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Layman explanation by Rita Vargas

 Hi and welcome to Neurophysiology 101. It has occured to me that many of you have questions related
  to autonomic dysfunction that require an understanding of normal neurophysiology. After all, how can
  you understand what's abnormal if you don't know what's normal? How can you understand
  pathophysiology if you don't know physiology?

  I am by no means infallible here. That is why I've chosen to place this in the advice column. I did work
  for six years as an RN on a Neurology floor, and I do still remember some stuff despite having
  autonomic dysfunction! This is how I understand the system and I freely interject opinions! Also ,
  spelling and grammer have never been my best attributes.

  OK, let's get started.

  Some of this you already know, but let's review anyway.

  PART 1: Basic anatomy of the nervous system, especially focusing on the sympathetic branch of the
  autonomic nervous system.

  The three general divisions of the nervous system are:

  1. Central nervous system (brain and spinal nerves)Your MOTOR pathways are in this system. They
  carry impulses from the brain to nerves supplying your muscles so you can move. Your SENSORY nerves
  pathways are in this group too - they make you feel things.
  2. Peripheral nervous system (cranial nerves and spinal nerves)These are the CRANIAL nerves in your
  head. They control movement of your eyes, lips, mouth, nose, etc.
  3. Autonomic nervous system (sympathetic and parasympathetic systems)

  Naturally, we will go into detail with #3. I just wanted to make sure you understand that #3 has
  NOTHING to do with the nerves that move your body or make you taste, smell, hear, etc.

  Autonomic or "automatic" nervous system is an "involuntary" system that is supposed to keep a
  constant state inside the body despite changing external conditions.

  It is made up of two parts: the sympathetic and the parasympathetic nervous systems. (I think they
  should have named it the "pathetic" nervous system because of what it does to us when it
  malfunctions, but nobody asked my opinion when it was named.)

  Since the sympathetic system is the cause of POTS and NMH, lets go there first.

  First you have to remember basic spinal anatomy. The CERVICAL vertebrae are in the neck, the
  THORACIC vertebrae are behind the chest and abdomen , and the LUMBAR vertebrae are just above
  the tailbone. The SACRAL vertebrae or just SACRUM are the last.

  The SYMPATHETIC nerve fibers originate between the first thoracic and second lumbar vertebrae. Now
  that's a long distance and sympathetic nerve fibers come off each of the vertebrae from T1 (the first
  thoracic vertebrae all the way down to L2)You're talking about 14 vertebrae here, folks!
  The sympatheitc nerve fibers, coming off the first four vertebrae, end in all areas of the heart. Here is a
  list of all the sympathetic nerves and what they innervate (what they supply):

  There is a branch of the sympatetic nerve trunk that goes upward but does not come off the cervical
  vertebrae. These nerves are called the "Superior cervical ganglion"

  Superior cervical ganglion--------innervates the glands in the eyes, the parotid gland in the brain, glands
  in your mouth and neck

  T1, T2, T3,T4
  All four innervate the heart and lungs

  T5, T6, T7, T8, T9
  All 5 come together to form part
  of something called the CELIAC
  GANGLION and from there innervate
  the stomach and pancreas

  T10
  T11 ------------------------------ These three also form part of the
  T12 celiac ganglion and innervate parts of the stomach, pancreas,
  adrenal glands (they sit above
  each kidneys) and part of the gut.

  L1 ------------------------------ Meets up with some of the nerve fibers from T5-T12 to form the
  Superior mesenteric ganglion that
  innervates the first part of the
  large intestine and the small intestine.

  L2 ------------------------------- Also meets up with some of the
  nerve fibers from T5-T12 to form the Inferior mesenteric ganglion
  that innervates the colon, rectum
  and bladder.

  Remember how there was a branch up at the top that didn't come off any vertebrae?? Well, there is a
  branch at the bottom that is right in front of the SACRUM, but doesn't originate from the sacrum. These
  nerves innervate the "reproductive organs".

  Branches from all ganglia(nerve fibers) also serve blood vessels, sweat glands, and hair follicles.

  Bored with anatomy yet???? I am.

  Lets move on to what happens when you stimulate these babies!!!

  You can stop here and allow a brain rest.

  PART 2" Normal function of the sympathetic nervous system.

