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Osteopathic approaches to Lyme.

Treatment of Lyme and co-infections is most effective when providers apply a multidisciplinary approach to treatment, integrating synergistic therapies for the benefit of their patients. Osteopathic physicians are well prepared for patient co-management, drawing on the unique skillset of their discipline to support the innate healing ability of the body.

In my experience, patients with chronic Lyme complex who receive osteopathic manipulative treatment (OMT) invariably benefit by having fewer herx reactions and tend to experience faster overall improvement, frequently reducing the need for antibiotic therapy by a matter of months.

Rather than referring your patients to a series of providers for physical medicine, for example, a physical therapist, and then subsequently a craniosacral therapist, and later a massage therapist for lymphatic drainage, the osteopathic physician (DO) is trained in all these osteopathic modalities and has access to them literally at their fingertips.

As an osteopath, I got involved in working with Lyme disorders because I noticed a subset of patients who were not responding to therapies that are normally highly effective. When we began identifying patients who might be suffering from Lyme disease, and tested and treated them for Lyme whenever present, we found that OMT initiated a stronger healing process that was then sustained. A skilled DO can increase the rate of healing using hands-on diagnosis and any number of direct and indirect treatments (OMT), including myofascial unwinding, facilitated positional release, balanced ligamentous tension release, visceral manipulation, muscle energy, Jones strain-counterstrain, high velocity/low amplitude, and lymphatic pumping/drainage treatments, as well as osteopathy in the cranial field.

The most outstanding case for the efficacy of OMT on record in the United States is the flu epidemic of 19181919. This pandemic caused an estimated 30 million deaths worldwide, just over 1% of the world population. At the time, the osteopathic medical profession had relatively few hospitals, but treated over 110,000 patients during the pandemic with a mortality rate of 0.25%. Whereas, at the counterpart allopathic hospitals, the mortality rate ranged from 36% to 68%, depending on which allopathic hospital was reporting. Treatment at conventional hospitals consisted of aspirin and cough syrup. At the osteopathic hospitals, treatment consisted of cough syrup and OMT; the aspirin was omitted, as fever was considered a natural and powerful remedy. (Basic research has confirmed that fever is the signal that ramps up the immune response, initially through the release of heat shock proteins that promote increased levels of cytokines and immune activity.) I trained with a number of older physicians who told me that they would see hospital patients three to five times a day before the advent of antibiotics, providing treatment such as lymphatic drainage, which can be highly effective in combating infectious illness.

Osteopathic Treatment Strategies for Lyme

One of the fundamental principles of osteopathy is to seek the key lesion. As in functional medicine, we look for the most basic underlying cause triggering the symptoms and the disease process. For example, if a Lyme patient is experiencing debilitating episodes of dizziness or chronic headaches, are those symptoms generated in the sacrum or the head, or due to an inflammatory infectious process? In treating Lyme and its co-infections, the key lesion will tend to correspond to the body's most vulnerable system(s), which the borrelia typically exploit. This dynamic also further confounds the complexities of Lyme diagnosis: an old shoulder injury will flare up more often in a Lyme patient, leading that patient to discount the injury as a chronic problem that is not Lyme related. OMT has proven effective for a number of the issues central to a Lyme diagnosis and Lyme treatment.

Inflammation. I find that until the inflammation is resolved by the use of herbs, antibiotics, or any combination thereof, provided in conjunction with OMT, the patient's symptoms will remain consistently present or will continue to recur in a cyclical predictable manner reflecting the growth cycle of the particular microbes that are predominating. Stability occurs when the underlying neurotoxins and inflammation triggered by the borrelia and co-infections are no longer present.

Case history. A good example of this is a 58 year old female who presented with chronic knee pain despite two surgeries after an injury five years prior. I know the surgeon to be among the best in the area, so I wanted to explore possible reasons for the failed surgery. Since the patient had a strong tick exposure history, we investigated the possibility of Lyme infection and found that she tested positive for borreliosis. I started her on the appropriate antibiotics, and in one month her pain was decreased by 50%. In conjunction with the antibiotic therapy I performed OMT utilizing myofascial unwinding, balanced ligamentous tension release, and cranial osteopathy. She has remained knee-pain free for more than three years.

Bell's palsy and trigeminal neuralgia. Cranial osteopaths are often well-versed in the treatment of cranial nerve palsies that we see with Lyme and babesiosis, such as Bell's palsy (CN VII), and trigeminal neuralgia (CN V) palsy. From the minute a palsy is diagnosed, the clock is ticking: the lag time after an insult is a defining factor in how fully the patient can recover.

Case history. A 60-year old male presented with a 10-month history of debilitating and disfiguring Bell's palsy and suspected Lyme. He had been seeing a well-meaning acupuncturist and theoretically receiving treatment from him two to three times a week, from the time his symptoms initially developed. Although my Lyme-literate colleagues told me that antibiotics probably would not help as it had been too long, I initiated treatment with antibiotics, and highly focused OMT, and he recovered over the course of a year of treatment, restoring approximately 70%-80% of normal function. Within two months he no longer needed a tissue to dry his weepy eye and drooling mouth, a significant improvement in functionality. The acupuncture would have been more effective if provided in conjunction with Lyme treatment such as antibiotics. Conversely, a 12-year-old patient came down with a severe, acute Bell's palsy, and with immediate antibiotic treatment in conjunction with OMT, it completely resolved in 1 week. In this case, the positive Lyme test was back two weeks later, after the symptoms resolved.

