The Effects of Specific Upper Cervical Adjustments on the CD4 Counts of HIV Positive Patients

The Effects of Specific Upper Cervical Adjustments on the CD4 Counts of HIV Positive Patients

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Unformatted text preview: Chiropractic Research Journal Volume 3 - Number I 1994 URI The Effects Of Specific Upper Cervical Adjustments On. The CD4 Counts Of HIV Positive Patients Jeffrey L. Selano, Brett C. Hightower, Bruce Pfleger, Karen Feeley Collins. John D. Grostic THE EFFECTS OF SPECIFIC UPPER CERVICAL ADJUSTMENTS ON THE m—GDA COUNTS 0F HIV POSITIVE PATIENTS Jeffrey L. Selano, DC. Brett C. Hightower, DC. . Bruce Pfleger, PhD. Karen Feeley Collins, D.C. John D. Grostic, DC. CPU-32 ABSTRACT The researchers of this project sought to demon— strate that upper cervical specific adjustments would have a profound. effect on the physiology, serology and immunology of Hi V positive indi- viduals. - The eflect of specific upper cervical adjustments on the immune system CD4 cell counts oleV positive individuals was measured by (IDs/mam in. the blood. 1 hese tests were perfiirmecl by the patients independent medical center where they were under medical supervision for the condition. The measured CD4. counts in the regular group were dramatically increased over the counts of the control group. A 48% increase in CD4 cells was demonstrated over the six month duration of the studyfor the adjusted group. Key Indexing Terms: Chiropractic, atlas, subluxation, CD4 count, immunology, dentate ligament, HIV. SELANO,HIGHTOWER.PFLEGER, FEELEY COLLINSI GROSTIC Chiropractic Research Jou mal Ivolume 3 - Number 1 ‘3 1984 CRJ INTRODUCTION The concept of the subluxation has been the cornerstone of the theory and practice of chiropractic since its founding in 1895 by DD. Palmer. It is one of the most controver- sial concepts in health care today, and it finds its supporters and critics both within and outside the chiropractic profession.1 Today it is estimated that 20 million patients receive chiropractic care annually at an estimated cost of 2 billion dollars.2 As a profession, chiropractic has only begun to scratch the surface of the endless possibilities that stand before it in the realm of the subluxation and its effects on the nervous system. Over the past 20 to 30 years several excellent attempts have been made within the profes— sion to correlate the effects of adjustments on the likes of substance P, cortisol and lympho- cytes.3 Since 1984, the growing number of immune-compromised people who have contracted HIV has left researchers world- wide scrambling for answers. It is estimated that this year the HIV population in the US. will reach 2.5 million.4 This pilot study attempts to explain chiropractic’s potential role in the care of these patients and the potential role of adjustments and their effect on the nervous system and the relationship between the nervous system and immunity. BACKGROUND Since the beginning of the HIV epidemic, the infection has slowly become a chronic illness. Initially, patients were diagnosed with acute medical conditions requiring intensive medi— cal therapy, and more chronic indolent prob- lems were rarely addressed. Now with the improvement of early diagnosis and prophy- lactic therapies, patients are living longer. These circumstances have created an arena where wellness and quality of life issues are increasingly pertinent. The search for and ultimately the detection of HIV, back in 1984 was promoted when researchers suspected that the consistent findings of opportunistic infections among hundreds of immune—compromised patients could be related back to a single etiology. The virus itself is not detected in the blood of an infected patient, but rather the antigens to the virus are detected. The first standard test is the Elisa which can prove to result in false positive should the patient have a bad cold, flu or a hypersensitivity response as in aller- gies. The back-up test is the Western Blot test SELANOHIGHTOWERPFLEGER, FEELEY COLLINS, GROSTIC