Obscene osteopathic experiences (periodic updates)

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disgruntled do

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Being accepted into medical school was the happiest day of my life.

However, I feel this overwhelming need to speak out about some of the more dubious educational experiences I have had so far in osteopathic school. I am an OMS-2 at what is generally considered to be one of the better DO schools.

What follows is some of the ridiculous rhetoric that we are constantly exposed to on a daily basis.

1) An OMM professor comes up to the front of the class and throws out this gem: "...we are not here to cure disease, we are here to optimize function."

2) The new lab manual says the following:

"Suture fibrous joint; this is a very strong joint with virtually no relative movement. Osteopathic physicians specialising in cranial rhythms can successfully manipulate small adjustments of fibrous joints for patients with diminished cranial rhythmic impulse amplitude related to headaches and upper respiratory congestion."

Many of you may be wondering why I am choosing to speak out when countless others have chosen to remain quiet on this topic. We, as future physicians, have a moral responsibility to adhere closely to evidence-based medicine. Nothing else can suffice.

I will be updating this thread periodically in the future with other similar experiences. Please feel free to post your own experiences.
 
Ignore it like everyone else does and move on.
 
disgruntled do said:
What follows is some of the ridiculous rhetoric that we are constantly exposed to on a daily basis.

1) An OMM professor comes up to the front of the class and throws out this gem: "...we are not here to cure disease, we are here to optimize function."
Click to expand...

I actually don't have too much of an issue with this one. The entire goal of medicine is to make people better. Sometimes it's doing nothing ("watchful waiting" for symptoms that normally come from self-limited diseases), sometimes it's curing patients (infections, acute conditions), sometimes it's symptom management (diabetes, heart failure, mental illness, etc. Most diseases that are treated fall into this), and sometimes it's palliative care (hospice, etc. Sometimes letting the patient die peacefully is the answer).

The problem is that when it's thrown out in OMM class the unwritten words are "somatic dysfunction" and "OMM." If you think you're going to cure diabetes by throwing a few drugs or an insulin sliding scale at it, then you're mistaken. If you think you're going to cure heart failure with some lasix, digoxin, and beta blockers, then you're mistaken. Think you're going to increase a person's quality of life by doing so? Definitely.
 
disgruntled do said:
Being accepted into medical school was the happiest day of my life.

However, I feel this overwhelming need to speak out about some of the more dubious educational experiences I have had so far in osteopathic school. I am an OMS-2 at what is generally considered to be one of the better DO schools.

What follows is some of the ridiculous rhetoric that we are constantly exposed to on a daily basis.

1) An OMM professor comes up to the front of the class and throws out this gem: "...we are not here to cure disease, we are here to optimize function."
Click to expand...

Agree with the previous poster. There are some diseases we can cure but for most of the chronic ones, we do our best to improve quality of life while knowing the person will always have that disease and will more than likely die from it or its complications.



2) The new lab manual says the following:

"Suture fibrous joint; this is a very strong joint with virtually no relative movement. Osteopathic physicians specialising in cranial rhythms can successfully manipulate small adjustments of fibrous joints for patients with diminished cranial rhythmic impulse amplitude related to headaches and upper respiratory congestion."

Many of you may be wondering why I am choosing to speak out when countless others have chosen to remain quiet on this topic. We, as future physicians, have a moral responsibility to adhere closely to evidence-based medicine. Nothing else can suffice.
Click to expand...

Actually plenty of people have spoken against cranial. There are threads on this site against cranial. Many of my classmates, including myself, think cranial is hogwash and we have no issues expressing our disbelief in it publicly.

I was at an OMM clinic last year with a fellow student. We were seeing a patient and she was doing cranial. She asked me to try to feel the CRI after I said I could never feel it. I put my hands on the patients skull and she then placed her hands on mine. She proceeded to say she could feel the CRI and asked if I could, to which I said no. Now if the CRI is a very small movement, how could she feel it on top of my hands? At the same clinic, the physician said one could modify the CRI in a patient who has psychiatric problems and help them go away. Both of these are just more anecdotal experiences of mine which lead me to continue to despise cranial and think its quackery.
 
Deadhorse is an unincorporated community in North Slope Borough, Alaska.
 
like above, ignore the cranial stuff because nobody cares and nobody uses it. just pass the exam and move on.
and there is still no "cure" for cancer/herpes/migraine/cold/flu/adhd/myopia/etc.
 
#1 is largely true.

As for #2, stop whining -- even a modest google search would have yielded the general consensus on cranial tx. It's junk, and I like the way PCOM does it... one lab devoted to it and then an additional optional supplement.
 
MaximusD said:
#1 is largely true.

As for #2, stop whining -- even a modest google search would have yielded the general consensus on cranial tx. It's junk, and I like the way PCOM does it... one lab devoted to it and then an additional optional supplement.
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kinda makes you curious. my school only had one bareboned powerpoint on it too, dont remember if we had the lab. why is it testable topic on the national board exams when it seems like the general consensus out there is that it's quackery?
 
bleeker10 said:
I was at an OMM clinic last year with a fellow student. We were seeing a patient and she was doing cranial. She asked me to try to feel the CRI after I said I could never feel it. I put my hands on the patients skull and she then placed her hands on mine. She proceeded to say she could feel the CRI and asked if I could, to which I said no. Now if the CRI is a very small movement, how could she feel it on top of my hands? At the same clinic, the physician said one could modify the CRI in a patient who has psychiatric problems and help them go away. Both of these are just more anecdotal experiences of mine which lead me to continue to despise cranial and think its quackery.
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kinda makes you wonder how such people can learn and understand the sciences behind medicine and also believe in this crap.... seems like mutually exclusive ideas to me. Also makes me question the capacity for understanding of the things that matter that such a practitioner would have. :scared:
 
I haven't been able to feel anything throughout the entire first year. Just act confident and make the professors believe you can feel the bs and move on. It's so stupid but it is unfortunately what you have to do
 
With so few DOs doing any manual therapy at all in practice, the numbers for cranial itself must be miniscule. Why so much emphasis still today? Historical linkage, I'd guess.
 
Cranial is most likely around due to powerful forces within the DO community --

Remember:

1. many of the current almost retirement age DOs experienced outright discrimination to the point of having to set up their own hospitals to even be able to practice.