  With stimulation, these nerve endings give out a neurotransmitter (a fancy name for a chemical) called
  NOREPINEPHRINE. This causes the following to happen to the heart. (now remember this is NORMAL).

  1. increased heart rate

  2. increased conduction speed through the AV node (don't worry about it , it's just an electrical node
  that helps keep the old ticker ticking)

  3. Increased contractility of the heart (it beats harder not just faster)

  4. Peripheral vasoconstriction (don't panic, I don't expect you to know what that means; peripheral
  means farther away from the central core of the body like the nerves in your hands and feet would be
  peripheral nerves. Peripheral blood vessels would be those in your hands and feet, arms and legs.
  Vasoconstriction, I think you all know, means narrowing of blood vessels, making them smaller
  inside.)So, it means "making little blood vessels far away from the heart get narrow."

  WHY THE HECK A BETA BLOCKER??????????????
  Now bear with me on the next part. It's going to get a bit technical, but when we're done, you'll
  understand why so many doctors order beta blockers like Inderal, Tenormin, Toprol, etc. to treat us.

  Sympathetic nerve pathways as you saw before, innervate the adrenal glands ( remember - those little
  glands above each kidney?)
  When stimulated the adrenals release CATECHOLAMINES (norepinephrine and epinephrine) into the
  blood stream. By the way, epinephrine is the fancy medical term for adrenaline. They are the SAME
  thing.

  These 2 neurotransmitters interact with Adrenergic receptors found in the cell membranes of the heart
  and blood vessels. Don't worry about the terminology here, just remeber that there are RECEPTORS
  that soak up these chemicals in the heart and blood vessels.

  The RESPONSE of the heart and blood vessels depends on the type and location of the receptors
  involved. There are 3 types of receptors.

  OK, this is where it gets hairy. Stick with me, it will be worth it in the end, I promise! This is where you
  begin to appreciate what a physician has to learn and remember to become a neurologist or a
  cardiologist. (So I guess we should be more patient with them, but I can tell you right now, I'm NOT!!!!
  Guilty as charged!)

  First I have to explain your blood vessel system: Think of a plumbing project in your home. It's a closed
  system of pipes with water in them. If you add more water, the water pressure will go up. If you take
  water out of the system, the water pressure will go down. If you replace all the pipes with smaller
  pipes and still have the same amount of water, the water pressure will go up. If you replace the pipes
  with larger ones, the water pressure will go down. Ditto for your blood vessels and blood pressure. So
  know you understand basic blood pressure control. (Keep this in mind, you'll need it later)Well, you're
  welcome to cheat and scroll back up.


  THE THREE TYPES OF RECEPTORS:

  1. ALPHA - They are adrenergic (there's that technical word again) receptors located in peripheral
  arteries and veins. Remember what peripheral means? Farther away from the core of the body? So they
  are found in small blood vessels in the legs and arms. Right?
  WHEN STIMULATED: they produce a very strong VASOCONSTICTIVE effect.(Shrink those little babies!)
  Can you see how stimulation of this system can cause high blood pressure??? Please say YES! You
  know, smaller pipes, same amount of water.... increased pressure.....

  2. BETA 1 - Adrenergic(Oh, I'm sooo sick of this word) receptors that are mostly in the heart.
  WHEN STIMULATED: causes an increased heart rate (fast pulse), increase AV node conduction (sound
  familiar?), and increased force of heart contractions. This can cause increased blood pressure.

  3. BETA 2 - Adrenergic (YUCK) receptors found in the walls of arteries and in the bronchial walls. (In the
  lungs)
  WHEN STIMULATED: cause smooth muscles to dilate (get bigger, open up) causing VASODILATION (get
  bigger, open up) of arteries and bronchi (You know, the smaller branches that look like tree branches
  that are in the lung?) You have smooth muscles in your bladder, gut, lungs...

  Generally speaking: Epinephrine acts on ALPHA and BETA 2 receptors and norepinephrine acts on
  ALPHA and BETA 1 receptors.

  Now I know I promised this would be all about NORMAL stuff, but this is the perfect place to add in a
  little pathophysiology:
  If you have POTS, can you see that misfiring of these nerves can cause the BETA 1 receptors to receive
  too much stimulation? That would cause an increase in heart rate (hence the fast pulse you feel) an
  increase in the force of the beat (hence the palpitations you feel) and increased electrical activity that
  keeps the heart hyperactive. Initially this response causes a rise in blood pressure.

