Dismiss Notice
SDN members see fewer ads and full resolution images. Join our non-profit community!

ED Chiropractic?

Discussion in 'Emergency Medicine' started by Jeff698, Apr 30, 2007.

  1. Jeff698

    Jeff698 EM/EMS nerd

    Joined:
    Aug 11, 2000
    Messages:
    2,000
    Likes Received:
    14
    Status:
    Attending Physician
    I picked up this link from another list. I couldn't believe what I was reading.

    Take a look...

    This article is by Jon Cref, DC. It was copied from http://www.chiroweb.com/columnist/cerf/

    **************

    Guidelines for Emergency Room Chiropractic Reimbursement

    It is crucial that those involved in clinical case management, both in the hospital and the insurance industry, be familiar with the appropriateness and indications for chiropractic care in the hospital setting. In 1987, the American College of Surgeons published a position paper that approved of the association with chiropractors in the hospital setting. Their statement read, in part, as follows:

    The provision of treatment privileges and diagnostic services in or through hospital facilities; working with and cooperating with doctors of chiropractic in hospital settings where the hospital’s governing board, acting in accordance with applicable law and that hospital’s standards, elects to provide privileges or services to doctors of chiropractic; association and cooperation in hospital training programs for students in chiropractic colleges under suitable guidelines arrived at by the hospital and chiropractic college authorities; participation in student exchange programs between chiropractic and medical colleges.1

    In my six-plus years of being on-call in the hospital emergency department (ED), I have seen numerous ED physicians gain familiarity with the indications for chiropractic consultation. I have enjoyed seeing the attending physicians learn to appreciate the role of the chiropractor in the ED. Even more enjoyable is witnessing the ED physician’s growing dependence on their staff of chiropractors.

    On occasion, I have been required to explain the necessity of chiropractic care to an insurance company representative so they could appreciate the benefits as well. Most insurance and review professionals are much more familiar with chiropractic as an office-based, “rehabilitation” type of service. The hospital serving as a place for chiropractic procedure does not always fit into insurance company or review organization algorithms or reimbursement guidelines. Chiropractic services provided in the hospital are primarily an emergency service. There is no time to pre-certify emergency care and there is no treatment plan beyond the initial visit. Insurance professionals who are very familiar with chiropractic may have no knowledge of chiropractic provided as an emergency service in the hospital setting.

    The following case history illustrates an example of an ED patient whose insurance company denied reimbursement until receiving further explanation. As you will read, there was no logical reason to deny care. The denial was obviously due to unfamiliarity, a computer programming difficulty, or simply failure of the claim to fit within historical parameters for chiropractic claims. Fortunately, once aware of the nature of the claim, the insurance representative quickly reversed the previous denial.

    This case involved a woman suffering from a severe and disabling headache. The attending ED physician evaluated her condition. She discovered that the patient had a long history of migraine headaches, for which she had been under the care of a neurologist. For the past week, the patient had suffered progressively worse headaches that were not relieved by numerous prescriptions or over-the-counter medications. The ED attending physician had to consider co-morbidities and other risk factors, including the patient’s history of a previous CVA. After obtaining the appropriate imaging studies, the attending diagnosed the patient as suffering from migraine with cervical tension cephalgia characteristics. The patient had already self-medicated with Imitrex at home. The attending first ordered administration of Toradol, a potent nonsteroidal anti-inflammatory drug. When Toradol did not relieve the patient, the attending ordered Demerol, a strong narcotic analgesic. When Demerol failed to provide relief, the attending had to consider additional treatment options.

    It was the attending physician’s opinion, as the ultimate authority in the emergency department setting, that it was not in the patient’s best interest to re-medicate or to administer additional narcotic analgesia. The attending physician weighed the risks and benefits of the available treatments and decided that chiropractic care for emergency pain relief offered the best alternative for this patient. At 11:30 p.m., I answered the call to consult with the patient in the ED. I found the woman in bed, with the lights off. She complained of excruciating pain that had not been relieved by the medication she had taken at home or that had been administered in the hospital. Keeping her eyes closed, she complained that she could not imagine herself attempting to leave the hospital in her current condition.

