The AAO F For JOURNALc919297.r97.cf2.rackcdn.com/ocktiqlit24os7msqonq0avxrnhgsa-opti… · integration of osteopathic principles, practices and manipulative treatment in patient care

Potential New Dimensions in Dermatology...pg. 34

Forum For osteopathic thought

Official Publication of the American Academy of Osteopathy ®

tradition shapes the Future Volume 23 number 4 december 2013

JOURNALThe AAO

The American Academy of Osteopathy® is your voice . . ....in teaching, advocating, and researching the science, art and philosophy of osteopathic medicine, emphasizing the integration of osteopathic principles, practices and manipulative treatment in patient care.

• AccesstothemembersonlysectionoftheAAOwebsite,whichwillbeenhancedinthecomingmonthstoincludenewfeaturessuchasresourcelinks,ajobbank,andmuchmore.

• DiscountsonadvertisinginAAOpublications,ontheWebsiteandattheAAO’sConvocation.

• TheAmericanOsteopathicBoardofNeuromusculoskeletalMedicine,theonlycertifyingboardformanualmedicineinthemedicalworldtoday,accepts,withoutchallenge,allcoursessponsoredbytheAAO.

• MaintenanceofanearnedFellowshipprogramtorecognizeexcellenceinthepracticeofosteopathicmanipulativemedicine.

• Promotionofresearchontheefficacyofosteopathicmedicine.

• SupportforthefutureoftheprofessionthroughtheStudentAmericanAcademyofOsteopathyonosteopathicmedicalschoolcampuses.

• Yourprofessionalduesaredeductibleasabusinessexpense.

Ifyouhaveanyquestionsregardingmembershipormembershiprenewal,pleasecontactSusanLightleat(317)879-1881orslightle@academyofosteopathy.org.ThankyouforsupportingtheAmericanAcademyofOsteopathy.

TheAAOMembershipCommitteeinvitesyoutojointheAmericanAcademyofOsteopathyasa2013-2014member.TheAAOisyourprofessionalorganization.ItfostersthecoreprinciplesthatledyoutochoosetobecomeaDoctorofOsteopathy.

Forjust$5.01aweek(lessthanalargespecialtycoffeeatyourfavoritecoffeeshop)orjust71centsaday(lessthanabottleofwater),youcanbecomeamemberoftheprofessionalspecialtyorganizationdedicatedtothecoreprinciplesofyourprofession!

Yourmembershipduesprovideyouwith:• Anationaladvocateforosteopathicmanipulative

medicine(includingappropriatereimbursementforOMMservices)withosteopathicandallopathicprofessionals,publicpolicymakers,themediaandthepublic.

• ReferralsofpatientsthroughtheSearchforaPhysiciantoolontheAAOwebsite,aswellascallstotheAAOoffice.

• DiscountsonqualityeducationalprogramsprovidedbyAAOatitsannualconvocationandweekendworkshops.

• Newonlinecourses.• Networkingopportunitieswithyourpeers.• DiscountsonpublicationsintheAAOBookstore.• Freesubscriptiontothe AAO Journalpublished

electronicallyfourtimesannually.• FreesubscriptiontotheonlineAAO Member Newsletter.

Potential New Dimensions in Dermatology...pg. ???

Forum For osteopathic thought

Official Publication of the American Academy of Osteopathy ®

tradition shapes the Future Volume 23 number 4 december 2013

JOURNALThe AAO

About the artist for the September AAOJ cover:

JordanBlumerisa19-year-oldaspiringartist.ShegraduatedfromCorvallisHighSchool(Corvallis,OR)in2012withbuttwovisualartsclassesunderherbeltandhasyettoentercollege.Havinggrownupwithdoctorsasparents,shepullsmuchinspirationfromthemedicalfield.Aftertheyleftananatomytextbooklyingaroundoneday,shestoleitawayanddiscoveredanewpassioninanatomicaldrawing.Althoughherfavoritemediumiscompressedcharcoal,shehasexploredeverythingfromjewelry-makingandmetalworktocreatingherpromdressoutofducttape.

Cover photo by Dr. Kate McCaffrey, Ashland, Oregon, ©2013.

mailto:slightle%40academyofosteopathy.org?subject=

JThe AAO Forum for Osteopathic Thought

Official Publication of the American Academy of Osteopathy

TRADITION SHAPES THE FUTURE • VOLUME 23 NUMBER 4 • DECEMBER 2013

The mission of the American Academy of Osteopathy® is to teach, advocate and research the science, art and philosophy of osteopathic medicine, emphasizing the integration of osteopathic principles, practices and manipulative treatment in patient care.

OURNAL

Vol. 23, No. 4, December 2013 • The American Academy of Osteopathy Journal Page 3

3500DePauwBoulevard,Ste.1080Indianapolis,IN46268

Phone:(317)879-1881•Fax:(317)879-0563www.academyofosteopathy.org

American Academy of Osteopathy®

DavidCoffey,DO,FAAO. . . . . . . . . . . . . . . . . . . . . . . . .PresidentKennethJ.Lossing,DO. . . . . . . . . . . . . . . . . . . . .President-ElectDianaL.Finley,CMP. . . . . . . . . . . . . . . . . . . ExecutiveDirector

Editorial Advisory BoardDeniseK.Burns,DO,FAAOEricJ.Dolgin,DOClaireM.Galin,DOWilliamJ.Garrity,DOStephenI.Goldman,DO,FAAOStefanL.J.Hagopian,DO,FAAORaymondJ.Hruby,DO,MS,FAAOBrianE.Kaufman,DOHollisH.King,DO,PhD,FAAODavidC.Mason,DOKateMcCaffrey,DOPaulR.Rennie,DO,FAAOHallieJ.Robbins,DOMarkE.Rosen,DOKatherineA.Worden,DO,MS

The AAO JournalKateMcCaffrey,DO. . . . . . . . . . . . . . . . . . . . . . . ScientificEditorKatherineA.Worden,DO,MS. . . . . . . . . . . . . .AssociateEditorDianaL.Finley,CMP. . . . . . . . . . . . . . . . . . . .SupervisingEditorLaurenGood. . . . . . . . . . . . . . . . . . . . . . . . . . . . ManagingEditor

The AAO Journal is the official publication of the AmericanAcademyofOsteopathy.® IssuesarepublishedinMarch,June,SeptemberandDecembereachyear.

The AAO Journalisnotresponsibleforstatementsmadebyanycontributor.Althoughalladvertisingisexpectedtoconformtoethicalmedicalstandards,acceptancedoesnotimplyendorsementbythisjournal.

OpinionsexpressedinThe AAO JournalarethoseoftheauthorsanddonotnecessarilyreflectviewpointsoftheeditorsorofficialpolicyoftheAmericanAcademyofOsteopathy®ortheinstitutionswithwhichtheauthorsareaffiliated,unlessspecified.

Pleasesendemailaddresschangesto:[email protected].

AdvertisingratesforTheAAO Journal, officialpublicationoftheAmericanAcademyofOsteopathy®(AAO).AAOandAmericanOsteopathicAssociationaffiliateorganizationsandmembersoftheAcademyareentitledtoa20percentdiscountonadvertisinginthisjournal.CalltheAAOat(317)879-1881formoreinformation.Subscriptions:$60.00peryear.

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In this Issue:

AAOCalendarofEvents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

CMECertificationofHomeStudyForms. . . . . . . . . . . . . . . . . . 13

The AAOJ2013Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38

ComponentSocietyCalendarofEvents. . . . . . . . . . . . . . . . . . 44

Editorials:

ViewfromthePyramids:ItTakesanOsteopathicVillage . . . . . 4Kate McCaffrey, DO

LookingBackandLookingAhead . . . . . . . . . . . . . . . . . . . . . . . .5Katherine A. Worden, DO, MS

Original Contribution:

ATaleofTwoSisters:AnOsteopathicStory. . . . . . . . . . . . . . . . .7Lawrence Uhrig, DO

TheEffectoftheStudentAmericanAcademyofOsteopathySummerPreceptorshipProgramonStudents’PerceptionofOsteopathicManipulativeTreatment . . . . . . . . . . . . . . . . . . . . . 14

Kathleen M. Vazzana, OMS IV; Vivian Chan, OMS II; Charles Wenzel, JD, OMS IV; and Sheldon C. Yao, DO

TheApplicationoftheCranialConceptintheInvestigationofBafflingMedicalDisordersandTheirTreatment:ASynergopathicMedicalDiseaseModel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Krishnahari S. Pribadi, MD

PotentialNewDimensionsinDermatology:TheOsteopathicApproachtoCutaneousDisease . . . . . . . . . . . . . . . . . . . . . . . . . .34

Ana M. Michunovich, BS, OMS III; and Robert Stern, MD

Case Study:

UseofOMTtoTreatPatientwithRamsayHuntSyndromeandHIV:ACaseStudy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Joshua P. Baker, DO, FAAFP

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http://www.academyofosteopathy.org

Page 4 The American Academy of Osteopathy Journal • Vol. 23, No. 4, December 2013

View from the Pyramids

It Takes an Osteopathic VillageKate McCaffrey, DO

CME QUIZ

The purpose of the quiz, found on page 13, is to provide a convenient means of self-assessment for your reading of the scientific content in “Use of OMT to Treat Patient with Ramsay Hunt Syndrome and HIV: A Case Study” by Joshua P. Baker, DO, FAAFP.

Please answer each question listed. The correct answers will be published in the March 2014 issue of the AAOJ.

To apply for Category 2-B CME credit, record your answers to the AAOJ CME quiz application form answer sheet on page 13. The AAO will note that you submitted the form, and forward your results to the AOA Division of CME for documentation. You must score a 70 percent or higher on the quiz in order to receive CME credit.

DearColleagues,

IwouldliketowelcometoourAAO JournalournewAssociateEditor,KatherineA.Worden,DO.Dr.WordenisanassociateprofessorintheOMMDepartmentatAZCOMandisfromMichigan.Wearefortunatetohaveatalentedandsageosteopathicphysicianjoinoureditorialstaff.IwouldalsoliketoacknowledgethemanydedicatedAAOPublicationCommitteeMembersfortheireditorialassistanceandguidance.ThankyoutoDr.BrianKaufman,Dr.ClaireGalinandDr.RayHrubyforrecruitingauthorsandeditingnumerousarticles.Iwouldliketoaskyou,mycolleagues,topleasecontinueyoureffortstorecruitandreferbothexperiencedandnewwritersandresearcherstosubmittheirworktotheAAOJ—wecanmakethisjournalsuccessfulwitheveryone’shelp!This is your journal and this is our history—let’s create this story together!

ThisDecember2013AAOJisinterestingandthoughtprovoking.Itincludesatouchingarticleaboutthebenefitsofregularosteopathicmanipulationandcareovertwolifetimes.ThroughDr.Uhrig’sarticle,A Tale of Two Sisters: An Osteopathic Story,Iamremindedofthehealththatregularosteopathicmedicalcareprovidesourpatients.

Dr.Baker’scasestudyre-engagesusonadeeperlevelwithneuroanatomyandtheinterconnectednessbetweenOsteopathyintheCranialField,HIVandtheRamsayHuntSyndrome.Heconcludeswithproposingresearchonthistopiconalargerscale.

Welcometoourosteopathicmedicalstudentcontributers!PleasereadStudentDoctorsKathleenM.Vazzana,OMSIV;VivianChan,OMSII;CharlesWenzel,JD,OMSIV;andtheirAttending,Dr.SheldonC.Yao’s,analysisofasummerSAAOProgram’simpactontheperceptionofOMT.KudostoAnaM.Michunovich,BS,OMSIII,andhermentor,Dr.RobertStern,forthereminderofhowabalancednervoussystemaidsinoverallhealth,decreasestheallostericloadanditscoetaneousmanifestation.Welldonestudents!Keepresearching!

Inhisusualandengagingstyle,Dr.Pribadicontinuestochallengeourprofessiontoexpanditsvisionofosteopathyandwhereitfitsintoothermodalitiesanddiseasessuchas“leakygut”syndrome,foodintolerancesandEasternMedicine.

Andfinally,IwouldliketodrawyourattentiontothenumerousCMEopportunitiescomingyourwaythisyearandnextinthebeautifulstateofColoradoandbeyond!

Respectfully,

KateM.


Hello!

Thisfallhasbeenabusyosteopathicseason.IamhonoredtohavejoinedtheteamhereattheAAO JournalwithDr.McCaffrey,LaurenGoodandthePublicationsCommittee.IwouldliketothankDr.SeffingerforthenudgetovolunteerfortheAAO Journal,andIamexcitedaboutitsfuture!

Iwanttosharewithyouasnapshotofmylasttwomonths…andavision.ThispastSeptemberItraveledtomy25threunionfromMSUCOMinEastLansing,MI,whereitwasgreattovisitoldfriends,swapadventures,and,ofcourse,towatchtheSpartanswin!IthoughtitwashightimewepresentedvisceraltreatmenttoMichigandoctorsandpresentedaworkshoponthetreatmentforthe“MichiganNose”thatwaswellreceived.OurAZCOMOMMDepartmentJournalClubmettodiscussthenew10-yearStrategicPlanforOsteopathicResearch.Wealsodiscussedthemulti-sitestudyonCounterstraintenderpointfrequencyinosteopathicmedicalstudentsheadedbytheKirksvilleteam.Kudostoall!WegraduatedourfirstNMMPlusOneResidentfromournewprogram,GregHeller,DO,whowonhisdivisionoftheAAOResearchPosterContestatConvointheSpring.

InearlyOctoberEdnaM.Lay,DO,FAAO,FCA,andtheSCTFfacultyvisitedAZCOMandpresentedanIntermediateCranialCourse.ThiswasDr.Lay’sfinalteachingventure,andweweregratefultoherforallofherteachingsovertheyears.WealsoconvenedacommitteetodevelopanOCA-approved40-hourBasicCranialCourseoncampusforstudents.

Inmid-OctoberIfinallymademyvisitto“theMothership,”A.T.StillUniversityinKirksville,MO.BrianL.Degenhardt,DO,andhisteammettocontinuetobuildaOsteopathicPhysician–BasedResearchNetwork(PBRN)whichyoumayhaveheardofasDO-Touch.Net.Thisnetworkwillallowourresearcherstodevelopclinicalstudieswithlargernumbersofsubjectsbycombiningdatafrommultiplesites.Thisforwardthinkinginvolvesbuildinganinfrastructureinourprofessionfromwhichbetterresearchmaybeaccomplished.Ifyouorothersyouknowareinterestedinjoiningthisnetwork,[email protected].

Looking Back and Looking Ahead Katherine A. Worden, DO, MS

WhatfuntodrivedownOsteopathyStreetinKirksville,haveyourpicturetakenwiththeStatueofthe“OldDoc”onthetownsquare,seethepreservedlogcabinandfirstschoolofOsteopathy,andgazeuponthewallsoftheroominwhichweweremeetingtoseeapictureofayoungLouisaBurns,DO,andtheoriginalportraitofW.G.Sutherland,DO—yesthatone!Thehighlightofthetrip,however,wassittinginthebackroomofthelocalwateringhole,theWoodenNickel,onSaturdaynightbeingenthralledbystoriesoftheearlydaysofOsteopathytoldbyJason,thecuratoroftheMuseumofOsteopathy.Recentdiscoverieshaveledtonewmysteries,suchasWhat did A.T. have inside those boots all those years and why?

InNovemberIwasoneofmanyDOsrecruitedtohelpadministertheNMM/OMMBoardExamstoalargeclassof50+whoareseekingBoardCertification.

WhydoIshareallthiswithyou?SothatyoumaytakeheartthatOsteopathyisaliveandwellandgrowing…inourtreatmentrooms,onourcampuses,inourresidencies,andinourpresentandfutureresearchendeavors.Dowecontinuetohaveuniquechallengesinthecurrentmedicalclimate?Absolutely.ButweareproducingthelargestandperhapsthebrightestgenerationofDOswhowillhelpustofindcreativewaystomeetthosechallenges.Itisourjobasmentorstokeeptheminspiredandengagedingrowingtheirosteopathichandsandhearts.Itistimeforosteopathicphysicianstocreatesteppingstonesratherthanroadblocksforthisnextgenerationtolearnoftheirrichheritage,developtheirosteopathicskillsandleadusintothefuture.

ItistheAAO Journal’scollectivevisiontofillaneededvoidindevelopingnewwritersandresearchers.Wewouldliketocontinuetorecordosteopathichistoryasithappens.Eachissuestrivestobeasnapshotofcurrenteventsaffectingourprofession.IfyouhaveideasabouthowtomakethisJournalevenbetterortosubmitanarticle,feelfreetocontacttheAAO [email protected].

Thanksforlistening…

KateW.

mailto:[email protected]


AAO Calendar of Events

Mark your calendar for these upcoming Academy meetings and educational courses.All times local.