  Now do you see why the doctors give you beta blockers. Please say YES!!!
  Those beta blockers, like Tenormin and Toprol,are "beta 1 selective adrenergic blocking agents." Now,
  blocking the beta 1 receptor will cause a drop in your normal heart rate. Doctors hope that it will dull
  that hyper effect we get when the nerve misfires. I know that it has helped some people, but the
  reason it doesn't work for others is because, some people keep misfiring so badly, once the nerve is
  stimulated that they just pump out tons of chemicals. This is no match for the dose of beta blocker
  you're on, Think of it as the nerve having a seizure. Sometimes it's a mild seizure that only lasts a few
  seconds and the medication can handle it. But for some its a "grand mal" seizure that lasts for minutes
  at a time.

  Now some of you are thinking, ah why is this used for treatment for high blood pressure? Well, because
  stimulation of the beta 1 receptors causes high blood pressure, and doctors want to dull this response,
  but I can tell you right now that these medications only help people who have mild to moderate high
  blood pressure. They won't do too much for severe hypertension, they are just not strong enough, and
  often high blood pressure is a combination of factors that have gone wrong. Hence, some people are
  on beta blockers and water pills to control their high blood pressure.

  I would encourage those who have POTS to try the beta blockers to see if they help for you. (Well, you
  might as well try, there isn't much else out there, you know!)

  So now I think we've answered the frequently asked question: Why the heck am I on a blood pressure
  pill?????

  There is one more thing we have to discuss. Your body likes to stay in balance. When it detects a too
  rapid pulse, it will eventually try to drive your blood pressure down. Think of the plumbing system. If
  you increase the speed of the water flow, you don't need as much pressure to get it to where it needs
  to go, like making all the pipes slant down, so that gravity facilitates flow. Some people with POTS will
  drop their pressure as their pulse races away, others have very little drops in pressure. Those who do
  drop their pressure, tend to faint more quickly. This is only in POTS. In NMH, the first thing that happens
  is your pressure drops, Why you ask? Scroll back up and read what happens when beta 2 receptors are
  stimulated, because that's you! You have smooth muscle receptors in your gut, lungs, etc... and it
  causes those and the blood vessels to VASODILATE (open up, get bigger) Soooooo... think of the
  plumbing system again. You just replaced the pipes with bigger pipes and you didn't increase the flow.
  Drop in pressure, right? So blood pools in the gut vessels, the lung vessels, the bladder vessels and
  their isn't enough pressure to get that blood back up to the brain. Hence, your kissing the floor again!
  Doctors try to keep your blood pressure higher overall by asking you to increase fluids and salt. Now
  there is another malfunction involving the adrenal glands and the kidneys, that will also cause massive
  losses of water and salt, which leads to decreased blood pressure. This is called the renin - angiotensin
  - aldosterone system and involves hormones controlled also by the sympathetic branch of the
  autonomic nervous system. I don't want to go there now because I have only run into one or two
  people in the forum that have this type of autonomic dysfunction and one of them is an RN It's also a
  very complicated system to explain.

  Well that takes us to the end of this section of neurophysiology.

  I would like to do more. The next topic would continue this discussion and go over the parasympathetic
  nervous system. Those of you with vaso-vagal syncope will find your problem root cause in this system.

  I would also like to go through baroreceptors and other things that influence our symptoms, including
  what the medical community thinks causes the muscle aches and the fatigue.

  I would like to discuss the role of serotonin and why certain antidepressants that increase serotonin
  levels help with the brain fog.

  Lastly, I'd like to go over the current theory of why we get this. I'm no authority, and there may be
  more theories out there then I am aware of, but we good get a grip on the main ones.

  However, this is a lot of data to convey. If you read this and find it too technical or not pertinent or
  inaccurate, please let me know.

  If this isn't helpful, then there is no sense to keep going. I know that usually you have to surf many
  web sites to get one answer. When you find it, it is sometimes too technical to understand. I did this
  because I have been getting the same questions asked over and over again, and instead of
  responding individualy it was easier for me to just post the info here in the forum for everyone.

  Now, if there are errors, let me now, but I won't stand corrected! (get it, STAND corrected, ha ha ha!)
  Yuck, bad joke!


Welcome to Neurophysiology 201.

  I'm hoping you're here because you got something out of Neurophysiology 101!