    Examination findings of particular importance included the presence of cervical hypertonicity, suboccipital tenderness and cervical vertebral joint fixation. She responded well to treatment with ischemic compression, peripheral neurofacilitation and spinal manipulation. She reported significant relief from the chiropractic treatment. She improved sufficiently to allow for discharge. She avoided admission for intravenous analgesic narcotics and the need for other specialist consultation. I returned home at approximately 2:00 a.m.

    It was surprising to obtain a denial for my services from the insurance company. The denial related only to the location of services: chiropractic provided in the hospital setting. I had previously received reimbursement for similar treatment provided in the office or a patient’s home. I imagine I would have received reimbursement for providing similar services on a park bench. Unfortunately, placing the code for hospital as the place of service on the billing form creates a mismatch in the insurance computer.

    As I explained to the insurance representative, this patient did not respond to several types of medication. As per the federal EMTALA regulation, she was considered unstable due to her continued severe pain, and it would have been improper and illegal to discharge her to go home. In accordance with the federal ERISA guidelines, the attending physician was responsible for determining that the patient’s level of pain was severe enough to constitute an emergency. Also per ERISA, reimbursement for care cannot be denied without a detailed explanation.

    All have to agree that the attending physician benefited by having the ability to call a chiropractor as chiropractic care helped the attending resolve the patient’s complicated condition without hospitalization or the risks of additional medication. The attending was able to more quickly free up an emergency department bed, as patients who are being admitted from the ED frequently have to wait until there is an available bed on one of the floors. The hospital benefited by improved reputation. You can imagine how this patient must have told her friends and relatives how the hospital staff went as far as calling in a chiropractor when all other treatment failed. The insurance company benefited by not having to pay for inpatient hospitalization and numerous specialist consultations and diagnostic tests. The benefit to the patient is obvious. Her pain improved and she was able to return home. The only neglected person was the chiropractor who provided the needed care.

    Insurance company policy-makers need to be aware of how chiropractors can improve the care for their policy-holders while decreasing costs. Our chiropractic department is in its sixth year of providing on-call chiropractic services for our hospital’s ED. We have increased patient satisfaction and freed up valuable human and facility resources for other patients. We have reduced re-medication, the need for narcotic analgesia, repeat visits to the ER for the same complaint, and most importantly, hospitalization for IV narcotic analgesia of neck and back pain.

    While chiropractors have been improving care for the patient, improving the image of the hospital and saving money for insurance companies, a small number of insurance companies and chiropractic review organizations have yet to become familiar with the benefits of chiropractic treatment in the ED setting.

    The American College of Surgeons published a policy approving chiropractors in the hospital setting. Medical physicians who work with chiropractors in the ED have learned how to use the chiropractors as a tool to offer the best treatment to their patients. Insurance carriers and review organizations need to create appropriate policies regarding chiropractic services provided in hospitals. The companies need to start by altering the reimbursement computer programs to prevent automatic denials of claims that contain chiropractic treatment codes associated with the hospital as the place of service. I have worked with insurance carriers and review organizations to adopt these changes. I welcome the opportunity to assist others in adopting appropriate policies and procedures for handling chiropractic claims generated in the hospital setting.

    Reference

    Bulletin of the American College of Surgeons, November 1987;72(11):10.

    **************

    Take care,
    Jeff
     
  2. Thread continues after this sponsor message. SDN Members do not see this ad.

  3. GeneralVeers

    GeneralVeers Globus Hystericus
    Physician

    Joined:
    Mar 19, 2005
    Messages:
    4,698
    Likes Received:
    1,680
    Status:
    Attending Physician
    Chiropractors, and their quack-witch-doctory need to stay away from me and any patients I take care of.
     
  4. MacGyver

    MacGyver Banned
    Banned

    Joined:
    Aug 8, 2001
    Messages:
    3,759
    Likes Received:
    4
    Lets all remember here boys and girls that ED docs just like all docs are competiting for fixed source of money.

