Is it true?

[DropkickMurphy]

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I'm sure that if you have individuals come in with some sort of muscular injury from a fall or accident, it could be handy in some form or another.

I wouldn't necessarily call holistic theory "mumbo jumbo" although it should be taken in stride. If you are a subspecialist it doesn't mean the same thing as if you are a family physician, but it can still be useful... getting to know the patient and their background can be important for environmental factors of any illness. There is no disputing that.

But I agree completely, all of the osteopathic theory must be taken for what it's worth... the same as any belief system. Use what you can and discard the rest... the end goal should always be to use teh maximum amount of effective tools at our disposal. If you make comments like "I will practice the same thing whether I am a MD or DO" that leads me to believe that you may not even consider OMM from the outset which could possibly mean that your endgoal isn't to use all means necessary. Our knowledge of biomedicine and psychological determinants are growing everyday... it is naive and foolish to believe that the current medical model is all-encompassing which is why it is important and necessary to keep an open, yet centered and scientific, mindset.

I don't think you meant to berate DOs, btw. I was just concerned about your generalization.

I didn't mean that approach a patient as a whole is a bad idea, just that I laugh when people think that they- meaning the osteopathic side of the physician career field- somehow have the market still cornered in relation to this. The "practice the same way" approach is simply that I will do what the evidence in the literature shows to be reliable, appropriate and feasible. Nothing more, nothing less.

 

[Dr JPH]

I would think that vagal maneuvers/adenosine and good infection control program respectively would be much more appropriate. I don't see why there is a need to try to apply OMM to everything when standard approachs work just as well.

Perhaps you are confused over the usage of OMM as an "adjunctive" modality.

No one (at least to my knowledge) is promoting OMT as the sole or lone therapy in a disease state, but rather as an additional means of benefitting the patient.

Vagal maneuvers are indeed helpful tools and there are a couple (I can think of 2 right away) osteopathic techniques that are just as effective and can be incorporated into your quick set of vagal maneuvers. Much safer than compressing the orbit or a rectal probe.

Infection control for any infection is less than stellar in most hospitals. Many physicians will agree that despite best efforts (and research does back this up) hospital acquired infection is still a great concern.

So when given an opportunity to benefit a critically ill patient in the unit with OMT (which has been shown in research to increase circulating WBCs, increase pulmonary blood flow, increase pulmonary expansion, increase ABX levels in the blood) then I am certainly going to take a few minutes of my day and offer that therapy.

As far as adenosine goes, its a great drug. I dont know any doc who gets excited to push it and I am sure if a few vagal maneuvers and quick OMT can break a rythm then they would be much happier than having to use such a malignant drug.

And just as a side note regarding "when standard approachs work just as well". We are losing the battle against hospital acquired infection. I dont know any physician who thinks that current methods of infection control in the hospital, particularly in the unit, are successfull. If they were there would be no need to pay one nurse good money to keep track of infections...there wouldnt be enough work to go around, but this is clearly not the case.

 

[Kuba]

This is the one topic I will say what JP usually says. Premeds cannot debate this topic and be taken seriously. We barely know anything about OMM. Untill we go through a year or two of OPP I think we are just talking of our arses. Havins said that, there are some 2nd and third years on SDN who agree with much of what DKM has said, although they are few and far between.

 

[AustinFinklea]

If you all would go to this page and see that there are more than just a rotating intern year, this might help to answer some questions and clarify some misconceptions.

http://opportunities.osteopathic.or...60e854102-495B9DBB-D5C5-4781-586BEE26F8E8D127

As for those who are bickering, I think we have more important things to worry about. To say to a fellow student, even classmate, that you wish they didnt get into a DO program is quite juvenile. There are going to be alot of freakin DO docs that arent going to continue OMM with patients and will not see much of a difference between them and their MD counterparts: there is nothing wrong with that. If there are those "set in stone" about the osteopathic philosophy, thats freakin awesome too. To reduce ourselves to this kind of behavior is a waste of time, especially if we arent even in Med school yet. We all know what we want to do in terms of our medical careers, and its frankly nobody else's business, bottom line, to belittle others because of their aspirations. I think many will agree with me that its fun to talk about our potential careers, gaining some knowledge and maybe some constructive criticism from others rather than acting like a bunch of *******.....

Nate, if you hear me, rid us of this thread, PLEASE!!!!!!!!!!😱

 

[DropkickMurphy]

Much safer than compressing the orbit or a rectal probe.

