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| Osteopathy
and Influenza
by Walter Llewellyn McKone D.O.
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Here’s
the scientific stuff
(In handout form)
Introduction
Influenza made the osteopaths of the beginning of the twentieth century
famous. It has since been found that the foundations of osteopathy were
rooted in the treatment of bacterial and viral infections. A. T. Still
discovered a “system of immunity”
and treated diseases “philosophically,”
no mention of manipulatively.
During the 1917-18 pandemic osteopaths were successful in saving the lives
of hundreds of patients who caught the flu. Why has this not been noted
in osteopathic history or education?
History
“Spanish flu” pandemic
of 1917-18 killed 50 to 100 million people
Was labelled the H1N1 virus
Virus was a strain of avian influenza
Spread from person-to-person contact
Killed large numbers of healthy adults
Three other epidemics
H3N2 – 1889
Unknown deaths
H2N2 “Asian flu” – 1957
Killed more than 2 million
H3N2 “Hong Kong flu” – 1958
Killed more than 1 million
H1N1 “swine flu” was a pandemic scare
The pandemic didn’t happen
What does “HN” notation mean?
Influenza A virus has one of 16 H subtypes
And one of 9 N subtypes
Only avian viruses have H5 and H7 subtypes
Neuroendocrine
and immunology
of inflammatory response to diseases
All inflammation and inflammatory responses are mediated by a bidirectional
activity between the neuroendocrine and immune system.
"The
physiological picture of influenza centres around one of the smallest
but most important and interesting organs of the body - the adrenal gland.
"In the female, it is the partner gland, the
pituitary body, that is correspondingly more important. And you will note
that there is a marked difference in the "flu" in males as with
females."
Tucker, E. E. (1919) Spanish Influenza.
Specific
actions of the adrenal gland the fight-flight gland from the 1919 Journals
of the American Osteopathic Association, mainly from Tucker (1919):
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Dilates bronchial tubes |
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Admits more air/oxygen |
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Dilates capillaries of the lung |
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Admits more blood to lung |
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Hence tendency for pneumonia |
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Esp. Central or bronchial pneumonia |
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Adrenaline contracts abdominal vessels |
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Abdominal blood usually a reservoir of reserved blood |
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Not in this case |
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More blood in muscle/skeletal circulation |
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Circulation shift enlarges vessels in the liver |
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All this portal blood must pass through liver on way to lungs |
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Hence gastro-intestinal form of disease |
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Adrenaline stimulates thyroid gland |
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Thyroxin acts as reducing substance that absorbs the oxygen into
blood |
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Frequently find goitres from gland strain |
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Can find soreness at the root of the neck |
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Enlargement of gland during influenza possible |
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Adrenaline stimulates heart |
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Heart, blood vessels and all sympathetic nervous system bathed
in adrenaline |
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In males larger hearts and blood vessels give cardiac symptoms
of flu |
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Dryness of skin, profuse perspiration |
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Profound prostration |
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Adrenaline stimulates brain |
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Brain blood vessels dilated |
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Mood changes - aggression |
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Meningeal irritation |
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Mucous membrane thickening |
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Brain stimulated - muscles stimulated |
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Brain-muscle-movement flight response |
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Large muscles that move body as whole [crossing more than one
joint] |
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Myalgia |
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Adrenaline releases carbohydrate from liver |
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Carbohydrate stored for muscle use |
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Another reason gastro-intestinal problems |
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More recent thinking, especially from Eskandari et al (2003):
The CNS relates to the immune system via
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hormonal pathways |
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hypothalamic-pituitary-adrenal axis |
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Hormones of neuroendocrine stress response |
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Neural pathways - ANS |
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Hypothalamic-pituitary-gonadal axis - sex hormone |
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Immune system signals CNS through:
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Immune mediators |
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Cytokines – Water-soluble proteins Water-soluble proteins |
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Produced by white blood cells |
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Act as chemical messengers between cells |
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These... |
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1. cross blood-brain barrier |
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2. Act indirectly through the vagus- PNS |
Neuroendocrine relation-action with immunity essential for survival during
dis-stress/stress or infection
In healthy person:
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Negative feedback loop of |
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Immune, CNS and hormonal |
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CNS regulation of immune system
1. Hormonal response
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• Hypothalamic-pituitary-adrenal axis (HPA |
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• Hypothalamic-pituitary-gonadal axis (HPG) |
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• Hypothalamic-pituitary-thyroid axis (HPT) |
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• Hypothalamic-growth hormone axis |
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2. Autonomic nervous system
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• Release of norepinephrine (noradrenaline) |
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• Acetylcholine from symp. And parasym. nerves |
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Immune system regulates the CNS through cytokines
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Cytokines released in periphery change brain function |
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Cytokines produced in CNS act like growth factors |
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Cytokines produced at inflammatory sites signal brain to produce
sickness signs and symptoms in depression and fever |
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Cytokines produced locally have effects on hormone secretion
and cell proliferation |
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This dynamic relationship/interaction between the neuroendocrine and immune
system is vital for disease free function.