2014

January 1 FAAOApplicationsDue

January 29 COFAAOWebConference,8:30pm

TBD MembershipCommitteeTeleconference

February 1-2 BoardofTrustees’StrategicPlanningMeeting—AAOOffices,Indianapolis,IN

February 7-8 EducationCommitteeMeeting—1:00pm,AAOOffices,Indianapolis,IN

February 14-16 Basic Percussion Course—RichardW.Koss,DO—TCOM,FortWorth,TX

March 15-18 New Approach to Osteo-Articular Manipulations Including the Superior and Inferior Limbs(Pre-Convo),Jean-PierreBarral,DO(France);KennethJ.Lossing,DO—TheBroadmoor,ColoradoSprings,CO

March 17-18 Osteopathic Approach to Common ENT Complaints of Childhood (Pre-Convo)—HeatherP.Ferrill,DO,TheBroadmoor,ColoradoSprings,CO

March 17-18 Fascial Distortion Model(Pre-Convo)—ToddA.Capistrant,DO,TheBroadmoor, ColoradoSprings,CO

March 18 COFAAOMeeting—TheBroadmoor,ColoradoSprings,CO

March 19 BoardofTrusteesMeeting—8:00am,TheBroadmoor,ColoradoSprings,CO

March 19 BoardofGovernorsMeeting—1:00pm,TheBroadmoor,ColoradoSprings,CO

March 19-23 AAOConvocation—Trauma: An Integrated Osteopathic Approach DeniseK.Burns,DO,FAAO,ProgramChair—TheBroadmoor,ColoradoSprings,CO

February 14–16, 2014 at TCOMCourse Description and Background:At Dr. Fulford’s last course in May of 1997, he expressed his desire to leave his ailing body after his scheduled presentation to the Cranial Academy in June. After demonstrating what he was going to present to the Cranial Academy, he asked Dr. Koss (Program Chair) and Dr. Rajiv L. Yadava to continue teaching his work to the Osteopathic profession. Dr. Fulford passed away four days after the Cranial Academy presentation.

This course has been restructured to provide the participant a more complete understanding and experience of Dr. Fulford’s contributions to Osteopathy. Although hand and percussion techniques are included, the course emphasizes increasing the clarity of one’s working knowledge. Based on the participant’s inclinations, there is freedom within the curriculum to change the direction of what information is relayed. Time needed to assimilate what is taught will also be respected.

Prerequisites:This Level III course is for DOs, MDs, dentists and students with a 40-hour approved Cranial course and/or prior training and experience

in Cranial Osteopathy or permission from the program chair.

Course Objectives:• One will recognize that many of Dr. Fulford’s

ideas are rooted in Dr. Still’s and Dr. Sutherland’s teachings;

• One will begin to see that the results realized from the use of the percussor is directly dependent on the osteopath’s understanding;

• One will see that the use of the percussor will save the physician time and energy; and

• One will appreciate that Dr. Fulford gave more to Osteopathy than a new technique.

CME:22 hours of AOA Category 1-A credit is anticipated

Course Location:Texas College of Osteopathic Medicine3500 Camp Bowie Blvd.Fort Worth, TX 76107(817) 735-2000

Richard W. Koss, DO

Robert C. Fulford, DO

Dr. Robert C. Fulford’s Basic Percussion Course

Click here to register

online.

https://netforum.avectra.com/eweb/DynamicPage.aspx?Site=AAO&WebCode=EventDetail&evt_key=035088e2-b5f9-4b8f-94d1-05baae12243e




A Tale of Two Sisters: An Osteopathic Story Lawrence M. Uhrig, DO

Hereisaniceanecdotalstoryoftwosisterswhohavewalkedthisearthfornearlytwocenturiesbetweenthetwoofthem.Dorothyhasbeenapatientinmypracticeforover55years,gettingregularosteopathictreatmentsand,rarely,medicaltreatmentforminorillnesses.Ihavetreatedherforthe23yearsthatIhavebeeninthisofficewithmytraditionalosteopathicpractice.IhavetreatedDorothywiththoroughosteopathicmanipulationonamonthlybasisformyentirecareer.

Dorothyisanelegant95-year-oldwomanwhoisveryactivewithchurchactivities,shopping,socializingandgoingouttoeatwithfriendsalmostdaily.Shewalksfullyupright,hasveryfewcomplaintsaboutarthritis,backachesorinternalproblemsbutdoescarryacaneincasesheneedsitinherdailyactivity.ShehasbeentreatedintheofficewhereIcurrentlyworksincethelate1950swhenHerbertC.Miller,DO,FCA,andWilliamRankin,Sr.,DO,workedhere.WilliamRankin,Jr.,DO,treatedherfollowinghisfather’sdeathin1965,andIstartedtreatingDorothyin1990whenIjoinedDr.Rankin,Jr.’s,practice.Dorothyisamodelpatient,neverforgettingherappointments,stilldrivingandlivingbyherself,alwaysverypleasanttotreatandthankfulforwhatOsteopathyhasdoneforherovertheyears.Shehasenjoyedatremendouslyhealthylifewithonlyrecentperiodicheartirregularityandanepisodeofshingles.Littleelsehasevertroubledher.

Dorothy’soldersister,Violet,is97yearsoldandalsoisaverypleasantwomantochatwithandvisit.

Violethasneverbeentreatedinourofficeand,otherthansomeregularfluvaccinations,hasneverbeentreatedbymeforanymedicalissues.Sheseesanotherprimarycarephysiciantohelpherdealwithanumberofmedicalandmusculoskeletalissues.Violethas,therefore,neverreceivedosteopathiccareduringhernearcenturyonearth.

OtherthanoccasionalvisitstochurchonSunday,Violetrarelyleavesherhouse.Shesitsinareclinermostofthedayandusesawalkertoambulatewhatlittlesheisableto.Shehasatypicalstoopedosteoporoticposturewithambulation.Sheisnotabletowalkfarorcarrymuchweightduetoherweakness,spinalcompressionandosteoarthritisrestrictions.

So,wehaveananecdotalcomparisonoftwosisterswhohavereceiveddifferentapproachestotheirhealthcareduringtheirlives.WeknowthatOsteopathywasfoundedontheprinciplesofA.T.Stilltomaintainhealthasmuchaspossiblebyworkingtoimprovecirculationandoptimizemobilityasclosetonormalaspossible.Certainlygeneticandenvironmentalforcescaninfluencehealthinmanywaysbutitisawonderfulconsiderationthat,atleastinDorothy’scase,Osteopathyhasprobablyallowedhertoenjoybetterhealthandmobilityandmaximizeherabilitytogetthemostoutofwhatlifehashadtooffer.DorothyandVioletarebothwonderfulpeopletoknow,andhopefully,bothhavemorehealthyyearsahead.

Thankyou,Dr.Still!

Above: Dorothy in the office. Right: Dorothy and Violet.


Figure 171. Pterygopalatine ganglion.Putz, Pabst: Atlas of Human Anatomy ©Elsevier GmbH, Urban & Fischer, Munich.

Abstract

A31-year-oldmalepresentswithaskinrashonafewlocationsonhisleftearandleftforehead.Apresumptivediagnosisofimpetigoismadeandtreatmentisinitiated.Severaldayslater,thesamepatientreturnswithfacialparalysisonthesideoftheskinlesions.AdiagnosisofRamsayHuntsyndromeismadeandthenconfirmedthroughtissuepathologicanalysisandPCRanalysis.RamsayHuntsyndrome,thereactivationofherpeszosterviruswithinthegeniculateganglionofthefacialnerve,presentswithavarietyoffacialnervepathologiesincludingskinrashandfacialparalysisasitdidinthiscase.Itcanpresentwithavarietyofothercranialnerveneuropathicpresentations,asitdidinthiscaseaswell.Adjuvanttreatmentwithosteopathicmanipulativetreatment(OMT)wasinitiatedattheonsetofthefacialpalsy.HIVpatientswithRamsayHuntsyndromehaveshowedtohaveapropensitytomoresevereneurologicsymptomsandcomplications.Inthiscase,thepatientresultedincompleteresolutionofallhissymptoms.

Use of OMT to Treat Patient with Ramsay Hunt Syndrome and HIV: A Case StudyJoshua P. Baker, DO, FAAFP

Presentation of a Case

A31-year-oldCaucasianmalepresentedFebruary2013ondaytwoofarashonhisleftforeheadandleftearthatbegansimultaneously.Bothlesionsappearedasscab-like,theearlesionasmildlypruriticinhisearcanalwitherythemaaroundthelesion,whiletheforeheadlesionwasasymptomatic.Thepatientdeniedburning,stinging,bleeding,pain,vertigo,dizziness,weakness,headache,fevers,chills,sweats,hearingloss,tinnitusandfacialparesthesias.Hefeltcompletelynormalexceptforthisnewrash.Healsopresentedondaytwoofasorethroatwithmildodynophagia,whichhestatedwascomparabletowhenhehadpreviouslybeendiagnosedwiththrush.Hisphysicalexamwasunremarkablewiththeexceptionofthethreebelowregions:

1. Leftforehead:scabbedoverpapule3mmx3mmwithtendernesstopalpation.Nofluctuance,surroundingredness,honey-crustedscale,discharge,hyperesthesia,purulence,vesicles.

2. LeftEar:tender,fluid-filled2mmx2mmpustuleonantihelixwithassociatedhoney-crustedplaqueinvolvingantihelixaroundthepustule

approximately1cmx1cmwithearrednessinthisregion.Thescalealsospreadfromtheantihelixtotheconchaandintothelateralone-fourthofthesuperioraspectoftheearcanal.Wherethecrustinghadbeenremovedintheearcanal(duetopruritus),therewasunderlyingerythema.Noinduration,fluctuance,warmth,edema,clearfluidfilledvesicles,hyperesthesia,


bleeding,discharge,tympanicmembraneabnormalities.

3. ENT:diffusebilateralpharyngealerythemawithscatteredwhiteplaques.

Thepatient’smedicalhistoryincludedadiagnosisofhumanimmunodeficiencyvirus(HIV)madeAugust2012withinitiationofhighlyactiveantiretroviraltreatment(HAART)atthattime.HispresentingillnessAugust2012wasanAIDS-definingillness:pneumocystisjirovecipneumonia.Theremainderofhismedical,surgical,allergy,alcohol,tobaccoandsocialhistorywasunremarkable.

ThepatientreportedthathismostrecentCD4countwasnormal.(Thoserecordsareunavailabletotheauthor.)CurrentmedicationsincludedReyataz(atazanavir)300mgPOoncedaily,Truvada(emtricitabine/temofovirdisproxil)200mg/300mgPOoncedaily,andBactrimDS(trimethoprim/sulfamethoxazole)160/800POoncedaily.

Theinitialshortlistassessmentofthisskinrashincludedimpetigo,varicella-zostervirus(VZV)andherpessimplexvirus(HSV).Thepharyngealabnormalitywasconsistentwithoropharyngealcandidiasisandlesslikelyesophagealcandidiasis.Theseskinlesionswerehighlyconsistentwithimpetigo.HelackedmultiplesymptomsthatareusuallypresentinVZVorHSV,namelyparesthesias,tingling,hyperesthesias,pain,burning,stingingandclearfluidfilledvesicles.Othermoreseveresymptomsmayhaveincludedfacialnervepalsy,tinnitus,hearingloss,vertigo,dizziness,conjunctivitis,photophobia,visionchanges,eyepainandothereyesymptoms.Additionally,thelocationofthelesiononhisforeheadwasinthedistributionofophthalmicdivisionofthetrigeminalnerve(V1),andtheearlesionwasonthemandibulardivisionofthetrigeminalnerve(V3)andpossiblymayhaveinvolvedthefacialnerve(CNVII)attheearcanal.ThiswouldmakeHSVunlikelyandwouldmakeVZVmultidermatomalinnature;whichisuncommon.

Thetreatmentplanincludedthefollowing:fluconazole(Diflucan)100mgPOoncedailyfor30days(firstdoseof200mgfollowedby100mgonsubsequentdays);Nystatin100,000units/mLsuspension5mlrinseandswallowfourtimesperdayfor10days;mupirocintopical(Bactoban)2%ointmentappliedtopicallytoaffectedareasthreetimesdailyfor14days.

Ondaynineoftheillness,thepatientreturnedtotheofficebecausehenoticedatwo-dayprogressivelyworseningleftfacialparalysiswhichincludedthe

inabilitytoclosetheeye,puffouthischeeks,smileandfrown.Thepharyngealpainhadcompletelyresolved.Theforeheadlesionwasstillscabbedoverandasymptomatic.Theearlesionhadresolutionoftheredness,resolutionofpruritus,significantdecreaseofscaling/crusting,andhewasotherwisefeelingwell.Hisreviewofsystemswasnegativeforvisionproblems,eyepain,redeye,photophobia,eyesymptomsofanykind,vertigo,tinnitus,dizziness,earpain,eardrainage,palatepain,tongueparesthesias,tasteproblems,facialparesthesias,headache,fevers,chills,andsweats.Hewasfeelingcompletelynormaldespitethisnewonsetfacialnerveparalysis.

ApresumptivediagnosisofRamsayHuntsyndrome(reactivationofvaricella-zosterviruswithinthegeniculateganglionoftheseventhcranialnerve)wasmade.EvaluationincludedlesionalswaboftheforeheadandearlesionsforHSVandVZV,moleculardetection,polymerasechainreaction(PCR),dermal,andcompleteexcisionoftheleftforeheadlesionsentforpathologicanalysis.Hisnewtreatmentincludedacyclovir(Zovirax)800mgPOfivetimesdailyforsevendays;Prednisone9-daytaper(50mgPOoncedailyforfivedays,40mgx1day,30mgx1day,20mgx1day,10mgx1day);Systanebrandophthalmiclubricantduetoinabilitytoclosehiseyelidcompletely;initiationofosteopathicmanipulativetreatment(OMT)anddiscontinuationoftopicalmupirocin(Bactroban).AdetaileddescriptionofsomaticdysfunctionsandOMTprovidedwillbeaddressedinthediscussionsectionofthisarticletofollow.

Figure 1181. Facial nerve VII; the facial canal and tympanic cavity have been opened; viewed from the right. Clinical term: cerebellopontine angle.Putz, Pabst: Atlas of Human Anatomy ©Elsevier GmbH, Urban & Fischer, Munich.


Onday11,theHSVandVZV,moleculardetection,PCR,dermaltestresultedinthedetectionofvaricella-zostervirusDNA.

Byday17(postoperativedayeight),thewoundonthepatient’sforeheadwaswellhealed,andsutureswereremoved.Theskinlesiononhisearwascompletelyresolved.Heneverusedtheophthalmiclubricant,ashewasabletofullyclosehiseyeinamatterofdaysafterhewasseenondaynineoftheillness.Hereportedhewasunabletonoticehisfacialpalsy.Hisphysicalexamwasconsistentwithanormalappearingforeheadandear.Hisfacialpalsywasnearlyresolvedbutstillperceptibletoadetailedexam.OMTwasperformed.

Onday18,thepathologyreportontheforeheadlesionrevealedabenignulcerwithnoevidenceofherpesviruscytopathiceffectseen,namelyviralinclusions.

Onday24,arecheckintheofficewasperformed,andhewasunabletoperceivethefacialpalsy.Uponexamduringhisnormalconversation,thepalsywasimperceptible.Detailedexaminationrevealedamildlyperceptiblefacialasymmetrywhenhesmiled,frownedandfurrowedhiseyebrowswithmaximalintensity.OMTwasperformed.

Onday31,arecheckintheofficerevealedacompleteresolutionofanyfacialasymmetryondetailedexam.OMTwasperformed.

Recheckswereagainperformedondays38and45toperformOMT.Onday45,resolutionofhiskeylesionwasnotedpriortoinitiationofOMT.Atthatpoint,nofurtherevaluationortreatmentwasrecommended.Atday45,hissymptomswerecompletelyresolved,hiskeysomaticdysfunctionwasnolongerpresent,andnofurtherfollowupwasrecommendedforthisproblem.

Clinical Discussion: Ramsay Hunt Syndrome

RamsayHuntsyndrome(RHS)isreactivationoftheherpeszostervirusoriginatingfromthegeniculatenucleusofthefacialnerve(CNVIII)thatislocatedwithinthefacialcanalwithinthetemporalbone.1

Typically,RHSpresentswithunilateralfacialparalysis,neuropathicpainanderuptionofherpeticvesicleswithinthedistributionofthesensoryinnervationsfromtheafferentfacialnervefibers.Othertypicalpresentationsincludetinnitus,vertigoandhearinglossduetothejuxtapositionofcranialnervesVIIandVIIIinthefacialcanal.Multiple,lesstypicalmanifestationsincludevariousneuropathiesofthefollowingnervespresentedindecreasingfrequency:vestibulocochlearnerve(CNVIII),glossopharyngealnerve(CNIX),trigeminalnerve(CNV),vagusnerve(CNX)andabducensnerve(CNVI).Additionally,thepresentationofRHSinpatientswithHIVisknownforitsmoresevereneurologicpathologyandisalsofoundtoresultingreaterneuropathicsequelae.1,2,3,4

brings to light a rich tradition of excellence in education and leadership. Currently, the Georgia Campus—Philadelphia College of Osteopathic Medicine, in the greater Atlanta area, has the following exciting positions available:

Full time faculty position in the Department of Osteopathic Manipulative Medicine. This individual will be expected to teach osteopathic medical students in both lecture and laboratory sessions in all four years of the curriculum, see patients and develop an outpatient clinic for M-3 month long rotation, plan and supervise OMM Inpatient Student Service, assist in preparation of OMM video clips and tutorials, participate in existing research and initiate new OMM research, assist in planning and production of new publications, and assist in planning and supervision of the OMM Residency. The successful applicant will have a D.O. degree and proficiency in osteopathic manipulative medicine. The candidate needs to have or be eligible for a license to practice Osteopathic Medicine in the State of Georgia. Board Certification or eligibility by the AOBNMM or AOBSPOMM is required. Additional Board Certification or eligibility by the AOBFM is desirable. The review of applications will begin immediately and continue until the position is filled. Salary for this position will be commensurate with experience and qualifications.

Seeking qualified Osteopathic Physician for a full-time Clinical Education Coordinator. This full time position reports to the Chair of Undergraduate Clinical Education. This individual will be responsible as the Director of the Advanced Clinical Skills Program. He/She will supervise the Clinical Adjunct Faculty’s participation in the didactic educational programs and assist the Chair in management of the Clinical Clerkship program. Minimum of five years in a clinical practice. Experience in clinical education as a Clerkship Director, Program Director, Didactic Educator, or similar activities. Must be Board Certified in a Primary Care specialty.