which must pick up three different antigens in the blood, all present at the same time, to register a true positive. Only the presence of the HIV will render this outcome. The efficacy of chiropractic care in the field of somato-visceral disease processes has been demonstrated by several practitioners over the past two decades.5'8 Chiropractic, as it pertains to immunology, received a boost in 1991, when Patricia Brennan, Ph.D., et. al. conducted a study that ultimately demon- strated that when adjusting the thoracic spine the phagocytic respiratory burst of polymorphnuclear neutrophils (PMN) and monocytes from adjusted adults was en~ hanced.6 There have been numerous medical studies demonstrating the direct nerve inner- vation to the immune system.9“17 CPU-33 Chiropractic Research Journal Volume 3 a Number I '33 1994 OF“ MATERIALS AND METHODS Experimental Design: A randomized, controlled clinical trial utiliz- ing the Grostic method of analysis and adjust- ing the upper cervical spine was used.18'19 Twenty-two patients were selected from the public to begin the study which took a dura— tion of six months. The mean age was 28 years. Two patients expired during the study from complications of the disease. From the remaining 20 patients, five moved away or ceased care Without notice. Five other pa- tients did not submit significant blood work to warrant their inclusion in the final statisti- cal analysis. The remaining ten (N :10) pa- tients provided the significant data for our statistical workup. Three sets of blood work per patient for the ten patients was collected to assess the growth or decline of CD4 cells for each. Of the ten total patients, half were in the regular adjusted group (N=5) and half were in the control group (N =5). The regular adjustment was performed with the Laney KH—4 instrument with a transverse process contact on atlas. The vectors from the X—ray analysis were used with the patient on a Grostic adjusting table in the side pos- ture position. For the control group, an inactive Laney KH—4 instrument was placed on the patients mastoid bone and the trigger was depressed with the patient in the supine pesitiori. No force was emitted from the stylus to the control patients. Post adjust- ment x-rays were taken to determine if the laterality and rotational components of the subluxation were reduced. Patients were asked to complete the Rand Corporation SF- 36 quality of life questionnaire to establish a base line20 and then weekly for the remain; der of the study. PATIENTS HISTORY Each patient was required to have a physical exam performed prior to the first adjustment. This exam included visceral, orthopedic, chiropractic, range of motion and historical findings. Eight of the ten patients were cur- rently taking medication for the disease. Two of the ten were not under any medical care at all. Each of the patients on medication were taking AZT which is the drug of choice to combat the rapid decline of CD4 cells by influencing the reverse transcriptase in the T- 4 cells. Patient findings for opportunistic infections included thrush, kaposi’s sarcoma (KS), pneumocytis carnii pneumonia, back pain, neck pain and enlarged cervical lymph nodes. RESULTS The control group experienced a 7.96% de- crease and the adjusted group experienced a 48% increase in CDflL cell levels (P: 0.06). (Figs. 1—3) Both groups were monitored with the Rand Corp. SF-36 to determine quality of C HJ-34 life as rated subjectively. Both groups dem- onstrated subjective improvement with the control group exhibiting a slope of 1.62 and the adjusted group having a slope of 1.74. (Fig. 4.) SELANO,HIGHTOWER.PFLEGER. FEELEY COLLINS, GHOSTIC Chim pra mic Research Journal Volume 3- Number ‘I I2) 1994 (NJ cfi'NOPRA'EI'b CAREAND HIV [fins CONTROL PATIENTS (SHAM ADJUSTMENT) 600 - E 500 ! D o 400 O :I 300 8 VI. 200 D I o 100 - 133% 0 __ .._._ CHANGE OVER 6 MONTHS PER PATIENT Figure 1 _ENIROPRAETIC CARE—BIND HIV / AIDS ADJUSTED PATIENTS _ .._____.. ___ ..__.___ E 500 - I.) O 400 -- 0 A1 :.'300 - I209? LU O ? . I g " . . :7; l _l 0100- -- gum __ . 