IMT ™ and Myasthenia Gravis: A Personal Account
The Successful Application of IMT™ for Immune Dysfunction
Author: Janice Case MT IMP.C
Abstract: This article is a personal account of a woman with Myasthenia Gravis who received treatment with Integrative Manual Therapy (IMT). Prior to receiving this treatment, the woman was experiencing a multitude of symptoms including weakness and overall decrease in function and activities of daily living. The woman received thirty hours of IMT and performed fifty hours of Neurofascial Process homework. After this amount of therapy was completed, the woman reported a significant increase in her quality of life. She returned to work and leisure activities that she had not been able to do for a long time.
Key words: Myasthenia gravis, Muscle disease, Acetylcholine, Thymectomy, Immune Disorder, Degenerative, Double vision, Weakness , Fatigue, Depression, Hopelessness, Immune Deficiency Motility, Disruption of Membrane, Lymph Node, Bone Bruise, Neurofascial Process ™, Applied Psychosynthesis ™
Introduction
The following is a single subject account and demonstrates the remarkable ability of Integrative Manual Therapy™ to understand and identify the multiple components of immune dysfunction and effectively treat conditions which allopathic medicine perceives as degenerative and terminal.
This account clearly defines the disease process of myasthenia gravis and the traditional medical management. It further shows the specific symptoms that developed over the course of nine years of allopathic management in a subject called Jessie. The methods of IMT™ evaluation and treatment are identified and explained. The results of thirty hours of treatment with Integrative Manual Therapy ™ are itemized. This account gives hope and empowerment to all looking for another way to manage health conditions that appear to be hopeless.
I have used Integrative Manual Therapy™ for more than 10 years. I have numerous personal experiences of its amazing abilities to facilitate recovery of health. This is one of my favorites.
This story begins in 1991. After months of extreme fatigue, weakness and frequent episodes of double vision the subject was diagnosed with myasthenia gravis.
"Myasthenia gravis is a muscle disease that is caused by immune mediated loss of acetylcholine (ACh) receptors and having characteristic temporal and anatomic patterns" (1).
"Myasthenia gravis is an autoimmune disease in which the neuromuscular junction functions abnormally, resulting in episodes of muscle weakness. The immune system produces antibodies that attack the receptors that lie on the muscle side of the neuromuscular junction. The particular receptors damaged are those that receive the nerve signal by the action of acetylcholine, a chemical substance that transmits nerve impulses across the junction (a neurotransmitter).
What causes the body to attack its own acetylcholine receptors isn’t known, but genetic predisposition to the immune abnormality plays an essential part (2).
Carol Mattson Porth writes in Pathophysiology: Concepts in Altered States of Health, the following: "The primary clinical manifestations of myasthenia gravis are weakness of the eye muscles, with ptosis (drooping of the upper eyelids) and diplopia (double vision) caused by weakness of the extraoccular muscles. Neuromuscular and eyelid weakness can be checked following instructions to have a person firmly close his or her eyes. Normally the lashes are not seen with firm eye closure. In persons with myasthenia gravis, the eyelid muscles are weakened and the eyelashes often remain visible. Extraoccular muscle weakness can be tested by having the person maintain an upward gaze for 2 to 3 minutes while observation for eye muscle fatigue is made.
The clinical course varies. The disease may progress from occular muscle weakness to generalized weakness, including respiratory weakness. Chewing and swallowing may become difficult, and persons with the disease often choose to eat soft puddings and cereals rather than meats and hard fruits. Masticatory weakness can be checked by having the person repetitively open and close the jaw against resistance. Weakness of limb movement is often more proximal than in distal parts of the extremity, so climbing stairs and lifting objects are difficult. As the disease progresses, the muscles of the lower face are affected, causing speech impairment. When this happens, the person often supports the chin with one hand to assist in speaking. In most people, the symptoms are least evident when rising in the morning but grow worse as the day proceeds. General muscle weakness can be assessed by having the person continuously maintain a position, such as holding the arms overhead or extending the fingers.
Cranial nerve weakness and progressive muscle fatigue after exertion without sensory symptoms, changes in consciousness, or autonomic dysfunction are early signs of myasthenia gravis. Because the disease is relatively uncommon, it frequently goes undiagnosed until generalized weakness occurs. The diagnosis is based on a Tensilon (edrophonium chloride) test, during which edrophonium, a short acting acetylcholoesterase inhibitor is administered intravenously. The drug has the effect of decreasing the breakdown of ACh at the myoneural junction by the enzyme acetylchonesterase. When weakness is due to myasthenia gravis, a dramatic transitory improvement in muscle function occurs.