2. Due to #1, they cling to the one obvious thing they can point to that sets them apart -- manipulation. Cranial has been turned into 'If you don't accept cranial, you're not a real DO' type of deal amongst that generation -- or at least it seems that way. Very few people have the testicular fortitude to say,"Hogwash" out loud in a crowd of their peers to an idea that has been enthroned for so long.

3. Most forget that it's not manipulation that sets us apart -- it's how we view our patients and approach their care.

4. I have had cranial done to me by both chiropractors and DOs -- seems like a good head massage but I can't really tell benefit/harm.

5. I too have questions regarding the 'research' presented -- we seemed to go from one pulsating neuron in a petri dish to being able to palpate the mitochondrial oxidation pathways (forget the exact term - it's been a few years - tail end of the glycolytic pathway to form ATP using oxygen)--- which makes me suspect as does a lot of OMM.

6. I can say that I use OMM quite frequently in my practice when it's indicated. I'm no rock star with it but my patients benefit from it for musculoskeletal complaints and I do it like I do any other procedure.

My rant -- I just want to bring some sanity and real use of OMM (with the evidence to back it up) into the DO world. I do think we're different from MDs in our outlook and perspective on patient care....not better or worse, just different.
 
JustPlainBill said:
Cranial is most likely around due to powerful forces within the DO community --

Remember:

1. many of the current almost retirement age DOs experienced outright discrimination to the point of having to set up their own hospitals to even be able to practice.

2. Due to #1, they cling to the one obvious thing they can point to that sets them apart -- manipulation. Cranial has been turned into 'If you don't accept cranial, you're not a real DO' type of deal amongst that generation -- or at least it seems that way. Very few people have the testicular fortitude to say,"Hogwash" out loud in a crowd of their peers to an idea that has been enthroned for so long.

3. Most forget that it's not manipulation that sets us apart -- it's how we view our patients and approach their care.

4. I have had cranial done to me by both chiropractors and DOs -- seems like a good head massage but I can't really tell benefit/harm.

5. I too have questions regarding the 'research' presented -- we seemed to go from one pulsating neuron in a petri dish to being able to palpate the mitochondrial oxidation pathways (forget the exact term - it's been a few years - tail end of the glycolytic pathway to form ATP using oxygen)--- which makes me suspect as does a lot of OMM.

6. I can say that I use OMM quite frequently in my practice when it's indicated. I'm no rock star with it but my patients benefit from it for musculoskeletal complaints and I do it like I do any other procedure.

My rant -- I just want to bring some sanity and real use of OMM (with the evidence to back it up) into the DO world. I do think we're different from MDs in our outlook and perspective on patient care....not better or worse, just different.
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#3: how exactly do we view/treat our pts differently from our MD counterparts?
 
MedicineMike said:
#3: how exactly do we view/treat our pts differently from our MD counterparts?
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this is the biggest myth about osteopathic medicine that is around today. It gets spun into things like "we are more primary care oriented" or "better bedside" when there is simply nothing to substantiate it. If a DO treats you like crap, then you go home saying your doctor was a d-bag. If he is super nice then you go home saying "DOs are super awesome". Given that a good many (if not most) DO students either had applied MD or would have taken it if they considered it likely, there is not a difference in mind set between groups
 
maybe it's just where I'm doing my training but it seems that quite frequently, my MD counterparts tend to lose the patient in their haste to quote research or recent studies or clinical prediction rules. I don't seem to recall any of that during my time as a student at one of the top DO schools. The focus was more on treating the patient in their environment in the totality of their circumstance - rather than examining and communicating with them like they're lab rats or bacteria growing in a petri dish who's condition can be explained/treated via Well's Criteria or Ranson's Criteria, etc.

Again, this may be a function of where I'm at in my training - currently embedded in an ivory tower of academic/research oriented medicine -- but I can tell you anecdotally that every DO preceptor and classmate that I've run into has commented on the same thing.....again, may just be my experience or particular worldview.
 
I would have taken DO over MD, but I really really really like the idea of OMM, and I'm excited about it, as are my friends and family. I want to be able to do it, and that was the reason I applied to more DO schools than MD... I could have retaken my MCAT to be more competitive for MD, but it wasn't important to me because I preferred DO... I have a friend who is the same, she has a 3.89 and 28 MCAT and applied to ZERO MD schools...
 
JustPlainBill said:
maybe it's just where I'm doing my training but it seems that quite frequently, my MD counterparts tend to lose the patient in their haste to quote research or recent studies or clinical prediction rules. I don't seem to recall any of that during my time as a student at one of the top DO schools. The focus was more on treating the patient in their environment in the totality of their circumstance - rather than examining and communicating with them like they're lab rats or bacteria growing in a petri dish who's condition can be explained/treated via Well's Criteria or Ranson's Criteria, etc.

Again, this may be a function of where I'm at in my training - currently embedded in an ivory tower of academic/research oriented medicine -- but I can tell you anecdotally that every DO preceptor and classmate that I've run into has commented on the same thing.....again, may just be my experience or particular worldview.
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:shrug: i dont know what to tell you.... i mean obviously I am behind you in training so I cannot speak to that effect. But I just want to caution such ideas as perpetuated by the people they stand to benefit. There is bias in that. You look for it because you expect it to be there. are you saying that you do not communicate lab values with your patients? Or is it something less tangible like an oscar-winning teary eyed look to convey the compassion that the pre-allo section believes is the only way to not outright kill your patients? :meanie:

I know that with my [simulated] patients I am always very careful to explain things in simple terms and avoid just rambling off a bunch of numbers. But this idea of "treatingg the whole patient" is something that in conversation has almost no meaning whatsoever beyond its rhetoric and when dissected isnt even necessarily a good thing. JiffyLube also treats the whole car when you only go in for an oil change :shrug: and nobody likes that :laugh:. In the clinics I have been in the only difference between the MDs and DOs is the badge. Maybe it is your particular med school or just the group of people you hung around, but this doesnt make it intrinsic to DO. Otherwise we are trying to describe a mechanism by which random assortment yields a reproducible and significant difference between large sample groups which makes the scientific part of my brain want to spontaneously aneurysm and die.
 
