OMM Blues

[UTsksk]

I like hvla. I don't have time to gently move the torso in and out of flexion 10-50 times to try and correct a segment. If hvla doesn't work, I'll teach them home exercises to loosen up the soft tissue.

I liked the thoracic and lumbar HVLA, but I was pretty afraid when my partner tried doing cervical HVLA on me. I really thought my neck was going to be broken.

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[me83]

Exactly, people seem to forget this. My rads professor told me that something like 95% of scans he does for PE are negative. With #'s like that - ordering that test is not evidence based medicine. It's I don't want to get sued medicine.

Jesus Christ.... wtf. Ordering imaging scans for suspected PE IS evidence based medicine. Let me help you - https://acsearch.acr.org/docs/69404/Narrative/

 

[Jwalker]

A good point though, not all of medicine is level 1A evidence based, but there is at least evidence behind certain practices.

But these OMT cranial people have ancedotal evidence which for me is good enough for an alternative treatment that won't kill you (putting light pressure on someones head is not going to kill them). For whatever reason some patients swear by these treatments. I personally would have no problem referring someone for cranial given that all other more traditional approaches have failed. The OMT faculty at my school have more than enough demonstrated that they are master clinicians in all things MSK - which makes me thankful to be at the school im at after hearing other peoples posts about the subject.

Jesus Christ.... wtf. Ordering imaging scans for suspected PE IS evidence based medicine. Let me help you - https://acsearch.acr.org/docs/69404/Narrative/

I was quoting my rads professor on that one (MD/residency ivy league). I'll defer to him over you sorry bro. The point he was making was that if you order a test that is negative 95% of the time, the criteria for ordering needs to be revamped or people are purposefully ordering it without qualifying criteria. Which means you are not ordering it based on proper clinical evidence.

 

[HoboCommander]

2nd post in 5 years lol. i guess your post forced him out of the shadows.

 

[Mad Jack]

I'm two months in, and I've already seen enough OMM as far as I'm concerned. I've been asked to "just believe" and "just think its moving" too many times, and we haven't hit cranial yet. I don't buy the bogus separate but equal charade, and I definitely wouldn't put my future patients in the awkward positions my OMM class has done in 8 short weeks. Even if I wanted to I don't see when I'd have the time to do so during an office visit. I'll be a DO, but I won't consider myself an osteopathic physician. What we're being taught from a philosophy standpoint is no different than what our MD friends are learning at schools with an updated curriculum. Being in OMM class is a chore and I wish I didn't have to learn it, but I'm viewing it 100% as a practical anatomy review.

It's a shame too, because I was genuinely curious about it entering school. Now I never want to see it again.

There's some utility to some of the techniques. The problem is, you aren't doing them on people that are actually sick. As someone who's older and actually pretty messed up physically, classmates have had a lot of fun practicing muscle energy, some of the soft tissue techniques, and counterstrain on me. I'm not saying it's all great- I mean, really, when are you going to need to do counterstrain on someone's thumb FFS- but some of it works quite well and can substantially reduce disability and pain in someone with chronic pain like myself.

 

[touchpause13]

In one of our grand rounds one of the docs was gushing over this DO who would "pull the sutures apart" and how that was really helpful for patients. And this one prof keeps trying to plug her cranial elective....

Honestly it makes me really suspecious about OMT overall.

Although I did have a classmate fix my sore neck which was cool.

 

[Petypet]

But these OMT cranial people have ancedotal evidence which for me is good enough for an alternative treatment that won't kill you (putting light pressure on someones head is not going to kill them). For whatever reason some patients swear by these treatments. I personally would have no problem referring someone for cranial given that all other more traditional approaches have failed. The OMT faculty at my school have more than enough demonstrated that they are master clinicians in all things MSK - which makes me thankful to be at the school im at after hearing other peoples posts about the subject.

Just like a naturopath that prescribes 10000 mg of vit C. It doesn't kill the patient and the anecdotal evidence suggests that it helps. Power of placebo is strong. Suggest you read http://www.cochrane.org/about-us/evidence-based-health-care

 

[NurWollen]

Well this thread was all warm and fuzzy like... sigh.