To apply for these positions, send via E-mail a personal statement describing interest in and qualifications for this position, a curriculum vitae, and names and addresses of three references, preferably from current or former supervisors.

All inquiries must include salary requirements and should be directed to:EOE

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InformationregardingRamsayHuntsyndromeinpatientswithHIVislimited.Theauthorlocatedatotalofeightothercasesintheliteraturethatreportedavarietyofsigns/symptomsaswellasvariedfinaloutcomes.Thereisonlyoneothercasereporttodateofapatientrecoveringwithcompleteresolutionandwithoutsequelae.5

ThestandardtreatmentforRamsayHuntsyndromeisearlyinitiationofsystemicantiviralsthataretypicallyusedforvaricella-zostervirussuchasacyclovir(Zovirax)inadditiontotheuseofsystemiccorticosteroids(suchasprednisone)inavarietyofdosingschedules.6,7

ThereisalackofrecommendationsforthetreatmentofafacialnervepalsyfromRHS,butthereareothertreatmentoptionsforidiopathicfacialnervepalsythatincludethefollowing:acupuncture,physicaltherapy,occupationaltherapy,biofeedback,osteopathicmanipulativetreatmentandneuromuscularre-education.Surgicalintervention,intheformofdecompression,isnotrecommendedinRHSduetothetypicalpresenceof“skip”regionsanddiffusesneuritisofthefacialnerve.8,9,10,11,12

Thepatientinthiscasestudyhadsigns/symptomsthatinvolvedmultiplenervedistributions

• Facialnerve(CNVII)

» skinlesionsintheearcanal

» facialpalsy

• Mandibulardivisionoftrigeminalnerve(V3)

» skinlesionsontheearantihelixandconcha

• OphthalmicdivisionoftrigeminalverveV(V1)

» skinlesionontheforehead

Thispatientreceiveddelayedinitiationofantiviralandsystemiccorticosteroidadministrationduetotheatypicalpresentationbutdidreceivethemnonetheless.Asidefromthedelayedinitiationofthosemedications,nodeviationfromstandardcarewasidentified.

Clinical Discussion: Use of OMT in Ramsay Hunt Syndrome

AdjuvanttherapywithOMTwasutilizedinthiscasestudy.Thispatientdemonstratedrepeatedipsilateraltemporalbonedysfunctions,whichwerethekeylesions.Therewasnopatterntothespecificdysfunction.Occasionally,itwasfoundinternallyrotatedandatothertimesitwasexternallyrotated.Therewasnomorespecificpatternnotedthantherepeatedipsilateraltemporalbonedysfunctionitself.

Intotal,hereceivedOMTonsixoccasions,days9,17,24,31,38and45oftheillness.

OMTwasperformedonmultiplebodyregionsduringeachtreatmentsession,utilizingmultipletreatmentmodalities,withafocusofOsteopathyintheCranialFieldmainlyontheheadandsacrum.Aspreviouslymentioned,theipsilateraltemporal

Figure 1411. Inner ear with the facial nerve and the vestibulocochlear nerve; projected onto the petrous part of the temporal bone; superior view. Putz, Pabst: Atlas of Human Anatomy ©Elsevier GmbH, Urban & Fischer, Munich.


bonedysfunctionappearedtobethekeylesionthroughoutthishealingprocess.Comparedtotheotherdysfunctionspresentineachtreatmentsession,thetemporalbonedysfunctionsweremoresevereandrequiredmoretimetotreatuntilresolution.Thesedifficultdysfunctionsalwaysrespondedtotreatmentduringeachtreatmentsession.Directandindirecttreatmentmodalities(withapersonalpreferencetowardindirectbytheprovider)wereutilized.Therewasnopatternnotedaboutwhattypesoftreatmentsweremoreeffective.Onsomeoccasions,directtreatmentsweremosteffectivewhileatothertimes,indirecttreatmentswereeffective.Onsomeoccasions,bothtypesoftreatmentswereneeded.

Uponreviewofthemedicalliterature,therearenocasereportsinvolvingtheuseofOMTforafacialnervepalsyinducedbyRamsayHuntsyndrome.ThereareotherpublicationsregardingtheuseofOMTinotherknowncausesaswellasinidiopathicfacialnervepalsy.Twoofthesepublicationsnoteipsilateraltemporalbonedysfunctionsbeingprevalent,similartothiscasereport.Oneotherpublicationnotestheabsenceofthisfindingaltogether.13,14,15

Conclusions

RHSmaypresentinavarietyofways,especiallyinHIV,thusrequiringtheosteopathicphysicianunderstandthecranialnerves’structureand

functions.Thiswillthenenablecorrectrecognitionofneuropathies.TheadditionofOMTasadjuvanttreatmentforRHSisbasedupontheprincipalsofosteopathicmedicine.Inparticular,OsteopathyintheCranialFieldhaspotentialforabeneficialoutcomeinpatientswhopresentinthismanner.Treatmentofthepatient’scranialdysfunctionscanassistinthenormalizationofsomaticcomplaints.

Thepatientinthisstudyhadamagnificentendresultwithcompleteresolutionofallhissymptomsfollowingallthetreatments;howeveritisnotscientifictoclaimthatOMTwasthereasonhehadsuchanastoundingoutcome.Thiscaseexemplifiesoneapproachandcouldprovideaframeworkforfurtherstudyinthehopesthatovertimepatternsandconsistenciesthatcanhelpguideosteopathicphysicianscanbeestablished.

Acknowledgements:TheauthorwouldliketoacknowledgeTonyNguyen,MLIS,forhisexpertiseinliteraturesearch.

References1. Chapter7.CranialnerveVII.In:JonesHR,SrinivasanJ,Allam

GJ,BakerRA,eds.Netter’s Neurology.2nded.Philadelphia,PA:Saunders-Elsevier;2012:98-108.www.ClinicalKey.com.Accessed09-17-2013.

2. GilchristJM.SeventhCranialNeuropathy.Seminars in Neurology.2009;29(1):5-13.

3. GlesbyMJ,MooreRD,ChaissonRE.Clinicalspectrumofherpeszosterinadultsinfectedwithhumanimmunodeficiencyvirus.Clinical Infectious Diseases.1995;21:370-375.

4. MeenstraJ,vanPraagR,KrolA,vanDillenP,WeigelHM,SchellekensP,LangeJ,CoutinhoR,vanderMeerJ.ComplicationsofvaricellazosterreactivationinHIV-infectedhomosexualmen.AIDS.1996;10:393-399.

5. GoldaniLZ,FerreiradeSilvaLF,DoraJM.RamsayHuntsyndromeinpatientsinfectedwithhumanimmunodeficiencyvirus.Clinical and Experimental Dermatology.2009;34:e552-e554

6. UscateguiT,DoreeC,ChamberlainIJ,BurtonMJ.CorticosteroidsasadjuvanttoantiviraltreatmentinRamsayHuntsyndrome(herpeszosteroticuswithfacialpalsy)inadults.Cochrane Database of Systematic Reviews.2008;3:CDC006852.

7. UscateguiT,DoreeC,ChamberlainIJ,BurtonMJ.AntiviraltherapyforRamsayHuntsyndrome(herpeszosteroticuswithfacialpalsy)inadults.Cochrane Database of Systematic Reviews.2008;4:CDC006851.pub2.

8. ManikandanN.Effectoffacialneuromuscularre-educationonfacialsymmetryinpatientswithBell’spalsy:arandomizedcontrolledtrial.Clinical Rehabilitation.2007;21:338-343.

9. ShafshakTS,Thetreatmentoffacialpalsyfromthepointofviewofphysicalandrehabilitationmedicine.Europa Medicophysica.2006;42(1):41-47.

Figure 1429. Facial nerve within the petrous part of the temporal bone; the petrous part of the temporal bone, as well as the facial canal and the tympanic cavity, have been partially opened; posterior view. Putz, Pabst: Atlas of Human Anatomy ©Elsevier GmbH, Urban & Fischer, Munich.

continued on page 17


September2013AAO Journal CMEquizanswers:

1. E2. A3. C4. C

AnswerstotheDecember2013AAOJCMEquizwillappearintheMarch2014issue.

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READthefollowingarticleforAOACMEcredits.

Name of Article:UseofOMTtoTreatPatientwithRamsayHuntSyndromeandHIV:ACaseStudy

Authors: JoshuaP.Baker,DO,FAAFP

Publication: AAOJ,Volume23,No.4,Dec.2013,pp.8-12

Mailthispageto:AmericanAcademyofOsteopathy3500DePauwBlvd.Suite1080Indianapolis,IN46268

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ThisCMECertificationofHomeStudyFormisintendedtodocumentindividualreviewofarticlesintheAmerican Academy of Osteopathy JournalunderthecriteriadescribedforCategory2-BCMEcredit.

Completethequiztotherightbycirclingthecorrectanswer.MailyourcompletedanswersheettotheAAO.TheAAOwillforwardyourresultstotheAOA.Youmusthave70percentaccuracyinordertoreceiveCMEcredits.

1. RamsayHuntsyndromeisareactivationoftheherpeszosterviruswithinwhichnervebody?a. Geniculateganglionofthefacialnerve(cranial

nerveVII)b. Trigeminalganglionofthetrigeminalnerve

(cranialnerveV)c. C2Dorsalrootgangliond. Pterygopalatineganglion(alsoknownas

sphenopalatineganglion)ofthefacialnerve(cranialnerveVII)

2. RamsayHuntsyndromemaypresentwiththefollowingsymptomsexcept:a. Unilateralfacialmuscleparalysisb. Vesicularrashintheearcanalc. Vertigoandhearinglossd. Anosmia

3. WhichOsteopathicmanipulativetreatmentswouldbereasonabletoapplyonapatientwithRamsayHuntsyndromeandaunilateralfacialmuscleparalysiswhoalsopresentedwithanipsilateralinternallyrotatedtemporalbone?a. Directtreatmentaugmentingexternalrotation

ofthedysfunctionaltemporalboneb. Indirecttreatmentaugmentinginternal

rotationofthedysfunctionaltemporalbonec. Venoussinusdrainaged. Alloftheabove

4. PermanentneurologicsequalaeiscommoninRamsayHuntsyndrome.a. Trueb. False


The Effect of the Student American Academy of Osteopathy Summer Preceptorship Program on Students’ Perception of Osteopathic Manipulative Treatment

Kathleen M. Vazzana, OMS IV; Vivian Chan, OMS II; Charles H. Wenzel, JD, OMS IV;and Sheldon C. Yao, DO

Abstract

Context:Tomaintaintheidentityoftheosteopathiccommunity,itiscrucialtohaveprogramsthatencourageosteopathicmedicalstudentstoutilizeOMT.TheStudentAmericanAcademyofOsteopathy(SAAO)SummerPreceptorshipProgramisauniqueprogramthatfocusesongivingclinicalOMTexposuretosecond-yearstudents.

Objective:TodetermineifparticipationintheSAAOSummerPreceptorshipProgramaffectedstudents’perceptionsofOMTandlikelihoodofintegrationofOMTintostudents’futuremedicalpractice.

Design:Survey

Setting: NewYorkInstituteofTechnologyCollegeofOsteopathicMedicine(NYIT-COM)

Participants:Second-yearosteopathicmedicalstudents

Main Outcome Measure:WemeasuredtheinterpretationsofOMTusingLikertscalesreportedbytheparticipants.

Method: Fiftyparticipantswereadministeredapapersurveycontaining12multiple-choiceandfiveopen-endedquestionsregardingtheirperceptionsofOMTandexperienceswiththeprogram.

Results: Thirtystudentscompletedthesurvey.Twenty-ninestudentshadanimprovedconfidencelevelandunderstandingoftheclinicalapplicationwithusingOMT;onewasundecided.Twenty-ninestudentsweremorelikelytointegrateOMTintotheirfuturepractice;onewasundecided.Twenty-sevenstudentshadanexpandedawarenessofwhatconditionscanbetreatedwithOMT;threewereundecided.Twenty-ninestudentshadanoverallpositiveperceptionofOMT;onewasundecided.

Conclusions:TheSAAOSummerPreceptorshipProgramhadapositiveeffectonstudents’perceptionofOMTandlikelihoodofintegrationofOMTintotheir

futuremedicalpractice.Follow-upstudyiswarrantedtodetermineactualeffectsonfutureutilizationofOMTinclinicalpractice.

IRB: ApprovedbyNYITIRB.IRB#BHS970.(8/20/2013)

Introduction

Inmedicaleducation,thecurrentliteraturehasdeterminedthepositiveinfluenceofclinicalexperienceandrolemodelsonmedicalstudents’attitudestowardhealthprofessionsandcertaincareerspecialties.1-5AttheMayoMedicalSchool,exposuretoanoptionalweek-longpediatricsexperienceledtoanincreaseininterestandknowledgeinthefieldofpediatricsamongitsfirst-andsecond-yearmedicalstudents.Greaterthan25percentoftheschool’sfirst-andsecond-yearmedicalstudentsparticipatedinthisselectiveexperience,consistingofworkshopsandfacultyandresidentpaneldiscussions.6Otherstudieshavesimilarlydemonstratedthatexposingstudentstoparticularspecialtiesintheirpre-clinicalyearsincreasestheirpredilectiontowardschoosingthatspecialty.7,8

Practicingosteopathicmanipulativetreatment(OMT)ispartoftheuniqueidentityofdoctorsofosteopathicmedicine.However,ithasbeenutilizedlessfrequentlybyrecentosteopathicmedicalgraduates.9,10ChamberlainandYatesfoundthatpriortoenteringrotations,over70percentofsecond-yearosteopathicmedicalstudentsdecidedthattheywouldnotutilizeOMT.Withinthesamestudentpopulationupongraduation,thepercentageofstudentsthatweredisinclinedtowardOMTuseroseto90percent.11

Tomaintaintheidentityoftheosteopathiccommunity,itiscrucialtohaveprogramsthatencourageosteopathicmedicalstudentstoutilizeOMT.Teng,AK,etal.foundthattheadditionofamandatorythird-yearandfourth-yearclinicalosteopathicmanipulativetreatment(OMT)exposureledtoanimprovementinthestudents’reportedcomfortlevelwithOMT;however,students’overallattitudetoward


OMTusewasnotexamined.12TheeffectofprovidingOMTclinicalexperiencesduringthepre-clinicalmedicaleducationyearsmeritsfurtherstudy.

TheStudentAmericanAcademyofOsteopathy(SAAO)SummerPreceptorshipProgramisauniqueprogramofferedbyNYITCollegeofOsteopathicMedicine(NYIT-COM).ThisprogramprovidesOMTworkshopsandclinicalsessionstoincomingsecond-yearstudents.Thisstudyassessestheeffectivenessofthe2013SAAOSummerPreceptorshipProgramoninfluencingstudents’attitudesandprospectiveuseofOMT.

Description of SAAO Summer Preceptorship Program

Thisyear’sSAAOSummerPreceptorshipProgramranfromJune10toJuly26,2013.Fifty-tworisingsecond-yearmedicalstudentsparticipatedintheprogram;50studentscompletedtheprogram.Tocompletetheprogram,studentswererequiredtoattendatleast10outof14workshopsandcompletetwoshadowingsessionsofosteopathicphysiciansattheAcademicHealthCareCenteratNYIT-COM.The14workshopsincludedtopicsrangingfromcase-basedpresentationsutilizingOMTtoalternativemedicines.Mostworkshopsranforonehour,weretaughtbyosteopathicphysicians,andincludedtimeforstudentstopracticedemonstratedtechniquesononeanother.

Date Workshop Description

June10 IntroductiontotheProgramandBalancedLigamentousTension(BLT)workshop. Students were oriented to professionalism, HIPAA, and observation of OMT in the health center. Students then practiced BLT for the transverse carpal ligament, interosseous membrane, and rib cage after discussion of clinical cases in which they would be used (i.e., carpal tunnel syndrome and asthma).

June11 OsteopathicClinicalConsiderationsinTreatingIrritatedBowelSyndrome(IBS):Presentation on the nervous system’s role in IBS. Students practiced the following techniques: indirect myofascial on the thoracolumbar, sacroiliac articulation technique and sacral rocking, abdominal mesenteric lift, and suboccipital release.

June12 AlternativeApproachestoPatientEducation:Articles on alternative treatments were provided and discussed. Students practiced the Jacobson’s Muscle Relaxation Technique.

June18 TheStillTechnique:The Still Techniques for the first rib, cervical spine, and thoracic spine were demonstrated and practiced. Clinical correlations for treatment of these areas were discussed.

June24 Acupuncture:The origins and principles of acupuncture were presented. After the physician spoke about his own training and patients’ successes, he guided the students in how to use an acupuncture needle to alleviate their partners’ tense muscle.

June25 PainfromStudyingandtheEffectsofStressonVisceralOrgans:With guidance, students practiced the following stress-relieving techniques: condylar decompression, FPR on the trapezius and the first rib, thoracic outlet release.

July9 TaiChi:A Tai Chi instructor for NYIT’s Parkinson’s program led an outdoor Tai Chi session.

Date Workshop Description

July10 OMTinRotationsandPreparingforBoards:Academic scholars at NYIT-COM led small group sessions, sharing their experience with utilizing OMM and OMT in rotations, preparing for boards, and briefly presented on board topics, such as Chapman’s reflex points.

July17,3hrs

BiodynamicCranialOsteopathy:Biodynamic concepts were introduced. Students experienced a palpation workshop sensing their partner’s health through cranial, chest and lower extremity palpations.