    If you let chiros in on the game, that means less moeny for everybody.

    Take a look at the UK, which regularly cuts real doctors fees so they can add naturopaths, chiropractors, and acupuncturists to the membership.

    its total BS
     
  5. awdc

    awdc Senior Member

    Joined:
    Jul 13, 2002
    Messages:
    436
    Likes Received:
    1
    Status:
    Resident [Any Field]
    No positive experiences from chiropractors? Not all chiropractors employ "quack-witch-doctory" in their practice.
     
  6. ERMudPhud

    ERMudPhud Back for a visit

    Joined:
    Feb 24, 2003
    Messages:
    1,086
    Likes Received:
    21
    Anybody else notice "history of CVA" and "spinal manipulation" I thought one was a fairly strong relative contraindication for the other. I sure wouldn't want to be the attending who ordered spinal manipulation on that patient. If she stroked again any time in the next few months it wouldn't just be the chiro getting sued. As for the EMTALA arguments I don't ever recall severe pain by itself being a contraindication for discharge or transfer.
     
  7. The Tolf

    Joined:
    Feb 5, 2007
    Messages:
    52
    Likes Received:
    0
    Status:
    Medical Student
    So what are your feelings about DOs in the ED?
    I've know quite a few DOs who would treat a migraine patient the same as the Doc on the study (appropriate imaging etc to rule out more dangerous causes of headaches) and then would use some techniques to relieve tension and alleviate the pain the patient was feeling.
    I am not agreeing with the need for a chiropractor eval/tx in the ED, but I do feel this is an example of where a DO has an added skill in the ED.
     
  8. Dr. Dukes

    Joined:
    Sep 24, 2006
    Messages:
    916
    Likes Received:
    1
    Status:
    Medical Student
    One of the EPs I shadowed throughout college was a DO, head of the Dept, and FACEP. He mentioned that some times he has used OMM on a couple of patients who for one reason or another didn't accept any other treatments. Obviously I can't remember the specifics, and at that point I didn't know the specifics of the treatment/chief complaint, but seeing as this guy is FACEP I think we can stipulate he is competent. In a case like this, where a DO evaluates the patient, does the approperiate rule out, and then decides to offer the patient some OMM (manipulation, basically what chiropractors do), what is wrong with that?
    Is the only problem that if a chiropractor sees the patient then the money pie gets split one more way, or is it something to do with the actual treatment?
     
  9. GeneralVeers

    GeneralVeers Globus Hystericus
    Physician

    Joined:
    Mar 19, 2005
    Messages:
    4,698
    Likes Received:
    1,680
    Status:
    Attending Physician
    Quackery is a derogatory term used to describe questionable medical practices. According to Random House Dictionary, a "quack" is considered a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, knowledge, or qualifications he or she does not possess; a charlatan."[1]

    witch doctor often refers to an exotic healer that believes that maladies are caused by magic and are therefore best cured by it, as opposed to science or developed medicine.

    Source: Wikipedia
     
  10. awdc

    awdc Senior Member

    Joined:
    Jul 13, 2002
    Messages:
    436
    Likes Received:
    1
    Status:
    Resident [Any Field]
    Exactly my point. I guess you don't know that there are chiropractors that practice within the realm of science and evidence and do not subscribe to the original chiropractic theories. These practitioners limit their practice to the musculoskeletal system and do what most physical therapists or osteopathic physicians trained in OMM would do.
     
  11. Aloha Kid

    Aloha Kid Senior Member

    Joined:
    Mar 9, 2001
    Messages:
    419
    Likes Received:
    0
    Think of the implications if you are the patient - If it is deemed msk, I would want chiropractic, massage therapy, accupressure, reflexology, maybe accupuncture, aromatherapy, spa therapy, and more massage. Heck, why not?

    Also, I seriously doubt a chiropractor would come into the ED for a stat consult. They'd have to be crazy. Like every other specialist, they would rather prefer to be in their office.
     
  12. edinOH

    edinOH Can I get a work excuse?

