Sunday, September 15, 2013

Toxic Reaction After A Chiropractic Adjustment

I am first going to tell you something I inform every single one of my patients BEFORE their first adjustment.

YOU COULD GET SICK. Now, it isn't the doctor that made you sick, or the adjustment itself. However, if the doctor doesn't inform you of this and WHY it occurs, what else is a person to think?

Toxic relief. This is the experience that approximately 15-20% of the patience experience after their first chiropractic adjustment.

What are the symptoms? Well, I am going to go over the most common symptoms first, then go over what the rest of the symptoms we have seen in our clinic.

1) Lethargy: Patient within hours feels completely drained of energy. This isn't a sudden virus that attacked your body, it's your own body reacting to the chemical and electrical impulse the nerves send out to the body that were being denied regularly.

2) Headache: most often without fever. (This isn't a virus, but the body will look to fight what is going on).

3) Night time sweating: Profuse sweating (of course a loss of sleep). Body is looking to cool itself down.

What? Explain that again in layman's term Doc....  Your body sends out electrical and chemical impulses from the brain down the spinal cord 24 hours a day.

Before I go any further, I am going to attach a small synapses of nerve cells that both interestingly enough BOTH chiropractors and medical doctors agree upon.

Other S/Sx: eyes burning, loss of sensation of taste, difficulty breathing, diarrhea, ...and last (but very common...especially at the tail end of Toxic Relief)......very tight gastrocnemius muscles in the back of the leg.

The Nervous System: Composition and Organization

While our brains control nearly everything we do, the brain does not work alone. The brain is the central part of a complex body system known as the nervous system. The nervous system allows us to respond to the world around us. Both our involuntary actions, such as our blink reflex to bright light, as well as our voluntary actions, such as choosing to put on sunglasses, can be attributed to our nervous system. Such a system must necessarily be both complex and extraordinarily well organized to produce the coordinated functions that define human life. How does our nervous system manage to perform its various functions?
The nervous system is organized into two major subdivisions: the central nervous system (CNS) and the peripheral nervous system (PNS; Figure 1).3,15 A brief examination of the nervous system’s components helps create a broader context in which to understand the brain and brain function.

The central nervous system (CNS).

The central nervous system consists of the brain and spinal cord. It is the major information-processing center of the body. The spinal cord conducts sensory information (information from the body) from the peripheral nervous system to the brain. After processing its many sensory inputs, the brain initiates motor outputs (coordinated mechanical responses) that are appropriate to the sensory input it receives. The spinal cord then carries this motor information from the brain through the PNS to various locations in the body (such as muscles and glands).
Not all of the body’s motor responses travel through the brain for processing. The spinal cord alone is able to direct simple reflex actions, such as the knee jerk reflex, that require a quick response from the body. More complex motor actions, such as some involuntary and all voluntary actions of the body, require brain involvement. The brain is both the integrator and director of information through our bodies. Our brain devotes most of its considerable volume, energy, and computational power to processing various sensory inputs from the body in order to determine and initiate appropriate, coordinated motor output to the body.

3.2 he peripheral nervous system (PNS).

The peripheral nervous system is composed of all nerve tissue outside the brain and spinal cord. The PNS delivers information between the body and the central nervous system. It is divided into two subsections: the sensory/somatic nervous system and the autonomic nervous system. The somatic nervous system carries messages between the CNS and the body’s sensory organs and voluntary muscles. It allows us to detect changes in the world around us, and it delivers information related to actions that we decide to perform. In contrast, the autonomic nervous system carries messages between the CNS and our internal organs. It delivers information related to automatic tasks such as the regulation of breathing and digestive functions.
Figure 2
Figure 2. A neuron is made up of a cell body, dendrites, and an axon. Dendrites bring information into the cell body; information travels through the axon and exits the cell through axon terminals.

Cells of the Nervous System

All components of the nervous system, including the brain, are composed of billions of specialized cells: neurons and glia. Though the two cell types work together to provide the coordinated functioning of the nervous system, the unique structure of each type of cell allows it to perform its specific function.

Neurons.