SpecterGT260 said:
:shrug: i dont know what to tell you.... i mean obviously I am behind you in training so I cannot speak to that effect. But I just want to caution such ideas as perpetuated by the people they stand to benefit. There is bias in that. You look for it because you expect it to be there. are you saying that you do not communicate lab values with your patients? Or is it something less tangible like an oscar-winning teary eyed look to convey the compassion that the pre-allo section believes is the only way to not outright kill your patients? :meanie:

I know that with my [simulated] patients I am always very careful to explain things in simple terms and avoid just rambling off a bunch of numbers. But this idea of "treatingg the whole patient" is something that in conversation has almost no meaning whatsoever beyond its rhetoric and when dissected isnt even necessarily a good thing. JiffyLube also treats the whole car when you only go in for an oil change :shrug: and nobody likes that :laugh:. In the clinics I have been in the only difference between the MDs and DOs is the badge. Maybe it is your particular med school or just the group of people you hung around, but this doesnt make it intrinsic to DO. Otherwise we are trying to describe a mechanism by which random assortment yields a reproducible and significant difference between large sample groups which makes the scientific part of my brain want to spontaneously aneurysm and die.
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In general, I had a similar outlook as a student...I mean, WTF, take away the OMM and we're exactly alike - with the exception that our entrance standards are lower and we're playing catchup with Big Brother all the time....as we all know as foundational truth -- the PE in Conshahocken was done AFTER it became a necessary step in the USMLE chain -- ergo sum, we're a 'me too' profession.....(use of sarcasm here for the uninitiated)

And I asked old line DO's about what makes us different than MDs --- and I got two answers -- silence or a really nice powerpoint on full scope family practice that the sender confused with being a DO...and he was an old line DO.....

It wasn't until about 6 months of my intern year here at MD central that I came to realize that these people really think differently about things....and it's not just individual, but as a group....their approach is different if only slightly - but the difference is enough to be tangible.....the closest I can get to for a concrete answer is that being a DO is a gestalt that you have to experience....

Now, I am not saying that MDs are better/worse than DOs, nor am I trying to pick a fight. I used to be hip to the idea of doing away with the COMLEX chain, making OMM an elective two classes in 3rd/4th year and giving everyone an MD with a CAQ of OMM and be done with it....enough of the warfare between colleagues.....but after being out of school for a while and functioning in a residency, I can say from my perspective that there's enough of a difference to warrant a separate profession.

However, I would like to see less of a 'buy a vowel' type of questions on the COMLEX, less obvious stupidity put out as 'helpful tip of the day from the AOA' -- I think they did one on how to avoid thumb fatigue when texting -- really? seriously? and quit handing out resolutions that no one cares about. How about this -- let's really incorporate alternative medicine into our programs -- I went through two years of didactics and my nutritional training consisted of a one hour lecture on how to calculate ideal body weight, BMI and BMR -- seriously? I spent 2 years learning OMM but was never taught a cohesive, comprehensive shoulder exam that was readily available in two really good books that are thin and very efficient in that sort of thing -- from a top DO school? seriously?

My objective is to practice medicine, help the working poor and then have students who want to learn rotate through and teach them one on one all the things I wish I learned in school.....In my mind, the job of a good teacher is to distill into cohesive, useable chunks what it's taken a lifetime to master...so others can build on it....Sadly, that doesn't always happen in medicine

Anyway, gotta get to conference soon -- have a good one.
 
I guess here's my take, it's only two examples, but whatevs

1. The DO I shadowed spends ~5-20mns more with each patient than his MD counterparts in the clinic he works in. Why? From him, he says it is because he wants to ask more questions, especially with newer patients. He asks about mental health ALL the time, and not so he can get them on drugs, but to make sure they're doing well all around...

2. My husbands cousin, she has horrible scoliosis, gets horrible headaches from it, pretty much every doc she has seen sends her away with pain killers, it wasn't until I talked to her about it that she found a DO who is setting up real treatments for her to fix it (probably will be surgical)... All the MDs just sent her out with muscle relaxers and/or pain killers, never mind fixing the real problem...
 
SBB2016 said:
I guess here's my take, it's only two examples, but whatevs

1. The DO I shadowed spends ~5-20mns more with each patient than his MD counterparts in the clinic he works in. Why? From him, he says it is because he wants to ask more questions, especially with newer patients. He asks about mental health ALL the time, and not so he can get them on drugs, but to make sure they're doing well all around...

2. My husbands cousin, she has horrible scoliosis, gets horrible headaches from it, pretty much every doc she has seen sends her away with pain killers, it wasn't until I talked to her about it that she found a DO who is setting up real treatments for her to fix it (probably will be surgical)... All the MDs just sent her out with muscle relaxers and/or pain killers, never mind fixing the real problem...
Click to expand...

Careful, you're sounding like a chiropractor now. 😉
 
SBB2016 said:
I guess here's my take, it's only two examples, but whatevs

1. The DO I shadowed spends ~5-20mns more with each patient than his MD counterparts in the clinic he works in. Why? From him, he says it is because he wants to ask more questions, especially with newer patients. He asks about mental health ALL the time, and not so he can get them on drugs, but to make sure they're doing well all around...

2. My husbands cousin, she has horrible scoliosis, gets horrible headaches from it, pretty much every doc she has seen sends her away with pain killers, it wasn't until I talked to her about it that she found a DO who is setting up real treatments for her to fix it (probably will be surgical)... All the MDs just sent her out with muscle relaxers and/or pain killers, never mind fixing the real problem...
Click to expand...

In proper science it is not only appropriate to rule in your hypothesis but also rule out alternatives so here goes the devils advocate bit:

1) could also be explained by lower proficiency resulting in needing to take extra time

2) patients often want a "fix" even if it isn't medically warranted. I see nothing to suggest that pain killers are the recommended treatment and that these surgeries may be reckless
 
ShyRem said:
You have to have a book understanding of cranial though. It has shown up with more frequency on the level 2 and 3 boards these days.
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Level One as well.
 
Her back needs fixing... they are going to try non-surgical methods first, but throwing drugs at her and not even taking a look to see an incredibly obvious deformity isn't the right option... I know that people walk in and 'ask' for drugs, but it still comes down to the concept that the people she saw had no desire to do anything more than really push her right back out the door...