July19,2hrs

Occipital-AtlantoJointandBiodynamics:A presentation on biodynamic concepts reviewed cranial dysfunctions and how to treat an anterior and posterior atlas. Students were also guided through palpation exercises.

July23 UsingYourOsteopathicHandsandMind:This was a discussion on the principles of osteopathic and alternative medicines, including traditional Chinese Medicine.

July23 UsingandExplainingOMTinClinicalSituations;OMTinResearch:Advice and insight to common patient encounters and osteopathic research were discussed. Research concepts and advances in the field of OMM were discussed.

July26 OutdoorTherapeuticYogaIntegratingOsteopathicPhilosophy:An academic scholar led an outdoors yoga session integrating osteopathic philosophy and concepts.

July27 OMTinPediatrics;ProgramClosingNotes:Faculty demonstrated and discussed OMT use on children with two volunteer children from the faculty. The workshop covered key considerations in treating the pediatric population.

Table 1. 2013 SAAO Summer Preceptorship Program Workshops. Unless otherwise specified, workshops were taught by osteopathic physicians and professors at NYIT-COM and ran for one hour. New York Institute of Technology College of Osteopathic Medicine. Old Westbury, NY. 2013.


Table 1showsthedates,duration,andtopicofeachworkshop.

Methods

ThisstudywasapprovedbytheNYITInstitutionalReviewBoardasanexemptstudy(NYIT-IRBBHS#970).FollowingcompletionoftheSAAOOMTSummerPreceptorshipProgram,studentswereprovidedwithabrief,hardcopy12-questionsurvey(seeAppendixA,page20).ThestudywasconductedatNYIT-COMinOldWestbury,NY.Responderswerenotprovidedwithanyincentivestocompletethesurvey.

Thesurveycontainedfivemultiple-choicequestionsregardingtheimpactofthepreceptorshiponthestudents’perceptionsofOMT.ThesurveyemployedthestatisticallyvalidatedLikertscaleformatforfiveofthesevenscaledquestions.Thefive-pointLikertscaleanswerselectionsrangedfrom“stronglyagree”to“stronglydisagree.”13Thesefirstfivequestionsassessedtheeffectoftheprogramontheparticipants’perceptionofOMTconfidencelevel,understandingofclinicalapplicationsofOMT,awarenessofthescope,anticipatedfutureuseofOMTandtheiroverallperceptionofOMT.TheoutcomesmeasuredweretheinterpretationsoftheperceptionLikertscalesreportedbytheparticipants.

Responders’confidencelevelwasassessedbythestatement,“IbelievethisprogramhelpedmetoimprovemyconfidencelevelwithusingOMT.”Theirunderstandingwasassessedbythestatement,“Ibelievethisprogramhelpedmeunderstandthe

clinicalapplicationofOMT.”Participants’intentiontouseOMTinthefuturewasassessedbythestatement,“IbelievethisprogrampositivelyinfluencedmetoconsiderintegratingofOMTinmyfuturepractice.”TheirawarenessofthescopeofOMTwasassessedbythestatement,“IbelievethisprogramhelpedtoexpandmyawarenessofwhatconditionscanbetreatedwithOMT.”Finally,participantsratedtheeffectoftheprogramontheiroverallperceptionofOMTviathefollowingstatement:“IbelievethatthisprogrampositivelyimprovedmyoverallperceptionofOMT.”

Toevaluaterespectivelytheclinicandworkshopportionsoftheprogram,participantswereaskedtwo-partquestions.Thefirstpartofquestionssixandsevenrespectivelyaskedhowmanysessionsofeachdidthestudentattend.WeutilizedamodifiedLikert-typelevelofqualityscaleforthesecondpartofquestionssixandseven.14Theansweroptionsforthisscalewere:(1)VeryPoor,(2)Poor,(3)Neutral,(4)Good,(5)Excellent.

Thelastfivequestionsofthesurveywereopenandfree-forminnaturetoallowforfeedbackregardingtheleast/mostbeneficialaspectsoftheprogram,recommendedimprovements,andwhatthestudentwoulddodifferentlyafterparticipatingintheprogram.

DataanalysiswasperformedusingIBM©SPSS©statisticalsoftwareversion21.Theresponseratewascalculated.Frequenciesandpercentageswerecalculatedforeachofthescaledresponses:boththeLikertscalequestionsandthemodifiedLikert-typelevelofqualityquestions.

0.00

5.00

10.00

15.00

20.00

25.00

Helped me to improve myconfidence level with using

OMT.

Helped me understand theclinical application of OMT.

Positively influenced me toconsider integrating OMT in

my future practice.

Helped to expand myawareness of what

conditions can be treatedwith OMT.

Positively improved myoverall perception of OMT.

Num

ber o

f Res

pond

ents

Self-Reported Effect of Preceptorship on Respondents

Strongly Agree Agree Neutral Disagree Strongly Disagree

Figure 1. Likert Scaled Responses to OMT Perception Questions. N=30. New York Institute of Technology College of Osteopathic Medicine. Old Westbury, NY. 2013.


Results

Ofthe50second-yearmedicalstudentswhocompletedtheSAAOPreceptorshipProgram,30studentscompletedthesurvey.Theoverallresponseratewas60percent.ParticipantsrespondedtofivequestionsregardingtheeffectoftheprogramontheirperceptionofOMTonthevalidatedLikertscale.Whenassessingconfidencelevel,20percent(n=6)responded“stronglyagree,”76.67percent(n=23)responded“agree,”and3.33percent(n=1)responded“undecided.”

Theassessmentofparticipants’understandingofclinicalapplicationfoundthat50percent(n=15)responded“stronglyagree,”46.67percent(n=14)responded“agree,”and3.33percent(n=1)responded“undecided”totheLikertscalestatement.Thiswasa96.67percentpositiveresponseofeither“stronglyagree”or“agree.”

Whenassessingtheintentionoffutureclinicaluse,40percentofparticipants(n=12)responded“stronglyagree,”56.67percent(n=17)responded“agree,”and3.33percent(n=1)responded“undecided.”Thiswasa96.67percentpositiveresponserate.Assessment

ofparticipants’awarenessofthescopeofOMTwasassessedand26.67percentofparticipants(n=8)responded“stronglyagree,”63.33percent(n=19)responded“agree,”and10percent(n=3)responded“undecided.”Thiswasa90percentpositiveresponserateforscope.

AssessmentoftheoveralleffectoftheSAAOprogramonparticipants’perceptionofOMTfoundthat50percent(n=15)responded“stronglyagree,”46.67percent(n=14)responded“agree,”and3.33percent(n=1)responded“undecided”tothestatement.Thiswasa96.67percentpositiveresponseratefortheeffectoftheprogramonparticipants’overallOMTperception.Noparticipantsresponded“disagree”or“stronglydisagree”toanyofthesurveyquestions.(Figure 1)

Ofthe30completedsurveys,participantsattendedanaverageof2.21clinicshadowingsessions.Fiftypercent(n=15)ofparticipantsscoredthequalityofthesesessionsas“excellent”onthequalityscale;46.67percent(n=14)scoredthequalityas“good;”and3.33percent(n=1)scoredthequalityas“neutral.”

Participantsattendedanaverageof10.29workshopsessions.Twentypercent(n=6)ofparticipantsratedthequalityoftheworkshopsessionsas“excellent;”73.33percent(n=22)ratedthemas“good;”3.33percent(n=1)ratedtheworkshopsas“neutral.”

Sutherland Cranial Teaching FoundationUpcoming Courses

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10. HaltiwangerE,HuberT,ChangJC,Gonzales-StuartA.AcasestudyofBell’sPalsyapplyingcomplementarytreatmentwithinanoccupationaltherapymodel.OccupationalTherapyInternational.2009;16(1)71-81.

11. ChenN,ZhouM,HeL,ZhouD,LiN.AcupunctureforBell’spalsy.Cochrane Database of Systematic Reviews.2010(8):CDC002914.

12. TeixieraLJ,ValbuzaJS,PradoGF.PhysicalTherapyforBell’spalsyidiopathicfacialparalysis.Cochrane Database of Systematic Reviews.2011;7(12):CD006283.

13. GanzBJ,RedleafMI,PerryBP,GubbelsSP.Chapter28managementofBell’sPalsyandRamsayHuntsyndrome.In:BrackmannDE,SheltonC,ArriagaMA,eds.Otologic surgery.3rded.Philadelphia,PA:Saunders-Elsevier;2010:335-346.www.ClinicalKey.com.Accessed09-17-2013.

14. LancasterDG,CrowWT.Osetopathicmanipulativetreatmentofa26-year-oldwomanwithBell’sPalsy.Journal of the American Osteopathic Association.2006;106(5):285-289.

15. BakerJP,BakerCD.OsteopathicmanipulativetreatmentforLymedisease-inducedBell’sPalsy:acasereport.The AAO Journal.2013;23(1):12-15.

16. CarbonJR.Establishingacaseforcauseandeffect.Journal of the American Osteopathic Association.2006;106(8):443-444.

Accepted for publication: November2013

Address correspondence to:JoshuaP.Baker,DO,FAAFPWestForkFamilyMedicine,PC705ElmStreetEastRockwell,[email protected]

continued from page 12


axis. In collaboration with Alain Croibier, DO, Jean-Pierre Barral has also developed the modalities of Neural Manipulation and Global Joint Treatment based on their on-going clinical research. Dr. Barral holds the title of Curriculum Developer for the Barral Institute. Dr. Barral took the modalities and developed them into various manual therapy courses, which he taught since 1985. Dr. Barral has trained and certified a team of International Teachers who also instruct these courses around the world.Since 1999 he has maintained a private practice in Grenoble, France, and has served as Chairman of Department of Visceral Manipulation on the Faculty of Medicine Osteopathy, Grenoble, France; the Chairman of Department of Visceral Manipulation on Faculty of Medicine Paris du Nord; and Academic Director of International College of Osteopathy, St. Etienne, France.

Kenneth J. Lossing, DO, Program ChairDr. Lossing is a 1994 graduate of Kirksville College of Osteopathic Medicine. He completed internship and residency programs at Ohio University College of Osteopathic Medicine, and is certified in Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine and Family Practice. Dr. Lossing studied under French osteopath Jean-Pierre Barral, DO, and is known internationally as a lecturer on visceral manipulation. He is the AAO President-elect and a member of the AAO Board of Trustees.

New Approach to Osteo-articular Manipulations:Including the Superior and Inferior Limbs

Course Description: This course will present a new manner to check and to treat all the upper limb components, shoulders, elbows, wrists and hands.As well as offering an unique and original approach of the lower limbs including the hips, knees, ankles and feet. CME:The program anticipates being approved for 32 hours of AOA Category 1-A CME credit pending approval by the AOA CCME.

Course Location:The Broadmoor1 Lake Avenue, Colorado Springs, CO 80906Reservations: 7am to 9pm (MT), seven days a week.(800) 634-7711 (Mention AAO event.) https://resweb.passkey.com/go/aao14

Jean-Pierre Barral, DO, Featured SpeakerJean-Pierre is an Osteopath and Registered Physical Therapist who serves as Director (and Faculty) of the Department of Osteopathic Manipulation at the University of Paris School of Medicine in Paris, France. He earned his diploma in Osteopathic Medicine in 1974 from the European School of Osteopathy in Maidstone, England, and went on to teach spinal biomechanics at the institution from 1975-1982.He developed the modality of Visceral Manipulation based on his innovative theory that each internal organ rotates on a physiological

March 15–18, 2014 in Colorado Springs, CO

Register online at www.academyofosteopathy.org. For travel arrangements, contact Tina Callahan of Globally Yours Travel at (800) 274-5975 or [email protected].

Comment

TheSAAOSummerPreceptorshipProgramcombinesclinicalshadowingexperiencesandOMTworkshops,exposingstudentstoavarietyofosteopathicphysicians,providingmentorsinthefield,andhighlightingthemanyclinicalapplicationsofOMT.

TheresultsillustratethepositiveeffectsoftheSAAOSummerPreceptorshipprogramonsecond-yearmedicalstudents’perceptionsofandintentionstouseOMT.RespondentsreportedanoverallpositiveeffectontheirperceptionofOMT,whichcomprisedtheirOMTconfidencelevel,understandingofclinicalapplicationsofOMT,awarenessofthescopeofOMT,andanticipatedfutureuseofOMTinclinicalpractice.

Acomprehensivemedicaleducationprovidesstudentswithclinicalexperiencesandmentors.Ourresultscoincidewithcurrenthealthcareeducationalresearch.Niemanetal.observedthatparticipationintheTexasStatewideFamilyPracticePreceptorshipProgram(TSFPPP)wasassociatedwithanincreased

selectionoffamilypracticeresidency.TheTSFPPPincludeddirectandobservedinteractionswithpatientsininpatientandoutpatientfamilypracticesettings.Incontrasttonon-participants,significancewasfoundinstudentswhoparticipatedinthefirstandsecondyear(OR=1.62,95%CI:1.41-1.87);thirdandfourthyear(OR=2.31,95%CI=1.99-2.68);andthroughouttheirfouryearsofmedicalschool(OR=4.98,95%CI:3.75-6.68).15Likewise,researchersatStanfordUniversityMedicalCenterconductedastudyexaminingtheeffectsofan8-weekvascularsurgerysimulationelectivecourseon52preclinicalmedicalstudents.Priortotheelective,ninepercentofstudentswerehighlyinterestedinvascularsurgeryasaspecialty.Post-course,90percent(p=.03)oftheparticipantswereinterestedinpursuingvascularsurgery,andlong-termfollowup(onetothreeyears)revealedthat70percentremainedinterested.Mostrespondentsattributedtheircontinuedinterestinthespecialtytothesimulationpracticecourse(90percent)andfacultymentorship(70percent).16


online.

https://netforum.avectra.com/eweb/DynamicPage.aspx?Site=AAO&WebCode=EventDetail&evt_key=e27aabe5-08ef-4660-a185-b63d19d96d44




Future Studies

Thelong-termeffectsofthisprogramcanbeassessedinfuturestudies.ThiscanbeaccomplishedbysurveyingpastparticipantsoftheprogramontheiruseofOMTduringthird-andfourth-yearclinicalrotationsandinclinicalpracticeaftergraduation.ThisstudycouldalsobeusedtoguidealargerstudyexaminingtheeffectofthistypeofprogramonOMTuseandperception.

Limitations

Thelimitationsofourstudydeserveconsiderationandshouldbeaddressedinfuturesurveysonthistopic.Oursamplesizeof30participantswassmall.Thereisaselectionbiasinnatelypresentinthisstudy—studentsself-selectedtoparticipateintheSAAOSummerPreceptorshipProgram.Studyparticipantsfromthatself-selectedgroupthenvoluntarilyansweredthissurvey.Participantsmaynotbetrulyrepresentativeofthelargerpopulationofpreclinicalosteopathicstudents.Baselineassessmentofparticipants’OMTperceptionspriortothestartoftheprogramwasnotobtained.

Conclusion

The2013SAAOSummerPreceptorshipProgram’seffecthasbeenevaluatedby60percentofitsparticipants(n=30)aspositivelyaffectingtheirperceptionofOMT.Thispositiveevaluationsupportsthecontinuationandfurtherstudyofthisprogram.Tothebestofourknowledge,theimplementationofOMTclinicalexperiencesinthepre-clinicalmedicaleducationyearshasseldombeenassessed.Theeffectsofastructuredpre-clinicalexperienceonstudents’attitudes,knowledgeandpotentialbehaviorinregardstoOMTuseandapplication—andthepotentialbenefitsitcanhaveonthecontinuedusageofOMTintheosteopathicprofessionasawhole—meritsfurtherattentionandresearch.

Acknowledgements

TheauthorsofthispaperwouldliketothanktheOsteopathicManipulativeMedicinedepartmentatNYIT-COMforconductingtheSAAOSummerPreceptorshipprogramandtheparticipantsinthissurveyfortheircontributiontothisresearch.

References 1. ChangJC,OdrobinaMR,McIntyre-SeltmanK.Residents

asrolemodels:theeffectoftheobstetricsandgynecologyclerkshiponmedicalstudents’careerinterest.J Grad Med Educ.2010;2:341–345.Availableat:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951771/.AccessedOctober21,2013.

2. KutikovA,BonslaverJ,CaseyJT,DegradoJ,DusseaultBN,FoxJA,etal.Thegatekeeperdisparity:whydosomemedical

schoolssendmoremedicalstudentsintourology?J Urol.2011Feb;185(2):647-652.Availableat:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058515/.AccessedOctober21,2013.

3. StrausSE,StrausC,TzanetosK.Careerchoiceinacademicmedicine:Systematicreview.J Gen Intern Med.2006;21:1222–1229.Availableat:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924755/.AccessedOctober21,2013.

4. WrightS,WongA,NewillC.Theimpactofrolemodelsonmedicalstudents.J Gen Intern Med.1997;12:53-56.Availableat:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497058/pdf/jgi_09.pdf.AccessedOctober21,2013.

5. SternszusR,CruessS,CruessR,YoungM,SteinertY.Residentsasrolemodels:impactonundergraduatetrainees.Acad Med.2012Sep;87(9):1282-1287.

6. Keating,EM,O’DonnellEP,Starr,SR.“Howwecreatedapeer-designedspecialty-specificselectiveformedicalstudentcareerexploration”.Med Teach. 2013;35(2):91-94.doi:10.3109/0142159X.2012.731110.Epub2012Oct26.

7. JohnsonAL,SharmaJ,ChinchilliVM,EmerySE,McCollisterEC,Floyd,MW,etal.Whydomedicalstudentschooseorthopaedicsasacareer?J Bone Joint Surg Am.2012;94:e781–e789.