 

[Mad Jack]

Hmm, so I just started cranial, and I'm still at keeping an open mind. All we've basically done is palpate landmarks and do a vault hold. We'll see what happens in 1-2wks... this has worried me a bit though...



1) There is one professor that did this (publicly corrected the course director in front of the whole class) once or twice last year, but they stopped (most likely after being chewed out). Most others make statements to the whole class and the teaching doc, but they are usually things like alternative hand placement, etc. It's pretty messed up that they publicly "correct" the professor under their breath at your (and apparently other) schools. That would definitely turn me off to OMM.

2) Yeah, there definitely is some use of old terms, like inion, but that's true among all our older faculty, not just in OMM. There are tons of terms like that that change in medicine, like what's happening with the MCL becoming the TCL. It's like when older microbiologists day Pneumocystis carinii instead of Pneumocystis jiroveci.

No one really calls any school by the city/state they are in at my school, except maybe "Kirksville" - I've heard that a couple times.

Hell, most of the people I worked with in the hospital still used pneumocystis carinii because it's way easier to say than Pneumocystis jiroveci.

 

[D4C]

But these OMT cranial people have ancedotal evidence which for me is good enough for an alternative treatment that won't kill you (putting light pressure on someones head is not going to kill them). For whatever reason some patients swear by these treatments. I personally would have no problem referring someone for cranial given that all other more traditional approaches have failed. The OMT faculty at my school have more than enough demonstrated that they are master clinicians in all things MSK - which makes me thankful to be at the school im at after hearing other peoples posts about the subject.



I was quoting my rads professor on that one (MD/residency ivy league). I'll defer to him over you sorry bro. The point he was making was that if you order a test that is negative 95% of the time, the criteria for ordering needs to be revamped or people are purposefully ordering it without qualifying criteria. Which means you are not ordering it based on proper clinical evidence.

But I just can't

 

[Jwalker]

Just like a naturopath that prescribes 10000 mg of vit C. It doesn't kill the patient and the anecdotal evidence suggests that it helps. Power of placebo is strong. Suggest you read http://www.cochrane.org/about-us/evidence-based-health-care

You're missing the point. Alternative tx in pts who don't respond to traditional tx are always sketchy. It doesn't matter if its placebo or not if it takes someone in a dark place from an 8/10 headache to 4/10 and a less dark place it's worth it imo. "Cure if you can, alleviate if you cannot, but always comfort and support, and never take away hope"

 

[Mad Jack]

You're missing the point. Alternative tx in pts who don't respond to traditional tx are always sketchy. It doesn't matter if its placebo or not if it takes someone in a dark place from an 8/10 headache to 4/10 and a less dark place it's worth it imo. "Cure if you can, alleviate if you cannot, but always comfort and support, and never take away hope"

That right there is one of the biggest mistakes you can make in critical care. Sometimes you need to tell it like it is, or you end up with people clinging to the false hope that Jimmy's going to grow a functional brain back after completely losing all differentiation on CT s/p MVA. Ain't nothin' more cruel than false hope, it keeps the living clinging to the dead for weeks, months, and in the worst cases years.

 

[Jwalker]

That right there is one of the biggest mistakes you can make in critical care. Sometimes you need to tell it like it is, or you end up with people clinging to the false hope that Jimmy's going to grow a functional brain back after completely losing all differentiation on CT s/p MVA. Ain't nothin' more cruel than false hope, it keeps the living clinging to the dead for weeks, months, and in the worst cases years.

I never said blatantly give false hope. As with any case you need to be honest and realistic with your pts - even ones with permanent/irreversible damage. In other news, the sky is blue.