As for efficiency, you could argue that he's inefficient, but I would disagree, and he COULD push 25ppl per day through like a counterpart, but he chooses not to...
 
SBB2016 said:
Her back needs fixing... they are going to try non-surgical methods first, but throwing drugs at her and not even taking a look to see an incredibly obvious deformity isn't the right option... I know that people walk in and 'ask' for drugs, but it still comes down to the concept that the people she saw had no desire to do anything more than really push her right back out the door...

As for efficiency, you could argue that he's inefficient, but I would disagree, and he COULD push 25ppl per day through like a counterpart, but he chooses not to...
Click to expand...

how exactly is it known that she has bad scoliosis if nobody "took a look"?
Again, I am just pointing towards the bias here.
I have not experienced the "give him a pill and get him out of here" mentality in the hospital and I have never worked with a DO :shrug:. I think your experience is flavored by preconceptions :shrug:

and on to the efficiency thing - all I am saying is that your metrics are inappropriate for the conclusions. Lets just assume you are right and he chooses to take extra time and it is not a need based on competency. Have we established that this extra time is positively correlated to outcomes? did anyone else die while he was in the room with a patient who was by all accounts "taken care of"? Does he do it because he hates charting and he is lazy?

again, I am not saying these things are fact, but your argument does not preclude any of these as possibilities. Also, I find it very hard to believe that you have any solid data on how long the other docs in his practice stay with each patient. The conclusions you are trying to make are just not supported.

To be honest, all doctors are subject to the same legal stressers which drive an awful lot about what a doctor will ask/look for/test for. The things you described i've heard from every MD PCP ive ever worked with. They are simply not examples of differences.
 
I agree with all of the above for the most part. The difference is that the small population of OMM practicing DO's may treat pts differently from their MD counterparts, but the other 99% of DOs will be identical to MDs. I'm sick of this "treating the whole pt" nonsense. With the exception of a few academic MDs who are hardcore about research with no people skills at all (used to work at a medical school in NYC...I experienced quite a few of them), the rest of the MDs treat pts the same. I dont really understand how I am going to deliver anesthesia any different from my MD colleague....

DO MS-II
 
You wont need drugs for anesthesia. You will palpate the cranial rhythm and adjust it accordingly to induce anesthesia.
 
Specter, are you arguing me with stuff I stated out right were just my experiences?

Cousin's back: she has known since she was young that she had scoliosis... She (for whatever reason) did not realize it could be causing her headaches, and no one ever brought it up or checked

Doctors office, here's the thing, I was shown by him how they bill, how they are paid, etc. He chooses not to get bonuses for pushing more than 20+ people through per day. It would increase his salary dramatically (25k/yr) if he did, he knows it, but he still makes 215k in a town where 150k buys a heck of a house... Either way, I can't exactly call him and say Shawn please send me all the numbers on this... and it wasn't my point, it is that HE feels his job is to take extra time with his patients instead of rushing them out the door!

MM=do you ever see patients for more than 5 seconds??? I wouldn't expect an anesthesiologist to treat a pt differently, you aren't doing primary care. In primary care, the chances are better that you might...
 
SBB2016 said:
Specter, are you arguing me with stuff I stated out right were just my experiences?
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honestly.... yes 😀👍

but only because you are attempting to draw conclusions based on anecdote. This is simply wrong.

There are plenty of reasons your personal account simply doesnt hold water.
The surgeon who wants to correct the back issue could be offering a quack remedy
the doc you keep citing may simply be lying to you to boost his own ego (i still doubt you see the numbers put down by other docs)
You have not established that the scoliosis was not considered by previous docs - it may have been considered and ruled out by every other doc

It doesnt matter :idea: The reality could lie in either one of our statements or somewhere in between, and wherever it lays is completely irrelevant to the topic at hand: these "evidences" do not in any way, shape, and/or form support the notion that DOs have a different outlook on patient care than MDs. Furthermore, whenever there is anecdotal evidence provided, insufficient evidence is put forth to establish that the difference is a positive one instead of a negative. We have like 4 degrees of unsubstantiated claims here, all of which have a sort of "looks good on paper" ring to them, but when broken down critically are simply hot air.

I am not trying to diminish your own experiences and what they have meant or contributed to you, but you should be careful when trying to draw broad conclusions for limited data.... that is how we started bleeding people (and feeling for the CRI *badam-tish!* sorry, couldnt help myself 😳)
 
I agree with the above, but think it is pointless to argue or try and change the above persons viewpoint. Some people just drank the koolaid (even before starting medical school) and arguing with them is like arguing with a religious fanatic. No amount of reason will make a difference. They will continue to use anecdotal evidence as if it is completely conclusive and will see what they want to see.

Seriously, its bloody pointless, believe me, I have tried to talk to classmates about this kind of thing. I think DO schools self-select for the fanatical sometimes.
 
also.... im not super up to speed with spinal issues, but pubmed and google are not giving me too much linking scoliosis to headaches as you have described.... I did find a chiropractor who claimed it was true an offers to fix it 😀

If you have any literature on the matter I would really appreciate the read. However the more looking I do the more I start to suspect my hunch that surgical intervention may actually be malpractice 😱

EDIT: to clarify an earlier point - when I said patients just want a cure and to be sent on their way, i wasnt intending to mean that the pill pushing paradigm is actually what the patient wants (although actually it is in many cases). What I meant was that if a patient is told that treatment "x" is the best we can do, and that patient finds that answer insufficient, that patient is very likely to label the doctor as either incompetent, a quack, or uncaring (although I still maintain that one could have an equal emotional response to both a patients birthday and being burned at the stake and have this effect the ability to "doctor" precisely zilch :meanie:), and then the first doctor who says "yes, I can fix this" suddenly becomes the one who is competent or caring, even if he hasnt had the opportunity to paralyze your cousin yet :shrug: I just find this reasoning to be somewhat alarming when people attempt to draw practical conclusions from it.
 
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sylvanthus said:
I agree with the above, but think it is pointless to argue or try and change the above persons viewpoint. Some people just drank the koolaid (even before starting medical school) and arguing with them is like arguing with a religious fanatic. No amount of reason will make a difference. They will continue to use anecdotal evidence as if it is completely conclusive and will see what they want to see.