    Joined:
    Nov 13, 2002
    Messages:
    768
    Likes Received:
    3
    Status:
    Attending Physician
    I think we could find a massage therapist to take call much cheaper.

    Stat massage in room 3. Happy ending is optional.
     
  13. FoughtFyr

    FoughtFyr SDN Lifetime Donor
    Lifetime Donor Classifieds Approved

    Joined:
    Mar 19, 2003
    Messages:
    2,216
    Likes Received:
    26
    Status:
    Post Doc
    Fine, show me the "science" that these practitioners base their practice on and it will be all good. Come on, just one good study, that's all I've ever asked from the chiropractors who've suggested to me that their practice was "scientific". Because, as you well know, there are plenty of papers to decry the risks of chiropractic!

    - H
     
  14. kungfufishing

    kungfufishing Senior Member

    Joined:
    Mar 7, 2003
    Messages:
    1,053
    Likes Received:
    5
    Status:
    Attending Physician
    Depends on insurance status?
     
  15. Apollyon

    Apollyon Screw the GST
    Physician Lifetime Donor Classifieds Approved

    Joined:
    Nov 24, 2002
    Messages:
    18,814
    Likes Received:
    2,986
    When I was a resident that was something that was taught - the patient in pain is an unstable patient (it's not that I believe it, but it's mantra from the idiots).
     
  16. Thread continues after this sponsor message. SDN Members do not see this ad.

  17. corpsmanUP

    corpsmanUP Senior Member

    Joined:
    Jun 8, 2005
    Messages:
    944
    Likes Received:
    6
    As a DO in EM, I can find no practical use for OMM in this setting. The one or two patients who might actually benefit from it are way outweighed by the patients who will inevitably sue your ass when they don't get better, or get worse. We have no long standing relationship with these patients as family physicians who employ manipulation therapies do. We are easy targets to blame, and there is no way I am offering up my half-a$$ed OMM skills that are "poor" at best, to treat an ED patient. I'll continue reserving these skills for nurses who hassle me for them!!! :D If I was single, you single male EM residents would be playing catch up!!! :laugh:
     
  18. Dakota

    Dakota Senior Member
    Physician

    Joined:
    Sep 5, 2005
    Messages:
    2,179
    Likes Received:
    121
    Status:
    Attending Physician
    I can see the policy now "One (1) consult with a massage therapist in an emergency setting with happy ending is covered. Subsequent happy endings will incur a 40% co-pay."
     
  19. docB

    docB Chronically painful
    Physician Moderator Emeritus Lifetime Donor Classifieds Approved

    Joined:
    Nov 27, 2002
    Messages:
    7,742
    Likes Received:
    208
    Status:
    Attending Physician
    A few points:
    The article describes a patient with a severe headache, unresolved with meds, photophobia and a stiff neck (I don't care to go back and pick out the relavent quotes, just read the parts about cervical spasm again). Given that picture I like to think my next move would not be to get a chiro in to manipulate the neck.

    I work in a very DO heavy group and I have seen my colleagues do OMM in the ED once. That was to try to relieve shoulder pain in one of the housekeepers. Don't recall if it worked or not.
     
  20. GeneralVeers

    GeneralVeers Globus Hystericus
    Physician

    Joined:
    Mar 19, 2005
    Messages:
    4,698
    Likes Received:
    1,680
    Status:
    Attending Physician
    Part of our job as scientists, and rational human beings should be to decry anything that potentially will defraud our patients, or in some cases of neck manipulation actually harm them.

    Things like Q-ray bracelets, Focus Factor, spinal manipulation, anti-oxidants, etc. which have no solid basis in science or clinical trials should be viewed with skepticism. To use anecdotal evidence and state that "my patient with shoulder pain got better" isn't sufficient. We frown on these questionable medical practices the same way we would of exorcisms and faith healing.
     
  21. awdc

    awdc Senior Member

    Joined:
    Jul 13, 2002
    Messages:
    436
    Likes Received:
    1
    Status:
    Resident [Any Field]
    Umm... it's all over PubMed isn't it?