Postural orthopedic tachycardia syndrome (POTS). Chronic Lyme patients with autonomic dysfunction frequently experience a condition referred to as POTS, associated with excessive tachycardia and orthostatic hypotension. POTS patients can suffer from fatigue, headaches, dizziness, heart palpitations, nausea, brain fogginess, tremors, fainting, cold or painful extremities, chest pain, or shortness of breath. A skilled osteopath is trained to work with the musculoskeletal, vascular, myofascial, visceral, neuronal, and lymphatic tissues to bring about homeostasis through the use of OMT. The body is no longer in a state of somatic dysfunction, and patients therefore suffer less.

Benefits of Cranial Osteopathy for the Lyme Patient

The primary respiratory mechanism (PRM) of the body encompasses the inherent rhythmic motion of the brain and spinal cord, fluctuation of the cerebrospinal fluid (CSF) bathing the CNS and PNS, motion of the reciprocal tension membrane (RTM) of the dura, inherent rhythmic motion of the cranial bones, and involuntary motion of the sacrum (tailbone) between the ilia (hip bones). A key strategy in cranial work is restoration of the integrity of the PRM, given its fundamental role in human health and functionality. Osteopathic physiology points out that upon death, respiration through the heart and lungs stops before the PRM does. Until the individual is brain dead, the PRM continues.

Seizures and vertigo. The vast majority of Lyme patients I see have a type of injury referred to as an SBS compression, which is a somatic dysfunction of the synostosis, the juncture of the sphenoid and occipital bone in the vault of the skull. Generally speaking, an SBS compression is typically caused by blunt force trauma to the head, but, in Lyme, it seems to be related to inflammation affecting the PRM. An SBS compression results in poor range of motion (flexion and extension) of the cranial mechanism throughout the body and can cause epileptic seizures in children. Another good example of an SBS-compression-related disorder is vertigo. Seizures are often associated with bartonella infections.

Case history. I saw a patient last week who presented with acute vertigo, but she also had a history of Gilbert's syndrome. After a quick assessment I determined that she had an imbalance between her temporal bones, which is a very common cause. I performed cranial OMT, and the condition was corrected in short order. She came back a week later, and was 85% better. This is a good example of someone who would not have gotten better with the usual viral labyrhynthitis treatment of Antivert and prednisone, followed by a work up for Lyme and babesiosis. If she had Lyme and babesiosis she would not have been better at the one-week follow-up.

When we treat these patients, the first step is to achieve proper movement of the CSF and the PRM. Often, in Lyme patients this process is diagnostic: we find that we can get their cranial mechanism flowing well, yet when we return to reassess the patient ten minutes later it is as if no treatment had been performed. These patients all test positive for Lyme. Jeff Greenfield, DO, and I coined the term "Lyme head" to describe this pervasive dysfunction in the PRM and the fact that these treatments do not hold until the Lyme infection is successfully treated. In researching the literature, I found that Harold Magoun, DO, in his book Osteopathy in the Cranial Field, refers to SBS compression in cases of influenza, most likely noted in the flu pandemic of 1918-1919.

Hormonal imbalances. Clinically, a somatic dysfunction in the SBS can also affect the production and release of hormones. The pituitary body sits in the sella turcica on the upper surface of the sphenoid bone just in front of the SBS. A restriction in this area can affect the diaphragmatic sella (part of the dura mater) that wraps around the pituitary stalk like a collar and has a vascular plexus that allows for passage of hormones. This directly relates to the dural RTM which in turn directly affects drainage of CSF from the head. OMT can often negate the need for exogenous BHRT or limit need for its use long term in the Lyme population.

Integrative Osteopathic Treatment

In osteopathic training, we are taught that structure and function are interrelated, and that the body is a unit, and has its own innate ability to heal. These three tenants are encapsulated in a clinical approach that incorporates this philosophy of the integration of the body. Although our primary focus is harmony between all anatomical structures, each of the different systems (neuronal, lymphatic, musculoskeletal, and so on) serves as a fulcrum point that enables us to promote and leverage healing throughout the body.

The take home point is that almost every Lyme patient will benefit from being evaluated by a skilled, "hands on" osteopathic physician to assess, treat, and clear somatic dysfunctions. Osteopathic manipulative medicine also serves as an important adjunct to any chronic Lyme treatment plan by reducing inflammation, supporting lymphatic drainage, and increasing detoxification,

Resources

There are two good referral sources for qualified osteopathic physicians:

Cranial Academy

www.cranial academy.org

317-581-0411

American Academy of Osteopathy (AAO)

3500 Depauw Blvd., #1100, Indianapolis, Indiana 46268

info@academyofosteopathy.org

317-879-1881

by Robert Gitlin, DO

About the Author

Robert Gitlin, DO, graduated from the Kirksville College of Osteopathic Medicine in 1992 after completing an Undergraduate Teaching Fellowship in Osteopathic Manipulative Medicine. He then became Board Certified with the AOBFP and the AAFP on completing Family Medicine studies with the certifying program at the Shasta-Cascade Family Medicine Program at Mercy Medical Center in Redding, California. He is a Lyme-literate physician in Northern California practicing integrative family medicine and osteopathic manipulative medicine.

Editorial

Nancy Faass, MSW, MPH, is a writer and editor in San Francisco who supports authors in their publishing endeavors, including books, articles, white papers, and writing for the Web. For more information, contact info@HealthWritersGroup.com.
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Author:Gitlin, Robert
Publication:Townsend Letter
Geographic Code:1USA
Date:Jul 1, 2014
Words:2006
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