nikegrl23

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http://www.nytimes.com/2007/08/07/health/07brod.html?_r=1&oref=slogin


August 7, 2007
Personal Health
Injections to Kick-Start Tissue Repair

By JANE E. BRODY
The human body is held together by a network of connective tissues that are highly vulnerable to injury — through exercise, accidents and even the normal lifting, pulling and pushing of daily life.
Few of us, for example, get through life without spraining an ankle. And as many sadly know, once an ankle is badly sprained, it may be sprained again and again. That often happens as well with other body parts: shoulders, wrists, neck, back, jaw, feet, even fingers and toes, all of which are subject to arthritic changes after an injury.
The risk of reinjury rises when the ligaments that hold bone to bone, or the tendons that connect bone to muscle, fail to heal completely. And such failure is apparently very common. Over time, and with multiple injuries, this incomplete healing can result in lax connective tissues that cannot fully support a joint.
Dr. K. Dean Reeves, clinical associate professor of physical medicine and rehabilitation at the University of Kansas Medical Center, likens the damage to a partly shredded rope that lacks the strength of an intact one, and to stretched putty that will not return to its former length. Dr. Reeves is one of several hundred physicians and osteopaths who specialize in a therapeutic technique called prolotherapy, an alternative medicine method to promote connective tissue repair even years after the damage occurred.
The technique received an endorsement of sorts from the Mayo Clinic. In its April 2005 health letter, the clinic stated that when chronic ligament or tendon pain fails to respond to more conservative treatments like physical therapy and prescribed exercises, “prolotherapy may be helpful.” And when surgery is the only remaining option to relieve chronic pain, prolotherapy is a much less invasive and expensive technique that may be worth a try — if you can find an experienced and skilled practitioner.
What Is Prolotherapy?
Prolotherapy involves a series of injections designed to produce inflammation in the injured tissue. To appreciate the value of such a seemingly counterproductive measure, you need to know something about connective tissue and how the body normally repairs it.
When tissues are injured, inflammation is a common natural response. It stimulates substances carried in blood that produce growth factors in the injured area to promote healing. Ligaments, tendons and cartilage have very poor blood supplies, which can result in incomplete healing.
The healing process can also be impeded when injuries are treated with anti-inflammatory medications like ibuprofen or Naprosyn, or prescribed nonsteroidal anti-inflammatory drugs (Nsaids) to relieve pain and swelling.
Unlike injections of corticosteroids, which also suppress inflammation and provide only temporary relief for a chronic condition, prolotherapy injections given over the course of several months are meant to provide a permanent benefit. In effect, prolotherapy tricks the body into initiating a healing response.
The technique reactivates the healing process by injecting a mildly irritating substance — commonly a somewhat concentrated sugar solution along with the painkiller lidocaine — into the injured area to stimulate a temporary low-grade inflammation. In some cases, growth factors themselves may be injected.
With growth factors in place at the site of inflammation, new tissue is said to be produced that strengthens lax or unstable ligaments and tendons. The technique may even support damaged or degenerated cartilage, which normally does not repair itself, by strengthening the fibrous connective tissues that stabilize the area.
Practitioners cite experiments in laboratory animals that demonstrated tissue growth in ligaments and tendons stimulated by prolotherapy injections. Two animal studies also showed healing of cartilage defects.
Prolotherapy cannot correct mechanical problems like spinal stenosis, in which two bones pinch a nerve, nor does it reverse arthritic changes. But it may reduce or even eliminate the discomfort associated with arthritis by tightening the connective tissues that support an arthritic joint.
A leader in the field, Dr. Donna Alderman, an osteopathic physician who is medical director of the Hemwall Family Medical Centers in California, published two long articles on prolotherapy this year in the magazine Practical Pain Management. She wrote that “prolotherapy has been used in the United States for musculoskeletal pain since the 1930s,” that it has been endorsed by former Surgeon General C. Everett Koop, and that it is increasingly being used to treat injuries in professional athletes.
Prolotherapy is also now the subject of a controlled clinical trial sponsored by the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health.
Since prolotherapy is a nonsurgical technique, patients who are now facing surgery because all else has failed might consider trying it before having an operation. Unlike many drugs and surgery, prolotherapy has minimal side effects when performed by an experienced practitioner who uses sterile techniques. Patients may experience bruising and a temporary increase in pain in the injected area because of the induced inflammation. Rare risks include infection, headache, nerve irritation or allergic reaction.
Does It Help?
There have been dozens of studies purporting to show benefits of prolotherapy for people with chronic pain as well as those with sports injuries. Among scientifically designed controlled studies, most showed a significant improvement in the patients’ level of pain and ability to move the painful joint.
According to Dr. Alderman, in a study of people with chronic low back pain resulting from injured ligaments in the sacroiliac joint, biopsies done three months after treatment showed a 60 percent increase in the diameter of connective tissue. The patients reported a decrease in pain and an increased range of motion.
In studies of knee injuries, patients with ligament laxity and instability experienced a tightening of those ligaments, including the often disabling anterior cruciate ligament in the center of the knee, Dr. Reeves showed in a double-blind study. Other studies showed a significant improvement in the symptoms of arthritis in the knee one to three years after prolotherapy injections.
Dr. Alderman cautions that prolotherapy is appropriate only for patients with musculoskeletal pain who do not have underlying conditions that would interfere with healing and who are willing to receive painful injections in an effort to recover.
A state-by-state listing of prolotherapy practitioners can be found at www.getprolo.com. Beware of practitioners who make rash promises, fail to take a full medical history and to tell you about the technique and its side effects, or who work in a disorderly or unclean facility.