Seriously, its bloody pointless, believe me, I have tried to talk to classmates about this kind of thing. I think DO schools self-select for the fanatical sometimes.
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I argue on here a lot (surprise, right? 😉 ) but it has very little to do with making the other person see my point of view. For every one of us posting in here there are anywhere from 100-500 people lurking or guest browsing (numbers adapted from a non-medical VB site that I administrate. We get stats about that, not sure if SDN publishes non-registered viewers or not). SBB2016 can continue to think whatever s/he wants to until s/he actually starts medicine at which point I hope s/he is smart enough to be unable to further reconcile such rationales with the newly acquired knowledge. The smartest people on earth can believe the dumbest things simply due to lack of information 👍 and most pre meds (or MS-0's 🙄) havent really had these ideas challenged sufficiently.

The people I have a REAL problem with are the ones who have been presented with the information and are still unable to see how the facts as we know them stand in direct contradiction to their pre-conceived notions. No apologies or pulled punches from me on this one, there is no explanation for that other than simple idiocy :shrug: obviously such people are not capable of really grasping and understanding the information in a practical way. Thank god for MC tests :laugh:
 
K31 said:
Careful, that's closed-minded allopathic thinking there. You're failing to consider the holistic gestalt of the anecdote.
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Gestalt: Had to google it :laugh: let it not be said that vocabulary is my strong point ha. But after a quick consultation with google I would like to say:
calcination!
 
SpecterGT260 said:
also.... im not super up to speed with spinal issues, but pubmed and google are not giving me too much linking scoliosis to headaches as you have described.... I did find a chiropractor who claimed it was true an offers to fix it 😀

If you have any literature on the matter I would really appreciate the read. However the more looking I do the more I start to suspect my hunch that surgical intervention may actually be malpractice 😱
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you can fuse scoliosis if the pt has reached skeletal maturity and the curve is > 50-55 degrees or if it's restricting respiration. you can also use braces prior to skeletal maturity but since some scoliosis resolves spontaneously the braces don't have a lot of good literature to support their use.
 
Deceptacon said:
you can fuse scoliosis if the pt has reached skeletal maturity and the curve is > 50-55 degrees or if it's restricting respiration. you can also use braces prior to skeletal maturity but since some scoliosis resolves spontaneously the braces don't have a lot of good literature to support their use.
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Yeah but now extend fusion as a treatment of headaches.... seems sketchy
 
Body functions as a unit, not as a collective of multiple isolated systems (or regions)

Have BAD scoliosis - your back will hurt (muscles constantly trying to keep you upright)

Your brain prefers to see on a level field. With bad scoliosis, other parts will have to adjust so that your eyes are on a level plane. This may involve twisting, turning, yanking, pulling of various muscles, ligaments, tendons, etc. They can cause pain/aches with time. Muscles/tendons/ligaments are also keeping your head upright. So with significant prolong structural defect, it is possible to develop headaches.

Ever had a bad tension headache and at the same time feel the back of your neck is tight. Ever had someone relieve that tension at the back of your neck (whether it is simple massage, or more formal OMT)? When your neck feels better, how is your headache?

*not saying that all scoliosis causes headaches, or all headaches are due to structural deformities, but that headaches are complex, and there can be a structural rationale for continued headaches. Main reason to fix scoliosis (if it is severe) is to prevent progressive respiratory compromise (instead of alleviating headaches)


People talking about osteopathic medicine as "MD + OMM" and occasionally throw in terms like "whole patients". But when it comes down to what osteopathic medicine truly is, it all comes down to the basic principles of osteopathic medicine, something that all first year osteopathic students learn in their first OMM class

1. the body is a unit, and a person represents a combination of body, mind, and spirit
2. Body is capable of self-regulation, self-healing, and health maintenance
3. Structure and Function are reciprocally interrelated
4. Rational treatment is based on understanding of these principles

We sometimes get bogged down with details, or theories, or even woo (especially cranial) .... but there are some aspects that are very helpful. You dont have to be a believer in cranial-sacral, or other OMM modalities (lymphatics, rib raising, etc) to be a good DO.

The more training (and specialize) I get, the more I realize how true the above principles are. As you progress in your training (especially from your pre-clinical years) and start to encounter more variety of patients in different settings with different conditions/comorbidities, you will start to gain appreciation that treating patients will be complex, each being unique - but the above principles will also hold true (whether you are an MD or DO)
 
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group_theory said:
Body functions as a unit, not as a collective of multiple isolated systems (or regions)

Have BAD scoliosis - your back will hurt (muscles constantly trying to keep you upright)

Your brain prefers to see on a level field. With bad scoliosis, other parts will have to adjust so that your eyes are on a level plane. This may involve twisting, turning, yanking, pulling of various muscles, ligaments, tendons, etc. They can cause pain/aches with time. Muscles/tendons/ligaments are also keeping your head upright. So with significant prolong structural defect, it is possible to develop headaches.

Ever had a bad tension headache and at the same time feel the back of your neck is tight. Ever had someone relieve that tension at the back of your neck (whether it is simple massage, or more formal OMT)? When your neck feels better, how is your headache?

*not saying that all scoliosis causes headaches, or all headaches are due to structural deformities, but that headaches are complex, and there can be a structural rationale for continued headaches. Main reason to fix scoliosis (if it is severe) is to prevent progressive respiratory compromise (instead of alleviating headaches)


People talking about osteopathic medicine as "MD + OMM" and occasionally throw in terms like "whole patients". But when it comes down to what osteopathic medicine truly is, it all comes down to the basic principles of osteopathic medicine, something that all first year osteopathic students learn in their first OMM class

1. the body is a unit, and a person represents a combination of body, mind, and spirit
2. Body is capable of self-regulation, self-healing, and health maintenance
3. Structure and Function are reciprocally interrelated
4. Rational treatment is based on understanding of these principles

We sometimes get bogged down with details, or theories, or even woo (especially cranial) .... but there are some aspects that are very helpful. You dont have to be a believer in cranial-sacral, or other OMM modalities (lymphatics, rib raising, etc) to be a good DO.

