Second Exam Week Six

Now that our classroom career is over and the last set of exams are here, it is time to study. Fortunately for us, the first tests last week were in Osteopathic Manipulative Medicine. This meant one good corporal realignment before a week of uncomfortable postures and mental torture.

Final Adjustments

"...Take a deep breath." I then waited as my study partner dropped his weight on my upper body and we both felt the audible release of a vertebral segment that was misaligned. In no time the pain was gone and we moved on to continue our studies. As this was our last set of exams, we had the task of performing a full body evaluation and applying a specific treatment of our choice aimed to restore function. Since we were successful in treating each other in practice, our partners the next day had little to correct during the test. I think I am going to miss these little "corrective" sessions.

The thought of being finished with school is really exciting. It doesn't take long, however, to remind myself that as soon as this week is over, it will be time to dig deeper in preparation for board exams. (So much for having a vacation between school and rotations.) One thing is for sure, this experience has been so much better than I could have ever imagined. Sure, it has been difficult, but it continues to pique my interest and lift my thoughts to a better future.

Board Prep Question of the Week

A 13-year-old figure skater botches a quadruple lutz and falls on her right outstretched hand. Several weeks later a cast is removed for a healed scaphoid fracture. She begins having episodes of intense burning pain, sweating, swelling, and redness that begin in her right hand and moves up her forearm, sometimes up to her shoulder. These episodes often occur when she is angry or upset. On exam her arm shows no visible abnormalities. Which of the following nerve types are involved in the pathogenesis of her disorder?

A. General somatic afferent
B. General somatic efferent
C. General visceral afferent
D. Special somatic afferent
E. Special visceral afferent

Answer & Explanation

Cranial Osteopathy

A unique component of Osteopathic medicine, osteopathy in the cranial field, aims to treat the structural dysfunctions of the skull through manipulative techniques.

Osteopathy in the Cranial Field

Whether due to birth trauma, accidental injury, or abnormal strains, insults to the head can cause anyone distress. The cranium has numerous bones that move in an organized fashion to maintain optimal health. Like a dislocated joint, when one of these bones is forced out of alignment, somatic dysfunction ensues. This may present in the form of headaches, sinus congestion, neck pain, agitation, vertigo and a host of other complaints.

Initially difficult to comprehend and palpate, cranial alterations are smalll displacements of bones within the skull. Through diverse techniques the trained practitioner can treat everyone from neonates to elderly. As a student I am excited to be able to palpate the cranial rhythmic impulse (CRI). Apparently it can take hours and days before the CRI is appreciated. Despite making a step in the right direction, I find the cranial methods difficult to employ consistently as a beginner. Forty hour courses are available for extensive training, but the way tests keep coming my way, I don't think there will be much time to dedicate to this detailed study. For those who may be interested in learning more about this treatment The Cranial Academy has set up a website with course offerings and more.

Board Prep Question of the Week

A 50 year old woman with a history of headache presents with complaints of chest pain. She described the pain as pressure, and tightness in her chest. She said that the pain occured after taking a drug, the name of which she forgot. The most likely mechanism of this drug is:

A. Antagonist action at serotonin receptor
B. Agonist action at serotonin receptor
C. Release of nitric oxide
D. Inhibition of calcium channel opening
E. Decreased levels synaptic levels of catecholamines

Answer & Explanation

Neck Pain Treatment

One highlight for osteopathic medical students is obtaining hands-on training in Osteopathic Manipulative Medicine (OMM). Cervical spinal manipulations are among the most anticipated of techniques and thankfully have successful outcomes.

Neck Therapy

With the Hollywood stigma and the spine tingling sound of cracking, it is no wonder that we have had to wait this long to learn the mechanics associated with such treatments. As students we are just as nervous performing the technique as we are to be the patient on the table. The risk of severe damage is reported to be rather low, nevertheless, attention to properly performing these treatments is critical.

There are numerous resources available for learning the art of OMM and the American College of Osteopathic Family Physicians' website outlines a few of the more common treatments performed by osteopathic doctors. Although it is needless to say, there is more available than we students have time to consume. After learning it in the lab, we have to take it upon ourselves to make the time to practice our new skills.

In cases of somatic dysfunction, when a diagnosis is obtained, a trained DO can perform these treatments which relieve unnecessary pain and muscle imbalance. Because it is so sensitive, the neck can have a significant amount of dysfunction. Osteopathic cervical treatment is a quick way for the patient to find relief from their symptoms, and it is an enjoyably unique part of most osteopathic medical students' curriculum.