0 __ i CHANGE OVEFI 6 MONTHS PER PATIENT FigureZ SELANOHIGHTOWEHPFLEGEH, FEELEY COLLINS. GHOSTIC CPU-35 Cmroprachc Researcw Journal Volgmu 3 o Numbcr1 © 1994 CRJ CHIROPRACTIC CARE AND HIV / AIDS ' " ADJUSTED VS. CONTROL PATIENTS I— i O a 3 40% 8 30% . .... __ _______ _ _ Z 20% - - — - - - - - - - LU L25 100/0 . _ _ _ _ _ . _ _ _ _ _ _ _ _ _ <1 I 00/0. ___ o I .. . i 5 _100/0 _.______. ' n . _ . 0— .'_d_f_= 8 t: 1.654 P(T<=t) 011C _tail =0.06 Figure 3 IMPROVEMENT IN QUALITY OF LIFE TEST UTILIZED: SF36 90 — __ fl ' . .- Béa . _ _ _ E70 ' — B 60 ; E : $50 I 40 5 —-+ - . . _fl- 0 1' 2 3 4 5 6 TIME (MONTHS) Figure 4 CRJ-SG SELANO,H|GHTOWEH.PFLEGER, FEELEY COLLINS‘ GROSTIC Chiropractic Research Journal Volume 3- Number 1 ® 1994 CFtJ DISCUSSION The Denta te Ligament Hypothesis proposed by Dr. John D. Grostic serves as the basis for this study. This hypothesis states that mis- alignment of the upper cervical vertebrae, because of their unique attachment to the Spinal cord by means of the dentate liga- ments, can directly stress and deform the spinal cord.21 Subsequently, this stress on the cord, in addition to direct mechanical irritation, may produce venous occlusion with stasis of blood and resulting anoxia in particular areas of the upper cervical cord. In fact, dentate ligament distortion has proven to have far reaching effects on the nervous system. High cervical cord lesions were found to have a profound degenerative effect on the nervous system.22 The dentate distor— tion was found to be related, in 1967, to kinking of the medulla in children.23 C1 subluxation may also result in torsioning of the spinal cerebellar tract. This sets up a system of high gate facilitation which results 'in sustained sympatheticonia.5 The Spino- cerebellar tracts are composed of the largest axons in the spinal cord (Type A fibers). They are located at the site of maximal me- chanical irritation. 1f traction disrupts cord function it does so first in the spinocerebellar tracts, tracts responsible for muscle tone and joint position sense. Long term hyperactiv- ity of particular sympathetic pathways is deleterious to the target tissues and may indeed have a rather general significance.5 This over stimulation of the proprioceptors at the C1-C2 and Cl—occiput articulations will set up the sustained sympatheticonia through high gate facilitation. The diversity of re- sponses in stimulating various peripheral sympathetic pathways is not through the influences of the sympathetic neurons, but in the respondent actions of the innervated tissues and organs. These actions are as SELANOHIGHTOWER,PFLEGER, FEELEY COLLlNS, GROSTIC varied as the tissues and organs they inner- vate. Sympathetic stimulation introduces no new qualities, but modifies (increases or decreases, accelerates or retards, stimulates or inhibits) the inherent functional properties of the target tissues, each, therefore, respond- ing in its own manner.5 It should not be surprising, in View of these diverse organ and tissue responses, that sympathetic hyper- activity, sustained over long periods of time, will tend to produce pathologic changes in the target tissues. This process of high gate facilitation will logically lower thresholds and increase neuronal firing. This would at first seem to contraindicate the idea that subluxation leads to a depression of CD4 cell production. The increased neuronal firing would imply that the target immunological tissues would increase their production under the influence of the sympathetic system. However, chronic subluxations and long term sympatheticonia will eventually lead to an attenuation in the neuronal physiology and “burnout,” which leads to a reduced state of cellular activity. We believe this sets up the depressed state in which the number of CD4 cells stimulated into production is less than previously re- quired to maintain proper health. One of the most important roles of the sym~ pathetic nervoussystem (SNS), not always emphasized or recognized in textbooks, is part of it’s “ergothrophic