The more training (and specialize) I get, the more I realize how true the above principles are. As you progress in your training (especially from your pre-clinical years) and start to encounter more variety of patients in different settings with different conditions/comorbidities, you will start to gain appreciation that treating patients will be complex, each being unique - but the above principles will also hold true (whether you are an MD or DO)
Click to expand...
The question was not "can scoliosis cause headaches?" And while I always appreciate a coherent mechanism as you have provided, it still doesn't address the issue: "does a DO who offers surgical correction of scoliosis for headache relief when MD counterparts have given pain meds constitute a doctor who is more aware of the'whole patient'?"


I would also challenge that 3 of the 4 of those principles you listed are lacking in scientific support or relevance and the 4th is thereby also irrelevant.
 
I guess a better way to ask might be, what specific actions, that are different than the average MD, are a result of those 4 principles? I suspect that they do not influence clinical behavior or patient treatment outside of fighting to validate specific OMM claims.....
 
group_theory said:
Body functions as a unit, not as a collective of multiple isolated systems (or regions)

Have BAD scoliosis - your back will hurt (muscles constantly trying to keep you upright)

Your brain prefers to see on a level field. With bad scoliosis, other parts will have to adjust so that your eyes are on a level plane. This may involve twisting, turning, yanking, pulling of various muscles, ligaments, tendons, etc. They can cause pain/aches with time. Muscles/tendons/ligaments are also keeping your head upright. So with significant prolong structural defect, it is possible to develop headaches.

Ever had a bad tension headache and at the same time feel the back of your neck is tight. Ever had someone relieve that tension at the back of your neck (whether it is simple massage, or more formal OMT)? When your neck feels better, how is your headache?

*not saying that all scoliosis causes headaches, or all headaches are due to structural deformities, but that headaches are complex, and there can be a structural rationale for continued headaches. Main reason to fix scoliosis (if it is severe) is to prevent progressive respiratory compromise (instead of alleviating headaches)


People talking about osteopathic medicine as "MD + OMM" and occasionally throw in terms like "whole patients". But when it comes down to what osteopathic medicine truly is, it all comes down to the basic principles of osteopathic medicine, something that all first year osteopathic students learn in their first OMM class

1. the body is a unit, and a person represents a combination of body, mind, and spirit
2. Body is capable of self-regulation, self-healing, and health maintenance
3. Structure and Function are reciprocally interrelated
4. Rational treatment is based on understanding of these principles

We sometimes get bogged down with details, or theories, or even woo (especially cranial) .... but there are some aspects that are very helpful. You dont have to be a believer in cranial-sacral, or other OMM modalities (lymphatics, rib raising, etc) to be a good DO.

The more training (and specialize) I get, the more I realize how true the above principles are. As you progress in your training (especially from your pre-clinical years) and start to encounter more variety of patients in different settings with different conditions/comorbidities, you will start to gain appreciation that treating patients will be complex, each being unique - but the above principles will also hold true (whether you are an MD or DO)
Click to expand...

Medicine is primarily an evidence-based field. As such, I have yet to see any Cochrane reviews on "the spirit". Rational treatment is based on the understanding of the spirit then? Wow.
 
CXCR4 said:
Medicine is primarily an evidence-based field. As such, I have yet to see any Cochrane reviews on "the spirit". Rational treatment is based on the understanding of the spirit then? Wow.
Click to expand...

that is kind of what I was getting at..... I could see an argument in the way of "the spirit, clinically, is only something that the patient believes in and is a remark on doctor/patient interaction and patient compliance", but in my experience this gets extended into actual pathophys mechanisms in which case we get pseudoscientific treatments like cranial
"I can feel your brain's heart beat!" 😕 (that was intentionally obnoxiously ignorant btw 😉 )
 
Thank you Group Theory. I would add additionally, that if the degree of spinal deformity is great, there is a decreased flow of CSF, which can then build, however slightly, in the brain, causing headaches. Not to mention if you've ever had a 'stress headache' from muscle tension in your neck, it should be obvious headaches can be caused by neck/back problems. FWIW, she looks like the hunchback of Notre Dame, and has limited ROM in all planes. This should have been fixed when she was young, but her parents are extremely religious, and poor, and didn't feel it was important if 'God didn't'...

Specter, I threw out some examples of things I had seen. I never said that EVERY MD or EVERY DO would or would not treat patients a certain way, I only threw out some examples that support the belief that a DO MAY treat a person as a whole rather than a body part.

as for 'spirit' to me that is 'mind' or mental health, but to each their own...

and for slyvanthus, come on... I don't think anywhere in my posts did I say ANYTHING that even REMOTELY comes off as fanatical or unreasonable and the assertion is rather annoying. I worked in biotech for ~15yrs, I have been an EMT for 20. I am not stupid, and while you're ahead of me, do yourself a favor and don't talk down to people.

CXCR4, why did you pick this specific chemokine?
 
SBB2016 said:
Thank you Group Theory. I would add additionally, that if the degree of spinal deformity is great, there is a decreased flow of CSF, which can then build, however slightly, in the brain, causing headaches. Not to mention if you've ever had a 'stress headache' from muscle tension in your neck, it should be obvious headaches can be caused by neck/back problems. FWIW, she looks like the hunchback of Notre Dame, and has limited ROM in all planes. This should have been fixed when she was young, but her parents are extremely religious, and poor, and didn't feel it was important if 'God didn't'...

Specter, I threw out some examples of things I had seen. I never said that EVERY MD or EVERY DO would or would not treat patients a certain way, I only threw out some examples that support the belief that a DO MAY treat a person as a whole rather than a body part.

as for 'spirit' to me that is 'mind' or mental health, but to each their own...

and for slyvanthus, come on... I don't think anywhere in my posts did I say ANYTHING that even REMOTELY comes off as fanatical or unreasonable and the assertion is rather annoying. I worked in biotech for ~15yrs, I have been an EMT for 20. I am not stupid, and while you're ahead of me, do yourself a favor and don't talk down to people.

CXCR4, why did you pick this specific chemokine?
Click to expand...
Ok, MS-0.... I am really trying to play nice here but you are pretty much digging your heels into nonsense and defending claims by pretending to not make them at all 😕.
and nobody is arguing about whether or not some DOs treat the patient as a whole. of course some do. some MDs do as well. The argument is not does this guy do xxxx, but is about a population. This is why I have been on your case about using anecdote and even claiming that it supports the notion. It does not.
Let us recap, shall we?