8. HauerKE,DurningSJ,KernanWN,FaganMJ,MintzM,O’SullivanPS,etal.Factorsassociatedwithmedicalstudents’careerchoicesregardinginternalmedicine.JAMA.2008;300:1154-1164.

9. JohnsonSM,KurtzME.Diminisheduseofosteopathicmanipulativetreatmentanditsimpactontheuniquenessoftheosteopathicprofession.Acad Med.2001;76:821–828.

10. ShannonSC,TeitelbaumHS.TheStatusandFutureofOsteopathicMedicalEducationintheUnitedStates.Acad Med.2009;84(6):707-711.

11. ChamberlainNR,YatesHA.“Aprospectivestudyofosteopathicmedicalstudents’attitudestowarduseofosteopathicmanipulativetreatmentincaringforpatients.”J Am Osteopath Assoc.2003Oct;103(10):470-478.Availableat:http://www.jaoa.org/content/103/10/470.long.AccessedOctober21,2013.

12. TengAY,TerryRR,BlueRJ.“IncorporatingaMandatoryOsteopathicManipulativeMedicine(OMM)curriculuminclinicalclerkships:impactonstudentattitudestowardusingOMM.”J Am Osteopath Assoc.2011Apr;111(4):219-224.Availableat:http://www.jaoa.org/content/111/4/219.long.AccessedatOctober21,2013.

13. Albaum,G.TheLikertscalerevisited:analternateversion.Journal of the Market Research Society.39.2(Apr.1997)p331.

14. Vagias,WadeM.Likert-typescaleresponseanchors.ClemsonInternationalInstituteforTourism&ResearchDevelopment,DepartmentofParks,RecreationandTourismManagement.ClemsonUniversity.2006.Availableat:http://www.jaoa.org/content/111/4/219.long.AccessedatOctober30,2013.

15. NiemanLZ,FoxhallLE,ChuangAZ,ChengL,PragerTC.EvaluatingtheTexasStatewideFamilyPracticePreceptorshipProgram,1992-2000.Acad Med.2004Jan;79(1):62-68.


Address correspondence to: SheldonC.Yao,DODepartmentofOsteopathicManipulativeMedicineNewYorkInstituteofTechnologyCollegeofOsteopathicMedicineRoom126NorthernBoulevardOldWestbury,[email protected]


Abstract

Despitecurrentprogressinmedicalresearchofdiseases,therearestillmanydiseasesthatareconsideredtobeenigmaticandbafflinginnature.Toinvestigatetheetiologiesandthenatureofmanybafflingdisorders,medicalresearchersdesigntrialstoexplorethepathwaysthatleadtoillnessandtosearchfornewwaystotreathumandisease.Therangeofavailablemodelsisextensive,rangingfromcomputermodelstosinglecellsandsimpleorganisms,suchasworms,tohighervertebratespecies.However,extrapolationintohumansubjectsremainsproblematic.Ideally,thebestdiseasemodelisthehumandiseasemodel,thereforeobviatingtheneedtoextrapolatetheresultsofresearchbasedonnon-

The Application of the Cranial Concept in the Investigation of Baffling Medical Disorders and Their Treatment: A Synergopathic Medical Disease ModelKrishnahari S. Pribadi, MD

humanmodels.However,manyinvestigativemethodsareintrusiveandmayintroduceunpredictablechangesandresponsesofthebodymechanisms.Thehumanorganismisverycomplexandmaynotberepresentedbyinanimateoranimalmodelslackinginmentalandspiritualdimension.

Byusinganon-invasivecranialpalpationmethodtodeterminethebioenergetic,spiritual,craniosacral,physicalmedical,meridian,acupuncture,endocrine,nutritional,foodintolerance,leakygut,circulation,specificpathologicalprofilesofanindividual,theauthorsuggeststhetechnicalprocedurestoevaluatetheclinicalcomprehensiveandholisticpictureofanindividualaffectedbyaspecificdiseaseprocess.Basedonthesefindings,wecandevelopthehypothesesof

APPENDIX A

SAAO Summer OMM Preceptorship Survey 2013

Pleasecircle/underlineorcompletethefollowingquestions:

1. IbelievethisprogramhelpedmetoimprovemyconfidencelevelwithusingOMT.

StronglyAgree/Agree/Undecided/Disagree/StronglyDisagree

2. IbelievethisprogramhelpedmeunderstandtheclinicalapplicationofOMT.


3. IbelievethisprogrampositivelyinfluencedmetoconsiderintegratingofOMTinmyfuturepractice.


4. IbelievethisprogramhelpedtoexpandmyawarenessofwhatconditionscanbetreatedwithOMT.


5. IbelievethatthisprogrampositivelyimprovedmyoverallperceptionofOMT.


6.a.Howmanysessionsdidyoushadowaclinicianinthisprogram?_________

b.Howwouldyouratetheoveralleducationalqualityoftheshadowingsession?VeryPoor/Poor/Neutral/Good/Excellent

7.a.Howmanyworkshopsessionsdidyouattendinthisprogram?_________

b.Howwouldyouratetheoveralleducationalqualityoftheworkshops?VeryPoor/Poor/Neutral/Good/Excellent

8. Whataspectsoftheprogramweremostbeneficial?

9. Whataspectsoftheprogramdidyoufindleastvaluable?

10. Whatimprovementswouldyourecommend?

11. Giveanexampleofonethingyouwilldodifferentlybecauseofthisprogram.

12. Pleasefeelfreetoshareanyadditionalcommentsandsuggestions.Andusethebackofthepagetocontinueifnecessary.(Youranswerswillbekeptconfidential.Thankyouforyour

assistancetocontinuetoimprovetheprogram!)


specificdiseaseswhichaffecttheindividuals.Thehypothesescanthenbetestedindesigntrialsusingvariousmodelsasappropriate.Varioustreatmentapproachescanbedevelopedandtestedout.TheSynergopathicDiseaseModelAssessmentFormhasbeendevisedbytheauthorandcanbeobtainedforfreeforclinicalandresearchpurposesbyemail.

Introduction

Despitecurrentprogressinmedicalresearchofdiseases,therearestillmanydiseasesthatareconsideredenigmaticandbafflinginnature.Koch’spostulates,developedinthe19thcentury,haveplayedanimportantroleinmicrobiology1asgeneralguidelinestoidentifyetiologiesofinfectiousdiseases.Theyhavebeensuccessfulinclarifyingthenatureofmanyinfectiousdiseaseprocessessuchascholera,smallpox,tuberculosis,poliomyelitisandmanyotherviralinfections. Recently,modernnucleicacid–basedmicrobialdetectionmethodshavemadeKoch’soriginalpostulateslessrelevant.Thesenucleicacid–basedmethodsmakeitpossibletoidentifymicrobesthatareassociatedwithadisease.2Yettherearestillmanybafflingdiseases,includingmanyautoimmunedisorders,degenerativediseases,fibromyalgia,chronicfatiguesyndrome,schizophrenia,autism,diabetesmellitustype1and2,Alzheimers’sdisease,Parkinson’sdisease,Guillain-Barresyndrome,leakygutsyndrome,polyneuropathy,allergicdiseases,variouscancersandmanyothers.Toinvestigatetheetiologiesandthenatureofthesebafflingdisorders,medicalresearchersdesigntrialstoexplorethepathwaysthatleadtoillnessandtosearchfornewwaystotreathumandisease.Thesescientistsusediseasemodelsintheirresearch,especiallytotestspecifichypothesesortoexploreunintendedreactions.Animalmodelsplayanintegralpartintranslationalresearch.Therangeofavailablemodelsisextensive,rangingfromcomputermodelstosinglecellsandsimpleorganismssuchasworms,tohighervertebratespecies.However,extrapolationintohumansubjectsremainsproblematic.3Thus,thetreatmentofbafflingdisordersremainshamperedbythelackofunderstandingofthediseaseprocessesandthelimitationsofconventionalmedicine,whichreliesheavilyonchemicalpharmacologicalinterventions,developedprimarilybasedonanimalmodelSandinvitrotesting.Ideally,thebestdiseasemodelisthehumandiseasemodel,thereforeobviatingtheneedtoextrapolatetheresultsofresearchbasedonnon-humanmodels.However,manyinvestigativemethodsareintrusiveandmayintroduceunpredictablechangesandresponsesofthebodymechanisms.Thehumanorganismisverycomplexandmaynotberepresented

byinanimateoranimalmodelslackinginmentalandspiritualdimension.Furthermore,thepowerofconventionalbedsidephysicalexaminationislimited.PsychiatricdisorderswereconsideredtohavenophysicalabnormalitiesbeforetheworkofWoods&Woods.Theirresearchdemonstratedthepresenceofabnormalcranialmechanisminschizophrenicpatientscharacterizedbymembranousrestriction,osteo-mastoidsuturalrestriction,sphenobasilarcompressionandslowandweakcranialimpulserhythm.4

Synergopathic Disease Model

WhatisSynergopathicmedicine?TheauthorcoinedthetermtodescribeasystemofmedicinecapableofintegratingvariousphilosophicalformsofmedicinewithinasingleframeworkbasedonsynergeticphilosophicalideasandconceptsaspromulgatedbyR.BuckminsterFuller.Synergyisastateofoptimalfunctioningofanintegratedsystemconsistingofpartsandcomponents.“Synergymeansbehaviorofintegral,aggregate,wholesystemsunpredictedbybehaviorsofanyoftheircomponentsorsubassembliesoftheircomponentstakenseparatelyfromthewhole.”5,6Disease is caused by a dis-synergic state of the systems and subsystems within an organism, caused by either internal or external factors or both.Synergopathicmedicinesynthesizesandintegratesallcurrentformsofmedicine—including,butnotlimitedto,allopathicmedicine,osteopathicmedicine,cranialosteopathy,homeopathy,naturalmedicine,chiropracticmedicine,acupuncture,herbalism,traditionalmedicine,bio-energeticmedicine,spiritualmedicine,etc.—withinasingleframeworkcapableofdissolvingalldifferencesandcontradictions,therebysynthesizingandintegratingallthecomponentsandsubassembliesoftheircomponentstoformasynergicstate.

Cranial Osteopathy is considered to be the core of Synergopathic medicine and is used to integrate all elements of various medicines since all forms of medicine affect the craniosacral system functioning as the highest regulatory system in the body. By evaluating, monitoring and manipulating therapeutically the craniosacral system, we synergetically apply any medical procedures capable of optimizing this system.Wenolongerdivideapatientintopartsandcomponentstobetreatedwithvariousformsofmedicine.Thus,wenolongertreatunilaterally—organswithvariouspharmacologicalmoietiesand/orsurgeries;themindwithmanipulationofthinking;emotionalpatternswithvariouspsychotherapeuticmodalitiesandinterventions;andthespiritwithpracticesofvariousbeliefsandmyths.Instead,weseeapatientasalivinghumanbeingconsistingofsystemsorganized


andintegratedbiologically,socially,mentally,cosmologicallyandspirituallytoformathinking,acting,willingbeingthathasfeelings,meaningandhopeaswellasphysicalcomponentsandspiritualexistence.Insteadofforcingapatientintooneformofmedicine,webringallformsofmedicinetothepatienttobeappliedsystematicallyandholistically.6

The Craniosacral Digital Diagnostic Method

Theauthor’sresearch,usingasurfacescanninglaserdisplacementmetertorecordmicro-pulsations,hasobjectivelyestablishedthepresenceofpulsations(withamaximumdeflectionof0.07mmandfrequenciesrangingfrom4to11cpm)atseveralacupuncturepoints,thecharacteristicsofwhichareidentifiedwiththecharacteristicsofthecranialrhythmicimpulse.7Thecranialrhythmicimpulse(CRI)reflectsthehomeostaticstatusofaperson.AbnormalCRIusuallyindicatesthereareproblemswithinthehomeostaticmechanismsofaperson.ThereareagentsandforcesthatcaninfluencetheCRIcharacteristics.The use of non-invasive and safe palpation, with “feeling, thinking, seeing and knowing fingers” is the cornerstone of the cranial diagnostic method as developed by William G. Sutherland, DO. MonitoringtheCRIwhileapplyingthecranialmanipulativeproceduresisanimportantaspectofthepalpationoftheCRI.Basedonthesefindings,theauthordevelopedtheCraniosacral Digital Diagnostic

Methodtoassessthecharacteristicsofpulsationsofspecificacupuncturepointstodeterminethemeridianprofileofanindividual.BypalpatingtheMUE49ofthehandfingersandtwoadditionalacupuncturepointsatthedorsalsurfaceofthemiddleknuckles,thetreatmentspecialistestablishesthecharacteristicsofthe12meridiansofanindividual.Thefollowingmethodsdevelopedbytheauthorcombinetocreateanindividual’sacupunctureprofile:

• CraniosacralAcupuncturePalpatoryMethod©isusedtolocateabnormalacupuncturepoints.

• CraniosacralNutritionalAssessmentMethod©determinesnutritionalrequirementsbypalpatingthenutritionalpointsforCRI.

• CraniosacralAllergyScreeningTest©canscreenfoods,substancesand/ordrugsforallergyorintolerance.

• CraniosacralTherapeuticSensitivityandDoseDetermination©determines individualtherapeuticsensitivitytotherapeuticagentsandtheirdoses.

• CraniosacralTele-DiagnosticMethod©canbeusedtodiagnose,aswellastreat,patientsfromgreatdistances.

• CraniosacralPathologicalProfileMethodisamethodtodeterminethenatureofthepathologicalprocessesofanindividual

GROWING FL PRACTICE SEEKS FP/DO/DERMATOLOGIST

ReliantFamilyPracticeinGainesville,FL,seeksspecialistinFamilyPractice/OMMand/orFamilyPractice/Dermatologyforitsgrowing,close-knit,supportivepracticeunderthedirectionofErikSchabert,DO.CallMikaHarris,OfficeManager,forfirstcontactat(352)[email protected].

NMM PLUS 1 POSITIONS AVAILABLE IN SUNNY

SOUTH FLORIDA

ResidencyprogramatLarkinHospital.ContactJoelD.Stein,DO,FAAO,at(954)[email protected].

NMM PLUS 1 RESIDENCY PROGRAM IN NEW YORK

NMMPlus1ResidencyatSouthamptonHospitalinbeautifulSouthampton,LongIsland.Applicationsarecurrentlybeingaccepted.Ifinterested,pleasecontactProgramDirectorDeniseK.Burns,DO,FAAO,atdrdenise@optonline.netorEducationDepartmentSecretaryKarenRobertsat(631)726-0409.

PRACTICE OSTEOPATHY IN BEAUTIFUL COLORADO

Successfulintegrativepracticeseeksaboard-certified/eligibleNMM/OMMphysicianforitsbusyDenveroffice.Preferablysomeonecomfortablewithabroadvarietyoftechniques.Verycompetitive

compensation.Friendlyandprofessionalatmosphere.Pleasecall(303)781-7862oremailCVtomgentile@cointegrative.com.Ourwebsiteiswww.cointegrative.com.

DO SOUGHT FORCONNECTICUT PRACTICE

PracticeavailableinHartford,CT.PrimarilyspecializesinOMT,prolotherapyandchronicpainmanagement.Incomefor2012was$700K,withnetincomeof$335K.Muchmoretoexplainregardingdemographicsofthecommunity,hospitalsintheareaandbeautifulnearbyresidentialareas.Ifinterested,pleasecontactGaryN.Wiessenat(631)[email protected].

CLASSIFIED ADVERTISEMENTS


(circulation,immunity,toxin,hormone,neoplastic,degeneration,nutritional,tissueoxygenation,spiritual).

Theauthoralsodevisedamethodtodeterminethespecificbloodbiochemicalvaluesofanindividualbypalpatingspecificpoints.AbnormalpointsareassociatedwiththeabsenceofPRMpulsationsofthespecificpoints(Upledger-Pribadi’ssign).Therearethreelevelsofpressuresused:light(0g),medium(5g)andhard(20g),representingsuccessivelythebioenergetic,chemicalandphysicaldimensionsofthediseaseprocessesbeingevaluated.8By determining the bioenergetic, spiritual, craniosacral, physical medical, meridian, acupuncture, endocrine, nutritional, food intolerance, leaky gut, circulation, specific pathological profiles of an individual, we can thus develop the clinical comprehensive and holistic picture of an individual affected by a specific disease process. Based on the findings, thus, we can develop the hypotheses of specific diseases which affect the individuals. The hypotheses can then be tested out in design trials using various models as appropriate. Various treatment approaches can then be developed and tested out. The Synergopathic Disease Model Assessment Form has been devised by the author.