  Before we get started, I found a helpful website to illustrate what nerves are in the parasympathetic
  and sympathetic systems and what they do. Now don't be insulted by the name of the website. I'm not
  dumbing you down, I just liked the pictures.
  Go to: faculty.washington.edu/chudler/auto.html

  Nice pictures, simple explanations, right?

  Okay, on with the show:

  PARASYMPATHETIC NERVOUS SYSTEM

  Remember it's the other branch of the autonomic or automatic nervous system.

  I have seen in the most recent literature, a reference to the third branch of the autonomic nervous
  system called the "enteric" system. In my day, that fell under the parasympathetic. If you'd like to pick it
  out separately, go ahead. The entire enteric autonomic system only innervates (supplies) the gut.

  The parasympathetic nerves arise from something called the DORSAL MOTOR NUCLEUS of the VAGUS
  NERVE in the MEDULLA OBLONGATA.(What???) They start around the brain stem, you know the bottom
  of the brain before it becomes the spinal cord?

  They are made up of the cranial nerves. There are 10 cranial nerves involved in the parasympathetic
  system. You may say, "I thought there were 12 cranial nerves!". Well, there are, but the last two only
  deal with motor movement that we can control. We're only interested in the ones that can also cause
  movements we can't control!

  Now I'm not going to list all 10 cranial nerves, because you can go to the website I just mentioned and
  look at them. Besides, as soon as I mention them, you're going to recognize them. Like, the first cranial
  nerve is Olfactory -smell. Number two is Optic-vision, etc. The parasympathetic cranial nerves deal a lot
  with secretion. Lubricating tears in the eyes, nasal secretions from the nose, secretion of acid in the
  stomach, etc. Again, were talking about things we can't control.

  WHEN STIMULATED: The parasympathetic system releases a neurotransmitter (chemical) called
  ACETYCHOLINE. Acetycholine does the opposite of norepinephrine. (Which, as you learned in 101, is
  produced by the sympathetic nervous system.)

  PARASYMPATHETIC STIMULATION CAUSES:

  1. a decrease in the rate of the SA node firing (just another one of those electrical things that causes
  your ticker to keep ticking)

  2. a decrease in heart rate

  3. the contractility of the heart is decreased (the force of the beat is decreased)

  Notice how 1-3 are the opposite of what happens in the sympathetic nervous system!

  Now cranial nerves #9 and #10 are the biggies here! #9 is the GLOSSOPHARYNGEAL and #10 is the
  VAGUS.

  We'll focus mainly on the Vagus nerve because it is HUGE and innervates (supplies) just about every
  internal organ you can think of. Like the heart, lungs, stomach, liver, intestines, bladder, etc.

  The Glossopharyngeal innervates (supplies) something called the carotid sinus. You know where your
  carotid artery is? There is one on either side of your throat, and they are the ones that supply lots of
  blood to your brain. You can easily find your pulse (heartbeat) by placing two fingers on the carotid
  artery. It is not a deep artery, so it's easy to feel. Behind those arteries on either side, is a cavity called
  the carotid sinus. It has something in it called baroreceptors that we are going to talk about later.
  Basically this carotid sinus monitors your blood pressure and pulse and sends out signals to the brain
  like:
  "1pm, and all is well"
  "2pm, and all is well"
  Unless it picks up a problem, like your blood pressure has just gone up. Then it sends out a signal like:
  "3pm, and all is not well; picking up an increase in pressure"
  The vagus nerve is then stimulated by the medulla oblongata and heart rate and blood pressure go
  down.

  So that takes us to the good old vagus nerve.

  Since it innervates (supplies) so many systems, any little glitch can cause it to fire. Soooooo, you end
  up dropping your heart rate and your blood pressure and you're kissing the floor. YOU HAVE
  VASO-VAGAL SYNCOPE! You are much more likely to faint with little warning. Most people with POTS can
  feel their heart rate increasing, and this gives them a little warning. It also keeps blood flowing to the
  brain. In vaso-vagal syncope, the poor brain is losing blood supply from both systems: the heart rate
  and the blood pressure. No increase in pulse, no increase in blood pressure, unless your sympathetic
  nervous system realizes that you're in a jam!

  Now to answer a specific question someone asked me. The vagus nerve joins up with some of those
  enteric fibers and supplies the gall bladder and bile ducts. If the vagus nerve misfires in that area, you
  are going to have gall bladder spasms and duct spasms. Sorry, sad but true!