I was thinking more along the lines of carotid sinus massage or having the patient bear down which are the two most frequently used techniques in adults. The only time I've see a rectal technique used is on kids. Ocular pressure......I wasn't aware that anyone did that anymore because of the risk of dislodging the lens......

As far as adenosine goes, its a great drug. I dont know any doc who gets excited to push it and I am sure if a few vagal maneuvers and quick OMT can break a rythm then they would be much happier than having to use such a malignant drug.

Trust me, I don't get in a hurry to give it either (it was included in my scope of practice at my last EMS service), but I don't consider it particularly malignant (especially compared to the other cardiac meds I've worked with) due to the short half-life.....pain in the ass to give.....you bet.

And just as a side note regarding "when standard approachs work just as well". We are losing the battle against hospital acquired infection.

Agreed, but I still don't see (and if you want to show me, please provide me with the journal article citations) how OMM would make that much of a difference in and of itself.

Premeds cannot debate this topic and be taken seriously.

Point taken, and I do agree to a great degree......but please at least give some consideration to the fact that I'm not your average wet behind the ears premed.....granted my knowledge of OMM would about fill an index card, but when it comes to CCM- particularly cardiac and pulmonary patients, I am up to speed on over 99% of the stuff out there because it's my job to be.

 

[Dr JPH]

I was thinking more along the lines of carotid sinus massage or having the patient bear down which are the two most frequently used techniques in adults.

True. Problem with both of those techniques, although effective, is one can be dangerous in patients with CA occlussion of significant extent and the other is reliant on patient ability to perform the maneuver. Certainly not always the case in these patients.

Agreed, but I still don't see (and if you want to show me, please provide me with the journal article citations) how OMM would make that much of a difference in and of itself.

There was some great research recently by a woman in texas. I will have to get her name tomorrow for you. But her research showed increased circulating leukocytes in dogs...they cannulated the thoracic duct and performed some OMT techniques. Very cool stuff. Its one of the springboard studies for something we are trying to start at PCOM within the next year.

One thing you can do is look on OstMed and try search terms such as "lymphatic pump", "pedal pump" and "leukocytes".

http://ostmed.hsc.unt.edu/scripts/starfinder.exe/3512/ostmedbasic.txt

There was some stuff by Slezynski (sp?) that worked with thoracic pump and comparing it to incentive spirometry for thoracic cavity expansion in patients with post op atelectasis.

One of the more recent OMT & Pneumonia studies that I can recall off the top of my head is by Noll (or Knoll ?), Shores and Heron. Showed shorter hospital stay and fewer days of ABX in elderly patients hospitalized with pneumonia.

I cant come up with more off the top of my head right now but those should give you a good start.

I would look at those studies and check out the bibliography. I am sure that will point you to some more papers.

 

[DropkickMurphy]

Thanks for the starting points.....it's appreciated.

 

[MiesVanDerMom]

This whole thread is making me dizzy...


1. DO's have full practice rights in all 50 US states
2. DO's have full practice rights in many other countries
3. DO's can complete an allopathic residency and gain full practice rights
4. DOs who wish to practice in PA, OK, FL, WV or MI must do one of the following: A) Complete an approved AOA residency (internship usually included); B) Complete an approved AOA internship + residency (DO or MD); C) Complete an approved ACGME residency and petition the AOA for full licensure

is this common or is it difficult to get this approved?

 

[Dr JPH]

is this common or is it difficult to get this approved?

There are a number of factors that go into getting it approved.

One is if you claim geographic reasons. If the area where you have decided to do a residency does not have an osteopathic internship available (for instance many part of NC and SC) then you can claim that your are unable to complete the requirement because of geographic hardship.

Couples matching is another scenario taken into account.

I dont know of many people who have had it denied. The people I DO know of who have had their request denied were trying to claim geographic hardship in areas where there were several TRI.

 

[jkhamlin]

Agreed, but I still don't see (and if you want to show me, please provide me with the journal article citations) how OMM would make that much of a difference in and of itself.