What worried me is that a difference is drawn between physicians and osteopaths, probably leading people who read this and don't know better to think that the two are separate. Isn't this an older term? Maybe we should e-mail them to change the terminology?



:mad:
 

DropkickMurphy

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What worried me is that a difference is drawn between physicians and osteopaths, probably leading people who read this and don't know better to think that the two are separate. Isn't this an older term? Maybe we should e-mail them to change the terminology?

:mad:
Maybe you just need to stop being so damn sensitive. No one who matters gives a **** about the letters after your name. Besides, if someone is that shallow to be concerned about it, they are not worth associating with.
 

phEight

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Maybe you just need to stop being so damn sensitive. No one who matters gives a **** about the letters after your name. Besides, if someone is that shallow to be concerned about it, they are not worth associating with.
It's not about being sensitive, it's about helping cure the tremendous ignorance associated with osteopathy. However I agree it's no big deal but it's definitely not any good that they're seperating physicans from osteopaths.
 
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cyclohexanol

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It's not about being sensitive, it's about helping cure the tremendous ignorance associated with osteopathy. However I agree it's no big deal but it's definitely not any good that they're seperating physicans from osteopaths.

Doubtful that this will ever be resolved; nobody cares.
 

Lamont

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relax folks...its not too big of a deal. the only letters that matter are the ones in front of your name. osteopathic physicians dont help themselves all of the time...read the book "The D.O.'s" by Gevitz (sp?). it will explain the philosophy.
 

DropkickMurphy

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It's not about being sensitive, it's about helping cure the tremendous ignorance associated with osteopathy. However I agree it's no big deal but it's definitely not any good that they're seperating physicans from osteopaths.
No, it's completely about being overly sensitive. The way you worded it is a perfect example. There is not a tremendous ignorance since most patients don't know what a DO is and most respond with "Oh, that's cool" or "Oh, interesting" when the doc explains it (on the relatively infrequent chance the patient brings it up).

As Cyclohexanol said no one cares (outside of premeds). If you are so concerned as to actually write an e-mail, all it will do is make you look like someone who is insecure or just writing to make themselves feel important. Either way, it will make you look like a tool.
 

JaggerPlate

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nobody cares.

Agreed. I'm not even sure if the person who wrote this really knows anything, it's most likely someone who just has no clue writing. I don't even think it was meant as an insult, and if it was ... once again; who cares?
 

mshheaddoc

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No, it's completely about being overly sensitive. The way you worded it is a perfect example. There is not a tremendous ignorance since most patients don't know what a DO is and most respond with "Oh, that's cool" or "Oh, interesting" when the doc explains it (on the relatively infrequent chance the patient brings it up).

As Cyclohexanol said no one cares (outside of premeds). If you are so concerned as to actually write an e-mail, all it will do is make you look like someone who is insecure or just writing to make themselves feel important. Either way, it will make you look like a tool.
Actually people DO care that they hear osteopath INSTEAD of physician. And yes, this is something that the AOA had been pushing to work on educating the public back a few years ago, and continually supposedly. Confusing osteopathic medicine with osteopathy in general (and on an international basis) was part of the reason why DO's had to fight for rights internationally.