 

[Mr Kenobi]

You're missing the point. Alternative tx in pts who don't respond to traditional tx are always sketchy. It doesn't matter if its placebo or not if it takes someone in a dark place from an 8/10 headache to 4/10 and a less dark place it's worth it imo. "Cure if you can, alleviate if you cannot, but always comfort and support, and never take away hope"

I dunno, seems like you are missing the point. Anyone can just make up their own alternative tx that causes no harm (like randomly touching the patients head lightly) and say it fixes problems (anacdotal evidence). For some patients, yes, the placebo effect is a real thing...Seen it with my own eyes. The key is beings a good clinician and developing the ability to recognize them- Then treat them accordingly. Here it comes-The point is, we don't need to be wasting our time training in this types of "anacdote based medicine" in our schools or tested on it in our licensing exams when a simple pat of the head and a reassuring statement from the physician could potentially accomplish the same goal.

 

[Jwalker]

I dunno, seems like you are missing the point. Anyone can just make up their own alternative tx that causes no harm (like randomly touching the patients head lightly) and say it fixes problems (anacdotal evidence). For some patients, yes, the placebo effect is a real thing...Seen it with my own eyes. The key is beings a good clinician and developing the ability to recognize them- Then treat them accordingly. Here it comes-The point is, we don't need to be wasting our time training in this types of "anacdote based medicine" in our schools or tested on it in our licensing exams when a simple pat of the head and a reassuring statement from the physician could potentially accomplish the same goal.

Can you show me a quote saying that I thought we should be taught it? Yeah. You can't. Cause' I didn't say that. Sorry Bro.

 

[Petypet]

Can you show me a quote saying that I thought we should be taught it? Yeah. You can't. Cause' I didn't say that. Sorry Bro.

 

[Mr Kenobi]

Can you show me a quote saying that I thought we should be taught it? Yeah. You can't. Cause' I didn't say that. Sorry Bro.

That's two posts now demonstrating your lack of understanding of "the point".

 

[Petypet]

That's two posts in a row now that demonstrate your lack of understanding of "the point".

Just let it go. Let him become an OMM professor and continue the trend of quality naptime, I mean cranial osteopathy

 

[wjs010]

Pulling the sutures apart? Oh god. Lol

 

[Lycian]

Why?

 

[touchpause13]

Pulling the sutures apart? Oh god. Lol

I rolled my eyes so hard I'm surprised I didn't see my own sutures

 

[Mr Kenobi]

Why?

"BECAUSE!"

 

[D4C]

The OMM 'guru' and all around gentleman at my school once made a comparison of AT Still to the music man...that came pretty close to blowing my mind on 2 separate levels.

 

[NontradCA]

Hmmm...naw. I dunno about you, but feels somewhat unethical to perform "procedures" and charge for them that I feel are fake and no benefit to the patient. I'll try to make my money legitimately backed up with some science and a side of morality.

This is my problem with OMM right now. I don't think Id ever feel comfortable doing it in practice. I thought this would pass, but it sounds like it will only get worse.

 

[wjs010]

Okay I don't want to bash OMM too much, but I heard sometimes on the written exams, it had rediculous q's like: what is this a picture of and where is it? And it's AT still's childhood cabin. Wtf. How is this conducive to helping treat people ?

 

[touchpause13]

Okay I don't want to bash OMM too much, but I heard sometimes on the written exams, it had rediculous q's like: what is this a picture of and where is it? And it's AT still's childhood cabin. Wtf. How is this conducive to helping treat people ?

Lol you'll think that about a lot of med school classes

 

[D4C]

Lol you'll think that about a lot of med school classes

Perhaps, but at least in biochemistry, or really any class, they don't show a picture of a dragon breathing fire and ask "hey zippy, what movie is this from?" As irrelevant as some of the material may seem, it almost always has a link to a pathology or is the basis of something you will soon learn. Point being the OMM cult bs and the Still worship is ridiculous and has no place in a medical school curriculum.