function,”24 which is the adjusting of circulatory, metabolic and visceral activity according to postural and musculoskeletal demands. It is here that we find an important link between the muscu- loskeletal system and the SNS. Hess im- presses upon us the importance of the dien- cephalon when, through neural probing, he demonstrated a connection never before observed by modern researchers. When CRJ-S? Chiropractic Research Jouma Volume 3 - Number 1 {D 1994 CPU probing the diencephalon in anesthetized cats, he observed the correlation between visceral acts and their postural counterparts. While probing the posterior part of the dien— cephalon, one cat begins to wretch as in vomiting and assumes the proper biome- chanical posture to assist in the act; hunching of the back and elevating of the hind quar- ters. The examples are vivid and give us, as chiropractors, a much needed boost in our search for scientific explanations for the effects of subluxations. We must go the final step in determining how the CD4 cells are potentially decreased. With decreased SNS function already established, we find that the SNS and immu— nologic tissues work on a system of stimulat— ing adrenergic receptors. We find cholinergic receptors are present on thymosic producing thymic epithelial cells and beta adrenergic receptors are identified on lymphocytes .25 CONCLUSIONS Though the study size was small, preliminary results suggest that chiropractic adjustments of the upper cervical spine may increase the CD4 levels in HIV positive individuals. These results suggest that follow-up studies of the link between the nervous system, immunity and the upper cervical region are well warranted. Although these results are very encouraging, it must be noted that we cannot generalize our findings to the general population. We are currently working on a larger study to include approximately 200 individuals with HIV. This larger study will hopefully, sub— stantiate these findings. ACKNOWLEDGMENTS The authors would like to thank the follow- ing people who helped make this project possible. Dr. Sid E. Williams, President and Founder of Life College, faculty and staff of the Sid E. Williams Research Center. Also, Shirley Lankford and Mary ]ane Berrien for CFlJ-SB their loving support and encouragement. Dr.im Smith for his enduring vision, clinical skills and friendship throughout the project. Atlanta X—Ray for the donation of their equip- ment and all the Life College clinicians who helped adjust and manage our patients. SELANO.HIGHTOWER,PFLEGEFl, FEELEY COLLINSI GHOSTIC 1 10. 11. 12. Chiropractic Research Journal Volume 3 - Number 1 @1994 CPU REFERENCES . Lantz CA: The Vertebral Subluxation Complex Part 1: An Introduction to the Model and Kinesiological Component. Chiro Research] 1989; 1 (3) :23—25. . McAndrews IF: Medical Gatekeepers. ACA] Chimpracti'c 1993; 30:69-72. McGillis et a1: Substance P and ImmunoreguIation. FASEB 1987; 001%9446/ 0046-0196-199. . CDC: 1993 Incidents of Reported AIDS Cases. CDC Report Mortality & Morbidity. 1994; Atlanta, Ga. . Korr 1M: Sustained sympatheticonia as a factor in disease. In Kerr (ed): The Neurobiologic Mechanisms in Manipulative Therapy. Plenum, New York, 1978: 229-268. . Brennan P, Graham M, 'l‘riano J, Hondras M: En— hanced phagocytic cell respiratory bursts induced by spinal manipulation: Potential Role of Substance P. lManip Physiolog Ther 1991; (14)7:399~400. . Tran TA, Kirby, ID: The effects of upper thoracic adjustments upon normal physiology of the heart. ACA J Chiropractic 1977; 11:25-28. . Wickes D: Effects of thoracolurnbar spinal manipulations on arterial flow in the lower extremity. J Manip Physioiog Ther 1980; 313-6. . Bullock K: Neuroendocrine immune circuitry: Pathways involved with the induction and persistence of humoral immunity, PhD. disser- tation 1981; U.C.S.D. San Diego. 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The Effects of Specific Upper Cervical Adjustments on the CD4 Counts of HIV Positive Patients

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