Posts Tagged ‘osteopathy’

Spinal manipulation and other tools

June 17, 2017

When it helps, it’s ever so nice

And for me, it’s not about price

For the old spinal crunch

Can sure help a bunch

I’ll manipulate, but not more than twice.

 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

For the most part I approach medicine in a go-by-the-book fashion. But I keep an open mind, and I try to keep more than a passing acquaintance with what has been called “fringe medicine.”

I took a month’s course in acupuncture as a senior in medical school, but it would take decades and much research it to gain anything like acceptance. We now have more evidence to support the treatment of chronic pain with acupuncture than with opioids (also known as narcotics), yet many more docs use the opioids than the needles.

Honey as a cough suppressant has become a mainstream recommendation.

I went to Michigan State, which has an MD school right next to an Osteopathic school. We shared most of the basic science classes in the first two years, and twelve members of my class demanded teaching in osteopathy.  We met for an hour twice a week in a basement, and we practiced on each other.

In fact, I learned spinal manipulation even before I finished premed. You could call the crowd I ran with “nerds” or you could note that we shared information whenever we could.  But I learned how to feel where other people hurt, and I learned how to crunch backs.

At Michigan State they taught me when to and when not to use the technique. I also learned what they called “muscle energy” manipulation; the technique is also known as “push-pull” or “strain-counterstrain.” You can improve range of motion if you move the affected part to the barrier, then have the patient do an isometric contraction away from the barrier.  I use the technique, for example, after prolonged immobilization in a cast renders a limb stiff.  But it also works when spasm limits mobility.

(Properly done the technique is more complicated than I have described. Please do not try it at home.)

When our oldest daughter contemplated medical school, I steered her towards the DO track; those tools come in handy in primary care. And so far this week I have used them several times, making the patients better before they got out the door, and teaching them how to use the tool in the future.

But the power of manipulation must be used with respect.

In another clinic in another town in another country, a while ago a patient came to me with classical back pain. His chiropractor twice had helped a lot but only for a couple of days.  I crunched him twice, with good relief.  But when he came back the third time, I stuck to my guns, and, rather than manipulating his spine, I sent him for a CT scan.  I could not have imagined beforehand the very grim diagnosis.

 

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An MD who acts like an osteopath

January 1, 2017

There once was a doctor named Still

Who wanted to cure more than bill

He went out on his own

For the crunching of bone

But retained the scalpel and pill

 

 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, and a couple of assignments in western Iowa, I’m back in Alaska. Any identifiable patient information has been included with permission.

In 1874, Andrew Taylor Still, MD founded osteopathy.

At the time, before the acceptance of the germ theory of disease, philosophical schools divided medicine. Allopaths, the dominant force, felt that illness came from outside the body.  Homeopaths felt that illness came from inside the body.

Still felt that illness resulted from a misalignment of the boney elements of the body, but embraced the scientific method and rejected dogma.

Time has marched on. Homeopathy gave rise to our discipline of immunology and our approach to allergies, but in 1954 Hahnemann University School of Medicine officially stopped being a homeopathic school.  Mainstream US medicine still calls itself allopathic, but recognizes autimmune diseases and medical problems arising from internal disregulation.

Osteopathy continues, distinguished only by teaching and use of osteopathic manipulation.

Michigan State, my medical alma mater, has programs for MDs and DOs. While I have an MD degree, my class was the first to cross the tracks to get instruction in osteopathic manipulation.

In fact, in my first undergrad career I had a roommate who had had a roommate who had been in chiropractic school, and via that long chain of learning, I acquired the skills to manipulate the spinal column. But I got those skills without the rest of medical school, so that I learned to manipulate without learning when or why or why not.  Yet, to the best of my knowledge I never hurt anyone.  I got a lot of practice on the young and the healthy.

(Daniel David Palmer, the founder of chiropractic, probably attended Still’s Osteopathic college in Kirksville, Missouri, for a short time.)

Osteopathy along the way evolved an approach to the patient that I find a good fit. The body, a complex system, functions as a unit.  Ask why the patient got sick before asking what you can do for the symptom.  Maximize the patient’s natural tendency to heal, and do your best not to interfere with it.

I still manipulate, but I recognize those who manipulate better than I do. I like to say that some chiropractors get better results than others, and if I don’t know the local talent pool I say so.

Yesterday I brought my skills into play, got the satisfying crunch so easily as to be humorous, and made the patient better before she left. (And she gave me permission to say more than I have.)

And the same day, I got praise for being thorough, digging through the layers of physiologic dysfunction to figure out the root source of the illness.

Both of those patients benefited from the osteopathic approach, more obvious for one than for the other.