The neuron (Figure 2) is the basic functional unit of the nervous system. Its primary function is communication. Neurons receive information from cells, and then transmit this information to other cells. The transmission of information between cells of the body and neurons enables us to react to changes in our internal and external environments. Neurons have a cell body, which contains a nucleus that directs the cell’s activities. Specialized extensions called dendrites bring information into the cell body. Other extensions at the opposite end of the neuron are called axons. These carry information away from the cell body. Information leaves a neuron through axon terminals, the endpoints of the axon. Bundles of axons are called nerves.
The nervous system includes three general types of neurons: sensory neurons, interneurons, and motor neurons. Sensory neurons are specialized to detect stimuli from the environment, such as light, sound, taste, or pressure. Detection of a stimulus triggers the sensory neuron to transmit a message to the central nervous system. There, the message is relayed to interneurons that integrate the information and generate instructions about how to respond. Instructions are sent back to the peripheral nervous system as messages along motor neurons. The motor neurons then stimulate muscles to contract or relax to make the appropriate responses. They also stimulate glands to release hormones.
Figure 3
Figure 3. Specialized glial cells form myelin sheaths around the axons of neurons.
Our nervous system is able to pass a message from a sensory neuron, through several interneurons, to a motor neuron within several milliseconds. Though this seems very fast, some sensory inputs (such as pain) requires an even more rapid response. If we touch a hot stove, for instance, it is beneficial for us to pull back as quickly as possible. How does the nervous system handle this reflex response? When responding to input that requires a very fast response, our nervous system allows sensory neurons to relay information through only one interneuron, or to connect directly to motor neurons. By reducing the number of inter-neurons required for signal processing, reflex responses are able to occur more quickly than other responses. Reflex responses are discussed further in Section 6, The Spinal Cord.

 Glia.

Glial cells, collectively called glia, greatly outnumber neurons. Why do we need so many glia? The functions of glia, though not as well known as for neurons, are generally to serve as the support structure for our immense neural network.14 For instance, some glia form myelin, the insulating sheath that surrounds certain axons (Figure 3). Myelin keeps electrical signals contained within axons and enhances the conduction of electrical signals. Other glia are scavengers that remove debris after injury or neuronal death. Some glia guide the migration of neurons and direct the outgrowth of axons during development, while others facilitate communication between neurons.2 Some glia may even serve to “feed” neurons, providing them with essential nutrients.
Figure 4
Figure 4. A nerve impulse is information (in the form of an electrical impulse) flowing through the dendrites, cell body, and axon of a neuron.

 Transmission of nerve impulses: electrical transmission.

Neurons send and receive messages to and from each other and the body. They do this through a two-part process called neural signaling. Neural signaling begins with the generation of an electrical impulse that is passed down the length of one neuron.
How does this work? An electrical impulse is generated when a stimulus (such as sensory input) causes a rapid change in electrical charge in one part of a neuron’s membrane. This electrical impulse is one unit of neural information. An electrical impulse flowing along the length of a neuron is called a nerve impulse.
Nerve impulses proceed in just one direction within a neuron—from the dendrites, through the cell body and axon, to the axon terminals (Figure 4). In addition, neurons produce nerve impulses in an all-or-nothing way. For example, if the stimulus that a neuron receives is too weak to trigger a nerve impulse, nothing happens—the neuron does not initiate an impulse. If the stimulus is strong enough or much stronger than the minimum required to trigger a nerve impulse, the neuron does initiate an impulse. However, the neuron does not initiate a stronger impulse in response to a more powerful stimulus. All that is required to initiate a nerve impulse is a minimum, or threshold, amount of stimulation. The frequency of nerve impulses, or the rate at which nerve impulses are initiated in a neuron, determines the intensity of the signal that travels through the neuron.



Okay... now that we have basic information on nerve cells and understand that BOTH a chemical and electrical impulse start from the brain and work it's way down the spinal cord and exit the CNS by way of the Dorsal Root Ganglia. From that point on it is called the PNS (Peripheral Nervous System).....

Why am I mentioning the DRG (dorsal root ganglia)? This is the area that the nerve exits and most importantly this is the area by the facet joint.......you know......the area where you feel the "crack", the area where you feel the "pop".........got it?

Now, imagine that the area where that DRG is pinched...Slightly or heavily....it doesn't matter......what this means is that the decreased amount of information from the brain to that nerve cell supplying that organ or muscle will be decreased. 

So? So what? What does that have to do with feeling tired? (Glad you asked). If you squeeze a garden hose,.........The faucet is turned on, the amount of water coming out of the hose is either minimal and if you squeeze the hose hard enough, no water will come out. Does this mean that the pressure from the hose has stopped? No,it is built up and starts to back up. 

So, now imagine this squeezed hose as your nervous system. If it's pinched and decreased amount of axonal information is being "bombarded" with electrical and chemical impulses...what do you think occurs? First of all your body will tell you things are wrong.
Pain, change of posture, constipation, appendicitis, gastric issues,....etc, etc, etc.