Synergopathic Herbal Formulas

Theauthorintroducedthecranialosteopathic,homeopathicandacupuncturemedicineconceptsalongwiththephyto-pharmacologicalconceptinformulatingherbalformulasinadditiontoutilizingtraditionaldiscoveriesaswellasvastliteraturesintheuseofIndonesianherbalplantsformedicinalpurposes.Eachherbalplanthasaspecificmeridianspectralresponsewheningested.Theuseofalaserscanningmetertodetectandmeasurepulsationatacupuncturepointshasthepotentialtoobjectivelyevaluatethemeridianspectrumofeachherbalplant.Theauthorusesaclinicalpalpationmethodoftheacupuncturepointstoevaluatetheherbalmeridianspectrum.Fortunately,duetothebio-energeticpropertiesofherbalplants,bysimplytouchingthebodywithacertainherbalplant,wecanevaluateandmeasurethespecificeffectsofthatparticularherbalplantuponthecraniosacral,meridian,acupunctureandbioenergysystemofanindividualaffectedbyspecificdiseases;thuseachformulahastherapeuticeffectsuponthephysiologicalandregulatorymechanismsatthechemicallevel(phyto-pharmacologicaleffect),themeridiansystem(meridianeffect),thecraniosacralsystemasthehighestregulatorysystemwithinthebody(craniosacraleffect),thevitalenergysystem(homeopathiceffect)andtheprimitivebrainsystem(olfactoryoraromatherapeuticeffect).Thismodern

andrevolutionizedapproachtopreparingherbalplantsasremedieshasproventobeveryeconomical,effective,safeandpowerful.9

Leaky Gut Syndrome

Leakygutsyndrome,orincreasedintestinalpermeability,10iscausedbyincreasedpermeabilityofthegutwallresultingfromtoxins,poordiet,parasites,infectionormedications.11Thispermeabilitythenallowssubstancessuchastoxins,microbes,undigestedfood,wasteormacromoleculestoenterthecirculation.Intestinalinflammationcausedbyintestinaldysbiosisorothersourcesofirritation,widensthejunctionsbetweenthecellsoftheintestinallining,allowingendotoxinsandincompletelydigestedparticlestobepartiallyabsorbed.Thesearetargetedbyantibodies,formingimmunecomplexeswhichcauseasemi-infectiousstate,andcanbecarriedbythebloodstreamtodistantsiteswheretheymaystimulatethereleaseofcytokines.12Althoughleakygutsyndromeisnotanestablisheddiagnosis,thereareclinicaldiagnosticteststhatactuallymeasurepermeabilityofthegutwall.Cranialpalpationmethodcanbeusedtodetectleakygutsyndrome.Placetwohandssimultaneouslyonliver-epigastrum,liver-navelandliver-colonareas.TheabsenceofPRMpulsationsindicatesthepresenceofleakygutsyndrome.ProbesofCrEDTA,PEG400,lactulose,mannitolandrhamnose,havebeenusedtomeasureintestinalpermeabilitybylookingaturinaryrecovery.13Anothertestusedbyresearchersquantitativelyassessesthetranslocationoflipopolysaccharide(LPS)moleculesacrossthegutwall.14Lowgradefever,transientgutpain,andasenseofinabilitytoabsorbnutrientsaresomereportedsymptomsinotherwiseundiagnosedpatients.15Leakygutsyndromeisassociatedwithmanydisorderssuchasasthma,diabetes,autoimmunediseaseslikelupus,diseaseslikescleroderma,internalcolitis,long-termdisorderslikerheumatoidarthritis,severeillnesseslikemultiplesclerosisandchronicfatiguesyndromeandCrohn’sdisease.Severaldietarytreatments,includinggluten-freediets,casein-freediets,antifungaldiets,low-sugardiets,aswellassupplementsthatincludenystatin,B12andprobioticshavebeenintroduced.16

Case Investigation

Seetheaccompanyingtableonpage25.

Conclusion and Proposed Research Issues

ThecaseinvestigationusingtheSynergopathicdiseasemodelhasidentifiedcommonissuesinthepathwaysofvariousbafflingdisorders.Centralinthedevelopmentofdiseasesistheroleofviralinfection,whichtriggersautoimmunereactionsagainstmostcells


inthebody.Therefore,identifyingvirusesresponsibleforinitiatingthediseaseprocessiscrucial.ThePCRmethodisrelevant.Immunesystemabnormalityisparticularlypresent.Thestudyofimmunologycomponents,cellularandhumoralfactors,isessential.Thepresenceofnegativeenergyfieldandweakbioenergysystemsuggeststheroleofspiritualforces.ThesecanbestudiedbyusingKirlianphotography,surfacescanninglaserdisplacementmetertomeasureacupuncturepulsations,acupunctureelectronicmeasurementdevice,magneticsensordevice,etc.Abnormalcraniosacralmechanismcausedbystructuralboneandconnectivetissuechangesshouldbestudiedusingobjectivemeasurementmethods.Laboratorybiochemicalassaystodetermineabnormalmetabolismandassessmentofvitamins,mineralsandenzymedeficienciesshouldbeconducted.Specificbiologicalmarkersshouldbeidentifiedandlaboratoryproceduresdevisedtoassistinthediagnosis.Leakygutsyndromeshouldbediagnosedbylaboratorymethods,candidamicrobiologyanddigestivestoolexamination.Toxinsfromvirus,candida,heavymetals,toxicmetabolitesandchemicaldrugsshouldbeidentifiedandmeasured.Researchofvarioustreatmentmethodsaddressingalltheabnormalmechanismstoestablishanewbalanceandhomeostaticregulationpattern,cellular,tissueandorganrepairandregenerationandnutritionaldeficienciesshouldbedevisedandstudied.Treatmentproceduresthataffectthecraniosacralsystemnegativelyarenotconsideredeffective.Effectivetreatmentproceduresmustcorrectspecificabnormalitiesofthediseases.SynergopathicherbalformulasforspecificdiseaseshavebeendesignedtosupportandcorrecttheabnormaldiseaseprocessesandwillproducemoreorlessnormalSynergopathicdiseasemodelprofiles.By simply placing the specific formulas on the body, all the profiles as tested by the cranial palpation method will revert to normal.Itisunlikelythatonlypharmacologicalinterventioniseffective.Patientswiththesediseasesmaydevelopimmunologicalreactionstosyntheticdrugsandserioussideeffects.

References1. KochR.UntersuchungenüberBakterien:V.Die

ÄtiologiederMilzbrand-Krankheit,begründetaufdieEntwicklungsgeschichtedesBacillus anthracisInvestigationsintobacteria:V.Theetiologyofanthrax,basedontheontogenesisofBacillus anthracis.Cohns Beitrage zur Biologie der Pflanzen, Vol.2.1876:277–310.

2. BrockTD.(1999).Robert Koch: a Life in Medicine and Bacteriology.WashingtonDC:AmericanSocietyofMicrobiologyPress;1999.

3. ChangMC,GriederFB.Dis Model Mech.2008Sep-Oct;1(2-3):99–102.doi:10.1242/dmm.001354.PMCID:PMC2562189

4. PribadiK.Psychosynergisis:ASynthesisofOsteopathicMedicine,AcupunctureMedicineandHomeopathyinPsychiatry.Amer Academy Osteo J.Spring,1998.

5. FullerRB.Synergetics: Explorations in the Geometry of Thinking.NewYork:Macmillan,1975,p.3.

6. PribadiK.SynergopathicMedicineandthecranialconceptinthesuccessfultreatmentofapatientwithparalyticileus:acasereport.Amer Academy Osteo J.2012;22(3):pp.12-18.

7. PribadiK.TheDetectionandRecordingofCranialRhythmicImpulseinAcupuncturePointsusingSurfaceScanningLaserDisplacementMeteranditsSignificance.Amer Academy Osteo J.2008;18(4):p.20-28.

8. PribadiK.VariousmethodsofCRIpalpationofbodyparts,theirdiagnosticvaluesandinterpretationofthefindings.Amer Academy Osteo J.2010;20(3).

9. PribadiK.“NaturalMedicineandMedicinalHerbalism.”GuestLectureatUniversityofPancasila,Jakarta,Indonesia,PharmacyDepartment:2008.

10. MeadowsS.TheBoywithaThorninHisJoints.TheNew York Times.AccessedFeb.1,2013.

11. LiuZ,LiN,NeuJ.Tightjunctions,leakyintestines,andpediatricdiseases.Acta Paediatr.2005;94(4):386–93.doi:10.1111/j.1651-2227.2005.tb01904.x.PMID16092447.

12. KieferD,Ali-AkbarianL.Abriefevidence-basedreviewoftwogastrointestinalillnesses:irritablebowelandleakygutsyndromes.Altern Ther Health Med.2004;10(3):22–30;quiz31,92.PMID15154150.

13. Assessmentofthelactulose-mannitoltestinCrohn’sdisease.FANDREetal.,Gut,1988,29,511-515

14. EvidenceforTranslocationofMicrobialProductsinPatientswithIdiopathicCD4+Lymphocytopenia.Leeetal.JInfectDis2009June1;199(11):1664–1670

15. LeakyGutSyndromes:BreakingtheViciousCycles.GallandL.TownsendLetterforDoctors,August/September1995,p.63.

16. Pizzorno,JE,Murray,MT,(November2005)TextbookofNaturalMedicine,3rdedition,ChurchillLivingstone,pp167,584,1527ISBN0-443-07300-7

17. LevySE,MandellDS,SchultzRT.Autism.Lancet.2009;374(9701):1627–38.doi:10.1016/S0140-6736(09)61376-3.PMID19819542.

18. NewschafferCJ,CroenLA,DanielsJet al.TheepidemiologyofautismspectrumdisordersPDF.Annu Rev Public Health.2007;28:235–58.doi:10.1146/annurev.publhealth.28.021406.144007.PMID17367287

19. AshwoodP,WillsS,VandeWaterJ.Theimmuneresponseinautism:anewfrontierforautismresearch.J Leukoc Biol.2006;80(1):1–15.doi:10.1189/jlb.1205707.PMID16698940.

20. PicchioniMM,MurrayRM.Schizophrenia.BMJ.2007;335(7610):91–5.doi:10.1136/bmj.39227.616447.BE.PMID17626963.

21. McLarenJA,SilinsE,HutchinsonD,MattickRP,HallW.Assessingevidenceforacausallinkbetweencannabisandpsychosis:areviewofcohortstudies.Int. J. Drug Policy.2010;21(1):10–9.doi:10.1016/j.drugpo.2009.09.001.PMID19783132.

22. O’DonovanMC,CraddockNJ,OwenMJ.Geneticsofpsychosis;insightsfromviewsacrossthegenome.Hum. Genet.2009;126(1):3–12.doi:10.1007/s00439-009-0703-0.PMID19521722.

23. SeltenJP,Cantor-GraaeE,KahnRS.Migrationandschizophrenia.Current Opinion in Psychiatry.2007;20(2):111–115.doi:10.1097/YCO.0b013e328017f68e.PMID17278906.



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FollowinganMRIvaccination,a4-year-oldboysuddenlyceasedhislanguagedevelopmentattheageof15months,accompaniedbytypicalautisticbehavior:pooreyecontact,socialavoidance,flapping,toe-walking,ritualcompulsivebehavior.Biomedicalinterventionsdidnotresultinsignificantimprovement.Historyincludesfebrileconvulsionandcesareandelivery.Nomedicalcomplicationsduringthefirsttwoyearsoflifeexceptforfebrileconvulsion.

Find

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ThisindividualshowspositiveUpledger-Pribadi’ssignattheCDAutism.AllCDsofpathologicprocessesrevealab-normalitiesindicatingthatthediseaseinvolvedallaspectsofhumanphysiology.However,thereisnoorganfailure.Automunnereactionsarepresentinmostorgans,notablybrain,nerves,thyroid,intrinsicfactor,gastrointestinesmostlikelytriggerredbymeaslesvirusfromvaccinationashedoesnothaveahistoryofchildhoodmeasles.MeaslesvirusispresentinthegeneticDNAandstemcells.Influenzavirusispresentinthenervoussystem,respiratory,GItract,immunesystem,musculoskeletalsystem,genitourinarysystem,etc.Mumpsvirusispresentintheparotidglandsandtestis.Leakygutsyndromeispresent,mostlikelycausedbyintestinalcandidainfectionandheavymetalspollution.Immunesystemisinefficientwithautoimmunecomponents.Allhormonesareaffected,notablytestosterone,steroid,pineal,thyroid,growthhormones.Neurotransmittersareabnormalwithhighdopamine,lowserotonin,acetylcholine,GABA.PolyneuropathymostlikelyduetodeficiencyofBcomplex,especiallyvitaminB12duetopoordigestionandabsorption.Notably,digestiveenzymesandbilesaltsarepoorlyproduced.NutritionaldeficienciesincludevitaminsA,Bcomplex,B12,C,E,bioflavonoid,chlorophyll,iodine,intrinsicfactor,calcium,magnesium,zinc.Heavymetalpoison-ingispresentnotably:aluminum,cadmium,mercury,arsenicum,lead.Toxinsarepresent.Mostmajoracupuncturepointsareabnormal,indicatingfailureofthebioenergysystem.Allchakras,auraarepoorlydeveloped.EMFshieldisweak,indicatingheiseasilyinfluencedbyenvironmentalEMF.Strongnegativeenergyandweakspiritualforcearedetected.Thehouseisfilledwithnegativeenergyfield.Thecraniosacralsystemislockedupandnotoperatingduetostresspatternsandweakenergysystem.Foodintoleranceincludes;gluten,casein,fryingvegetableoils,eggs,honey,sugar,tempeh,hotpepper,pepper,phenol-containingfruits,seafood,meat,chicken,fish,chocolate,coffee,additives,beans,nutswiththeexceptionofsoybeans.

Hyp

othe

sis

Centralinthedevelopmentofautismistheroleofviralinfection,whichtriggersneurodegenerationandautoimmunereactions,particularlytowardthebrainandnervecellularcomponents,intrinsicfactorandtissuewhichcauseabnormalneurotransmitterproductionandregulation.Immunesystemabnormalityisparticularlypresent.Abnormalcraniosacralmechanismcausedbyprenatal,natalornataltrauma,ispresent.Thickduralmembranes,SBScompression,medialcompressionaswellasbilateralosteomastoidrestrictionsandlumbosacralcompressionaredetected.Combinedwithpoorassimilationofneurovitaminsandantioxidantvitamins,thecentralandautonomicnervoussystemarejeopardized.Leakygutsyndrome,causedbyintestinalcandidainfection,sensitizestheimmunesystemtowardallergensandbodycomponents.Spiritualforcesplayintothedevelopmentofautismandthereforeshouldbeconsideredintreatingthisdisorder.Nutritionalapproachisessentialalongwithherbalandsupplementtreatment.Treatmentshouldbeholisticinnature,addressingalltheabnormalmechanismsandnutritionaldeficienciesandestablishinganewbalanceandhomeostaticregulationpattern.Leftandrightbrainintegration,audiovisualintegration,cerebralbrainstemintegrationarelacking.Autismisaneurodevelopmentaldisordercausedbymultiplefactorsinvolvingbody,mindandspiritualdimensions,includinggenemutations,heredity,viralinfection,autoimmuneresponsetovirus,leakygutsyndrome,neurotransmitterimbalance,nutritionaldeficienciesduetopoordigestionandassimilationofnutrition.Negativeen-ergyinterfereswiththebioenergeticregulatorysystematthecraniosacral,meridian-acupunctureandchakrasystem.

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Autismisadisorderofneuraldevelopmentcharacterizedbyimpairedsocialinteractionandcommunicationandbyrestrictedandrepetitivebehavior.Thegeneticsofautismarecomplex.Relationshavebeenfoundbetweenautismandschizophreniabasedonduplicationsanddeletionsofchromosomes.Evidencepointstosynapticdysfunctionasacauseofautism.17Environmentalfactorsthathavebeenclaimedtocontributeto,orexacerbate,autism,ormaybeimportantinfutureresearch,includecertainfoods,infectiousdisease,heavymetals,solvents,dieselexhaust,PCBs,phthalatesandphenolsusedinplasticproducts,pesticides,brominatedflameretardants,alcohol,smoking,illicitdrugs,vaccines18andprenatalstress.69Therelationshipofneurochemicalstoautismisnotwellunderstood;severalhavebeeninvestigated,withthemostevidencefortheroleofserotoninandofgeneticdifferencesinitstransport.3Aberrantimmuneactivityduringcriticalperiodsofneurodevelopmentispossible.

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Extractsofabriprecatorius,centellaeasiatica,curcumaofficinalis,morindacitrifolia,panaxginseng,phylanthusuri-naria,stachytarphetamutabilis,sonchiarvensis,zingiberisofficinalis,aloevera,avocado,cantaloupe,pineapple,guava,passiflorafruits,probiotic,lactobacillusacidophilusinsorbitolandnaturalalcohol20%.

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A38-year-oldmandiagnosedwithschizoaffectivedisorder,ahistoryofdrugabuse(marijuana,amphetamine,LSD,cocainebutnotheroine)andalcoholabusestartingatage16followingparentalseparation.Hehasbeenonantipsy-choticdrugsandvalproicacidforanumberofyears.Hehasengagedinaggressivebehaviortowardfamilymembers,criminalbehaviorsincludingtheftandrobbery,resultinginimprisonment.Symptomsincludemoodswings,auditoryhallucinations,persecutoryandgrandiosedelusionsandnegativesymptoms.

Table 1. Case Investigations


SCH

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(con

t’d.)

Find

ings

ThisindividualshowspositiveUpledger-Pribadi’ssignattheCDSCHIZ.AllCDsofpathologicprocessesrevealabnor-malitiesindicatingthatthediseaseinvolvedallaspectsofhumanphysiology.However,thereisnoorganfailure.Autoim-munereactionsarepresentinmostorgans,notablybrain,nerves,thyroid,mostlikelytriggeredbymeaslesvirusfromvaccineashedoesnothaveahistoryofchildhoodmeaslesleadingtowardneurodegeneration.MeaslesvirusaswellasthegeneticDNAandstemcells.Influenzavirusispresentinthenervoussystem,respiratory,GItract,immunesystem,musculoskeletalsystem,genitourinarysystem,etc.Mumpsvirusispresentintheparotidglandsandtestis.Leakygutsyndromesispresent,mostlikelycausedbyintestinalcandidainfectionandheavymetalspollution.Immunesystemisinefficientwithautoimmunecomponents.Allhormonesareaffected,notablytestosterone,steroid,pineal,thyroid.Neurotransmittersareabnormalwithhighdopamine,lowserotonin,acetylcholine,GABA.PolyneuropathymostlikelyduetodeficiencyofBcomplex,especiallyvitaminB12duetopoordigestionandabsorption.Notably,digestiveenzymes,andbilesaltsarepoorlyproduced.Highuricacid,cholesterol,triglyceridesuggestabnormalmetabolism.Intrinsicfactorislacking.Mostmajoracupuncturepointsareabnormal,indicatingfailureofthebioenergysystem.Allchakras,auraarepoorlydeveloped.EMFshieldisweak,indicatingheiseasilyinfluencedbyenvironmentalEMF.Strongnega-tiveenergyandweakspiritualforcearedetected.Thecraniosacralsystemisnotoperatingduetostresspatternsandweakenergysystem.Thisyoungmanexperimentedwithaddictivedrugsattheageof16followingparentalseparation.Theseaddictivedrugsintroducedhimtotheworldofnegativeenergy;consequently,hehasbeeneasilyinfluencedbynegativespiritualforces,withpoorimpulsecontrolandlackofconscience.Hehasengagedinmanyantisocialbehav-iors,includingaggressivebehavior,robberyandtheft,andhasbeenimprisonedonseveraloccasions.Hewasunabletopursuehisgraduateeducationashisintellectualfunctioningdeterioratedquicklyandhewasunabletocontrolhisbehaviorandmotivation.Heshowsperiodicpsychoticdecompensationwithextrememoodswings.Deficiencyinmostvitamins,mineralsandaminoacidsduetopoordigestionresultsinabnormalmetabolismandineffectiveneurotrans-mitterproductionandregulation.