  So, some of you might be saying, "Well what about those of us who only get vaso-vagal syncope when
  we turn our heads too far to the left or right?". You people have either cut off the blood supply to the
  carotid artery by turning your head too far, or you've just inadvertently stimulated the baroreceptors
  that live there. Or, you could have done both!

  Let's talk about baroreceptors now.

  The changes that occur NORMALLY in the parasympathetic and sympathetic nervous systems happen
  because important receptors are located throughout the body and these receptors send messages
  around. (You know like:"1pm and all is well").
  There are actually three groups of receptors. (Hey, it's never that simple!)

  1. Baroreceptors. (Long, long ago, we called these pressoreceptors) You already know that some live in
  the carotid sinus. (Remember, the little cavity behind your carotid artery in your neck?) Well, the rest
  live in the walls of the AORTA (the really big artery that carries blood away from your heart and to your
  body).
  These baroreceptors get stimulated whenever they sense an increase in the blood presssue of your
  arteries. Then they send a message up to the brainstem, the vagus nerve gets called into action,and
  the heart rate and blood pressure drop. Normally, just a wee bit. But watch out if they're
  dysfunctional!!!!!! When arterial pressure goes down enough, the baroreceptors send fewer messages
  to the brain stem. Then sympathetic vasoconstriction(smaller pipes) occurs and blood pressure and
  heart rate go up again. Can you see how this is really a constant tug of war?

  2. Stretch receptors. They are in the VENA CAVA ( the really big vein that goes to your heart) and in
  parts of the right side of your heart. These receptors react to changes in blood pressure due to not
  enough fluid or too much fluid in the blood system. When your blood pressure decreases (because you
  didn't drink any fluids today), stretch receptors send a signal to the brain and the brain stimulates the
  sympathetic system to compensate. Well, I bet you can tell me in your sleep that the blood pressure
  and heart rate will go up if the sympathetic system gets stimulated! When your nurse forgets about
  your IV and the whole bottle runs in over 15 min - you're waterlogged and you're going to stimulate
  these receptors. Then, it sends a signal to the brain to decrease heart rate and blood pressure.

  3. Chemoreceptors. Don't really need to talk about these. They go into action when you are exposed to
  things like too much carbon dioxide or when your blood gets too acidy (like in kidney failure).

  Well, that about sums up the parasympathetic system.

  I think the next topic will be about the theories. What they think causes the glitches. I've received a lot
  of e-mails about this one, so I think it should be next.

  Again, all feedback is appreciated.

 NEURO-PATHOPYSIOLOGY 301

.

   CAUSATION THEORIES, otherwise known as, "WHAT THE HECK HAPPENED TO ME THAT I'M NOW
   AUTONOMICALLY DYSFUNCTIONAL?"

   Well before I start on this one, I need to apologize, in advance, to anyone who really does have
   Attention Deficit Disorder. I'm not making fun of you in this piece, I'm just trying to illustrate a point.

   I also need to apologize to all science fiction fans.

   Lastly, I need to apologize for my warped sense of humor. It is a coping mechanism I've developed after
   having POTS for over 20 years, and vaso-vagal syncope for over 30 years. I really need to be able to
   laugh at myself and my disease. Also, if you don't like it, you don't have to read it! Just skip over the
   weird parts.

   First, you have to understand where viruses go when they are done beating up your body. They become
   dormant along your nerve tracks. Really, I'm not kidding. All viruses go there!

   Just to convince you, I'll tell you about the chicken pox virus. Remember when you or an older family
   member had the chicken pox? And you've all heard of shingles, right? Well, shingles is simply a
   re-outbreak of the dormant chicken pox virus along the nerve tracks. Shingles are painful lesions that
   break out along the nerve tracks on only one side of your body. When the lesions break open and are
   weeping, they contain live chicken pox virus! So, if you break out in shingles, it just means that you must
   have had chicken pox sometime in your life, and something triggered a re-outbreak. Usually we see
   shingles in elderly folks whose immune systems are weak and can no longer keep the virus dormant. If
   you have shingles, stay away from people that have never had chicken pox and that haven't been
   vaccinated for it.