Here is where it started:


JustPlainBill said:
Cranial is most likely around due to powerful forces within the DO community --

Remember:

1. many of the current almost retirement age DOs experienced outright discrimination to the point of having to set up their own hospitals to even be able to practice.

2. Due to #1, they cling to the one obvious thing they can point to that sets them apart -- manipulation. Cranial has been turned into 'If you don't accept cranial, you're not a real DO' type of deal amongst that generation -- or at least it seems that way. Very few people have the testicular fortitude to say,"Hogwash" out loud in a crowd of their peers to an idea that has been enthroned for so long.

3. Most forget that it's not manipulation that sets us apart -- it's how we view our patients and approach their care.

4. I have had cranial done to me by both chiropractors and DOs -- seems like a good head massage but I can't really tell benefit/harm.

5. I too have questions regarding the 'research' presented -- we seemed to go from one pulsating neuron in a petri dish to being able to palpate the mitochondrial oxidation pathways (forget the exact term - it's been a few years - tail end of the glycolytic pathway to form ATP using oxygen)--- which makes me suspect as does a lot of OMM.

6. I can say that I use OMM quite frequently in my practice when it's indicated. I'm no rock star with it but my patients benefit from it for musculoskeletal complaints and I do it like I do any other procedure.

My rant -- I just want to bring some sanity and real use of OMM (with the evidence to back it up) into the DO world. I do think we're different from MDs in our outlook and perspective on patient care....not better or worse, just different.
Click to expand...


MedicineMike said:
#3: how exactly do we view/treat our pts differently from our MD counterparts?
Click to expand...

The premise was set that DOs approach patients differently. No that some are the same and some are different (which is true. There are also incredibly holistic MDs out there - but across the population the t test returns a 1 😉 )
and you provided us with this:

SBB2016 said:
I guess here's my take, it's only two examples, but whatevs

1. The DO I shadowed spends ~5-20mns more with each patient than his MD counterparts in the clinic he works in. Why? From him, he says it is because he wants to ask more questions, especially with newer patients. He asks about mental health ALL the time, and not so he can get them on drugs, but to make sure they're doing well all around...

2. My husbands cousin, she has horrible scoliosis, gets horrible headaches from it, pretty much every doc she has seen sends her away with pain killers, it wasn't until I talked to her about it that she found a DO who is setting up real treatments for her to fix it (probably will be surgical)... All the MDs just sent her out with muscle relaxers and/or pain killers, never mind fixing the real problem...
Click to expand...
2 anecdotes in support of bill's claim that DOs treat differently.
facetguy said:
Careful, you're sounding like a chiropractor now. 😉
Click to expand...
even the chiropractor gave you crap about that!


SBB2016 said:
Her back needs fixing... they are going to try non-surgical methods first, but throwing drugs at her and not even taking a look to see an incredibly obvious deformity isn't the right option... I know that people walk in and 'ask' for drugs, but it still comes down to the concept that the people she saw had no desire to do anything more than really push her right back out the door...

As for efficiency, you could argue that he's inefficient, but I would disagree, and he COULD push 25ppl per day through like a counterpart, but he chooses not to...
Click to expand...
You are equating the patient not getting the answer they want with the doctor being uniterested in care. This is not only false, but a dangerous and counterproductive notion to propagate. For the sake of all of us, please stop perpetuating the idea that doctors do not care about the patient. The reality is that sometimes we cannot give the patient what they think (in their uneducated awesomeness) they need. 👍

but lets also go over what the MDs did.... you implied here:
SBB2016 said:
Specter, are you arguing me with stuff I stated out right were just my experiences?

Cousin's back: she has known since she was young that she had scoliosis... She (for whatever reason) did not realize it could be causing her headaches, and no one ever brought it up or checked

Doctors office, here's the thing, I was shown by him how they bill, how they are paid, etc. He chooses not to get bonuses for pushing more than 20+ people through per day. It would increase his salary dramatically (25k/yr) if he did, he knows it, but he still makes 215k in a town where 150k buys a heck of a house... Either way, I can't exactly call him and say Shawn please send me all the numbers on this... and it wasn't my point, it is that HE feels his job is to take extra time with his patients instead of rushing them out the door!

MM=do you ever see patients for more than 5 seconds??? I wouldn't expect an anesthesiologist to treat a pt differently, you aren't doing primary care. In primary care, the chances are better that you might...
Click to expand...

but you said earlier (I put it in bold) that the docs sent her out with muscle relaxers. Those are NOT headache meds. The MDs were aware of her back issues. Your argument really just comes down to "The MDs only tried to make her comfortable, and this DO is going to slice her open and rearrange things which may not be medically incated and could very well be quite risky, but this guy cares about the whole patients tra-la-la-la-la" 😕

If your take on bill's claim is based on these two incidents then you are doing an incredible disservice to yourself as a future physician. It is important to remain always critical and avoid plugging incidence into slots to fit pre-existing notions. This is the exact type of bias that placebo controls are designed to prevent in drug trials, but the bias exists in all forms of comparison.
 
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CXCR4 said:
Medicine is primarily an evidence-based field. As such, I have yet to see any Cochrane reviews on "the spirit". Rational treatment is based on the understanding of the spirit then? Wow.
Click to expand...

While it's put poorly, perhaps what this poster was trying to get across was that one has to consider psychological well-being when considering a patients health. And there's plenty of studies that show a correlation and likely causative factors between happiness and health:

http://www.springerlink.com/content/un76v5x36w7l7n76/
http://www.tandfonline.com/doi/abs/10.1080/08870449708406738
http://www.sciencedirect.com/science/article/pii/S1053535701001184

Though perhaps the poster would categorize happiness as a "Mind" feature. I dunno what one defines as the "spirit", but there's ways to classify it non-supernaturally.
 
