First film:
Gez introduces it by referring to Dr Curtin as an expert in 'ME/CFS and associated structural disorders'. He then introduces the film as providing information on these disorders 'How common are they in ME/CFS and does the same apply to Long Covid? And just how might a Covid infection bring on conditions like these?'
First introducing the doctor - she's an internal medicine physician. Had ME/CFS herself - says part of her reason for doing medicine was trying to figure out what was wrong with her. Figured out her own problems were POTS and hypermobility. Started treating patients with complex chronic medical conditions like ME/CFS and then started having Long Covid patients coming to her and saw some similarities.
Co-founded a tele health company to try to help deal with diagnositic delay.
Question: Asks for indication of how common anatomical problems are in diseases like ME/CFS and LC.
She replies by quoting from memory 'a paper' that showed over 50%. She misremembers it as from the karolinska institute, but I think she's probably referring to the highly problematic Bragee paper discussed
here. She says she has seen it in 'quite a few patients'. She concludes with 'I don't think we have numbers yet for LC'
4 minutes:
Question: Can you describe the differences between some of the structural issues and what the primary ones are you see in your practice?
She then goes into an attempt at a lay description of Chiari using confusing diagrams and analogies to try to explain cerebrospinal fluid. She gives scary sounding simplistic explanations of intracranial pressure and what might cause it
5.30 min. On to craniosacral instability. She shows a scan image and tries to expain why the diagnosis from it. Uses scary descriptions demonstrating with her hands 'the brain stem is smashed into the skull and kinked over it'.
6.33min. On to tethered cord. She says there are lots of other structural problems but these are 'the big 3 that I tend to see'. She attempts a lay description of tethered cord using a diagram of the lower spine. She says this can cause not being able to walk and some neurological signs 'some quite subtle'. You need a physician to diagnose them.
Question: In ME/CFS, of these 3 which is most common, and does it look like the same pattern you're seeing with Long Covid patients?
8.40 min. Can't tell in LC yet. 'It takes a while to do the work up process'.
In her patients with Chiari or CCI, 'tend to see tethered cord as well'. Probably more CCI than Chiari, some have all 3.
Question: if someone has a bit of Chiari or a bit of CCI, and has mild symptoms, then they catch Covid, and the develop Long Covid, and now it becomes a problem. And even the same thing for virally or bacterially triggered ME/CFS, do we know, are there any decent theories about what physically changes there with that infection that suddenly creates a problem that wasn't there before. Apart from, as you say, deconditioning from lying down, is there something to do with inflammation or with the way the body fights infection that can lead to these conditions getting worse. Or, I don't know if there's been much talk about this...
Answer:
Short version: She throws out lots of theories, mostly posed as questions, and concludes there are lots of possible explanations, but none established.
Long version:
There is theory around this, but none of it is confirmed yet. Some surgeons are taking a small piece of ligaments when they do surgery to 'do pathology on it', 'to look at it under a microscope to try to figure out what looks different and why. Looking at ? mast cells in and around the ligament becoming activated and releasing compounds that actually degrade collagen - is that may be part of what's going on? Is it actually translocation of 'bad bacteria from the throat', the other thing is that ligaments don't actually have the greatest blood flow, so is the blood flow to the area somehow compromised so the ligament can't repair itself so it becomes weaker and thinner. The other possiblity is that Grisel syndrome ? infection in the back of the throat is transmitted back and the veins that drain that area ' there have been accounts of infections draining back and established in the bones'. 'If there's not something we can detect it doesn't mean it's not happening.
Also you can imagine there's lots of cytokines and inflammatory molecules, you know, enzymes released from mast cells at the back of the throat, all kinds of things that would also be transmitted back to those veins, the impact of those on the ligaments at the back.
She then goes on to speculate wildly that because Covid is detected in the throat, the stuff she's speculating about could happen in Covid too. So for her the next challenge it 'getting that data'.