Ear infections in children are a major problem with bacterial resistance to antibiotics. Part of the problem is that the "standard approach" that docs use when a kid comes in for a well child, or even ill child exam is to prescribe antibiotics for a visualized asymptomatic ear infection, or a symptomatic one whether or not it can be visualized. These are caused by a virus the vast majority of the time, and will go away within a few days. If this happens a few times a year, such as with children in a household exposed to second hand smoke, the kid's natural flora will become resistant to the antibiotic. Resistant bacteria also become more virulent and opportunistic bacteria will worsen subsequent ear infections which will not be treated adequately with antibiotics. Then the "standard approach" becomes to start cutting on the kid's head. First they get tubes. The tubes come out and then they get more tubes. Then go the adenoids. Then go the tonsils. Then they get more tubes. It builds on itself due to "evidence based medicine" that neglects the real facts and continues to worsen the patient's condition to cover up its own blunders. Now, I stated this because there is a pediatrician at OSU that is researching OMM techniques to alleviate the symptoms of ear infections without the excessive use of antibiotics, and having good success from what I last heard.

 

[Mr_Doc]

billydoc, learn how to read before you flame. i said they CAN practice in NJ and CA.

 

[Dr JPH]

Ear infections in children are a major problem with bacterial resistance to antibiotics. Part of the problem is that the "standard approach" that docs use when a kid comes in for a well child, or even ill child exam is to prescribe antibiotics for a visualized asymptomatic ear infection, or a symptomatic one whether or not it can be visualized. These are caused by a virus the vast majority of the time, and will go away within a few days. If this happens a few times a year, such as with children in a household exposed to second hand smoke, the kid's natural flora will become resistant to the antibiotic. Resistant bacteria also become more virulent and opportunistic bacteria will worsen subsequent ear infections which will not be treated adequately with antibiotics. Then the "standard approach" becomes to start cutting on the kid's head. First they get tubes. The tubes come out and then they get more tubes. Then go the adenoids. Then go the tonsils. Then they get more tubes. It builds on itself due to "evidence based medicine" that neglects the real facts and continues to worsen the patient's condition to cover up its own blunders. Now, I stated this because there is a pediatrician at OSU that is researching OMM techniques to alleviate the symptoms of ear infections without the excessive use of antibiotics, and having good success from what I last heard.

Much of that research regarding OMT and otitis media has been done long ago and is now being rejuvinated, largely because of the literature supporting the "wait and see protocol."

👍

 

[koennen]

There are a number of factors that go into getting it approved.

One is if you claim geographic reasons. If the area where you have decided to do a residency does not have an osteopathic internship available (for instance many part of NC and SC) then you can claim that your are unable to complete the requirement because of geographic hardship.

Couples matching is another scenario taken into account.

I dont know of many people who have had it denied. The people I DO know of who have had their request denied were trying to claim geographic hardship in areas where there were several TRI.

Well, suppose you are in an area that has no shortage of osteopathic internships? The Philadelphia area, for example. Suppose there is no geographic hardship?

For example, you are a PA resident and plan to practice in PA. You graduate from PCOM and match into a ob/gyn residency at Jefferson. Assuming no couple matching issues, is that the type of scenario that would NOT be approved? After all, you could have done your ob/gyn residency at PCOM or probably several other AOA approved residency programs locally.

I assume all of this has to be sorted out before you begin a residency. One would not want to match into an allo residency only then to find out after the fact that the AOA would not approve it. And what would happen if one completes an allopathic residency without petitioning for approval of if approval is denied? Can't be licensed to practice in PA?

Finally, in your opinion, any chance this is likely to change any time in the near future?

 

[Dr JPH]

Well, suppose you are in an area that has no shortage of osteopathic internships? The Philadelphia area, for example. Suppose there is no geographic hardship?

That is correct. No geographic hardship.

For example, you are a PA resident and plan to practice in PA. You graduate from PCOM and match into a ob/gyn residency at Jefferson. Assuming no couple matching issues, is that the type of scenario that would NOT be approved? After all, you could have done your ob/gyn residency at PCOM or probably several other AOA approved residency programs locally.

Prior to applying to allopathic programs you would need to the AOA and find out if the first year of that particular program would be approved, or has been approved in the past. If it wasnt then you would need to complete a one year AOA approved TRI prior to beginning your residency there.

I assume all of this has to be sorted out before you begin a residency. One would not want to match into an allo residency only then to find out after the fact that the AOA would not approve it.

Exactly. Many of the local Philadelphia hospitals offer AOA approved TRIs, their program is dually accredited or they are affiliated with an AOA TRI.

And what would happen if one completes an allopathic residency without petitioning for approval of if approval is denied? Can't be licensed to practice in PA?

Correct. I dont know the process if someone goes to school and trains out of state or if someone ignores the requirement up front and then petitions for approval later.

Finally, in your opinion, any chance this is likely to change any time in the near future?

I havent heard any talk of change from the Pennsylvania Osteopathic crowd.