One thing you will find constant though is this. If you palpate that persons back where the nerve is pinched.....you'll actually feel heat. Not always pain,...because sometimes pain is the last thing you'll feel,... but you will feel diffuse heat. That heat is due to the blocked nerve flow transmittion  (again,...electrical and chemical impulses being bombarded at the DRG)

Dorsal Root Ganglia (in yellow)

Now, the fun part of my BLOG begins........I found an article someone wrote about their Chiropractic experience. Sounds like it wasn't positive. Why? Because the doctor never educated the patient of the possibilities of going through toxic relief.

I will underline the highlights in this article.



Chiropractic Adjustment: Risks of Chiropractic 

Neck Manipulation

My Unusual Reaction to Neck Manipulation

Jolynne Hudnell
My husband has a slight bulging disk in his back. We saw an ad sign on the road and decided to try chiropractic adjustment for his pain.
After a couple of sessions and a group learning session, the chiropractic workers offered me a free x-ray and exam. When someone offers something for free that may be useful, who am I to refuse?
I received my results immediately after the exam. I have scoliosis in two vertebrae in my mid to lower back (which my family physician discovered about 10 years ago). I was also informed that I have a reverse curve in my neck. And, of course, exaggerated and reverse curves in my back. All of these result in my poor posture. They spoke a lot about subluxations that cause problems. They recommended I receive chiropractic care at their office. As my insurance would cover this, I agreed.
The first chiropractic adjustment seemed to go great. It cracked and popped all the way from my neck down. It felt great when they cracked my back. My neck was different. The neck adjustments didn't really hurt, but it was a very odd feeling. Something just felt wrong about it. Being new to chiropractic care, I had never hear of risks of chiropractic neck manipulation.
By the time I got home, I felt drained. I took a nap. When I woke up about an hour later, I felt flushed and had chills. I took my temperature and it was 103 degrees. I assumed it was a virus. Possibly a flu. Over the course of the evening I developed the tell-tale aches and pains. For about 36 hours I had a fever, aches, pains, chills and fatigue. Then I was better. Good thing, it was time for my next chiropractic adjustment.
When I got there, I told them about my "virus". They acknowledged by saying a lot of their clients have had the same symptoms, though they didn't know the cause of those symptoms. They believed symptoms such as those would go away with further adjustments. I thought maybe toxins had been released from chiropractic neck manipulations dealing with the subluxations.
The back cracking was awesome, but again, the chiropractic neck manipulation just didn't feel right at all. I mentioned this. I was told it was because of the subluxations. Since I'm still not sure what a subluxation is, I was in no place to disagree.
As with the last time, when I got home I was so tired I thought I would pass out. Upon awakening, I had a fever again and developed the same symptoms for about 36 hours. Supposedly the body develops resistance to a flu virus. I highly doubted another flu virus would be around in the same geographical area at the same time of year that produced the exact same symptoms. Now I was concerned that the chiropractic neck manipulations were the culprit.
I canceled my next appointment, but attended with my husband for his. I had questions and wanted answers. How could the same negative experience happen after adjustment twice in a row? Were there risks of chiropractic neck manipulations?
This office had no answers. They offered no explanation for what I experienced twice after receiving chiropractic neck manipulation. The workers in this office defended chiropractic care to a point I almost felt like they were a part of some exotic cult or something. In my opinion, they could have at least come up with some reasoning of why the adjustments did this, such as the subluxations had released built up toxins into my body, causing such a weird negative reaction. I felt that may be what happened but they wouldn't even say that. They insisted zealously that chiropractic adjustments can't cause anything bad, but only good results. That's when my husband decided to stop going as well.
I spoke with my family physician about my fever and other issues following chiropractic adjustment, especially the neck manipulation. He said that although he's never heard of that specific reaction before, he doesn't doubt that there could be a correlation. His recommendation was that I do not have more chiropractic neck manipulation, but I could return for back care if I chose to.
After my experience, I researched for weeks trying to find out risks for chiropractic neck manipulation. I found no written evidence of a reaction even close to mine. I did find that there are a few cases of stroke linked to chiropractic neck manipulation.
According to the Chiropractic Stroke Awareness Group1, chiropractic neck manipulation can cause one of the major arteries in your brain to tear resulting in stroke. This can happen if the neck is turned too far. It mainly occurs if a chiropractor is inexperienced or careless. A good chiropractor will check your neck and not turn it too far.
Many articles that argue lack of scientific evidence to support the claim that chiropractic adjustments can cause stroke are written by chiropractors or chiropractic organizations. They compare what they know with others in their field. One of these groups, The World Chiropractic Alliance2, discovered that the risk of stroke from chiropractic neck manipulation is only 1-3 per million adjustments. That is a smaller risk than many other types of medical treatment for health conditions.
Other independent studies suggest otherwise. Stephen Barrett, M.D., for Quackwatch3, quotes a Canadian study that suggests the incidence of stroke caused by chiropractic adjustment is more like 1 in 100,000, but this is the only study I've found with a risk level that high.
You can find more information on a connection between stroke and chiropractic neck manipulation from the Chiropractic Stroke Awareness Organization4 and Neck911USA5. Remember, there has been no scientifically based studies to make a determination either way.
If you are concerned about your risks of chiropractic neck manipulation, be informed. Speak with your chiropractor about the potential for such risks. Ask about his or her experience and track record. As with any medical professional, they should be able to answer your questions to your satisfaction. Ask other clients and get their opinion. If necessary, ask your family physician and find a chiropractor who will listen and answer questions about risks of chiropractic neck manipulation.
NOTE: My situation was extremely rare. I have found no other person in literature who has had that reaction. It still could have been a release of the build-up of toxins. I will not go back to the office I was at since they acted like nothing was wrong and wouldn't answer my questions. Another chiropractor may have had the answers. As with any type of medical treatment, there can be risks with chiropractic neck manipulation. But chiropractic adjustments can be especially beneficial for many issues, especially for those individuals dealing with pain.