Changes in any direction can lead to susceptibility to infectious, inflammatory
or autoimmune disease.
Regulation of the
immune system by the CNS
Hormonal pathways
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HPA axis |
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HPG axis |
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HGH axis |
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HPT axis |
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Hypothalamic-Pituitary-Adrenal Axis
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• Stimulation of corticotropin release hormone
(CRH) |
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• Secreted from paraventricular nucleus of hypothalamus |
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• Into - hypophyseal portal blood supply |
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• CRH stimulates expression and release of adrenocorticotropin
(ACTH) |
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• From anterior pituitary gland |
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Hypothalamic-Pituitary-Adrenal Axis
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• ACTH stimulates release of glucocorticoids
(cortisosterone) from adrenal glands |
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• Glucocorticoids regulate immune-related cell expression
and function |
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• these incl. expression of cytokines, adhesion molecules,
adhesion molecules, inflammation mediators, immune cell migration,
maturation, and differentiation |
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Hypothalamic-Pituitary-Gonadal Axis
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• Particularly oestrogen modulate the immune
system |
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• Physiological [conc.] of oestrogen enhance immune responses |
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• Physiological [conc.] of androgens - testosterone and
dehydroepiandrosterone (DHEA) are immunosuppressive |
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Hypothalamic-Pituitary-Gonadal Axis
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• Immune stress, in inflammation, inhibits HPG
axis |
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• Gonadal function reduced in trauma conditions |
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Hypothalamic-Growth-Hormone Axis
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• GH mediates immune system |
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• GH stimulates proliferation of lymphoid cells |
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• Suggesting GH is a cytokine |
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Hypothalamic-Pituitary-Thyroid Axis
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• Bidirectional communication between the HPT
axis and immune system |
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• HPT regulates immune system |
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Neural Pathways
Sympathetic nervous system (SNS)
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SNS regulates immune system at regional, local and
systemic levels |
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All levels! |
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Immune organs incl. thymus, spleen, and lymph nodes |
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All innervated by SNS |
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Opioids
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• Opioids suppress immune responses |
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• Incl. Antimicrobal resistance, antibody production, delayed-type
hypersensitivity |
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Parasympathetic Nervous System (PNS)
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• Activation of PNS activates cholinergic nerve
fibres of efferent vagus nerve = release of acetylcholine at the
synapses |
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• With inflammation-activated sensory nerve fibres of vagus
nerve form the 'inflammatory reflex' |
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• Rapid mechanism of inflammatory signals reaching the brain |
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• Brain responds with rapid anti-inflammatory action through
cholinergic nerve fibres |
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Peripheral nervous system
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• Regulates immunity locally at sites of inflammation |
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• Via neuropeptides |
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• incl. Substance P, peripherally released CRH, vasoactive
intestinal polypeptide |
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• These molecules are released from nerve endings or synapses |
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Regulation of the CNS by the immune system
Cytokines
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• They connect and modulate the immune and neuroendocrine
systems |
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• Systemic cytokines affect brain through: |
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• 1. Active transport across blood-brain barrier |
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• 2. Leaky areas in blood-brain barrier |
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• 3. Through activation of neural pathways such as vagus
nerve |
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• Cytokines signal brain to: |
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• 1. Activate HPA axis |
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• 2. Facilitate pain |
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• 3. Mood and behavioural responses - “sickness-behaviour” |
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• Cytokines include IL-1, IL-6 and TNF-a |
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Vagus Nerve
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• Signals CNS to immune system |
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• Innervates most visceral structures – lungs, GIT |
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• Immune system stimulates vagal sensory receptors |
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Osteopathic Management
“However,
the lessons learned within the osteopathic medical profession as a result
of the 1917-1918 pandemic could prove useful once again if (or when) a
new influenza pandemic occurs. As AOA editor in chief, Gilbert E. D'Alonzo,
Jr, DO, noted in his 2004 editorial, "Influenza epidemic or pandemic?
Time to roll up sleeves, vaccinate patients, and hone osteopathic manipulative
skills," influenza patients treated osteopathically during 1917-1918
had a 0.25% mortality rate, as compared to the national average of 6%
(and 10% for pneumonia patients, compared with 33% to 75% for the national
average).” Michael Patterson, PhD, 2005. |
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article in printer-friendly form (PDF) |
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