 

[alpinism]

You're missing the point. Alternative tx in pts who don't respond to traditional tx are always sketchy. It doesn't matter if its placebo or not if it takes someone in a dark place from an 8/10 headache to 4/10 and a less dark place it's worth it imo. "Cure if you can, alleviate if you cannot, but always comfort and support, and never take away hope"

Except that patient might have an 8/10 headache from a ruptured aneurysm. Now they're not in as much pain and don't feel like going to the ED to get evaluated. They die that night from a SAH. Every treatment, whether alternative/mainstream, fake/real has side effects and unintended consequences.

Unless its proven (with high quality scientific research) to have a significant positive benefit, treatments shouldn't be used on patients.

 

[Jwalker]

Except that patient might have an 8/10 headache from a ruptured aneurysm. Now they're not in as much pain and don't feel like going to the ED to get evaluated. They die that night from a SAH. Every treatment, whether alternative/mainstream, fake/real has side effects and unintended consequences.

Unless its proven (with high quality scientific research) to have a significant positive benefit, treatments shouldn't be used on patients.

I said after traditional tx ... reading rainbow

Perhaps, but at least in biochemistry, or really any class, they don't show a picture of a dragon breathing fire and ask "hey zippy, what movie is this from?" As irrelevant as some of the material may seem, it almost always has a link to a pathology or is the basis of something you will soon learn. Point being the OMM cult bs and the Still worship is ridiculous and has no place in a medical school curriculum.

To bash cranial is one thing. But to bash OMM as a whole? You're saltier than a dash diet.

 

[D4C]

I said after traditional tx ... reading rainbow



To bash cranial is one thing. But to bash OMM as a whole? You're saltier than a dash diet.

 

[ortnakas]

Okay I don't want to bash OMM too much, but I heard sometimes on the written exams, it had rediculous q's like: what is this a picture of and where is it? And it's AT still's childhood cabin. Wtf. How is this conducive to helping treat people ?

Memorizing AT Still's life story has been the easiest part of OMS1 so far. Don't knock gimme test questions. And remember he flung the banner of osteopathy to the breeze in 1874.

 

[Mad Jack]

Okay I don't want to bash OMM too much, but I heard sometimes on the written exams, it had rediculous q's like: what is this a picture of and where is it? And it's AT still's childhood cabin. Wtf. How is this conducive to helping treat people ?

We've never had any of the weird A.T. Still questions at my school, just good 'ol fashioned "patient presents with X, what OMM treatment treats X and how is it performed?" We get an A.T. Still quote every now and again at the start of an OMM lecture, but it's just because he's the guy who laid some of the concepts out the best. Outside of the OMM department, I've seen him quoted once, ever, and that was during orientation.

 

[alpinism]

I said after traditional tx ... reading rainbow

Whether or not its after traditional tx is irrelevant. Often times, the pain is there for a reason, if you've already used traditional tx and it hasn't helped, you need to keep trying traditional treatments. If none of those work then it could be psychosomatic and a watch and wait approach is done. However, if you're giving alternative treatments instead, you may miss continued/additional symptoms when they appear.

 

[hallowmann]

Whether or not its after traditional tx is irrelevant. Often times, the pain is there for a reason, if you've already used traditional tx and it hasn't helped, you need to keep trying traditional treatments. If none of those work then it could be psychosomatic and a watch and wait approach is done. However, if you're giving alternative treatments instead, you may miss continued/additional symptoms when they appear.

You're patients will love you for this one. "You're in pain, but there's nothing we can do so we'll just wait and see what happens." No offense, but this is why people get converted to witchcraft homeopaths and naturopaths.

Now I'm not all for cranial or anything, but it seems to me that patients and docs alike have the opportunity to "miss continued/additional symptoms" all the time with "traditional treatments" like NSAIDs or opiates. That doesn't really make me worried about the few instances where OMM might help them. I'd rather risk making the patient feel better with lumbar ME than a handful of codeine.

 

[NurWollen]

You're patients will love you for this one. "You're in pain, but there's nothing we can do so we'll just wait and see what happens." No offense, but this is why people get converted to witchcraft homeopaths and naturopaths.