   Now lets talk about AUTO-IMMUNE THEORY. We already know that certain diseases are caused by our
   own bodies attacking us. For instance, in multiple sclerosis, the body attacks and destroys it's own
   myelin sheath (the covering around motor nerves). The body creates AUTO-IMMUNE antibodies
   (self-killing antibodies) that attack it's own tissue. Currently, as far as I know, the autoimmune antibody
   theory is the main one for what causes autonomic dysfunction. So , you may ask, "How the heck does
   that happen?"

   Well, you asked for it.

   Every time a virus enters our bodies, a group of antibodies are formed to try to kill off the virus. So,
   picture a whole class of antibodies being taught to recognize the intruder virus, attack it, and kill it. But
   some of these antibodies aren't the brightest, we'll call them "idiot antibodies". On top of it , some of
   these idiot antibodies have attention deficit disorder. The regular idiot antibodies and the ADD ones,
   make up only about 10% of all the antibodies in the classrooom. Some just can't learn the structure of
   the virus because they're either not bright enough, or they are too restless to listen carefully. The
   instructor finishes the class by telling the antibodies that a chemical will come after them to call them
   back, when they've finished their work. We'll call this guy, Officer O'Malley Antibaddy. Well, unfortunately,
   the ADD idiot antibodies where too restless to stay until the end of the class. They left early and started
   hunting down viruses. Soon the other healty antibodies and the rest of the idiot antibodies joined the
   fight. (Oh, the plot thickens!)

   Go to the next post if you'd like to keep reading.
   

  



  
    Some of the antibodies have already done a fine job of destroying a virus cell and causing it to lie
   dormant along an innocent nerve fiber. Along comes your worst nightmare: an ADD idiot antibody. It
   recognizes the virus and begins beating it. In the process, he's destroying the nerve fiber the virus is
   laying in. Other antibodies try to stop him, but he's really putting his heart and soul into this. He has
   now graduated to the title: Auto-immune ADD idiot antibody. If you're REALLY lucky, Officer O'Malley
   Antibaddy will come along at that moment and arrest the autoimmune ADD idiot antibody and give him
   30 years to life for abuse of a corpse. This will leave the poor nerve fiber damaged and inflammed, but
   not completely destroyed.

   Well, if the nerve fiber, or the cells of the nerve fiber, are not completely destroyed, it will take SEVERAL
   MONTHS TO TWO YEARS for the nerve fiber to heal. Hence we have those individuals who have a bad
   case of autonomic dysfunction after an infection, but after 2 years are doing significantly better.

   What if Officer O'Malley Antibaddy isn't able to stop this auto-immune ADD idiot antibody in time? The
   nerve cells or fibers are completely destroyed. Nerve fibers such as these do not spontaneously
   regenerate.
   Yes folks, I'm afraid they are dead, deceased, ceased to exsist....,etc.

   SONG IN MEMORIUM:

   "Oh my darlin', Oh my darlin', Oh my darlin' nerve o' mine"
   "You are lost and gone forever, dreadful sorry, nerve o' mine"

   You should sing to your autonomic nervous system every day, I know I do! (Hey, it works for plants,
   doesn't it?)

   Second verse. Please sing along:

   "Oh my darlin', Oh my darlin', Oh my darlin' brain o' mine"
   "There's a minor, defect-finder, in yer post-ganglion"

   (applause, applause, accolades...What....The Country Music Awards????........Best New Neurology
   Song.....)

   Anyway, not all antibodies become autoimmune antibodies because they're idiots. Some perfectly
   healthy antibodies will attack nerve fibers even if there isn't a dormant or active virus attached. Maybe it
   happens something like this: A perfectly normal antibody goes out of the classroom and begins
   searching for the virus. He floats along until he comes to the liver. He sees some of his buddies have
   dropped into the Liverpool Pub for a few. He decides to join them and help the liver do some
   detoxification.
   Once he's had his fill, or gets kicked out, he continues on his way, hunting viruses. Coming upon an
   innocent nerve fiber with no dormant virus, the antibody says, "Hey, you look (hic..), you look(hic..), you
   look jus' like this virussss I'm suppos' kill!" Although the nerve fiber tries to convince the antibody that
   he is not in fact a virus, the antibody doesn't listen. He has now graduated to a full fledged auto-
   immune-idiot antibody. If you're lucky, and Officer O'Malley Antibaddy comes along, the auto-immune
   idiot antibody will receive 30 years to life for assault with intent to do bodily harm and for destruction of
   a public transportation system. Again, the damage to the nerve could be temporary if the nerve is just
   inflammed, or permanent if the nerve has been destroyed.