    You and I know that we've been around these forums to know that none of the studies on manipulation presented to you apparently are not good enough for you. I'm sure you've read up on it more than I have so I'm not even sure I can dig up the appropriate studies within a reasonable amount of time. I'll concede to you on this point. Besides manipulation isn't the only issue. What about myofascial release, muscle energy techniques, ischemic compression, strain-counterstrain, soft-tissue and joint mobilizations, core and stabilization exercises? Last I checked, physical therapists use them regularly as part of their practice. Are these techniques/exercises just as unscientific? I'm asking because I really don't know whether or not they are studied as well as the high-velocity, low-amplitude manipulations.

    I suppose I could ask for one good study on this as well.

    I just find it very strange that the supposedly same techniques and exercises used by physical therapists and DO's specializing in OMM would escape the criticism of so many MD's ready to denounce all chiropractors. I can understand the uproar over traditional chiropractic however, I don't quite understand the uproar over the chiropractors who recognize the limitations of manipulative procedures.
     
  22. awdc

    awdc Senior Member

    Joined:
    Jul 13, 2002
    Messages:
    436
    Likes Received:
    1
    Status:
    Resident [Any Field]
    I absolutely agree. I guess we differ in our views of chiropractors. Having been a chiropractor myself, I'm familiar with the possible risks of spinal manipulation and dutifully informed my patients. If I didn't think it would help, I told them so. However, I used a lot more than spinal manipulation, which is apparently what everyone is thinking solely of when they hear "chiropractor." I guess we all tend to make all chiropractors fit into one mold. Truth is, chiropractors can be vastly different from one group to another. By the way, spinal manipulation is one of the most studied modalities in physical medicine and rehab. To my understanding, it's just as effective as other ways of treating low back pain (NSAIDS, physical therapy, acupuncture).
     
  23. awdc

    awdc Senior Member

    Joined:
    Jul 13, 2002
    Messages:
    436
    Likes Received:
    1
    Status:
    Resident [Any Field]
    Yeah, it's hard to justify HVLA neck manipulation with the given scenario. However, it looks like the chiropractor probably did some soft tissue techniques (ischemic compression) and peripheral neurofacilitation (a muscle energy technique) before going for the manipulation. It's a reasonable approach to gauge whether or not the patient's pain is musculoskeletal in origin and whether relief can be obtained using a musculoskeletal approach. Still, I think it's hard to say without a more detail.
     
  24. FoughtFyr

    FoughtFyr SDN Lifetime Donor
    Lifetime Donor Classifieds Approved

    Joined:
    Mar 19, 2003
    Messages:
    2,216
    Likes Received:
    26
    Status:
    Post Doc
    No, it isn't "all over PubMed". There are NO good studies that demonstrate the effectiveness of chiropractic. But if you know of one, please post it here...

    IT IS NOT ME! Look, evidence basis is evidence basis, this isn't a matter of opinion. Now, as I've said, I'm hardly the expert on EBM or on chiropractic, so let's look at what the experts do say. Neither of two cochrane reviews support it, nor can the The National Center for Complementary and Alternative Medicine (the Federal Government's lead agency for scientific research on complementary and alternative medicine) who state:
    "Overall, the evidence was seen as weak and less than convincing for the effectiveness of chiropractic for back pain. Specifically, the 1996 systematic review reported that there were major quality problems in the studies analyzed; for example, statistics could not be effectively combined because of missing and poor-quality data. The review concludes that the data "did not provide convincing evidence for the effectiveness of chiropractic." The 2003 general review states that since the 1996 systematic review, emerging trial data "have not tended to be encouraging…. The effectiveness of chiropractic spinal manipulation for back pain is thus at best uncertain." The 2003 meta-analysis found spinal manipulation to be more effective than sham therapy but no more or no less effective than other treatments." from: http://nccam.nih.gov/health/chiropractic/#9a

    Now, if The NCCAM remains unconvinced, and their entire existence is based on proving the effectiveness of alternative treatments, why is it that you see me as obstructionist? I'm sorry, but I'm just pointing out the information published by accepted experts. Don't attempt to rationalize chiropractic's shortcomings as a vestige of my personal animus.

