Le test de tension
pour les victimes de fatigue chronique : a quel stade en sont vos surrenales ?
Dans la cacophonie diagnostique actuelle : mononucléose chronique, candidose, fibromyalgie, fatigue chronique, hypothyroïdie ; n'ajoutons pas de la souffrance à la souffrance. Voyons d'abord si vos capsules surrénales sont épuisées ou non. Si oui, le traitement médical sera grandement aidé par le SEUL outil à votre disposition pour les ressourcer (à part l'alimentation ajustée, bien sûr): le repos couché ! Comment évaluer l'épuisement des surrénales ? Le docteur Poesnecker, qui soigne la fatigue chronique depuis plus de quarante ans sous le nom d'hypoadrénalisme, utilise un outil de détection bien pratique et bien peu cher pour évaluer si vos surrénales sont encore dans le vert, déjà dans l'orange, ou carrément dans le rouge.
Grâce à cet outil, vous pourrez évaluer si vous devez vous reposer de temps en temps, régulièrement ou... tout le temps ! Il est si efficace que le John Hopkins Hospital aux Etats-Unis utilise ce test pour les victimes de fatigue chronique - mais avec une table spéciale, à quel prix ? ... :)))
En résumé en français, l'original (en anglais ci-dessous) se trouvant dans le livre du docteur Poesnecker, disponible en ligne et gratuit sur http://www.chronicfatigue.org: "Chronic Fatigue unmasked".
- Equipez-vous d'un tensiomètre. Placez-vous en position couchée pendant 5 minutes. Notez la tension et gardez le tensiomètre au bras.
- Passez en position debout. Notez la tension.
- Restez encore debout une minute. Notez la tension.
Vous avez donc trois notations : TC pour tension couchée, TD pour tension debout et TDD pour tension debout après une minute. Chez les sujets à intégrité surrénale totale, la TD augmentera de 5 à 10 points par rapport à la TC. Si vos surrénales sont fatiguées, la TD sera plus basse que la TC. Si la valeur de TDD est encore plus basse que la TD, c'est que vous êtes dans le rouge, que vos surrénales sont en fatigue extrême ! La valeur de TD indique le stress à court terme sur les glandes surrénales, alors que la valeur de TDD est plutôt la marque de la regénérescence de la gande.
Exemple : pour une TC de 110/70, une TD de 100/65 et une TDD de 120/75, le docteur Poesnecker dirait que le sujet a eu un stress récent, de court terme, mais que la glande est en train de se remettre. Pour une TC de 110/70, une TD de 100/65 et une TDD de 95/60, il déduirait que ce patient ne récupère pas, que son traitement n'est pas encore efficace, et lui demanderait encore plus de repos, plus de réduction de stress divers, et changerait de traitement.
The Postural Blood Pressure Test
Extrait du site http://www.chronicfatigue.org
One of the most important diagnostic features of the physical examination is what is known as the postural (orthostatic) blood pressure test. In this test, which is routine in our office, the patient is placed in a reclining position four or five minutes; the blood pressure is then taken and recorded. The patient is brought to a standing position with the blood pressure cuff still in place on his arm. The blood pressure is immediately taken and recorded. The pressure is again taken in a minute with the patient still standing.
In the patient with full adrenal integrity, the blood pressure will be five to ten points higher in the standing position than in the reclining position when they first rise because of the increased tone of the abdominal blood vessels, which are under control of the adrenal glands. When you lie down, the heart relaxes, and all the large vessels tend to relax, because every vessel is at approximately the same height as the heart, and gravity has little effect on the blood flow. When you suddenly stand up, however, there is a tremendous downward pull of gravity on all the blood in the upper body, the tendency being for the blood to flow down into the large abdominal vessels and pool there. If there was not some compensatory mechanism to correct this, most of us would go into a state of oxygen deprivation (anoxia) whenever we stood up, immediately becoming dizzy or faint. However, there is a mechanism, mainly under the control of the adrenal glands, that increases tonicity (constriction) in the large abdominal vessels whenever we stand up. This abdominal constriction produces a slight rise in blood pressure that occurs normally upon standing. In adrenal insufficiency, however, this mechanism functions weakly. In fact, it reacts in inverse ratio to the integrity of the adrenal glands. Thus, the more the adrenal glands are depressed or unable to function, the less this mechanism is able to work. When a patient with hypofunctioning adrenal glands stands up from a reclining position, the blood pressure tends either to stay the same or drop slightly in mild cases. In the more severe cases, the drop may be considerable. I have seen patients in whom the blood pressure dropped forty points upon standing. These patients usually become quite dizzy upon standing--of all the symptoms of hypoadrenalism, this dizziness upon arising from a reclining state is one of the most consistent.
Because the degree of blood pressure drop is usually a dependable indication of the adrenal state, it is used at our Centers to measure patient improvement. As a patient is treated and makes subjective improvement, we also find objective improvement in the orthostatic blood pressure readings. Although not the most important adrenal function, it is the easiest to measure, and such improvement generally parallels improvement in the other particulars of adrenal function.
The difference in nature between the first and the second standing reading is also important. In my experience I find the first standing reading indicative of the short- term stress on the adrenal gland while the second reading is more inclined to give us information on the nature of the regeneration of the adrenal gland itself. For instance if a patient would read 110/70 lying down, 100/65 when first standing but 120/75 on the second standing reading, I would surmise that hr has had some recent short term stress but that the adrenal gland on a long-term basis is regenerating. On the other hand if the respective readings were: 110/70, 100/65 and 95/60, I would deduce that this patient is not regenerating and needs more stress reduction and increased treatment. If the first standing reading is lower than the reclining reading it means that the patient has been under some recent stress and would do well to back off his lifestyle until the adrenal gland is able to catch up to his needs. If the third reading is lower than the reclining reading it shows that the stress on the adrenal gland is such that it is deteriorating--not regenerating--and measures must be instituted immediately to correct this situation or it could become difficult to correct.
Although this test was developed many years ago, we find it used little by most physicians.* However, I find it an unerring indication of this rather enigmatic condition. One can even predict a patient's feelings for several days following the test once one becomes in tune with the patient and the test. The postural blood pressure varies from day to day and even from hour to hour in some cases, as does adrenal function. If I have a patient who has been doing well under treatment, whose orthostatic pressure suddenly drops considerably more than usual, I know that he is under some new or sustained type of stress that even he may not be aware of. We can then search for the new problem and correct it, even before it can produce viable symptoms. Physicians who do not regularly use this test deprive themselves not only of an effective diagnostic tool but also of a therapeutic guide par excellence.
To us, a combination of the history, the lab tests, and a positive postural blood pressure test is considered sufficient to make a diagnosis of functional hypoadrenalism, however, it is only with the ASI test that we are able to determine exactly the state of the patient in this condition. Of course, the programmed intuitive nature of the physician also enters into the diagnosis. When one has handled many hypoadrenal cases, they tend to stick out like sore thumbs. Their whole nature and being help make the diagnosis. The physician must only look and listen. The only real way to miss functional hypoadrenalism is to not be aware of its existence, or as the Bible says: "There are none so blind as those who will not see."
*Since this was written, work has been done at Johns Hopkins hospital by way of a tilt table to demonstrate this change in blood pressure in Chronic Fatigue patients. Of course we have been doing this test for over forty years now. With this in mind, however, perhaps in another forty years we may well find that the rest of our work with this condition will be "discovered."