blood volume (thanks to the
research of Drs. Bell and Streeten for that piece of the puzzle) for
our example lets use 4.5 liters (which may be a more generous amount
than some people with this illness actually have). Also, having
lower arterial blood pressure and higher venous pressure, blood flow
in the person with ME/CFS is going to be lower than that of the
"healthy" person. For this example lets assume that the blood flow
is 4.5 liters per minute (to make the math easier. In real life it
it probably closer to 4 liters per minute depending on the severity
of the condition.)

If the ME/CFS person's blood were fully saturated with oxygen that
would only give them about 900 ml of total oxygen in the blood
( 200 ml/liter * 4.5 liters ) This is 10% less blood by volume than
the healthy persons has.

However, looking at the blood gas values provided by Roberto and
Joyce, we find that blood oxygen saturation is nowhere near that of
a "healthy" person's.

Roberto reported a venous O2 saturation of 28%, lets add to that 20%
to get an approximation of what the arterial blood saturation may
be, 48% saturation on 4.5 liters of blood. So if Roberto were in a
breath holding contest with a health person. The healthy person has
1000 ml of O2 stored in the blood that their body can draw upon.
Roberto only has 432 ml of oxygen stored in his blood supply.

Let's assume that the oxygen requirements for the body's of the
"healthy" person and Roberto are identical. Each body needs 200 ml
of oxygen delivered each minute. The healthy person gets it from
his blood. How much is Roberto getting? 20% of 432 ml or 87 ml.
If Roberto's body needs 200 ml to function in a healthy manner, and
he is only being deliver 87 ml, the body has to make some
concessions somewhere. (This may be a lowball figure since elevated
2,3 DPG is trying to kick out as much oxygen from the hemoglobin,
but you get the point.)

It is not clear to me if the O2 saturation number that Joyce
provided is venous or arterial. she writes that it should be 95%
which leads me to think that it may be arterial blood but I can't
imagine a person with arterial blood O2 saturation that low would be
able to function much, so I'll assume that it is venous blood. Add
20% to give an approximation of the arterial O2 saturation, for a
total of 53%. So if Joyce were to join
this breath holding contest she would start out with an oxygen store
of about 477 ml (about 1/2 liter) of oxygen in her blood.

If you factor in a couple other variables such as lower body
temperature and higher blood pH for the person with ME/CFS, both
affect hemoglobin to hold more tightly onto oxygen, you begin to
understand why the person with ME/CFS cannot hold their breath as
long.

The healthy person would have to be a real wimp not to win the
breath holding contest, given that he is starting with over twice
the amount of oxygen in his blood. On the other hand, Roberto and
Joyce having dealt with CFS-FMS for so long are probably a lot
tougher.

Without oxygen, the mitochondria cannot make ATP. Without ATP the
cells cannot make glutathione. Without ATP the cells cannot
maintain electrolyte balance. Without ATP the parietal cells cannot
make HCl. Without oxygen the cells rely more upon anaerobic
respiration to fill in some of the needs for ATP, this is indicated
by the higher lactic acid level that Roberto reports.

I've got a couple articles in the works that will better explain
some of my thinking. I wish I had a greater liking for writing.
I've got some ideas on how to remedy the situation hopefully I'll be
able to find some people to prove them for themselves.

All the best,
Jim