Hyp

othe

sis

Centralinthedevelopmentofschizophrenicillnessistheroleofviralinfection,whichtriggersneurodegenerationandautoimmunereactionsparticularlytowardthebrainandnervecellularcomponentsand/ortissue,whichcauseabnormalneurotransmitterproductionandregulation.Immunesystemabnormalityisparticularlypresent.Mentalstressinvitesnegativeenergyforces,andinthiscaseviatheuseofaddictivedrugsandlifestyle.Abnormalcraniosacralmechanismcausedbyprenatalornataltrauma, ispresentwithweakpotencyandenergyandSBScompressionaswellasbilateralosteomastoidrestrictionsandlumbosacralcompression.Combinedwithpoorassimilationofneuro-vitaminsandantioxidantvitamins,thecentralandautonomicnervoussystemSarejeopardized.Theperiodicnatureofthisillnessappearstoberelatedtocyclingduetoinefficienthomeostaticregulationandenvironmentalfactors.Deteriorationmayfollowprogressiveviralinfectionandautoimmunedestructiveprocess.Leakygutsyndromecausedby intestinalcandida infectionsensitizes the immunesystemtowardsallergensandbodycomponents.Hallucina-tionsanddelusionsareproducedbythecombinationofneurotransmitterfailure,bioenergeticdysregulationandviralinfectiontriggeredbymentalstressaswellasspiritualandtoxicfactors.Spiritualforcesplayintothedevelopmentofschizophrenicillnessandthereforeshouldbeconsideredintreatingthisdisorder.Nutritionalapproachisessentialalongwithherbalandsupplementtreatment.Treatmentshouldbeholistic innature,addressingalltheabnormalmechanismsandnutritionaldeficienciesandestablishinganewbalanceandhomeostaticregulationpattern.Theuseofaddictivedrugsisverydestructivetotheprogressionofillness.Schizophreniaisaneurodevelopmentaldisordercausedbymultiplefactorsinvolvingbody,mindandspiritualdimensionsincludinggenemutations,heredity,viralinfection,autoimmuneresponse,leakygutsyndrome,neurotransmitterimbalance,nutritionaldeficienciesduetopoordigestionandassimilationofnutrition.Negativeenergyinterfereswiththebioenergeticregulatorysystematthecraniosacral,meridian-acupunctureandchakrasystem.

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Schizophreniaisamentaldisordercharacterizedbyabreakdownofthoughtprocessesandbyadeficitoftypicalemo-tionalresponses.Commonsymptomsincludeauditoryhallucinations,paranoidorbizarredelusions,ordisorganizedspeechandthinking,accompaniedbysignificantsocialoroccupationaldysfunction.Thegreatestriskfordevelopingschizophreniaishavingafirst-degreerelativewiththedisease(riskis6.5percent);morethan40percentofmonozygotictwinsofthosewithschizophreniaarealsoaffected.20Manypossiblecandidateshavebeenproposed,includingspecificcopynumbervariations,NOTCH4,andhistoneproteinloci.21Anumberofgenome-wideassociations,suchaszincfingerprotein804A,havealsobeenlinked.22Parentingstyleseemstohavenomajoreffect.Livinginanurbanenvironmentduringchildhoodorasanadulthasconsistentlybeenfoundtoincreasetheriskofschizophreniabyafactoroftwo.Otherfactorsthatplayanimportantroleincludesocialisolationandimmigrationrelatedtosocialadversity,racialdis-crimination,familydysfunction,unemploymentandpoorhousingconditions.23Abouthalfofthosewithschizophreniausedrugsoralcoholexcessively.24Evidencesupportsalinkbetweenearlieronsetofpsychoticillnessandcannabisuse.25Thereisevidencethatalcoholabuseviaakindlingmechanismcanoccasionallycausethedevelopmentofachronicsubstance-inducedpsychoticdisorder,e.g.,schizophrenia.Themoreoftencannabisisused,themorelikelyapersonistodevelopapsychoticillness,withfrequentusebeingcorrelatedwithtwicetheriskofpsychosisandschizophrenia.26Factorssuchashypoxiaandinfection,orstressandmalnutritioninthemotherduringfetaldevelopment,mayresultinaslightincreaseintheriskofschizophrenialaterinlife.Peoplediagnosedwithschizophreniaaremorelikelytohavebeenborninwinterorspring(atleastinthenorthernhemisphere),whichmaybearesultofincreasedratesofviralexposuresinutero.20StudiesusingneuropsychologicaltestsandbrainimagingtechnologiessuchasfMRIandPETtoexaminefunctionaldifferencesinbrainactivityhaveshownthatdifferencesseemtomostcommonlyoccurinthefrontallobes,hippocampusandtemporallobes.28Reductionsinbrainvolume,smallerthanthosefoundinAlzheimer’sdisease,havebeenreportedinareasofthefrontalcortexandtemporallobes.Particularattentionhasbeenpaidtothefunction


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ofdopamineinthemesolimbicpathwayofthebrain.TheinfluentialdopaminehypothesisofschizophreniaproposedthatexcessiveactivationofD2receptorswasthecauseof(thepositivesymptomsof)schizophrenia.Thedopaminehypothesis isnowthoughttobesimplistic,partlybecausenewerantipsychoticmedication(atypicalantipsychoticmedication)canbejustaseffectiveasoldermedication(typicalantipsychoticmedication),butalsoaffectsserotoninfunctionandmayhaveslightlylessofadopamineblockingeffect.29Lowlevelsofglutamatereceptorswerefoundinthepostmortembrainsofthosediagnosedwithschizophrenia.30

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Extractsofhydrocotyleasiatica,panaxginseng,pinussylvestris,curcumaofficinalis,aeruginosa,xanthorriza,mangga,avocado,aloevera,apple,cantaloupe,nonifruit,passiflora,pineapple,guavainsorbitol.Propolisaspreservative.Con-tainsprobioticlactobacilusacidophilusbacteria.Containsnoalcoholorman-madechemicals.

MU

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CLE

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e A36-year-oldmansufferingfromweakness,legparalysis,attacksofunconsciousness,currentlywheelchair-bound.Hewasdiagnosedwithmultiplesclerosisbyaneurologist.ExaminationwasdonebyCraniosacralTelediagnosisashedidnotrespondtotheauthor’sinterestinexamininghimviaFacebookcommunication.

Find

ings

ThisindividualshowspositiveUpledger-Pribadi’ssignattheCDMS.AllCDsofpathologicprocesses(infection,degenera-tion,circulation,immunity,toxicity,hormones,neoplasticprocess,nutrition,spiritualdimension,tissueoxygenation)revealabnormalitiesattheenergetic,chemicalandphysicallevels,indicatingthatthediseaseinvolvedallaspectsofhumanorgans,tissues,cellsandphysiology.Mostmajoracupuncturepointsareabnormalatbioenergetic,chemicalandphysicallevels,indicatingfailureofthebioenergysystem.Allchakras,auraarepoorlydeveloped.EMFshieldisweak,indicatingheiseasilyinfluencedbyenvironmentalEMF.Strongnegativeenergyandweakspiritualforcearedetected.Thecraniosacralsystemisnotoperatingduetostresspatterns,SBScompression,bioccipitalmastoidrestrictions,OAand lumbosacralcompression.Allphysiologicalsystemsandorgansareaffectedatthebioenergetic,chemicalandstructurallevels.Autoimmunereactionsarestronglypresentinmostorgans,notablyimmunesystem,skin,internalorgans,brain,nerves,heart,arteries,veins,allendocrines.Enterovirusandinfluenzavirusesinfecttheimmunesystem,skin,allinternalorgans,tissuesandcellsaswellasthegeneticDNAandstemcells.Leakygutsyndromeispresent,mostlikelycausedbyviralinfection,intestinalcandidainfectionandheavymetalspollution.Toxinsarepresentinallstructuresofthebody.Immunesystemisinefficientwithautoimmunecomponents.Allhormonesareaffected,notablymalehormone,steroid,pineal,thyroid,insulin,growthhormone,etc.Neurotransmittersareabnormalwithnormaldopamine,lowserotonin,acetylcholine,GABA.PolyneuropathymostlikelyduetodeficiencyofBcomplex,especiallyvitaminB12,duetopoordigestionandabsorption.Notably,intrinsicfactor,digestiveenzymes,andbilesaltsarepoorlyproduced.Highuricacid,cholesterol,triglyceridesuggestabnormalmetabolism.Deficiencyinmostvitamins,mineralsandaminoacidsduetopoordigestionresultsinabnormalmetabolismandineffectiveneurotransmitterproductionandregulationaswellasosteoporoticchanges.Allnutritionalcomponentsarelow,notablyantioxidantvitamins,vitaminsBcomplex,C,D,K,bioflavonoids,calcium,magnesium,zinc,potassiumandnatriumarelow.Bloodsugarandcreatinineareslightlyelevated.Poorbloodcirculationandpoorcellularoxygenationarenoted.

Hyp

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sis

CentralinthedevelopmentofMSistheroleofviralinfection,nervoussheathandmutationofthegenes.Immunesystemabnormalityisparticularlypresent.Thepresenceofanegativeenergyfieldandweakbioenergysystemsuggesttheroleofspiritualforces.Abnormalcraniosacralmechanismcausedbystructuralboneandconnectivetissuechangesispresentwithweakpotencyandenergy.Combinedwithpoorassimilationofneurovitaminsandantioxidantvitamins,thecentralandautonomicnervoussystemarejeopardized.Thefailureofhomeostaticregulatorysystemisobvious.Remissionanddeteriorationmayfollowthewaxingandwaningofviralinfectionandautoimmunedestructiveprocess.Leakygutsyndrome,causedbyintestinalcandidaandviralinfection,sensitizestheimmunesystemtowardallergensandbodycomponents.Toxinsfromvirus,candida,heavymetals,toxicmetabolitesandchemicaldrugsmayaccumu-late.PoortissueandcellularoxygenationduetolowvitaminB12preventstissuerepair.Treatmentshouldbeholisticinnatureaddressingalltheabnormalmechanismsandestablishinganewbalanceandhomeostaticregulationpattern,cellular,tissueandorganrepairandregenerationandnutritionaldeficiencies.MSisanimmune-mediateddisordermediatedbyacomplexinteractionoftheindividual’sgeneticsandasyetunidentifiedenvironmentalinsults.4Possibletargetsoftheimmuneresponseincludemyelinbasicprotein(MBP)andproteolipidprotein(PLP).RecentdatasuggestaroleformyelinlipidsinMS.24Virusmayberesponsiblefortriggeringautoimmuneresponse.Strongspiritualfactorsarepresentinthiscasebutexternalinnature.

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Multiplesclerosis(MS)isaninflammatorydiseaseinwhichthefattymyelinsheathsaroundtheaxonsofthebrainandspinalcordaredamaged,leadingtodemyelinationandscarringaswellasabroadspectrumofsignsandsymptoms.31MostlikelyMSoccursasaresultofsomecombinationofgenetic,environmentalandinfectiousfactors.Anumberofgeneticvariationshavebeenshowntoincreasetheriskofdevelopingthedisease.32Possibletargetsoftheimmunere-sponseincludemyelinbasicprotein(MBP)andproteolipidprotein(PLP).RecentdatasuggestaroleformyelinlipidsinMS.33Diseaseactivationbiomarkersincludeinterleukin-6,nitricoxideandnitricoxidesynthase,osteopontinandfetuin-A.34Severestressmaybeariskfactoralthoughevidenceisweak.35Smokinghasalsobeenshowntobeaninde-pendentriskfactorfordevelopingMS.36Associationwithoccupationalexposuresandtoxins—mainlysolvents—hasbeenevaluated,butnoclearconclusionshavebeenreached.35Vaccinationswereinvestigatedascausalfactorsforthe


MU

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t’d.) disease;however,moststudiesshownoassociationbetweenMSandvaccines.35Evidenceforvirusesasacauseincludes

thepresenceofoligoclonalbandsinthebrainandcerebrospinalfluidofmostpeoplewithMS,humanherpesviruses,measles,mumpsandrubellahavealsobeenrelatedwithMS.31

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Extractsofpanaxginseng,caselpiasappan,sonchusarvensis,stachytarpethamutabilis,isotomalongiflora,curcumaofficinalis,aeruginosa,xanthorriza,mangga,avocado,aloevera,pineappleinblackhoney,propolisasapreservative.Containsprobioticlactobacilusacidophilusbacteria.Containsnoalcoholorman-madechemicals.

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e A56-year-oldwoman,thefounderoftheIndonesianLupusAssociation,hasbeendiagnosedwithSLEforanumberyears.TheauthorperformedCraniosacralTelediagnosisbyviewingherpicturebroadcastviaTV.Theindividualisunknowntotheauthor.Sheappearstobehealthyandfunctional,beingabletoclimbupanddownmountains.

Find

ings

This individual showspositiveUpledger-Pribadi’s signat theCDSLE.AllCDsofpathologicprocesses (infection,degeneration, circulation, immunity, toxicity, hormones, neoplastic process, nutrition, spiritualdimension, tissueoxygenation)revealabnormalitiesattheenergetic,chemicalandphysicallevels,indicatingthatthediseasepermeatesallaspectsofhumanorgans,tissues,cellsandphysiology.Mostmajoracupuncturepointsareabnormalatbioenergetic,chemicalandphysicallevels,indicatingfailureofthebioenergysystem.Allchakras,auraarepoorlydeveloped.EMFshieldisweakindicatingsheiseasilyinfluencedbyenvironmentalEMF.Strongnegativeenergyandweakspiritualforcearedetected.Thecraniosacralsystemisnotoperatingduetostresspatterns,SBScompression,bioccipitalmastoidrestrictions,OAandlumbosacralcompression.Allphysiologicalsystemsandorgansareaffectedatthebioenergetic,chemicalandstructurallevels.Autoimmunereactionsarestronglypresentinmostorgans,notablyimmunesystem,kidneys,skin, internalorgans,brain,nerves,heart,arteries,veins, intrinsicfactor,allendocrines.Epstein-Barrandinfluenzavirusesinfecttheimmunesystem,skin,allinternalorgans,tissuesandcellsaswellasthegeneticDNAandstemcells.Leakygutsyndromeispresent,mostlikelycausedbyviralinfection,intestinalcandidainfectionandheavymetalspollution.Toxinsarepresentinallstructuresofthebody.Immunesystemisinefficientwithautoimmunecom-ponents.Allhormonesareaffected,notablyfemalehormone,steroid,pineal,thyroid,insulin,growthhormone,etc.Neurotransmittersareabnormalwithnormaldopamine,lowserotonin,acetylcholine,GABA.PolyneuropathymostlikelyduetodeficiencyofBcomplex,especiallyvitaminB12,duetopoordigestionandabsorption.Notably,intrinsicfactor,digestiveenzymes,andbilesaltsarepoorlyproduced.Highuricacid,cholesterol,triglyceridesuggestabnormalmetabolism.Deficiencyinmostvitamins,mineralsandaminoacidsduetopoordigestionresultsinabnormalme-tabolismandineffectiveneurotransmitterproductionandregulationaswellasosteoporoticchanges.Allnutritionalcomponentsarelow,notablyvitaminsA,Bcomplex,C,D,K,bioflavonoids,calcium,magnesium,zincarelow.Natriumishighandpotassiumislow.Poorbloodcirculationandpoorcellularoxygenationarenotedonallregions.Creatinine,bloodsugarandliverenzymesareslightlyelevated.

Hyp

othe

sis

CentralinthedevelopmentofSLEistheroleofviralinfection,whichtriggersautoimmunereactionsagainstmostcellsinthebody.Immunesystemabnormalityisparticularlypresent.Thepresenceofnegativeenergyfieldandweakbioenergysystemsuggeststheroleofspiritualforces.Abnormalcraniosacralmechanismcausedbystructuralboneandconnectivetissuechangesispresentwithweakpotencyandenergy.Combinedwithpoorassimilationofneurovita-minsandantioxidantvitamins,thecentralandautonomicnervoussystemarejeopardized.Thefailureofhomeostaticregulatorysystemisobvious.Remissionanddeteriorationmayfollowthewaxingandwaningofviralinfectionandautoimmunedestructiveprocess.Leakygutsyndrome,causedbyintestinalcandidaandviralinfection,sensitizestheimmunesystemtowardallergensandbodycomponents.Toxinsfromvirus,candida,heavymetals,toxicmetabolitesandchemicaldrugsmayaccumulate.PoortissueandcellularoxygenationduetolowvitaminB12preventstissuerepair.Treatmentshouldbeholisticinnature,addressingalltheabnormalmechanismsandestablishinganewbalanceandhomeostaticregulationpattern,cellular,tissueandorganrepairandregenerationandnutritionaldeficiencies.SLEisanimmune-mediateddisordermediatedbyacomplexinteractionoftheindividual’sgeneticsandasyetunidentifiedenvironmentalinsults.Virusmayberesponsiblefortriggeringautoimmuneresponse.Strongspiritualfactorsarepres-entinthiscasebutexternalinnature.