Yes DO's are osteopath's but they are physicians as well. The two are not mutually exclusive as the article would lead to suggest. And while it may not be a big deal to some, for strides in the profession, it does speak volumes. Especially with all the ignorance out there (the public, not the profession). Yes DO=MD overall in real world medicine but when used in the context of articles and the sort, no wonder the public is confused when they call DO's chiropractors (like my next door neighbor did the other day).

So actually I agree with the OP in the fact where the misunderstanding of what DO's are in the US is part of the reason why they have been hiding from the limelight and the DO initials mean nothing to the general public. Look at all the recent "DO mishaps in the press" that pretty much prove the lack of knowledge to the public and the media. They use what sells. DO doesn't sell b/c who knows what they are? The majority of americans don't. They just know them as doctor and assume M.D.
 

nikegrl23

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I appreciate the backup, mshheaddoc.
DropkickMurphy and others, sorry to have ignited such crazy passion in you, but yeah, I think it's somewhat important how people refer to us. It's not too big of a deal, I agree, but then I'm not suggesting we storm NYTimes headquarters or anything... just a simple e-mail...
It's just how they said it that makes it seem like we're not physicians.
Please don't misunderstand. I myself have no doubts or insecurities about my future ability (or that of my colleagues) as a physician. I will have patients who appreciate my work and concern regardless of the letters after my name. It's taken me time to realize that, but I have. It's just simply that the phrasing they use doesn't do anything to help what DOs have fought for for so long, recognition that they are doctors as well. Why not educate the public correctly?

I guess the bottom line of all my emotional talk is, SORRY I GOT EVERYONE ANGRY at me, but I still think it's important. I just wish I could put what I was thinking as nicely as mshheaddoc just did.

Friends?
 
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JaggerPlate

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It's Osteopathic Medicine. "Osteopathy" is an archaic term.

True dat. And to the OP, I don't really think you were being 'over sensitive,' it's just that for most people who are going DO, it's just kinda whatever. Public perception is wrong on soooo many things, and DO = MD as far as everything is concerned so, does it really matter what somebody incorrectly wrote that in an article in the long run? No. Is it frusturating to work your arse off for something, just to have people say you practice osteopathy and not medicine? Yes. So your reaction was fine, it's just that most of us kind of shrug it off.
 

JaggerPlate

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eh I like the name "cyclohexanol" as a username haha

hahah I know its clever. However, one time I was studying for an O-chem midterm, logged onto SDN for a while to take a break and then saw a post by 'cyclohexanol' and was like: 'damn, have to go back to work.'
 

gujusnike

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hahah I know its clever. However, one time I was studying for an O-chem midterm, logged onto SDN for a while to take a break and then saw a post by 'cyclohexanol' and was like: 'damn, have to go back to work.'

hahahah. the username just ruined the attempt at keeping your mind away from ochem.
 

nikegrl23

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True dat. And to the OP, I don't really think you were being 'over sensitive,' it's just that for most people who are going DO, it's just kinda whatever. Public perception is wrong on soooo many things, and DO = MD as far as everything is concerned so, does it really matter what somebody incorrectly wrote that in an article in the long run? No. Is it frusturating to work your arse off for something, just to have people say you practice osteopathy and not medicine? Yes. So your reaction was fine, it's just that most of us kind of shrug it off.


That's true, you're right. Thanks, man.
 

gasapple

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That's true, you're right. Thanks, man.

You should also give Jagger some "true dat" in return and state that he needs to stay in his "hizzy" and get "all up and out of your Kool-Aid, yo"; lest he not understand :smuggrin:
 

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It does matter, DOs are also physicians.

This is just one more instance where the media erroneously portrays our profession. We should do our part to get it corrected.

I am personally contacting the AOA so they can do their usual procedures to request a correction.

The more the AOA jumps in to rectify these misconceptions the less we will see them in the future.

Op, thanks for bringing up that article :thumbup:
 

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Many of you make very good points.

However, I do feel that it DOES matter and people DO care about MD vs. DOs. Some of you may say that people like that are not worth associating with. If you thought that way about many of the issues you care about, you may might as well live on an island. The fact of the matter is that in this world, whether we like it or not what others think matters a great deal. Most of what we do revolves around what others think even if you think you are your own boss and that you do what you feel passionate about. In my opinion, one of the most powerful tool a person can have is to influence how others think and to change their opinions. It goes on in politics when voting on bills and it goes on in the court rooms. Yes, we do care about what others think and DOs should not feel comfortable with what the original poster feels how the media is portraying DOs as "physicians and osteopaths" as if DOs are not physicians.

