The following cases are chosen carefully to demonstrate the more common aspects of osteopathic management. The "hero stories" or quick cures have not been included. Though a very good number of patients with chronic problems have had their symptoms go away in several visits, it is unrealistic for most patients to expect to respond this way. If a patient has had a problem for 20 years it is rare that it will go away in several visits with treatment from any skilled osteopathic physician.
Keep in mind that only the structural findings are stated and the remainder of the physical exam has been excluded. Most conditions will improve with treatment, but, of course, all cases cannot be cured.
A typical treatment regimen for a chronic problem is to begin by treating a patient once a week for eight weeks; as they improve, space the treatments farther apart. This is enough time for the average person to improve. I do caution my patients that they are each an individual being and respond at their own pace. Some get better faster, others more slowly, and it is very difficult to predict the rate of improvement.
Many times patients need manual medicine. As a physician, many times other areas are deemed important for recovery. Diet, exercise, lifestyle changes, etc. do constitute part of the treatment regimen.
AM, a 6 month old male came to my office with a history of asthma for 3 months, an unusual affect, and a "floppy voice box." He was using inhaled bronchodilators 3 times a day and had been given 2 rounds of steroids in the past 2 months.
Physical examination revealed a very sickly looking child with a slightly high pitched cry and labored breathing.
There were numerous structural changes, apparently from trauma at birth due to a difficult labor and delivery. Most prominent were a very restricted left frontal, a deep strain to the base of the skull, bilateral occipital condylar compression and a restricted diaphragm. These changes put together an anatomic/physiologic picture of his illness.
He was treated with osteopathic manual medicine (Sutherland technique) and his problems slowly improved. It has been 3 years since his first visit, he never has needed steroids again, and he was off all medication after a year.
This was one of sickliest looking children I have treated in my office. He improved slower than the average asthma case, but this was due to the amount of birth trauma present.
CI, a 3 year old female was brought to my office by her mother with a history of a fall from a shopping cart striking her head on the supermarket floor. She developed right sided medial strabismus (crossed eye) after this. She was evaluated and there were no signs of fractures of intracranial bleeding.
It was apparent that the trauma had affected the right tentorium cerebelli (membranes in the right side of her head), causing increased tension in the right petrosphenoid ligament. This affected Cranial Nerve VI (a nerve that goes to the eye muscles), causing the medial strabismus.
She was treated twice with osteopathic manual medicine and the problem resolved. 6 months later she was brought in the office again by her mother for the same complaint. It began after her older brother pushed her and she fell 5-6 feet from a swing set, striking the right side of her head. She was treated once and is fine to this day.
YS, a 2 year old male was brought to my office with a complaint of chronic serous otitis media, recalcitrant to treatment. His father did not want myringotomy tubes used and reluctantly brought him in at the insistence of his wife.
He was evaluated and treated. I discussed the case with his pediatrician who said that he would be very surprised if I could help him at all, but very interested in the result. As it was a difficult case with a long history of problems and heavy antibiotic usage, it took about 4 months of weekly treatment before he was healthy. He no longer had ear infections after this, much to the surprise of his father, now a firm believer in osteopathy.
Most cases of otitis media take less time than this to treat, some take just five or six visits, but this was a complicated case. I never heard from the pediatrician.
MW, a middle aged patient came to my office with a history of 4 herniated and 6 bulging discs (half cervical, half lumbar) from a severe lifting injury 4-5 years previously. The patient was always in a great deal of pain and could do little but stay at home and rest. Almost anything this person did aggravated the problems. There was a history of disc surgery with no improvement and perhaps even more pain following the surgery.
This individual was evaluated and treated. I said that I could probably help, as there were severe structural problems, but that I did not know the extent to which I could help due to the severity of the damage.
There was significant improvement after the first treatment and this was enough encouragement to continue with the prescribed regimen. The quality of this person's life has increased greatly with a fraction of the pain previously experienced, including a significant number of pain free days.
Keep in mind that a person with this much pathology can rarely be cured, however the quality of their life can be greatly improved. This person can drive, get around and do some lifting, but is still limited in her activities. She does require long term maintenance treatment as the anatomy has been permanently disrupted.
One case I will not forget was that concerning an elderly women whom I was treating for a musculoskeletal complaint, following a fall. She was in a store and tripped, striking her left shoulder on the ground. She complained of continued pain in her left shoulder only.
Physical exam revealed a left shoulder contusion with much tenderness on palpation and quite limited range of motion. No pertinent findings other than this were noted in the history and physical exam.
I treated her 3 times with much improvement.
On the 4th visit her upper body felt much different. I noticed slight structural changes in the area of T2-3 on the left. One might expect changes in this area with persistent shoulder pain, however, the changes were such that they were recognizable as somatovisceral reflexes, that is, changes in the musculoskeletal system due to altered function of underlying organs.
In this case, the underlying organ was the heart. I expressed my immediate concern and sent my patient to the cardiologist. She told me that she went to her internist and was given a clean bill of health. I spoke with her in several days and, again she had no symptoms suspicious of cardiac involvement. This was very confusing as it did not agree with my structural findings. She was adamant that her internist said she was fine.