WOW!!!! This is a simple and normal reaction when it is not explained what can go on with the body.
Let's go over all of these things I underlined.
1) husband has a slight bulging disk in his back : A person having a bulging disk in their back is often referred to as a herniated nucleus pulposus...or HNP. It's actually safe for a chiropractic adjustment if the doctor explains that what they are doing is going above and below the affected area. Many doctors do not do biomechanical and kinesiological work, therefore the adjustment is FINAL.........I have apprehensions about that myself, for I believe in rotating the pelvis properly to increase or decrease the IVF (the hole that the nerve comes out of) thereby decreasing the mechanical stress on the body.
2)  decided to try chiropractic adjustment for his pain.: over 80% of the people come in for a pain related incident.  What is interesting is the "I"ll try" aspect of this comment. That is where the person starts to fail before they begin. Chiropractic isn't "I'll try" but rather, I'll switch my philosophy of thought and change my way of poor living.  The Pain they are experiencing is a symptom,...not the cause. With chiropractic, we are aiming to resolve the issues biomechanically, and allowing the body's restoration to complete healing all from within...........ADIO...Above> down> inside> out.  The flow pattern of how the body heals. Brain to spinal cord,
3)  I have scoliosis in two vertebrae in my mid to lower back (which my family physician discovered about 10 years ago). : Impossible. It is IMPOSSIBLE to have scoliosis on only 2 vertebrae. Very definition of scoliosis is lateral curvature of the spine 20 degrees or more. If she has 2 vertebrae that are misaligned, that is extremely possible, but never scoliosis. So, this patient was uninformed, or took information improperly.
4)  I was also informed that I have a reverse curve in my neck.: very common with people that work in front of the computer every single day. It is possible to reverse the cervical neck through at home exercises and chiropractic care. This is also very common among people who are lazy in nature, bad self-esteem, or those that have extremely bad posture.
5) The first chiropractic adjustment seemed to go great. It cracked and popped all the way from my neck down. It felt great when they cracked my back. My neck was different. : Very common reaction. A great proprioceptive feeling occurs during an adjustment, often fooling the patient into thinking "they are well". The fun has just begun for them.....How their body reacts to this adjustment will decipher how well they are.
6) Being new to chiropractic care,: This patient is telling us exactly what she needed to tell the doctor. In her case, apparently she did tell the doctor everything. She was simply looking for answers that were not given to her,...so she came up with her own analysis. Would you be any different? Of course not.
7) By the time I got home, I felt drained. I took a nap. When I woke up about an hour later, I felt flushed and had chills. I took my temperature and it was 103 degrees. I assumed it was a virus. : This toxic reaction occurrence happens more often than we think. Interestingly enough, as a doctor, it is hard to predict whom this reaction will occur in. I've had patients with a terrible looking spine that have a very small reacton. Vice versa also: patients who have a beautiful looking spine and they get sick as a dog. That is why I tell EVERY new patient that comes in the possibility of a toxic reaction. This way they are aware of it happening to them.
8)  Over the course of the evening I developed the tell-tale aches and pains. For about 36 hours I had a fever, aches, pains, chills and fatigue. Then I was better. Good thing, it was time for my next chiropractic adjustment. Everything was matter-of-factual here. A) She had a toxic reaction B) encouraged to return to the Chiropractors office for a follow up visit. Where the chiropractor and staff failed was in understanding what was happening to this woman, AND how to convey that message to her. So, she is going to come up with her own conclusions. She sought out an answer,...and will continue to seek out an answer (even if it's not the correct one), until she can justify her state of being. Makes sense to me.