   In summary, we don't know why these antibodies attack the dormant virus in the nerve. We also don't
   know why some antibodies attack and destroy nerves that don't contain viruses. We only know that it
   does happen. Testing for autoimmune antibodies after having autonomic dysfunction for a long time, is
   futile. The antibodies will be long gone. You may never again make that antibody and you may never
   damage any other nerve fibers. Some of us will produce the antibodies again during a viral invasion, and
   chances are high that they will cause further damage to the autonomic nervous system. The abstract
   that was on the forum a few weeks ago, (and forgive me, I don't remember the title) was trying to prove
   this theory. They had found that many people with POTS and NMH have nerve damage in their legs.

   Go to the next post to read on.
   



  
So, that takes us to the glitches. Once the end nerve fibers are damaged or destroyed, they will
   over-react or under-react to a stimuli. Other nerves, that would never have been stimulated if the whole
   system remained intact, are sparked. The wrong message can travel up through the autonomic nervous
   system and trigger other wrong messages. We all know the results of that!

   You might be feeling a little depressed right now because it has dawned on you that there is no way to
   cure this. The damage has been done. However, there is hope on the horizon. Researchers are working
   on ways to get nerves to regenerate. Specifically, they are working with motor nerves that involve
   voluntary movement. They are working to try to help people like actor Christopher Reeves; people who
   are quadriplegic. All motor neuron pathways are similar. If researchers do make a breakthrough, it will
   benefit all of us. Until then, we can only treat the symptoms and try to avoid the triggers.

   So let's get into some of those nasty symptoms and what causes them. Here is an example of POTS and
   NMH:

   "Captain, I've detected an alien neurogenic field surrounding the ship!"
   "Can we break free of it, Mr. Sulu?"
   "We can try, sir."
   "All available power to the engines." "Whenever you're ready, Mr. Sulu."
   "Aye, Captain!"
   WHAP
   "No effect sir, we can't break free."
   "Red Alert! All hands to battle stations!" "Mr. Scott, I need more power to the engines."
   "Captain, I kinna do that! She's under a strain as it is!"
   "Scotty, I've got to have that extra power. Shut down all non-essential systems on decks 5 through 14
   and reroute power to the engines!"
   "Captain,the engines will overload!"
   "Scotty, the lives of 400 crewmen are at stake, I need power now!"
   "Aye Captain, rerouting power."
   "Mr. Sulu. Bring us hard about and try again."
   "Yes sir!"
   WHAP
   "No effect sir." "We are still trapped in the neurogenic field."
   "Captain, the engines are at critical levels, I dunna think they'll stand another run!"
   "Sir, the neurogenic field, it's....gone, sir."
   "What?, scan for the field."
   "Scanners detect nothing in a 10 light-year radius, sir."
   "Cancel red alert. Scotty, shut down engines, all stop!"
   "Mr. Spock, what do you make of this?"
   "Curious, Captain. I believe the alien neurogenic field was simply an illusion, that it never really
   exsisted."
   "Why would an alien being create such a thing?"
   "Most likely to protect themselves from intruders."
   "So we were never really in any danger?"
   "Correct, Captain."
   "Mr. Scott, damage report."
   "Well, the engines took quite a beatin', sir. The matter-antimatter waste system is backed up."
   "How soon until engines are at 100% efficency?"
   "They'll be at 80% in two or three days, sir, but never at 100%. Not unless we get to a starbase and
   have her overhauled for two weeks!"
   "Any other damage, Scotty?"
   "Aye, decks 5 through 14 have blown several power grids, it'll take several days to replace them all!"
   "Begin repairs immediately!"
   "Aye, Captain."
   Now pretend that the ship is stuck in a temporal time loop, that repeats itself over and over again.

   Just in case you missed the symbolism:
   The alien neurogenic field is the stimulus that sets off the autonomic nervous sytem.
   The Red Alert is the reaction to the preceived threat your body sees because of the misfiring of nerves
   along the autonomic system.
   The shutting down of decks 5 through 14 is the way our body shuts down non-essential systems in
   order to get enough blood to the heart and brain.
   The matter-antimatter backed up waste system is (do I really have to spell it out???) Well, it's
   constipation.
   The burnt out power grids symbolize fatigue.
   The overloaded engines also symbolizes weakness and fatigue.