 

[koennen]

That is correct. Prior to applying to allopathic programs you would need to the AOA and find out if the first year of that particular program would be approved, or has been approved in the past. If it wasnt then you would need to complete a one year AOA approved TRI prior to beginning your residency there.

Does "have been approved in the past" mean will be approved in the future? In other words, is it known that the AOA routinely approves the first year of certain residency programs as "acceptable" for purposes of satisfying the TRI?

 

[Kuba]

hmm, the past President of POMA is my supervisor's father... I should ask him some of these questions.

 

[koennen]

I guess what I'm really trying to get to is how much of an issue getting AOA approval presents for someone graduating from PCOM and intending to do an allopathic residency in the Philadelphia area. Major issue? Minor issue?

When I look at PCOM's match list, I see relatively few people going into a TRI. Does that mean the rest of the people matched into programs that have had their first year approved by the AOA? If that's the case, it would appear that many programs have had their first year approved.

Edit: Ok, looked at match list again and there are more going into TRIs than I remembered and fewer going into Philadelphia area allo residencies than I remembered. But, still would like to know how much of an issue this would present.

 

[Dr JPH]

koennen

Its a valid concern.

Many of the people I know who are doing allo residencies have had their internship approved.

With that said I also know a large number of people who are currently in TRI and are applying to some of the bigger allo spots here in the city. Seems that PCOMers have had a good record of matching into the local programs and philly TRIs are quite popular...there are a few that not only fill but are quite coveted by PCOM grads. Intern pay, hours, call schedule all factor in.

Also realize that many of the local TRIs allow a good number of electives outside their own system. This can be extraordinarily helpful for mediocre or just "good" interns who want top allo spots...they can prove themselves while working as an intern.

Like I said, many people I know dont sweat the extra year. It seems that the people that are all up in arms about it are looking at it from the outside. I dont understand that. 😕

If doing one year of an internship is going to help with getting that medicine spot at Penn or the ortho spot at Jeff, then its not such a sacrafice. JMO

Personally I am (hopefully) going to a dually accredited program.

 

[RuralMedicine]

Ear infections in children are a major problem with bacterial resistance to antibiotics. Part of the problem is that the "standard approach" that docs use when a kid comes in for a well child, or even ill child exam is to prescribe antibiotics for a visualized asymptomatic ear infection, or a symptomatic one whether or not it can be visualized. These are caused by a virus the vast majority of the time, and will go away within a few days. If this happens a few times a year, such as with children in a household exposed to second hand smoke, the kid's natural flora will become resistant to the antibiotic. Resistant bacteria also become more virulent and opportunistic bacteria will worsen subsequent ear infections which will not be treated adequately with antibiotics. Then the "standard approach" becomes to start cutting on the kid's head. First they get tubes. The tubes come out and then they get more tubes. Then go the adenoids. Then go the tonsils. Then they get more tubes. It builds on itself due to "evidence based medicine" that neglects the real facts and continues to worsen the patient's condition to cover up its own blunders. Now, I stated this because there is a pediatrician at OSU that is researching OMM techniques to alleviate the symptoms of ear infections without the excessive use of antibiotics, and having good success from what I last heard.

I had to reply to this as a Med-Peds attending. First of all I assure you your "standard practice" was anything but standard for the Med-Peds and Peds attendings and residents where I trained. We were quite comfortable with pneumatic otoscopy and did not treat OME with antibiotics. We also followed the AAP guidelines which do not recommend treating OM in children over 2 unless there is certainty of a bacterial process. I will admit that I have seen a different approach by the ED physicians in the rural community I practice in and by the midlevel providers that practice unsupervised in an UVC in our county. But since you mentioned well child visits I presume you are referring to pediatricians (or perhaps FM docs who are hopefully practicing in a fashion similar to what I outlined above). Antibiotic resistance is a real problem and mismanagement of OM certainly contributes to the problem. At the same time we do need to realize that mastoiditis and meningitis are potential complications of OM so we need good instructions and followup for treated and untreated children. I just admitted a child with mastoiditis this week so it is out there and it does happen.

Now as a DO, who admittedly trained in an allopathic program and did not use much OMM (save diagnostic techniques that are ingrained into my musculoskeletal exam) during the four years of my Med-Peds residency I will admit that lymphatic and sinus drainage techniques are one of the first things I've brought back. I will drain sinuses and do eustachian tube work in kids because it's high yield, quick, and very safe from a risk benefit standpoint. [I also tend to do a lot of ME, FPR, and counterstrain for the same reason. I wasn't a huge HVLA fan as a student and I do very little of that now--and probably still would do little had I trained in an osteopathic program.] I still use antibiotics where indicated as well though. I'm not familiar with the recent OSU work however, there is some older literature that does support benefit as well.