    You were a chiropractor weren't you? And yet, I, as a senior EM resident, am more well versed in the chiropractic literature than you? Yeah, I think you are really proving the point of chiropractic's scientific basis.

    Again, the studies do not necessarily separate out specific aspects of chiropractic care. However, as I understand it, that is more a problem of a lack of a standardized approach within the profession than a research construct.

    I'm not sure and actually I don't care. If these services are already provided within mainstream medicine, then please provide the argument for allowing a duplication of services..

    Ask away. But I think the PM&R forum might be better suited to answer the question.

    There are three problems with "the chiropractors who recognize the limitations of manipulative procedures". First, who are they? That is to say how does a physician or member of the lay public identify such a chiropractor among the majority who don't recognize these "limits". Second, if these chiropractors are not practicing the complete chiropractic as taught by DD and BJ, what are they basing their practice on? Their own best guess? Intuition? The third is that there is still no evidence that it ever works! But there are certainly risks, a discussion you simply ignore.

    - H
     
  25. Squad51

    Squad51 Paracelsus'es Love Child

    Joined:
    Feb 14, 2004
    Messages:
    214
    Likes Received:
    0
    You just called FoughtFyr out on chiropractic in the EM forum? Really!?! :laugh:

    *** Getting some popcorn, this ought ta' be GOOD! ***

    *** Someone pass me a beer... ***
     
  26. awdc

    awdc Senior Member

    Joined:
    Jul 13, 2002
    Messages:
    436
    Likes Received:
    1
    Status:
    Resident [Any Field]
    Well, I do have to thank you for pointing out the NCCAM report. I was unaware of it. As I have stated elsewhere, I was familiar that chiropractic was no more or less effective than other treatments for low back pain. That was my point actually.



    I have no qualms that my knowledge of current evidence of chiropractic is marginal at best. I've spent the past five years either preparing for med school or going through it. Admittedly with little interest in chiropractic other than the occasional discussions on these forums and what I can easily contribute to the discussion based on my time.



    It's a problem either way.



    There is no good argument for duplication of services just as there is no good argument why we have DO's and MD's performing the same services. Or why we should have optometrists when ophthalmologists can perform the same services and more. NP's and PA's, CRNA's and anesthesiologists, etc. A lot just has to do with historical development and politics.

    I agree that these are very big problems especially your first point. Even I am not inclined to recommend chiropractic over PT to my future patients. However, there is the National Association of Chiropractic Medicine and the members of NACM may provide a springboard for the public to access such chiropractors. Of coure, it's not up to me how they would decide to do this. Chiropractors not practicing by the traditional chiropractic philosophies may be practicing under the best evidence available. According to NCCAM, chiropractic (I'm assuming it's spinal manipulation NCCAM is referring to) is just as effective and no worse than other forms of treatment for back pain. So does it work? Again, probably only as well as other forms of treatment including the medical care we would recommend... which is not very encouraging. And yes, there are very real risks and I hope any prudent practitioner would aknowledge them weigh the benefits vs risk for each patient and situation as well as patient preference and compliance.
     
  27. GeneralVeers

    GeneralVeers Globus Hystericus
    Physician

    Joined:
    Mar 19, 2005
    Messages:
    4,698
    Likes Received:
    1,680
    Status:
    Attending Physician
    Has anyone seen the Simpsons episode where Homer goes to the chiropractor?

    After a series of painful manipulations, Homer rubs his back and says: "It feels.....a little better!"
     
  28. awdc

    awdc Senior Member

    Joined:
    Jul 13, 2002
    Messages:
    436
    Likes Received:
    1
    Status:
    Resident [Any Field]
    Yeah... pretty crazy, huh?
     
  29. awdc

    awdc Senior Member

    Joined:
    Jul 13, 2002
    Messages:
    436
    Likes Received:
    1
    Status:
    Resident [Any Field]
    Yep, I've seen it but I don't remember much about the episode.
     