Now I'm not all for cranial or anything, but it seems to me that patients and docs alike have the opportunity to "miss continued/additional symptoms" all the time with "traditional treatments" like NSAIDs or opiates. That doesn't really make me worried about the few instances where OMM might help them. I'd rather risk making the patient feel better with lumbar ME than a handful of codeine.

I do agree with this. I have a friend who threw out her back and went to the urgent care. The doc there was a DO who prescribed her some Vicodin and told her to rest. She had recently had a ton of dental work done including a few oral surgeries and had almost become addicted to prescription painkillers from that. This is a person who tends to be suspicious and critical of doctors. I just thought to myself that the doctor probably could have done as much good for her if he had performed some lumbar ME, prescribed high dose NSAIDS and told her to rest... but she would have left thinking the doctor really took time to help her feel better. That's why people like chiropractors. Even if the manipulation doesn't doesn't improve the pain, there is a placebo effect in that the patient perceives that the doctor did something out of the ordinary.

 

[D4C]

I do agree with this. I have a friend who threw out her back and went to the urgent care. The doc there was a DO who prescribed her some Vicodin and told her to rest. She had recently had a ton of dental work done including a few oral surgeries and had almost become addicted to prescription painkillers from that. This is a person who tends to be suspicious and critical of doctors. I just thought to myself that the doctor probably could have done as much good for her if he had performed some lumbar ME, prescribed high dose NSAIDS and told her to rest... but she would have left thinking the doctor really took time to help her feel better. That's why people like chiropractors. Even if the manipulation doesn't doesn't improve the pain, there is a placebo effect in that the patient perceives that the doctor did something out of the ordinary.

In the future, I plan to have every patient leave my office with a sucker... a magic sucker.

 

[Mr Kenobi]

In the future, I plan to have every patient leave my office with a sucker... a magic sucker.

Lol

 

[JimmyB123]

For the med students: do you feel OMM takes away a huge chunk of your time to study for other more important classes? Has it made you manage your time better?

 

[D4C]

For the med students: do you feel OMM takes away a huge chunk of your time to study for other more important classes? Has it made you manage your time better?

No and no.

 

[hallowmann]

No and no.

Yeah, same here.

 

[Mr Kenobi]

For the med students: do you feel OMM takes away a huge chunk of your time to study for other more important classes? Has it made you manage your time better?

Honestly, it just puts more on your plate. DO students have a whole extra class to worry about. A lot of students triage OMM till the last minute or cram for it the nights before exams--but even that method takes away any free time you might have had to unwind and adds exam stress on a more regular basis. For instance: This past week we had a clinical medicine OSCE, a clinical medicine written exam and our final in our EENT systems course. That is a busy week with 3 exams (and still having OMM lab and lecture during the week). This upcoming week we have an OMM written exam and a practical exam...then the next week our first exam in our GI system. Would be nice to not have to worry about a large graded assessment every damn week. It really gets old having exams that often. Sometimes it makes you wonder when you are supposed to learn the material when you are constantly being assessed.

So to actually answer your question- yes you need to manage your time "better" since you have more to worry about, but most students reserve OMM for last minute studying and cramming so it doesn't necessarily cut into "a huge chunk" of your time to study for "more important classes". The fact that OMM causes you to have more exams definitely sucks though.

 

[Petypet]

For the med students: do you feel OMM takes away a huge chunk of your time to study for other more important classes? Has it made you manage your time better?

Yes and no. After my first few exams I realized i need to do XYZ to pass OMM. However, between practical exams, written exams, weekly quizes, and labs it was an unnecessary stressor. I think in most cases, MD students would just use that time as relaxation. At the end of the day many DO students do just as well on boards as their MD counterparts, and thus worrying about time management b/c of OMM is really a moot point. Just budget your time and it all works out.

 

[NurWollen]

For me OMM is like my personal scapegoat. When I'm sitting in OMM class a few days before a big pharm or path exam I love to whine and moan about what a waste of time it is... but if I were being totally honest with myself, it doesn't make much of a difference. If I didn't have OMM I'd probably be reading SDN or sleeping or reading the news. I don't think there has been a single test where I've thought to myself, "dang, if only I hadn't had OMM the other day I'd have had that much more time to study."