9)  When I got there, I told them about my "virus". They acknowledged by saying a lot of their clients have had the same symptoms, though they didn't know the cause of those symptoms : THIS is the very reason that chiropractors are closing their clinic. They become uninformative > patient wants a truthful answer > the patient isn't satisfied with the response > Patient leaves the clinic (unhealthy and dissatisfied).
10) I thought maybe toxins had been released from chiropractic neck manipulations dealing with the subluxations. : OMG...the patient actually knew more than the staff!!! She suspected what was going on and yet the office made her feel as though "they were justifying chiropractic"...therefore leading the patient to believe that chiropractic was some sort of cult...........I'd have fired the entire staff on the spot if that was my clinic. FACT!!!
11)  As with the last time, when I got home I was so tired I thought I would pass out. Upon awakening, I had a fever again and developed the same symptoms for about 36 hours.  : Of course. Makes sense to me... Here's what I tell my patients.
"I'm going to let you know that you may or may NOT get a toxic reaction after today's adjustment.". I won't go over the numerous signs and symptoms that can occur, but I will go over a few of them. Painful muscles, headache, dizziness, neck stiffness,  night time sweating and diarrhea. If these symptoms occur,...don't panic. Take water and antioxidants. Why? Toxins are looking to attach on to either muscles or organs and water is the medium we'd like them to attach to. They attach to the oxygen molecules  and get flushed out of the body. This being said, it won't take care of all the toxins 100%. This is where antioxidants come in to play. They are like "garbage collectors". They will pick up the remaining free radicals in the body. Please take plenty of water and if you do get an uncomfortable reaction come see  the next morning. Your body will attempt to fight. This is good. As uncomfortable as it seems, we want your body to learn how to fight. Increase the ability of your immune system. If you absolutely must take a pain killer,...do so. It's not my recommended plan of attack, but we don't want to see you in pain either. If you get this reaction, see you tomorrow,...if not, see you in 2 days. Last, but not least. I have found over my experience that toxic reactions last about 3 weeks. Meaning, you may hate me for 3 weeks, but after that you'll feel better than you've felt in a long time. I can handle your ire  and disappointment with how you are feeling,...because I know if you listen to what I say, and come when you are told,...you will get better very soon. Any questions?"
Now,..do you think I get patients who are scared after that? Rarely!!!! If the patient is still afraid after that,  walk them through it ONE more time. They may have not paid attention to you. If they don't remember after that?.......then it's their fault for not understanding and taking the proper steps to minimize the painful results and to get well within that 3 week period. Our job is to educate not babysit. So, after that,...I simply move on.
12) Now I was concerned that the chiropractic neck manipulations were the culprit.: What else is she supposed to think? Can you blame her? She's looking for resolution to her problem.
13)  The workers in this office defended chiropractic care to a point I almost felt like they were a part of some exotic cult or something. In my opinion, they could have at least come up with some reasoning of why the adjustments did this, such as the subluxations had released built up toxins into my body, causing such a weird negative reaction. : Justification period. The employees are trying to justify their work place, but they have no clue why things are happening......so, the patient thinks odd things i.e. cult experiences and what not. Perfectly normal reaction for a patient.
14)According to the Chiropractic Stroke Awareness Group1, chiropractic neck manipulation can cause one of the major arteries in your brain to tear resulting in stroke. This can happen if the neck is turned too far The patient is looking for answers. So, they google the hell out of the internet, until they can come up with a resolution. Sounds pretty good to me. I've done the same thing. Now,......what this patient is referring to is a VBAI. This is a Vertebral Basilar Arterial Insufficiency and although it is quite rare 1/4,000,000 cases , it does occur. It also only occurs with "rotary adjustments".  These are chiropractors that aren't specific in their adjustment and are merely looking to get "an audible"...or as the patient would say,....hear a crack or pop.  Although it is  a non specific adjustment style, this doesn't exclude the fact that it's a rotational adjustment rather than a cervical break. (cervical break...is used in a good term here. This refers to the lack of  cervical rotation,  a clean, crisp adjustment through the facet joint without giving the patient a "sliding  adjustment":(C0-C1) Occiput across the Atlas bone  creating an opportunity for tear of the vertebral artery.