In the 21st century, more and more MDs do manipulation, at a time when more and more DOs leave it behind.   And more and more of the non-subspecialist physicians, regardless of training, take a holistic and humanistic approach to the patient as a whole human being.

I saw profit motive build a bridge between the doctors and the chiropractors, when the docs own an MRI and want the business.

Birthday chocolate cake, neck pain, good friends, and shared knowledge

May 12, 2010

Acting upon a good hunch

I gave out a free spinal crunch

    The pleasure is mine

    When I straighten your spine,

Oh yeah, I love it a bunch.

 

My best birthday ever was my 60th

Our youngest daughter, Aliya, worked for months putting things together as a surprise; it was also the occasion of her graduation from college.  The last day of the event was Mother’s day.

Attending the festivities were two of my sisters, one of my brothers, two of my brothers-in-law, one of my sisters-in-law, two nieces, two nephews, all three daughters, five of Aliya’s friends, a Denver/Sioux City/Denver friend, my stepmother, and a friend of forty years.

Al and I met at Yale and lived under the same roof two of our four years.  After graduation we bicycled from New Haven to Denver, and we have visited back and forth since.

He went directly into real science.  After a few sputters, I went into medicine.

He has spent most of his time on the coasts, I in the interior.  He is nationally known, I am local.  We are both respected in our fields.

The two of us have an appreciation of intellectual honesty and a keen grasp of where knowledge fails.

We speak the same language, and I enjoy hearing about the frontiers of science.

Al and I were talking after supper, finishing the last crumbs of Aliya’s exquisite chocolate cake, when the young woman across the table from us put her left hand up to the muscle connecting the back of her neck to her shoulder-blade, as if to massage a sore spot.

I interrupted Al and nodded at the young woman, Aliya’s friend.  “Did you see that?” I asked.  Both Al and the young woman furrowed their brows at me.  “That gesture,” I imitated it, “says, ‘I didn’t sleep well last night.’  Tell me, how did you sleep last night?”

The young woman looked at me with open mouth surprise, stunned into silence.  “I slept pretty bad last night,” she said at last.

I said to her, “If you want me to, I can make you feel better.”

To Al I said, “This is what I do.  Want to watch?”

We went to the adjoining family room, I had her sit in a chair and I stood behind her. 

“This isn’t in the books,” I said to Al, “that I know of, but the first step in the sequence that ends in fibromyalgia is the specifically left trapezius knot after sleep deprivation.”  I kneaded the muscles in the back of her neck.  I could feel the lump just above the upper inside corner of her shoulder-blade; there was no corresponding knot on the right side.

My left thumb and forefinger squeezed the knot, and as I had her breathe in I let the pressure off.  When she breathed out I squeezed harder.  After three cycles I could feel the tension in the knot relax and at the fourth the knot was gone.

The ability to feel another person’s pain by touch is a surprisingly common gift; almost all massage therapists and chiropractors have it.  In intuitive terms, I think of it as listening with my fingers; in analytic terms I feel for very subtle variations in tissue texture, skin temperature and moisture.

“What I just did…” I started to say to Al, then I stopped.

“It’s a Breedlove move,” he said.  We stared at each other.

While my fingers gently walked down her spine between her shoulder blades, listening for the whispers of pain, I suddenly remembered our friend and roommate Bob Breedlove, saying “Feel where the ridge/valley sequence is interrupted.”  I flashed back to the course on manipulation I took in med school, where we learned the osteopathic lesion and diagnosis. 

The story of Bob coming into possession of his knowledge requires much telling, but he returned to Yale with a lot of information which he shared.  We all shared our learning back then, and many conversations were lecture swap meets. 

Years after Bob had handed me a set of very useful tools, I went to medical school and learned how to use them. 

The letters MD follow my name, but I went to Michigan State which also has the only state supported osteopathic medical school.  Political firebrands that we thought we were at the time, about twenty MD students demanded and got a course in the osteopathic manipulative therapy taught to the DO students.

In 21st century America the main difference between a DO and an MD is that the DO is more likely to have been trained in OMT, commonly known as spine crunching.  With each passing year that difference fades into historical notation, and nowadays the Michigan State Osteopathic school offers, but doesn’t require OMT.

Jesse, our oldest daughter, was torn between going to an MD school and a DO school.  I told her that if she wanted to do primary care, osteopathy would give her a very useful skill set.

I had the young woman stand and cross her arms.  I stood behind her, placing my right pectoralis muscle against the two-inch segment between her shoulder blades where the ache murmured.  I grasped her elbows, requested that she breathe out, and when the time was right, I pulled her elbows in.  Two vertebrae snapped satisfyingly, and I let go.  She grinned.

Al and I sat back down.  “This is what I do,” I said.  “I want to slow down enough so I can enjoy what I love.”