Treatment methods include use of pharmacologic agents, management of myasthenic crisis, thymectomy, and plasmapheresis. A thymectomy, the surgical removal of the thymus, maybe performed as treatment for myasthenia gravis. Because the mechanism whereby surgery exerts its effect is unknown, the treatment is controversial. Plasmapheresis, a procedure in which the plasma with the IgG immunoglobin fraction is separated and removed from a person’s blood, is a recent treatment method yielding variable results. Usually 6 to 8 treatments are needed to bring about a transient improvement. Immunosuppressant drugs may also be used in combination with plasmapheresis.
Women who wish to have children have an added risk of birthing babies that are affected with myasthenia gravis. The disorder appears transiently and lasts for days to weeks in about 10% of infants born to mothers with myasthenia gravis.
Persons with myasthenia gravis may develop a sudden exacerbation of symptoms and weakness known as myasthenic crisis. This usually occurs during periods of stress, such as an infection, emotional upset, pregnancy, alcohol ingestion, cold or following surgery" (3).
The Merck Manual of Diagnosis and Therapy, 16th edition, page 1525, stated that in addition to drug management by an experienced specialist that a thymectomy (surgical removal of the thymus gland) is beneficial in 80 percent of people affected with myasthenia gravis (4).
Initially, only allopathic medicine was considered. Drug management proved difficult and in July, 1992 a thymectomy was performed. This failed to make a change in her condition. It was extremely frustrating for her, as she was a gifted musician, teacher and parent to two young children. By Thanksgiving weekend in October of 2000 she announced to her family that she would be reducing her workload or possibly stopping teaching altogether as she was unable to meet the demands of caring for her children and working full-time as a teacher at a school for fine arts.
Even with the support of a husband who prepared all of the meals, did all of the housework and all laundry she was overwhelmed.
Examination
Jessie, as of October 2000, reported the following list of symptoms.
I was deeply concerned when I saw Jessie in October 2000. I recognized that she was seriously ill and felt she would deteriorate rapidly without intervention. Jessie’s belief systems stopped her from considering alternative therapies in the past but she had exhausted allopathic medical management at this point and was desperate. I asked her if she was interested in hearing about Integrative Manual Therapy ™ and offered her an explanation of her condition and possible treatment considerations.
One of Jessie’s immediate concerns was the weakness and lack of movement in her arms. Personal hygiene was challenging and her arms were so weak that writing on the blackboard at school became impossible as was playing her beloved violin. (Jessie had performed with the two orchestras on a regular basis.) She was unable to move her arms beyond 3 inches in any direction without pain.
Jessie listened with interest as I explained how many of her symptoms could be addressed with IMT ™ treatment. Jessie was intrigued but skeptical. To demonstrate the efficacy of technique right then and there I used a remarkable technique from the Lymph Level 1 class, Cardiac Lymph Bypass (5). This is a technique that is indicated whenever there are issues of toxicity in the lymphatic system that could compromise the heart. It can produce dramatic changes in ranges of motion of the shoulders and arms as well as the neck. In addition people frequently report it allows them to breathe with greater ease.
Jessie responded well to the technique. She experienced a large improvement in shoulder and neck motion. She could move her arms freely to shoulder height in flexion and abduction. Jessie was extremely surprised and excited about the possibilities of more treatment.
Methods of IMT™ Evaluation and Treatment Plan
Jessie came to my office the following day and I did an assessment with the following diagnostic tools, Myofascial Mapping (6) and toxicity mapping (7). I implemented a treatment plan that would involve two to three hours per week of office visits plus self-treatment with NFP™ (Neurofascial Process) (8) to be done at home. Neurofascial Process ™ is a simple and effective treatment that can be done at home with or without the assistance of family and friends. It helps to reduce symptoms and speeds the recovery process.
IMT ™ was used in adjunct to the allopathic pharmaceutical treatment she had used for 9 years.
One aspect of treatment that was woven into many of Jessie’s therapy sessions was Integrated Diagnostics for Applied Psychosynthesis ™. This is a process that addresses the emotional component of a chronic autoimmune illness. These are techniques that gently assist the processing of feelings and events that surface and need release and perspective (9).
The majority of Jessie’s treatment was based on techniques from Lymph Level 1 class (10). These techniques are designed to rehabilitate the lymphatic system. Traditional lymph therapies focus on the mechanical movement of lymph fluid through the lymph vessels. Sharon W. Giammatteo P.T., Ph.D., developed Lymph Node De-congestion Therapy (Lymph level 1) in response to a need to develop a more effective, efficient method of rehabilitating the body’s ability to deal with toxicity. These techniques facilitate the recovery of a functional lymphatic system and eliminate the ongoing need for mechanical stimulation. Currently other lymph therapies require frequent treatment (2 to 3 times weekly) to manually push lymph fluid through the tissues.