 

[TheFuture_22]

No and no.

No and no here as well. Outside of lab I really only spend a few hours the night before an integrated exam to prepare for the OMM portion and one full day before our once a block OMM practical to prepare for that. Total of about 14 hrs per block (9 week blocks) to prepare for OMM which averages out to about 1.5 hrs per week so not much at all.

 

[DocWinter]

No, OPP/OMT/OMM whatever you prefer takes about 2 hrs of lab time and 1-2 hours of lecture per week. Pre-test, we usually run through the names/actions a couple times and spend a night or half a day studying for it, every 5 weeks or so. It's really not a huge time-consumer.

I haven't had cranial yet, and OMT has been not been pushed as anything more than the "tool in the box" at my school. The head prof for OMT is gung-ho on everything about OMT, as he probably should be, but no one takes it to an unnecessary level.

Just do it, if you don't like it/don't believe in it just move on after the COMLEX.

 

[shibby1111]

I disagree with your assertion of it being something that doesn't exist.
I would assume your basis for that assumption is:
a) You cannot perceive it.
b) You have not seen sufficient evidence/research to change your mind on it.
Neither of those are actually very strong pieces of evidence to disprove it's existence.
The more accurate and truthful statement would be: based on my present level of understanding, I do not think the PRM exists, rather than stating definitively it is false, does not exist and anyone who thinks otherwise is intellectually compromised.
I also think there is a lot of evidence to suggest it is very likely to exist, from which many people have been sufficiently convinced to stake a large amount of their life on, but if you are coming from the arbitrary frame "it cannot exist" it makes it impossible to even be able to consider those points. This is a mentality patients hate, I have seen research showing highly correlates to malpractice lawsuits and is just not necessary.

I think a lot of people don't have the ability to do cranial, but it's good for students to be exposed to it since the ones who can will often go on to incorporate it into their practice and many of the DOs I know who have made the largest positive impression of Osteopathy in the lay public were cranial osteopaths.

So once again, if cranial doesn't work for you, that's fine, but for the reasons mentioned above, you should not attack the practice or anyone that likes it.

To make this all go full circle: I knew a woman who suffered from severe crippling migraines and over a 15 year course was hospitalized at least 30 times and pumped full of narcotics to cope with them, and explored every single thing she could think of that might help them. I eventually met her, had her see a cranial osteopath, the D.O. looked at her, said her PRM was messed up in a few places, explained to both of us on a skull what was out of place (and let me palpate it), corrected the bones preventing the PRM from moving properly, and then my friend stopped having migraines. You can sit in an ivory tower and dismiss things like this, but especially given the weight on the side individuals thinking their is something to the phenomena, and with the strength of your evidence I think it is a much better attitude to be open to the possibility it exists, although if you had to guess it did not.

Anyways there is nothing additional I can say on this subject so I will get back to studying pharmacology and I thank you for taking the time to read and consider what I said even if you don't agree with it!

Do you believe in Santa Clause?

 

[wjs010]

first OMM practical today. everyone was nervous as hell...I think i did well on everything except for palpation. I was asked to palpate something very difficult. Hope I don't fail med school because of a palpation. That is some real OMM blues right there

 

[D4C]

first OMM practical today. everyone was nervous as hell...I think i did well on everything except for palpation. I was asked to palpate something very difficult. Hope I don't fail med school because of a palpation. That is some real OMM blues right there

Even if you somehow managed to fail a OMM test, and summarily fail the class, I highly doubt they would give you das boot over it. You're simply to valuable to the school in a financial sense. And I'm 100% convinced that the only way to fail a OMM test is to spit in the proctors face.

 

[Mehd School]

For the med students: do you feel OMM takes away a huge chunk of your time to study for other more important classes? Has it made you manage your time better?

I feel this way 100%.

 

[NeuroLAX]

I feel this way 100%.

You might be spending too much time on OPP.