What if women before they were given the right to vote said to themselves, "I know I am just as worthy to vote as a man and have just as much political knowledge as men have. But, who cares what men think and others think. As long as I know I am better than what they think I am, I'm content." Movement to get women the right to vote may have taken longer. We should never feel that it's acceptable to tolerate of ignorance or injustice. I am not a DO. But, if I ever become one, I'd feel compelled to educate the public about the practice of DOs. I'd join any organization that promotes the profession of DO as an equal to MD.

To not care or to state that no one else cares is being irresponsible.....if you are a DO that is. But, most of you aren't. So, there goes nothing.
 

nikegrl23

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It does matter, DOs are also physicians.

This is just one more instance where the media erroneously portrays our profession. We should do our part to get it corrected.

I am personally contacting the AOA so they can do their usual procedures to request a correction.

The more the AOA jumps in to rectify these misconceptions the less we will see them in the future.

Op, thanks for bringing up that article :thumbup:

Wow, I didn't know they had a procedure for things like this. I DID get a response from the Times though, essentially telling me that they would be more careful in the future. I'll post it if you like, after I take this practice test...
 
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nikegrl23

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Many of you make very good points.

However, I do feel that it DOES matter and people DO care about MD vs. DOs. Some of you may say that people like that are not worth associating with. If you thought that way about many of the issues you care about, you may might as well live on an island. The fact of the matter is that in this world, whether we like it or not what others think matters a great deal. Most of what we do revolves around what others think even if you think you are your own boss and that you do what you feel passionate about. In my opinion, one of the most powerful tool a person can have is to influence how others think and to change their opinions. It goes on in politics when voting on bills and it goes on in the court rooms. Yes, we do care about what others think and DOs should not feel comfortable with what the original poster feels how the media is portraying DOs as "physicians and osteopaths" as if DOs are not physicians.

What if women before they were given the right to vote said to themselves, "I know I am just as worthy to vote as a man and have just as much political knowledge as men have. But, who cares what men think and others think. As long as I know I am better than what they think I am, I'm content." Movement to get women the right to vote may have taken longer. We should never feel that it's acceptable to tolerate of ignorance or injustice. I am not a DO. But, if I ever become one, I'd feel compelled to educate the public about the practice of DOs. I'd join any organization that promotes the profession of DO as an equal to MD.

To not care or to state that no one else cares is being irresponsible.....if you are a DO that is. But, most of you aren't. So, there goes nothing.

Thanks, this is another more eloquent statement of what I think I had in my mind when initially posting this but didn't have the ability to put so nicely into clear thoughts. It's just that when you suggest something like what we're suggesting and everyone seems to be aghast that you could be so overly sensitive at the terminology used, you wonder if you're overreacting. Do you think people really noticed? I mean, I just quickly glanced over it and almost missed it and even then, it struck me more as a misunderstanding or a typeo-like mistake. In the end though, I think we're lucky to not have to worry too much about terminology, not as much as people did in the past. But it's precisely because of their efforts that we have this luxury. I think you're right, to take it lightly would be to undermine those efforts and welcome more of the same of what was experienced earlier in the century. I just hope other people agree...
 

gasapple

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Thanks, this is another more eloquent statement of what I think I had in my mind when initially posting this but didn't have the ability to put so nicely into clear thoughts. It's just that when you suggest something like what we're suggesting and everyone seems to be aghast that you could be so overly sensitive at the terminology used, you wonder if you're overreacting. Do you think people really noticed? I mean, I just quickly glanced over it and almost missed it and even then, it struck me more as a misunderstanding or a typeo-like mistake. In the end though, I think we're lucky to not have to worry too much about terminology, not as much as people did in the past. But it's precisely because of their efforts that we have this luxury. I think you're right, to take it lightly would be to undermine those efforts and welcome more of the same of what was experienced earlier in the century. I just hope other people agree...

I concur.
 

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SORRY I GOT EVERYONE ANGRY at me

I wasn't angry. I just disagreed. BIG difference.

Yes, we do care about what others think and DOs should not feel comfortable with what the original poster feels how the media is portraying DOs as "physicians and osteopaths" as if DOs are not physicians.