 

[Dr JPH]

I had to reply to this as a Med-Peds attending. First of all I assure you your "standard practice" was anything but standard for the Med-Peds and Peds attendings and residents where I trained. We were quite comfortable with pneumatic otoscopy and did not treat OME with antibiotics. We also followed the AAP guidelines which do not recommend treating OM in children over 2 unless there is certainty of a bacterial process. I will admit that I have seen a different approach by the ED physicians in the rural community I practice in and by the midlevel providers that practice unsupervised in an UVC in our county. But since you mentioned well child visits I presume you are referring to pediatricians (or perhaps FM docs who are hopefully practicing in a fashion similar to what I outlined above). Antibiotic resistance is a real problem and mismanagement of OM certainly contributes to the problem. At the same time we do need to realize that mastoiditis and meningitis are potential complications of OM so we need good instructions and followup for treated and untreated children. I just admitted a child with mastoiditis this week so it is out there and it does happen.

Now as a DO, who admittedly trained in an allopathic program and did not use much OMM (save diagnostic techniques that are ingrained into my musculoskeletal exam) during the four years of my Med-Peds residency I will admit that lymphatic and sinus drainage techniques are one of the first things I've brought back. I will drain sinuses and do eustachian tube work in kids because it's high yield, quick, and very safe from a risk benefit standpoint. [I also tend to do a lot of ME, FPR, and counterstrain for the same reason. I wasn't a huge HVLA fan as a student and I do very little of that now--and probably still would do little had I trained in an osteopathic program.] I still use antibiotics where indicated as well though. I'm not familiar with the recent OSU work however, there is some older literature that does support benefit as well.

👍

Excellent post. Thank you for the contribution.

Above I mentioned some of the newer literature talking about the "Wait And See Protocol."

Any experience with this? How is it being taken in the Peds community?

 

[jkhamlin]

I had to reply to this as a Med-Peds attending. First of all I assure you your "standard practice" was anything but standard for the Med-Peds and Peds attendings and residents where I trained. We were quite comfortable with pneumatic otoscopy and did not treat OME with antibiotics. We also followed the AAP guidelines which do not recommend treating OM in children over 2 unless there is certainty of a bacterial process. I will admit that I have seen a different approach by the ED physicians in the rural community I practice in and by the midlevel providers that practice unsupervised in an UVC in our county. But since you mentioned well child visits I presume you are referring to pediatricians (or perhaps FM docs who are hopefully practicing in a fashion similar to what I outlined above). Antibiotic resistance is a real problem and mismanagement of OM certainly contributes to the problem. At the same time we do need to realize that mastoiditis and meningitis are potential complications of OM so we need good instructions and followup for treated and untreated children. I just admitted a child with mastoiditis this week so it is out there and it does happen.

Now as a DO, who admittedly trained in an allopathic program and did not use much OMM (save diagnostic techniques that are ingrained into my musculoskeletal exam) during the four years of my Med-Peds residency I will admit that lymphatic and sinus drainage techniques are one of the first things I've brought back. I will drain sinuses and do eustachian tube work in kids because it's high yield, quick, and very safe from a risk benefit standpoint. [I also tend to do a lot of ME, FPR, and counterstrain for the same reason. I wasn't a huge HVLA fan as a student and I do very little of that now--and probably still would do little had I trained in an osteopathic program.] I still use antibiotics where indicated as well though. I'm not familiar with the recent OSU work however, there is some older literature that does support benefit as well.

👍 Thanks for this info. A lot of my experience with this deals with talking to many doctors and pharmacists as a result of a battle over my own daughter's "chronic" ear infections. As a result, the FP who was her doctor at the time actually violated my daughter's HIPAA rights and called my boss to discuss with her the fact that I was doing my own investigation, which included utilizing resources I had at work. Apparently, the good old boy doctor network, including the ENT doc we took her to, supported the throwing antibiotics at every ear infection approach. I put a stop to it all and told my wife that if she gets another ear infection, just give her NSAID's, and if it persists for more than five days, take her to a doctor. She hasn't had a problem since.

Incidently, I looked more in depth into the doctor at OSU. Apparently she is an OMM professor and an MD! She calls herself a "born again Osteopath." How cool is that? At least one allopath gets it.