"An elaborate system of lymphatic vessels runs throughout the body. These vessels collect a fluid called lymph (lympha = clear fluid) from the loose connective tissue around the blood capillaries and carry this fluid to the great veins at the root of the neck (the thoracic duct drains into the superior vena cava) (11).
Lymph travels through lymph capillaries into lymph vessels. Several lymph vessels will flow into a single lymph node. Lymph passes through several chambers or sinuses within the lymph node to allow cleansing. If the nature of the lymph is too toxic for the node to purify it will spasm to contain the toxicity. This has a dual effect of disabling the immune system and creating tension and spasm in the tissues surrounding the lymph node. Lymph nodes are frequently located in close proximity to major vessels and organs in addition to concentrations around joint sites. Lymph node spasm can irritate the tissues in the area contributing to both pain and stiffness (12).
"Sometimes lymph nodes are overwhelmed by the very agents they are trying to destroy. For example, when large numbers of bacteria or viruses are trapped in the lymph nodes, the nodes become enlarged, inflamed and very tender to touch"(13).
Each lymph node is a self-contained detoxification chamber. Lymph nodes filter the lymph fluid (14). Every node is enervated by the autonomic nervous system and is complete with its own blood supply, both artery and vein. Each node has several afferent lymph vessels flowing into it and has only one or sometimes two efferent vessels flowing from it. This slows the movement somewhat but allows the node to purify the lymph fluid and if needed, release lymphocytes that are stored within the node (15).
Each node has the intelligence to discern the nature of material flowing into it. If the node becomes overwhelmed with toxic load, it will contract to contain the noxious material. This means that toxins in the area now have no where to go. Lymph fluid accumulates and congests the area.
In Lymph Node De-congestion Level 1 (16), Sharon W. Giammatteo P.T, Ph.D., developed a technique to eliminate spasm in individual lymph nodes. It allows the node to relax and become a functional part of the lymph system again. Another technique that was used extensively during Jessie’s treatment sessions was one that helped to normalize areas of deficient immune support. Treatment of Immune Deficiency Motility is used to stimulate immune function (17).
In addition, Disruption of Membrane Technique is used to address fascial cohesion problems (18). Disruptions of Membrane are frequently present in areas with impaired immune function. The covalent bond is gapped between the strands of proteins comprising connective tissues. This allows increased permeability of the tissue and the ensuing diffusion through this compromised barrier creates inflammation and chronic irritation. It is frequently accompanied by spasm.
Different techniques were used to treat Jessie’s upper and lower extremities. When the pathway for processing toxicity is compromised by lymph node spasm the body is forced to hold the toxins in other tissues and spaces. The long bones are frequent sites for toxicity containment (19). This affects the integrity of the bone tissue itself. The medullary cavity of the long bone is where the toxins are stored. It is also where B-lymphocytes are produced; this is an important aspect of our immune defense (20). Red blood cell production also occurs within the medullary cavity (21). Red blood cells carry oxygen to our tissues. Insufficient numbers of red blood cells significantly contributes to fatigue. Both these processes are adversely affected by toxic storage within the medullary cavity. The bone is weaker, may frequently ache and is susceptible to Bone Bruise phenomena. Bone Bruise (22) is the name of an area of osseous tissue that is painful to touch and is accompanied by spasm of the neighboring tissues. It is actually microtrabecular trauma. This can be verified with MRI studies or a challenge test.
A challenge test is accomplished by applying direct pressure over the suspect tissue. The tolerance for contact is extremely limited in a Bone Bruise location. The bone cells are disorganized and there is a lack of structural integrity. This can be the result of direct physical trauma or secondary to toxicity (23). The technique used to correct this problem is extremely efficient and effective. Further information on microtrabecular trauma is available through "A Compilation of Information on Bone Bruises" from web searches through Dialogues in Contemporary Rehabilitation (24).
Post treatment changes in symptoms
After 30 hours of office treatment in addition to 50 hours of Neurofascial Process self- treatment Jessie made a dramatic recovery. By Christmas 2000 she was radiant. She was overjoyed with her recovery.
She reported the following changes:
Discussion
Jessie’s symptoms changed after IMT ™ treatment. Subsequent to the initial 30 hours of treatment over the course of 10 weeks Jessie received less than 6 hours of office treatment in the following 10 months, (to the writing of this account). She continued with only minimal NFP™ self-treatment.
This would suggest that IMT™ was able to affect long term changes in her immune system. Jessie is convinced that without the intervention of IMT treatment she would have faced permanent disability.
Conclusion
IMT ™ changed the course of myasthenia gravis for Jessie and clearly shows the efficacy of the therapy in application with immune disorders. IMT ™ was used concurrent to allopathic treatment and was successfully integrated with traditional medical management.
IMT ™ offers hope to others struggling with immune dysfunction.
References