  30. awdc

    awdc Senior Member

    Joined:
    Jul 13, 2002
    Messages:
    436
    Likes Received:
    1
    Status:
    Resident [Any Field]
    Okay, enough SDN for me now. Must. Get. Out.
     
  31. kungfufishing

    kungfufishing Senior Member

    Joined:
    Mar 7, 2003
    Messages:
    1,053
    Likes Received:
    5
    Status:
    Attending Physician
    Whether or not chiro works, it doesnt belong in the ED.
     
  32. WestcoastMedicine

    WestcoastMedicine Senior Member

    Joined:
    Nov 6, 2004
    Messages:
    408
    Likes Received:
    1
    Status:
    Fellow [Any Field]
    I realize the thread was about DC, but there was some discussion about the DOs in the Emergency Department.

    I did a search on OSTMED, an osteopathic journal search engine looking for OMT and Emergency Medicine. Most of the articles I found relating to the ED and OMM was that it aided in diagnosis and ruling out of musculoskeletal problems versus more serious conditions. Besides that the other articles stated it was useful in the ED for mainly back pain or other musculoskeltal compaints in addition to standard RICE, NSAID, etc... AFTER serious conditions had been ruled out.

    I found three articles relating to somatic presentation of cardiac ischemia/infarction in segments that share similar innervations. All were basically set up the same so only posting this one:
    "Authors
    Nicholas AS; Debias DA; Ehrenfeuchter W; England KM; England RW; Greene CH; Heilig D; Kirschbaum M
    Institution
    PCOM, Philadelphia, Pennsylvania, USA

    Title: A somatic component to myocardial infarction: three-year follow-up
    Source: JAOA: The Journal of the American Osteopathic Association 1989 Oct;89(10):1357
    ISSN
    0098-6151

    Abstract
    In the original study, 62 patients were randomized to be seen by osteopathic physicians for palpation of the thoracic paravertebral soft tissue, T1-T8, to establish the presence of a somatic component to myocardial infarction (MI).[1] Paravertebral soft tissue changes were palpable in the 25 in whom clinically acute MI was diagnosed. No such changes were detected in the control group of 22 normal subjects. Of the original 62 subjects studied, 20 returned for reexamination, 17 died, and 25 refused reevaluation. As assessed by palpatory examination, the somatic component was significantly reduced in the 8 patients with previously diagnosed MI. The disappearance of the somatic component observed in the follow-up examination indicates that the resolution of the somatic component accompanies stabilization of the MI. [1. Nicholas AS, DeBias DA, Ehrenfeuchter W, et al: A somatic component to myocardial infarction. JAOA 1987;87: 123-129.]"

    They tought us in school that T2-T3 paravertebral muscles are hypertonic most often due to the sympathetic response facilitated from the heart.

    If someone comes in with crushing chest pain, history of Diabetes, CAD, CABGx2, am I going to skip the ekg, cardiac markers,etc... of course not, but I imagine if you were somewhere where you did not have access to it, it might be helpful in diagnosis. As mentioned before it could also lead my clinical decision away from a serious pathological process if I see findings that a musculoskeletal dysfuction is the main problem.
     
  33. WestcoastMedicine

    WestcoastMedicine Senior Member

    Joined:
    Nov 6, 2004
    Messages:
    408
    Likes Received:
    1
    Status:
    Fellow [Any Field]
    Found one more. I am by no means discounting OMT, I use it quite often on family when indicated and no contraindications are present. If I enter a primary care field I would hope to be able to implement it as a tx modality for my patients. Just supporting that it may not be the best thing in the ED initially. This article supports that:

    "Title: Osteopathic manipulative treatment applications for the emergency department patient

