Wisdom Wednesday: Treatment Before the Diagnosis?

This is an abbreviated case history to illustrate some of the unique features of the QA (Quintessential Applications) protocol.

A 34 four-year-old female came to my office with a chief complaint of severe pain under her left jaw. She had been to her primary care physician who thought it was a salivary gland but found no evidence of infection.

On palpation I could elicit pain but not from the salivary gland but actually from a small area just adjacent to a salivary gland. The area did not feel inflamed or abnormal in any sense, except she reacted to the pain.

Chiropractors are very good at palpation. It’s skill that is honed in school by palpating a hair through pages of Gray’s Anatomy. With practice, you can feel the distortion through about 80 pages of text. Now add 38 years of practice, palpating spines all day long.

So I was just as confused as her PCP. I could not identify the tissue from palpation.

Using the QA protocol, I looked for an injury reflex. However, Autogenic Facilitation was intact (any weak muscle strengthened when the nerve supply to that muscle was stimulated) eliminating an injury.

TL (therapy localization) to the jaw was active – if she placed her hand on the location of pain, any weak muscle became strong. Now I had a tool to evaluate her symptoms.

Next I checked to see what inflammatory pathway might be active. She was negative for prostaglandins but positive for both leukotrienes and cytokines. These pathways stimulate the immune system and when both are active can be autoimmune in nature. Typically, such cases will not respond favorably to ginger or boswellia, requiring a supplement that modulates the immune system.

Immune System Changes Tied to Chronic Fatigue Syndrome

Chronic fatigue syndrome appears to be linked to specific changes in a person’s immune system, particularly increased amounts of chemical messengers that regulate immune responses, researchers report.

The study adds to growing evidence that chronic fatigue syndrome is caused by a malfunctioning immune system, said lead author Dr. Mady Hornig. She is director of Translational Research at the Jerome L. and Dawn Greene Infectious Disease Laboratory at Columbia University’s Mailman School of Public Health, in New York City.

The immune system of a new chronic fatigue syndrome patient appears unable to shut down or reduce its response to an infection that has passed, Hornig said.

Instead, the system continues to pump out large amounts of cytokines – chemical messengers that coordinate the response of the immune system’s may cell types. However, this only seems to occur during the first 3 years of the disease.

“Their immune system is no longer resilient and able to bounce back after this cytokine surge” in response to an infection, Hornig said. “We need the system to be regulated, so it shuts off after the disease is gone, and that isn’t happening here.”

Doctors now can look for increased levels of these chemicals in the blood of patients who might have chronic fatigue syndrome, potentially aiding in their diagnosis, she said.

The new study, published February 27 in the journal Science Advances, comes on the heels of a new Institute of Medicine (IOM) report that declared chronic fatigue syndrome a “legitimate” illness that should be treated by doctors as a disease rather than an emotional problem.

Between 836,000 and 2.5 million Americans suffer from chronic fatigue syndrome, and an estimated 84 to 91% of people with the disorder are not diagnosed, according to the IOM. Chronic fatigue syndrome tends to strike people in their 40s and 50s, and occurs four times more often in women than men.

New Clues to How Colds Can Spur Asthma Attacks

Scientists have pinpointed a molecule that may trigger potentially life-threatening asthma attacks brought on by colds.

The researchers say this finding could offer a target for new drugs to be developed to treat these attacks.

Most asthma attacks (80-90%) are caused by viruses that infected the airways, according to the British researchers. Most of these are rhinoviruses which are the main cause of the common cold.

The researchers found that a specific molecule called IL-25 may play a major role in asthma attacks caused by colds. The findings are published in the Oct. 1 issue of Science Translational Medicine.

“Our research has shown for the first time that the cells that line the airways of asthmatics are more prone to producing a small molecule called IL-25, which then appears to trigger a chain of events that causes attacks,” study co-lead author Nathan Bartlett, of the National Heart and Lung Institute at Imperial College London, said in a college news release.

“By targeting this molecule at the top of the cascade, we could potentially discover a much-needed new treatment to control this potentially life-threatening reaction in asthma sufferers,” he added.

Wisdom Wednesday: Boswellia

This is my favorite herb for personal use – it works really well for me as an anti-inflammatory compound. Boswellia or Indian frankincense is derived from the resin of Boswellia serrata. There are no known contraindications, it is deemed safe for use in pregnancy and breast feeding. However, a few people have had mild diarrhea or skin rash as an allergic reaction. I have had one case in ten years of clinical use.

The key constituents of Boswellia serrata include the boswellic acids but the resin also includes essential oil. The typical dosage is 600 to 1200mg/day of extract standardized to contain 60% boswellic acids.

I use a complex that also includes some Celery Seed fruit, ginger, and Turmeric. This combination will target leukotriene and cytokine inflammation with some benefit in reducing prostaglandin inflammation as well. Although it works in the same pathway, it does not prevent the production of leukotrienes and cytokines like ginger. It has an effect on the Vagus nerve that stimulates the breakdown of these immune inflammatory compounds in the liver.

Boswellia is extremely effective in the treatment of asthma as well. It is thought that the effect on the Vagus nerve also has a calming effect on the goblet cells lining the respiratory tract. The result is a reduction in both bronchial inflammation and mucous production in the respiratory tree.

Wisdom Wednesday: Ginger

Herbs are a vital aspect of my practice. When used properly, they are powerful supplements that can restore normal function quickly. My favorite herb is Ashwaganda, but my most popular herb is ginger.
Traditionally, ginger is used to treat morning sickness, nausea, motion sickness, or any digestive disturbance. It is safe for use (at recommended doses) in both pregnancy and breastfeeding.

I use ginger as an anti-inflammatory compound. Scientific research has established that ginger blocks the enzyme lipooxygenase. This enzyme is required to form leukotrienes and cytokines, common inflammatory compounds arising from the immune system. Clinically, about 40% of my new patients are producing excessive leukotrienes and/or cytokines. For a majority of them, ginger will reduce their inflammation quickly and effectively with no side effects.

Like most herbs, there are quality issues with ginger. I use a 1:2 liquid extract that is manufactured in Australia. All herbal products in Australia are produced to pharmaceutical standards by law. This is the only way I can guarantee my patients are using an effective product.

European herbal companies have similar standards that the industry has voluntarily established. In the US there are no such standards and the FDA considers herbs as food. Government food quality restricts contamination from cockroach parts and rat feces but does not address herbal quality. Therefore, in the US a product listed as ginger does not need to contain any ginger.