Manipulative Treatment

Biped creatures such as ourselves put a lot of force on our feet plaguing us with unnecessary pain and discomfort. Fortunately, there are ways to provide a needed respite for sore, worn out feet. When massage leaves you aching, osteopathic manipulative treatments (OMT) may be an easy solution.



Osteopathic Manipulative Treatment

As osteopathic medical students, we routinely learn the manipulations of our practice. Various techniques allow us to fill our toolbox with multiple solutions to common structural problems. Most recently we have been working with the lower extremities including the feet.

After getting over the initial distaste of handling the feet of our colleagues, we set out to learn the principles that would heal our future patients. These treatments focus primarily on the muscles, bones, and connective tissues in an effort to relieve pain or discomfort.

As my best friend is commonly involved in activities that put great amounts of stress on her feet, it came as no surprise that she had started developing pain one morning. Before running off to class, I was able to employ some of the skills I had learned previously to 'reset' her foot and relieve the pain she was experiencing. Amazed, she let me know the pain was gone, which I initially thought was her way of making me feel better about myself. She assured me that this was not her intention and that the techniques had actually improved her level of comfort.

Little by little we are gaining the pieces of knowledge that will make us better professionals and physicians in the work place. I was fortunate enough to be able to use those skills at home and witness first hand, the positive effects of OMT.

Anatomy

Sticking to the lower extremity, I thought I would discuss the latest news in the anatomy department. With the thorax and gastrointestinal contents of the abdomen behind us, we have started our examination of the spinal cord and perineum. In order to get a better look at the structures involved, some intense dissections had to be performed.

The first was a laminectomy where the outer coverings of the vertebrae were cut away to reveal the underlying spinal cord. It is amazing to think that this well protected and delicate structure carries impulses that permit control of most of our body.

The second dissection required the removal of a leg as high up as the belly button, which included part of the lower spine . This exposed the contents of the groin for inspection while being able to observe the organic proximity of reproductive, urinary and gastrointestinal structures. I never imagined having to remove an entire limb for that purpose, but it gives us a better appreciation for the anatomy we are studying.

In only a month's time, we will have completed our first semester of medical school. It is exciting to think that we have made it this far and are slowly seeing goals become a reality.

Pathways Galore

You may not fully understand it (like myself), but it is happening right now inside your body. The breakdown of sugar into usable energy or glycolysis is one of the many biochemical pathways our bodies use to function.

Biochemistry

Once again, the week has been occupied with many hours of in and out of class biochemistry. Only two weeks into the semester, we have finished three quizzes and a significant portion of the textbook's material. It is comforting to know that I am not the only student in the class that has a difficult time following every lecture. My routine has become a state of confusion during lecture that is cleared when I read the book to clear up the details. It takes a lot of time, but the material is making sense that way.

It has become clear that there is a lot of memorization to be done. Once the amino acids are crammed in my head, it is time to learn the pathways: glycolysis, the tricarboxylic acid cycle, oxidative phosphorylation, and the list is going to keep growing. We usually chuckle when the professors say there is no need to memorize the pathway, but know the starting materials, products, and enzymes involved. Adding it all up, we really do need to know the pathway in detail. When was the last time your doctor broke it all down in the exam room?

Osteopathic Manipulative Medicine

OMM as it is called is one of those classes that is unique to schools of osteopathy. In fact it is, at this point, one of the more enjoyable courses. We will be learning how to find problematic points of the body, manipulate them, and ultimately seek healing as a result. We take turns acting as patient and provider while learning the body and manipulations. I have a feeling this will be my family's favorite part of medical school as I have to practice on someone in order to study. As we are not too far into the curriculum, it ends up being more of a massage than a corrective technique. Over time, I imagine that will change.

In order to be considered an osteopathic physician, we have to be enrolled in OMM during each semester of school. Hence, this is a long term course that will build from semester to semester as we progress in our techniques. It is unfortunate that many osteopathic physicians do not employ these skills and perhaps do so because their practice does not incorporate them explicitly. Many people are convinced after only one treatment that OMM has significant healing results. Fortunately, or else osteopathic schools would not exist.

Anatomy

No relief in the anatomy department. We have explored the chest, shoulders and arms in great detail. Thankfully, my undergraduate education provided a strong foundation for most of these anatomical anomalies. We have yet to be tested on anything, which will be quite an eye opener I am sure. Just when you feel secure in your understanding and memorization, you have to be humbled by the intellectual development of your professors' years of experience and training. Needless to say, our memorization skills are improving at a rapid rate...or maybe I am just being hopeful.