Originally posted October 10, 2008
With flu and cold season coming up, I thought it would be a good time to discuss how an osteopathic physician looks at infections. The standard medical approach to infections is that they are “caused” by bacteria or viruses (lets call them pathogens) and you need antibiotics or antivirals in order to recover from the infection. This viewpoint is based primarily on the work of Louis Pasteur, a French microbiologist during the mid- to late- 19th century. He established that bacteria were present in disease states. During the next 150 years, medicine has focused on these pathogens, and medical research has searched for more and more powerful drugs to kill them.
What is lost in this analysis, however, is the role of the patient in infections. Pathogens (bacteria and viruses) are around us all the time. They line the surfaces of our body, and the environments around us. Why, then, are we not constantly sick? A peer (and rival) of Pasteur, Antoine Bechamp , postulated that the role of the pathogen in disease was minimal; it is the state of the terrain (body) which determines whether pathogens will thrive and “cause” infections. In other words, a sick body will allow bacteria or viruses to grow, and the outward presentation is an infection. Treatment of the patient, if it focuses simply on killing the pathogen, will not result in a healthy body. One needs to dig further to find out why that particular patient presented with an infection.
Around the same time period in America A.T. Still was formulating his philosophy of Osteopathy, which he envisioned as a complete system of medical care which placed a prime emphasis on the patient instead of the disease. He looked specifically at the role of the musculoskeletal system in producing an environment where disease can take place. When he was asked his impression of the so-called “germ theory” of Pasteur , he stated that it was fine if people wanted to say that bacteria were present in disease, but that still doesn’t explain why a particular person is sick while another is not. He was adamant that disease was only an effect, and the presence of germs were another effect, of a problem within the body. Still focused on the musculoskeletal system, as a method of treatment, but he understood the importance of the circulatory, respiratory, and nervous systems in maintaining the body’s ability to fight off disease. Over the last 134 years science has filled in many of the gaps, and given us a clearer picture of how these systems work together to promote homeostasis (or the tendency for the body to be healthy).
Today traditional or classical osteopath are still utilizing these concepts to help patients fight disease. While we wouldn’t argue that antibiotics are necessary at times, our first approach is to help augment the body’s normal immune response. This might be through improving nutrition, using vitamins or herbs if necessary; it might involve helping to remove stress from the body, either external (work, family, etc.) or internal (strains in the musculoskeletal system, pain, etc.); it usually will involve manual treatment aimed at improving lymphatic flow (the lymphatic system is the “garbage collection system” of the body, collecting pathogens, dead cells, antigens, etc. and bringing them to the immune system for analysis). Only if those methods fail will we resort to killing pathogens with drugs, and even then we will still emphasize these other factors in disease as well.
A case study might be relevant here. This is one I published in California DO magazine in the spring of 2007. The case involved a young female patient who presented to the hospital with complaints of right back/flank pain. She had been previously treated with antibiotics for a presumed kidney infection. In the hospital she was found to have a right sided pneumonia and her urine was without infection. She was started on antibiotics, appropriately, as she had a fever and was showing signs of systemic or blood infection. This treatment, though, did not give us an indication of why she was sick, nor how to best make sure she wouldn’t get sick again. I was called to evaluate her from an osteopathic perspective.
When I asked about previous traumas, she initially denied anything significant. On examination, I found that the right lower ribcage was depressed and did not move when she took a breath. The right diaphragm (the muscle which separates your abdomen from your chest and causes you to breath ) was also restricted and didn’t move very well when she breathed. On further questioning she remembered that she had been involved in a car accident several months ago, and the seat belt had tightened against the right side of her rib cage, causing a bruise.
Now the situation was becoming clearer. She had had a trauma which impaired her ability to take a deep breath. This had set up a situation where bacteria, which are normally present in the lung, were able to overgrow and lead to an infection. The infection in the lung irritated her diaphragm, causing the flank pain she had initially presented with. The antibiotics would have killed off the bacteria in her lung and “treated” the infection, but without treating the musculoskeletal system the predisposing situation would continue to be present, and she was at risk for further infections. Taking a whole body approach allowed us to help her return to a greater state of health.
It is clear that antibiotics are occasionally required to treat infections, especially when the natural defenses are so diminished that the patient is at risk of overwhelming infection. Our goal, as osteopathic physicians,is to get deeper into the problem. If possible, we want to treat when the infection is early enough to augment the natural responses and avoid medications. Even in situations where medications are required, the osteopathic philosophy requires that we treat the precipitating cause, wherever the location, and allow the natural health we all possess to thrive.
“Now the situation was becoming clearer. She had had a trauma which impaired her ability to take a deep breath. This had set up a situation where bacteria, which are normally present in the lung, were able to overgrow and lead to an infection.”
I’m sorry, I’m only a premedical student, but would you mind explaining why the impairment in the patient’s lung led to the bacterial overgrowth and ultimately infection? Also what does “infection” mean if our bodies are always filled with bacteria anyway?
2 great questions! For the first, let me say that I have tried to keep the anatomy and physiology simplified for the purposes of this blog, which may be why it didn’t seem clear.
I can draw an analogy to a patient who has had abdominal surgery and now develops pneumonia. The pain from respiration prevents them from taking a deep breath, which changes the blood flow to and from the lower segments of the lung. This typically will lead to an impaired immune response through the sympathetic nervous system which then allows infection to develop.
In this patient the restrictions of the lower rib cage likewise prevented her from taking deep breaths. Through a similar mechanism she ended up with pneumonia. I hope that makes some sense to you.
As to your other question, that’s very philosophical. I could offer that an infection occurs when the body’s immune response is “overwhelmed” either temporarily or completely by the presence of bacteria, or sometimes we might say if the bacteria are where they aren’t supposed to be, such as under the skin or in the blood stream.
Thanks again for the questions, keep on Digging On!