Yes, but the "separate yet equal" approach didn't work for race relations and it seems to be a hangup on the road to doing away with the misconceptions regarding DOs.The people who do care are either DOs- either those who were thoroughly brainwashed and are "true believers" or who were unable to get into an MD program, old school MDs (who will be out of the picture in a few years anyhow) and premeds. Most patients couldn't tell you the difference because there is not one for the purposes of the way most DOs practice. Quite frankly I imagine if you surveyed 1,000 patients of DOs, maybe 100 could tell you that their doc is a DO instead of an MD and maybe 20 or 30 of the people would give a flying rat's ass about the degree the person held. The rest would just be appreciative of quality care regardless of whom is delivering it- allopathic or osteopathic. Someone should seriously do such a study and then maybe we could actually see if the sissy fit Medhacker is trying to incite from the AOA is really a justified response based upon the only people whose opinions matter- the patients.

Anyone beyond that, if you think it matters enough to waste time alerting the AOA at every perceived slight, then maybe you need to get thicker skin because this will not go away until such time as the two fields combine in an across the board fashion. I just find it funny that the same people who get the most bent out of shape over every little comment about DOs are the same ones who are desperately trying to prevent the one valid solution to the issue from occurring.
 

nikegrl23

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Quite frankly I imagine if you surveyed 1,000 patients of DOs, maybe 100 could tell you that their doc is a DO instead of an MD and maybe 20 or 30 of the people would give a flying rat's ass about the degree the person held. The rest would just be appreciative of quality care regardless of whom is delivering it- allopathic or osteopathic. Someone should seriously do such a study


Actually, I agree about such a study. But since I haven't seen anything in the lit yet... or ever... what I have to go on is what most average people say to me when they hear that I'm looking into a DO. There are three different conversations I've been having over the past 3 years:

1. "What the heck is that?"
"It's a physician...It's basically like an MD, only a different approach, blah blah"
"Oh, ok... (slow, cautious response)"

2. Or if the person has some idea but doesn't actually have a DO as a doctor him/herself,
"Oh yeah, I've heard of those. I don't know, it sounds kind of weird. Why wouldn't I just go to an MD instead?"

3. "Yeah, I had one of them DOs as a urologist once. I didn't really like him so much."
"Was it because he was a bad doctor or was it because you found out he was a DO?"
"I don't know..."

Of course, my conversations probably don't reflect an accurate cross-section of the population of the US. And I'd like to think what you're saying about patient perceptions, Dropkick, is true, but from the little of what I've seen so far, it seems kind of idealistic.
 

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i believe this is quite irrelevant compared to our MCAT studying and application filling out dontcha think?
 

nikegrl23

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i believe this is quite irrelevant compared to our MCAT studying and application filling out dontcha think?

I don't think so... maybe you'll get into med school what that mindset, but once you're there, you'll be pretty uninformed about the profession you just worked so hard getting into... "dontcha think?"
 

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1. "What the heck is that?"
"It's a physician...It's basically like an MD, only a different approach, blah blah"
"Oh, ok... (slow, cautious response)"

2. Or if the person has some idea but doesn't actually have a DO as a doctor him/herself,
"Oh yeah, I've heard of those. I don't know, it sounds kind of weird. Why wouldn't I just go to an MD instead?"

3. "Yeah, I had one of them DOs as a urologist once. I didn't really like him so much."
"Was it because he was a bad doctor or was it because you found out he was a DO?"
"I don't know..."
QUOTE]


That's funny. My interactions have gone like this:

1. DO.?.?..What's that??? I explain the physician, same training blah blah....then I get a blank look.

or

2. DO...oh you guys can write prescriptions, can you refill my.....

or

3. DO...I love DO's. The philosophy is amazing and I think that you guys just care more for patients....blah blah blah.

Either scenario I say. Really, great....ok so follow up with your primary doc in 1-3 days and GOMER (get outta my ER) :D.
 

DocBR

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Is it offensive or in anyway wrong to use the term osteopathy?


I was under the impression that osteopathy refered to manipulation (OMM). This is common in other parts of the world where a D.O. is not a trained physician, but rather akin to a chiropractor (no biochem, pharmacology, surgical or medical privileges).

Which is why some US trained DOs get upset when they are referred to as "osteopaths" because a US D.O. is not simply an osteopath, but also a physician.
 
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