   What REALLY causes the fatigue, weakness, and joint pain?

   Go to the next post if you want to read on.
   

OK, we were at "what realy causes the fatigue, weakness, and joint pain?"

   Well, let's see. In POTS, your heart rate is going around as though it just ran the Boston Marathon. In
   NMH, your pressure can go so low that hardly any blood is getting around. In vaso-vagal syncope, your
   heart rate and blood pressure are so low that blood is getting around very sluggishly.
   Blood cells are supposed to give oxygen and nutrients to tissue cells as they float by through the blood
   stream. Tissue cells are supposed to give up all waste products to the blood cell. The blood cell will carry
   the waste products to the kidney and liver. Then the blood cell will go pick up more oxygen at the lung.

   Now, bear with me here.

   If the blood cells are going around too fast, they cannot stop long enough to give up all their oxygen
   and nutrients to the hungry cells. They also aren't around long enough to collect the waste products and
   properly dispose of them. We feel tired and weak because our muscle cells aren't getting the oxygen
   and nutrients to keep going. If the blood pressure and pulse are low, the blood is getting around so
   sluggishly, it's not feeding the cells fast enough, and it isn't getting there to remove waste products.
   Also, pooling blood gets concentrated, and loss of tissue oxygen causes build up of lactic acid (a waste
   by-product). This builds up in muscle tissue and causes cramps and muscle aches. It may take some time
   before the body is able to clean up the mess. Less oxygen and nutrients to the brain will cause the
   "brain fog" we all love so much.
   "Due to recent autonomic activity beyond our control, oxygen levels will remain low for the next few
   hours". "The waste management team is backed up for several days. Please continue to leave all waste
   products curbside and they will be collected as soon as possible. We apologize for any inconvenience
   this may have caused."

   Well, at least that's how I understand the system!

   ANOTHER THEORY:

   You have all heard of the Chiari Malformation that infants are born with. They are born with a very small
   opening in the skull where the brain and spinal cord meet. Parts of the brain are squished. The defect is
   repaired as soon as possible in infants.
   This theory suggests that people with autonomic dysfunction have a smaller than normal opening at the
   base of the skull, but not small enough to cause the obvious symptoms that an infant presents with who
   was born with a real bad defect. Some people may have been born with a slightly smaller opening, and
   some may have had it damaged in an accident.
   The theory is that a small piece of brain gets squished, enough to cause the autonomic nervous system
   to misfire. Some people with autonomic dysfunction have had MRIs that show a small opening that is
   squishing part of the brain. Now, they can opt to have surgery to open up the hole and unsquish the
   brain. But let's take a closer look at that. For one thing , it is MAJOR NEUROSURGERY! They have to cut
   the back of your brain and spinal column open! And guess what? What do you think has happened to
   those nerve fibers that have been squished for the last 20, 30,40,or 50 years? Yah, well, they are
   probably DEAD! Yes, they got destroyed from years of pressure on them. So, many neurosurgeons won't
   do the surgery because they know that you won't come out any better. That isn't to say that, if you've
   had a recent accident, the brain is squished and that's confirmed by MRI, and the nerves are simply
   inflammed, that this surgery wouldn't work for you; It probably would, but it would take almost two
   years to know for sure if the surgery helped.

   Many researchers believe that both theories are accurate. That some people have autonomic
   dysfunction because of an autoimmune antibody malfunction, and some have autonomic dysfunction
   because of damage where the brain meets the spinal column.

   If any of you know of other theories, please post!

   Would like to address "managing symptoms" next time.

   That ends this post!
   Bye!


                                                                        I found a website that describes autoimmune diseases and how they are caused. It's a bit technical
   because it gets into T cells and B cells, etc. You can browse through the whole thing or click on
   "autoantibodies". Remember, with autonomic dysfunction, this cause is just a theory. There could be a
   glitch along any part of the immune system. This website is good because it goes through all of the
   known glitches that occur in the immune system and gives specific examples of diseases.
   You won't find autonomic dysfunction listed here because it has not yet been proved that it is an
   autoimmune disease.
   Good luck!
   Rita
   www.niaid.nih.gov/publications/autoimmune/autoimmune.htm
 
   

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