    Source
    JAOA: The Journal of the American Osteopathic Association 1996 Jul;96(7):403-409
    Publication Type
    Journal Article
    Country of Pub.
    United States
    Language
    English
    ISSN
    0098-6151
    NLM Unique ID
    96349756
    Doc Availability
    UNTHSC
    Abstract Number
    NA
    MeSH Term
    1. Emergency Service, Hospital/Trends 2. Emergency Service, Hospital 3. Human 4. Musculoskeletal Diseases/Diagnosis 5. Musculoskeletal Diseases/Therapy /osteopathic manipulation 6. Patient Satisfaction 7. Support, Non-U.S. Gov't 8. Treatment Outcome 9. Low Back Pain/osteopathic manipulation 10. Back Pain/osteopathic manipulation 11. Chest Pain/osteopathic manipulation 12. Asthma/osteopathic manipulation 13. Sinusitis/osteopathic manipulation 14. Torticollis/osteopathic manipulation 15. Manipulation, Osteopathic/methods 16. Manipulation, Osteopathic
    Additional Term
    1. OMT

    Abstract
    The emergency department (ED) setting offers osteopathic physicians multiple opportunities to provide osteopathic manipulative treatment (OMT) as either the primary therapy or as an adjunct to the intervention. In doing so, osteopathic physicians can decrease or eliminate the morbidity and symptoms associated with protracted dysfunction. Low back pain, chest pain, torticollis, asthma, and sinusitis are some of the illnesses in which OMT should be implemented as part of the management plan, note the authors. They provide a guide to the general usage of OMT when the aforementioned illnesses present themselves in ED patients, but also emphasize the importance of first ruling out any underlying illnesses that could be manifested by musculoskeletal symptoms."
     
  34. greytmedic

    greytmedic Faster than you

    Joined:
    Dec 17, 2005
    Messages:
    313
    Likes Received:
    2
    Status:
    Resident [Any Field]
    For all your viewing pleasure

    [YOUTUBE]http://www.youtube.com/watch?v=fEw82pChGaQ[/YOUTUBE]
     
  35. paramed2premed

    paramed2premed Senior Member

    Joined:
    Feb 22, 2003
    Messages:
    423
    Likes Received:
    8
    Status:
    Attending Physician
    A spirited defense of evidence-based medicine against chiro AND a Simpsons episode?!?!?

    Truly the best thread ever.
     
  36. Aloha Kid

    Aloha Kid Senior Member

    Joined:
    Mar 9, 2001
    Messages:
    419
    Likes Received:
    0
    The only thing that matters is the patient saying it worked. As human beings we are more than rationalizing scientific calculators.

    Tell the millions of Chinese out their that accupuncture and herbal medicine is a sham - they'll stir fry you.

    Remember, if not for the push by early pioneers in America towards a scientific based method, Homeopathy would be the ruling practice in America.
     
  37. GeneralVeers

    GeneralVeers Globus Hystericus
    Physician

    Joined:
    Mar 19, 2005
    Messages:
    4,698
    Likes Received:
    1,680
    Status:
    Attending Physician
    To the millions of Chinese: Your traditional medicine is a SHAM!

    Remember, the life expectancy of the average person in China 1000 years ago was about 35 despite all of their "medicine".
     
  38. tkim

    tkim 10 cc's cordrazine
    Physician

    Joined:
    Aug 2, 2002
    Messages:
    7,604
    Likes Received:
    325
    Status:
    Attending Physician
    That's the problem with being Chinese - even if you're 'one in a million', there's a thousand guys just like you.
     
  39. Jeff698

    Jeff698 EM/EMS nerd

    Joined:
    Aug 11, 2000
    Messages:
    2,000
    Likes Received:
    14
    Status:
    Attending Physician
    Perhaps it's just me, but I think you just argued against yourself wtih your homeopathy comment. There were lots of people who'd have taken up arms if you'd told them homeopathy was a sham.

    Take care,
    Jeff
     
  40. bartleby

    bartleby Senior Member

    Joined:
    Jan 17, 2005
    Messages:
    449
    Likes Received:
    3
    If you are charging a person good money for a service, you owe them more than hocus pocus and flim-flam for their hard earned dollars.

    Some leisure reading for you (H.L. Mencken)

    http://www.bizbag.com/mencken/menkchiro.htm

    "An unexamined life is not worth living"
    -Socrates

     

Share This Page