TenderRender said:
While it's put poorly, perhaps what this poster was trying to get across was that one has to consider psychological well-being when considering a patients health. And there's plenty of studies that show a correlation and likely causative factors between happiness and health:

http://www.springerlink.com/content/un76v5x36w7l7n76/
http://www.tandfonline.com/doi/abs/10.1080/08870449708406738
http://www.sciencedirect.com/science/article/pii/S1053535701001184

Though perhaps the poster would categorize happiness as a "Mind" feature. I dunno what one defines as the "spirit", but there's ways to classify it non-supernaturally.
Click to expand...

body, mind, and spirit were all listed explicitly. As such, they are distinct ideas as listed. Nobody is arguing the power of the mind.... i am right now at this moment talking to a friend who is swearing by "adrenal Success" although I am pretty sure the resolution of her chronic tiredness has more to do with her choosing to stop drinking coffee at 7pm (due to said tiredness) when starting the supplement and thereby getting a good nights sleep :laugh:. Placebo effect people! its real! It causes people to buy root extracts and assume their DO is more likely to remember their name 🤣
 
Specter, it should have taken only ONE doctor to do a physical exam to notice the back, realize it needed correcting, and fix it, whether it be with PT or surgery (last time I checked muscle relaxers do little for long-term success). Don't try to say that severe scoliosis never gets treated with surgery, we all know it does. Her issues have been going on for years (I've known her 8, and they started before that). I threw out two examples and now you're on a witch hunt because I disagreed with you. Get over it. You don't think that there is a difference, I think it is possible there is...
 
SBB2016 said:
Specter, it should have taken only ONE doctor to do a physical exam to notice the back, realize it needed correcting, and fix it, whether it be with PT or surgery (last time I checked muscle relaxers do little for long-term success). Don't try to say that severe scoliosis never gets treated with surgery, we all know it does. Her issues have been going on for years (I've known her 8, and they started before that). I threw out two examples and now you're on a witch hunt because I disagreed with you. Get over it. You don't think that there is a difference, I think it is possible there is...
Click to expand...

no. That is not an appropriate conclusion. by your own testimony all of the docs were aware of the scoliosis (muscle relaxants....) and potentially even humoring the link between this persons findings and symptoms.
Your argument hinges on whether or not "fix it" was the appropriate act. Yes, a patient without scoliosis would be ideal. But if (according to you) several doctors opted to treat symptomatically rather than perform surgical correction there may be a reason for it. We have already brought up bone maturity and other factors. Your anecdote in no way indicates that these other doctors 1) were not aware of the condition, 2) did not address the condition in their treatment and 3) did not perform to the highest standard of care in their treatment plan.

at what level is the spine inappropriately curved, and to what degree? You dont know that a surgery isnt incredibly risky for a number of reasons including ones that I cant even imagine (and by extension you could imagine even less.....). We dont know what the doctors before decided and why, but you are hinging your opinion on 1 doc that gave the answer you wanted. If I look hard enough I could find a doctor who will electively remove my pituitary. Doesnt make all the doctors who refused uncaring, uncareful, or quacks.


If you cannot see this then I just hope to [insert PC deity here] that you figure it out by the time you actually are in medical school. It has nothing to do with you disagreeing with me, but everything to do with you ignorantly demanding specific outcomes and drawing conclusions therein. This isnt a witch hunt. It started out by genuinely hoping to help you see how to really be critical of the situation and to discuss the topic critically. we are beyond that and now it has more to do with the hope of convincing any onlookers to not adopt your shod logic in determining their own conclusions. At this point the validity of your logical progression is an EXACT parallel to "Justin Beiber has brown eyes and makes a lot of money, therefore I should by a brown car for the optimal fuel efficiency".... as long as you are ok with that we can end this "witch hunt" :shrug: but otherwise please stop propagating nonsense and perpetuating unnecessary and harmful (to the patients) stereotypes on a public forum, at least until you have actually set foot in a medical classroom
 
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Yep surgeries are risky, but people still do them when they increase quality of life. If you really think that I don't see that, and that I am that stupid, **** off... Will you assume all your patients are that stupid? I "hope to [insert PC deity here] that you figure it out by the time you actually are a" physician that you don't because you won't have many return patients... or make sure you go into surgery where you can be an asshat and everyone expects it from you. As I said, I was an EMT for 20 yrs, you were probably barely out of diapers when I started backboarding people... Do you even know what a back board is???

I am curious how with almost 20 posts per day since February when you joined that you have had time to learn anything in med school... much less sit here and treat me like I'm some idiot because I know a situation that you don't... If you think it is never appropriate to do a back surgery on a person with a back problem, what will your patients do when it is necessary?? For the record, the angle of deformity at the T1/C7 is 30 degrees (as said by her to me). Since you don't have any knowledge of the case besides your own opinions, and you're telling me that the physician who told her that corrective action IS needed for her back is wrong, who is stupid now? The person who has actually graduated? So you're smarter as a student than a licensed physician?? MMMhhhhmmmm...
 
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SBB2016 said:
I am curious how with almost 20 posts per day since February when you joined that you have had time to learn anything in med school... much less sit here and treat me like I'm some idiot because I know a situation that you don't... If you think it is never appropriate to do a back surgery on a person with a back problem, what will your patients do when it is necessary?? For the record, the angle of deformity at the T1/C7 is 30 degrees (as said by her to me). Since you don't have any knowledge of the case besides your own opinions, and you're telling me that the physician who told her that corrective action IS needed for her back is wrong, who is stupid now? The person who has actually graduated? So you're smarter as a student than a licensed physician?? MMMhhhhmmmm...
Click to expand...

Someone of your ability probably would be curious about that 😉 too direct? well, you did tell me to eff off 🙄

I didnt say someone with a back problem shouldnt get back surgery and again, i really really hope it is the heightened emotions talking and not your rational side because that is scary. I said you don't know why this individual was not offered surgery by the other docs. I do not claim to know more than anyone (nor have I so kindly stop putting words in my mouth.... I am simply not dumb enough to actually concede such juvenile arguments, and that's gotta sting coming from someone who was wearing diapers while you were back boarding 😉 ) But the medical consensus per your own testimony would suggest that surgery was not indicated. Regardless, I started off just trying to address how such anecdotes do not lend validity to the discussion and should be avoided and you got stubborn and pissy. Your conclusions do not fit your data and no amount of getting pissy is going to change that 😀👍
 
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