Four days later she had a near fatal MI (heart attack).
It is a shame that the observations were not taken more seriously at the time of her cardiac evaluation.
A young women came to me with symptoms of a urinary tract infection. I treated her appropriately and rechecked her in several days. Her symptoms had improved a little, but I was worried as I found somatovisceral reflexes indicating kidney involvement, though the physical exam and lab results from the previous day did not demonstrate this. I repeated the lab tests as the treatment regime began and indeed her condition was worsening, but there was no other indication of kidney involvement. However, I had learned to trust the structural findings above all else.
I changed the treatment regimen and several days later the structural changes went away, which I am sure avoided a bad case of pyelonephritis (kidney infection).
A family member called me to the ER where he was being seen for abdominal pain, possibly from appendicitis. The medical staff at the hospital was not sure whether or not he had an acute abdomen and needed immediate surgery. They were in a quandary and wanted to keep him for evaluation.
I examined him and determined from both my allopathic and osteopathic training that he did not have an acute abdomen and thus did not require surgery. I saw him at my office late that day and treated him. He was fine the next day.
Four years later he was being seen in the ER for a similar problem and asked me for my opinion. I examined him. The regular physical exam was ambiguous for appendicitis while the osteopathic findings did indicate an acute appendix. At my recommendation he had surgery later that day. His surgeon concurred that he had a hot appendix, which was removed.
His recovery was uneventful.
A middle aged male patient came to my office complaining of gastroesophageal reflux (heartburn) for 20 years. He had tried many different medications and diets, but they had little effect.
Upon examining him, I noted that his chest was very, very restricted and had the consistency of a piece of oak (as opposed to a piece of soft, green wood). His diaphragm and thoracic area (mid-back) were also quite tight as the anatomy of all these areas is intimately related.
I told him that the structural changes indicated a problem from birth, due to the feel of the tissues and severity of the structural changes. It appeared that after being born, he did not get a proper first breath, which re-expands the rib cage after it is compressed from going through the birth canal. As a result his chest had been tight since that time and only became tighter over the years. He admitted that he never could really take a deep breath.
Much to my surprise, his symptoms went away after a few visits. Apparently there was enough of a change in the proper areas to make a difference, even though there were significant structural problems remaining.
He has stuck with treatment over the past 6 months and his body has changed quite a bit. His general level of health should continue to improve.
An elderly female complained of asthma for the past 1-2 years and subsequent history revealed that she had irritable bowel syndrome for 15 years.
Examination reveled a very restricted diaphragm, pelvis, cervicothoracic junction, lower thoracic and upper lumbar areas along with compression of the developmental parts of the sacrum (tailbone) and base of the cranium (head).
I informed her that it would take quite a while before she was better due to the long standing nature of the problems in her body. She told me that she did not understand as the asthma had only existed for a year.
I explained that traumas in her childhood were responsible and that it was to her credit that she had not had respiratory symptoms until this time. But now that she did, the changes would have to be reversed before she improved. I informed her that this type of change would take months and that she needed to be patient.
I treated her for 3 months and the irritable bowel syndrome improved, but not the asthma. She frequently inquired about the length of time needed to be "cured."
She stopped seeing me shortly after this, which did not surprise me. Anxious patients can be difficult to reassure and she was new to the philosophy and approach of osteopathic medicine. She only had my word and clinical experience to rely on.
Later that year I saw her again and she told me that after the last visit, six months previous to this one, the digestive complaints improved a great deal and the asthma symptoms were greatly diminished, but neither went away completely. The symptoms started to return a month before the current visit.
I told her that this was not surprising as her body needed more treatment, she needed exercise, and a change in diet should be instituted to insure continued improvement in her health.
I saw her three or four more times after this and have not seen her since.
A six year old boy was brought to my office by her mother who related to me that her son was overly active and that she had been told that he probably had ADD and would need medication in the future. She did not like that idea and wanted his problem addressed osteopathically.
I found a very restricted head- the cranial base exhibited a great deal of compression from a prolonged labor and the frontal area was extremely restricted. Both these areas would affect the whole central nervous system, especially the frontal lobe of the brain. These pathological changes would cause him to exhibit this type of behavior.
He was difficult to examine and treat as he was not capable of lying still on the treatment table. I once turned for a second to pick up a toy that had fallen on the floor and he was out the door into the front office by the time I put the toy back on the table.
After two and a half months of treatment the mother said that he had not changed at all. I felt that I needed to get his cranial base loose and recruited another DO In order to give him a two person treatment, which proves much more effective.
I felt that his body was beginning to work by the end if the visit and expected him to improve. The patient's mother called back in a week, saying that there was no change and the boy never returned.
A year later the mother came to me for strain in her back. I inquired concerning the health of her son and she said to me, "He is fine." I was confused as the last time I spoke with her she said that he was no better. I asked her to explain to me what she meant and she looked at me in a puzzled way and said it meant that he was normal. I asked about his hyperactivity and she said it went away. She explained that month following his last visit that his symptoms gradually began to improve until they were gone completely and that he was doing quite well in school.
Apparently, he had been treated enough to unlock the potential in his body was able to continue treating out the problem on his own, as nature intended.