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gs ConstitutiveoverexpressionofBAFFinBAFF-transgenicmiceleadstoexpandedB-cellpopulationsandpolyclonalhy-pergammaglobulinemia.37,38,39Increasedserumand/orplasmalevelsofBLyShavebeendocumentedinhumansystemicerythematosus(SLE),rheumatoidarthritis,Sjögren’ssyndromeandHIVinfection.40-43

Her

bal

For-

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a Extractsofpanaxginseng,sonchusarvensis,stachytarpethamutabilis,cinnamomumburmani,curcumaofficinalis,xanthorriza,mangga,avocado,aloevera,guava,pineappleinblackhoney,propolisasapreservative.Containsprobioticlactobacilusacidophilusbacteria.Containsnoalcoholorman-madechemicals.


Course DescriptionAn additional model used in the diagnosis and treatment of musculoskeletal pain. This course will cover the ankle, shoulder, and knee. FDM is a model of thinking that provides a framework to view the function of the body and the expres-sion of pain. Fascia can be viewed as the “wrapper” of our bones, muscles, and organs. Fascia is an integral part of the body’s nerve network. Dr. Still identified the importance of the fascial system when seeking health. Treatments in the FDM are directed at the fascia and restoring its function by focusing on correcting distortions in the fascial system and thereby eliminating pain. The FDM provides practitioners another model in which to view the body and another tool in the battle against musculoskeletal pain. FDM expands the capability of traditional Osteopathic modalities by specifically addressing the fascia and the distortions which are identified. Treatment of the fascial distortions can provide dramatic results by addressing the Biotensegrity of the body. The FDM is driven by a patient’s body language, verbal description, and the provider’s underlying understanding of the fascial distor-tions and their impact on the whole system. CME16 hours of AOA Category 1-A credit are anticipated.

Course TimesMonday and Tuesday: 8:00 am - 5:30 pmBreakfast and lunch on your own, coffee provided.Todd A. Capistrant, DO, MHA, Program ChairDr. Capistrant is a board-certified Family Medicine physician specializing in Osteopathic Manipulation. He has been with Tanana Val-ley Clinic in Fairbanks, AK, since 2006, where he first began attending to patients in their 1st Care Center. In June 2013 he was selected as the Medical Director of Tanana Valley Clinic and oversees the thirteen different departments that comprise the clinic. Dr. Capistrant received a B.S. in Biology from the University of Minnesota and a D.O. at Des Moines University in Iowa. In addition to his medical education, Dr. Capistrant received a master’s degree in Healthcare Administration from Des Moines University in Iowa. He is one of three physicians in the U.S. certified to teach seminars on the FDM model.Course LocationThe Broadmoor1 Lake Avenue, Colorado Springs, CO 80906Reservations: 7am to 9pm (MT), seven days a week. (800) 634-7711 (Mention AAO event.) https://resweb.passkey.com/go/aao14

An Introduction to the Fascial Distortion Model (FDM)March 17–18, 2014

Course DescriptionThis course is designed for participants with intermediate to advanced skills in OMM and those who have taken intermediate level Cranial courses. We will take an in-depth look at the anatomical and structural influences of the pediatric ENT patient, taking a close look at the cranial and facial anatomy and its influences on health and function of the middle ear, sinuses, and temporomandibular joint.CME16 hours of AOA Category 1-A credit are anticipated.Course TimesMonday and Tuesday: 8:00 am - 5:30 pmBreakfast and lunch on your own, coffee provided.Course LocationThe Broadmoor1 Lake Avenue, Colorado Springs, CO 80906Reservations: 7am to 9pm (MT), seven days a week.(800) 634-7711 (Mention AAO event.) https://resweb.passkey.com/go/aao14

Osteopathic Approach to Common ENT Complaints of Children

Heather P. Ferrill, DO, Program ChairDr. Ferrill, a 2000 Michigan State University College of Osteopathic Medicine graduate, is an Associate Professor of Osteopathic Manipulative Medicine (OMM) at the Rocky Vista University College of Osteopathic Medicine (RVUCOM). Board-certified in Family Practice and Neuromusculoskeletal Medicine/OMM, her practice emphasizes Osteopathic Manipulative Treatment in the pediatric population. She serves on the AAO Board of Governors and the Education Committee.

March 17–18, 2014

Register online at www.academyofosteopathy.org. For travel arrangements, Contact Tina Callahan of Globally Yours Travel at (800) 274-5975 or [email protected].


online.


online.

https://resweb.passkey.com/go/aao14

https://resweb.passkey.com/go/aao14


https://netforum.avectra.com/eweb/DynamicPage.aspx?Site=AAO&WebCode=EventDetail&evt_key=1faabacc-eae6-4ebf-b595-bcd2258e4d15



https://netforum.avectra.com/eweb/DynamicPage.aspx?Site=AAO&WebCode=EventDetail&evt_key=8351d8cf-07d4-453e-8236-d749d203c854




VIT

ILIG

O

Cas

e A55-year-oldmanwithprogressivevitiligoduringthelastsixyears.Nomedicaltreatmentsucceededinstoppingtheprogressionandimprovingpigmentation.Healsohashypertension,highuricacid,cholesterolandtriglycerideandobesity.Heworksasaphotographer.

Find

ings

ThisindividualshowspositiveUpledger-Pribadi’ssignattheCDVIT.AllCDsofpathologicprocesses(infection,degen-eration,circulation,immunity,toxicity,hormones,neoplasticprocess,nutrition,spiritualdimension,tissueoxygenation)revealabnormalitiesattheenergetic,chemicalandphysicallevels,indicatingthatthediseaseinvolvedallaspectsofhumanorgans,tissues,cellsandphysiology.Mostmajoracupuncturepointsareabnormalatbioenergetic,chemicalandphysicallevels,indicatingfailureofthebioenergysystem.Allchakras,auraarepoorlydeveloped.EMFshieldisweak,indicatingheiseasilyinfluencedbyenvironmentalEMF.Strongnegativeenergyandweakspiritualforcearedetected.Thecraniosacralsystemisnotoperatingduetostresspatternsandweakenergysystem.Allphysiologicalsystemsandorgansareaffectedatthebioenergetic,chemicalandstructurallevels,Autoimmunereactionsarestronglypresentinmostorgans,notablyimmunesystem,skin,internalorgans,brain,nerves,heart,arteries,veins,allendocrines.Unknownvirusandinfluenzavirusinfectstheimmunesystem,skin,allinternalorgans,tissuesandcellsaswellasthegeneticDNAandstemcells.Thedepigmentedareasare infectedwiththeunknownvirus.Leakygutsyndromeispresent,mostlikelycausedbyviralinfection,intestinalcandidainfectionandheavymetalspollution.Toxinsarepresentinallstructuresofthebody.Immunesystemisinefficientwithautoimmunecomponents.Allhormonesareaffected,notablymalehormone,steroid,pineal,thyroid,insulin,growthhormone,etc.Neurotransmittersareabnormalwithnormaldopamine,lowserotonin,acetylcholine,GABA.PolyneuropathymostlikelyduetodeficiencyofBcomplex,especiallyvitaminB12duetopoordigestionandabsorption.Notably,intrinsicfactor,digestiveenzymes,andbilesaltsarepoorlyproduced.Highuricacid,cholesterol,triglyceridesuggestabnormalmetabolism.Deficiencyinmostvitamins,mineralsandaminoacidsduetopoordigestionresultsinabnormalmetabolismandineffectiveneurotransmitterproductionandregulationaswellasosteoporoticchanges.Tissueuricacidisestimatedat8.5,Cholesterol230,triglyceride280,bloodsugar130,creatinine0.9,SGOT40.Allnutritionalcomponentsarelow,notablyantioxidants,vitaminsBcomplex,DandK,calcium,magnesium,zinc,potassium,natriumarelow.Poorbloodcirculationandpoorcellularoxygenationarenoted.Asitturnedout,anegativeenergyfieldemanatingfromanoldgravebehindthehousewasdetected.Elimina-tionofthisnegativeenergyfieldbyenergytechniqueandspiritual-religousmethodresultedinthedisappearanceofnegativeenergyinthebodybioenergysystem.

Hyp

othe

sis

Centralinthedevelopmentofvitiligoistheroleofviralinfectionofanunknownidentity,whichtriggerscellularde-generation,especiallytheskinmelanocytesandautoimmunereactions.Immunesystemabnormalityisparticularlypresent.Thepresenceofanegativeenergyfieldandweakbioenergysystemsuggesttheroleofspiritualforces.AbnormalcraniosacralmechanismcausedbystructuralboneandconnectivetissuechangesispresentwithweakpotencyandenergyandSBScompressionandlumbosacralcompression.Combinedwithpoorassimilationofneurovitaminsandantioxidantvitamins,thecentralandautonomicnervoussystemarejeopardized.Thefailureofhomeostaticregulatorysystemisobvious.Remissionanddeteriorationmayfollowthewaxingandwaningofviralinfectionandautoimmunedestructiveprocess.Leakygutsyndromecausedbyintestinalcandidaandviralinfectionsensitizestheimmunesystemtowardsallergensandbodycomponents.Toxinsfromvirus,candida,heavymetals,toxicmetabolitesandchemicaldrugsmayaccumulate.Nutritionalapproachisessentialalongwithherbalandsupplementtreatment.PoortissueandcellularoxygenationduetolowvitaminB12preventspigmentationandtissuerepair.Treatmentshouldbeholisticinnature,addressingalltheabnormalmechanismandestablishinganewbalanceandhomeostaticregulationpattern,cellular,tissueandorganrepairandregenerationandnutritionaldeficiencies.Vitiligoisasystemicdiseasecausedbyautoimmunereactionsagainstbodycomponents,particularlytheskinmelanocytes.Strongspiritualfactorsarepresentinthiscasebutexternalinnature.

Curr

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gs Agenome-wideassociationstudyfound10independentsusceptibilitylociforgeneralizedvitiligo,responsiblefor7.4percentofthegeneticrisk.TYRencodestyrosinase,whichisnotacomponentoftheimmunesystem,butisanenzymeofthemelanocytethatcatalyzesmelaninbiosynthesis,andamajorautoantigeningeneralizedvitiligo.44Astudycomparing656peoplewithandwithoutvitiligoin114familiesfoundseveralmutations(single-nucleotidepolymorphisms)intheNALP1gene.TheNALP1gene,whichisonchromosome17locatedat17p13,isonacascadethatregulatesinflammationandcelldeath,includingmyeloidandlymphoidcells,whicharewhitecellsthatarepartoftheimmuneresponse.45

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Extractsofalpinagalanga,aloevera,caselpiasappan,curcumaofficinalis,aeruginosa,xanthorriza,mangga,avocado,aloevera,pineapple,guavainsorbitol,propolisaspreservativeandnaturalalcohol4%inglycerin.Useasalocalherbalformulatoapplyonthedepigmentedareas.


IDIO

PAT

HIC

TH

RO

MB

OC

YT

OP

EN

IC P

UR

PU

RA

(IT

P)

Cas

e A52-year-oldmanexperiencinglassitude,paleness,palpitationandpetechialrashoftwomonthsduration.Recentplateletcountrevealed15.000,necessitatingaplatelettransfusion.Upondischargefromthehospital,hewasprescribedasteroiddrug,anantibioticandmultivitamins.

Find

ings

ThisindividualshowspositiveUpledger-Pribadi’ssignattheCDITP.AllCDsofpathologicprocessesrevealabnormali-tiesattheenergetic,chemicalandphysicallevels,indicatingthatthediseaseinvolvedallaspectsofhumanorgansandphysiology.Mostmajoracupuncturepointsareabnormalatbioenergetic,chemicalandphysicallevels,indicatingfailureofthebioenergysystem.Allchakras,auraarepoorlydeveloped.EMFshieldisweak,indicatingheiseasilyinfluencedbyenvironmentalEMF.Strongnegativeenergyandweakspiritualforcearedetected.Thecraniosacralsystemisnotoperatingduetostresspatternsandweakenergysystem.Allphysiologicalsystemsandorgansareaffectedatthebio-energetic,chemicalandstructurallevels.Autoimmunereactionsarestronglypresentinmostorgans,notablyimmunesystem,bonemarrow,bloodcells(particularlythrombocytes),bloodstemcells,skin,internalorgans,brain,nerves,heart,arteries,veins,allendocrinesandtheintrinsicfactor.Epstein-Barr,fluvirusinfectstheimmunesystem,skin,allinternalorgans,tissuesandcellsaswellasthegeneticDNAandstemcells.Leakygutsyndromeispresent,mostlikelycausedbyviralinfection,intestinalcandidainfectionandheavymetalspollution.Toxinsarepresentinallstructuresofthebody.Immunesystemisinefficientwithautoimmunecomponents.Allhormonesareaffected,echovirusnotablymalehormone,steroid,pineal,thyroid,insulin,growthhormone,etc.Neurotransmittersareabnormalwithnormaldopamine,lowserotonin,acetylcholine,GABA.PolyneuropathymostlikelyduetodeficiencyofBcomplex,especiallyvitaminB12,duetopoordigestionandabsorption.Notably,intrinsicfactor,digestiveenzymes,andbilesaltsarepoorlyproduced.Highuricacid,cholesterol,triglyceridesuggestabnormalmetabolism.Deficiencyinmostvitamins,mineralsandaminoacidsduetopoordigestionresultsinabnormalmetabolismandineffectiveneurotransmitterproductionandregulationaswellasosteoporoticchanges.Tissueuricacidisestimatedat10.5,Cholesterol230,triglyceride2560,bloodsugar130,creatinine0.9,SGOT20.Allnutritionalcomponentsarelow,notablyantioxidants,vitaminsBcomplex,DandK,calcium,magnesium,zinc,potassiumandnatriumarelow.Poorbloodcirculationandpoorcellularoxygenationarenoted.Asitturnedout,anegativeenergyfieldemanatingfromanoldtreeinfrontofthehousewasdetected.Labresult:thrombocytewaslow,anemic,leukopenia.

Hyp

othe

sis

CentralinthedevelopmentofITPistheroleofviralinfection,probablyEpstein-Barr,whichtriggerscellulardegenera-tionandautoimmunereactions,particularlytowardthebloodcells,especiallythrombocytes,skin,connectivetissues,skin,brainandnervecellularcomponentsandmanyorgans.Immunesystemabnormalityisparticularlypresent.Thepresenceofnegativeenergyfieldandweakbioenergysystemsuggeststheroleofspiritualforces.Abnormalcraniosa-cralmechanismcausedbystructuralboneandconnectivetissuechangesispresentwithweakpotencyandenergyandSBScompressionandlumbosacralcompression.Combinedwithpoorassimilationofneurovitaminsandantioxidantvitamins,thecentralandautonomicnervoussystemarejeopardized.Thefailureofhomeostaticregulatorysystemisobvious.Remissionanddeteriorationmayfollowthewaxingandwaningofviralinfectionandautoimmunedestructiveprocess.Leakygutsyndrome,causedbyintestinalcandidaandviralinfection,sensitizestheimmunesystemtowardallergensandbodycomponents.Toxinsfromvirus,candida,heavymetals,toxicmetabolitesandchemicaldrugsmayaccumulate.Nutritionalapproachisessentialalongwithherbalandsupplementtreatment.Treatmentshouldbeholisticinnatureaddressingalltheabnormalmechanismandestablishinganewbalanceandhomeostaticregulationpattern,cellular,tissueandorganrepairandregeneration.ITPisasystemicdiseasecausedbyautoimmunereactionsagainstbodycomponents,particularlythrombocytes,megakaryocytes,bloodstemcells,bonemarrow.Strongspiritualfactorsarepresentinthiscasebutexternalinnature.

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Idiopathicthrombocytopenicpurpura(ITP)ischaracterizedbypetechialrashassociatedwithanabnormallylowplateletcountofunknowncause.Averylowplateletcountcarriesanincreasedriskofbleedingandpurpura.ITPisdiagnosedbyalowplateletcountinacompletebloodcount(acommonbloodtest).Additionalinvestigations(suchasabonemarrowbiopsy)maybenecessaryinsomecases.Inapproximately60percentofcases,antibodiesagainstplateletscanbedetected.46MostoftentheseantibodiesareagainstplateletmembraneglycoproteinsIIb-IIIaorIb-IX,andareoftheimmunoglobulinG(IgG)typeandsomerenownedresearchestablishedtheimmunepathogenesisofITP.47Thecoat-ingofplateletswithIgGmakesthemsusceptibletoopsonizationandphagocytosisbysplenicmacrophages,aswellasbyKupffercellsintheliver.TheIgGautoantibodiesarealsothoughttodamagemegakaryocytes.47Recentresearchindicatesthatimpairedproductionoftheglycoproteinhormonethromboprotein,whichisthestimulantforplateletproduction,maybeacontributingfactor..

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Extractsofpanaxginseng,caselpiasappan,cameliasinensis,sonchusarvensis,stachytarpethamutabilis,pinussylves-tris,curcumaofficinalis,aeruginosa,xanthorriza,mangga,avocado,aloevera,pineapple,guavainsorbitol,propolisaspreservative.Containsprobioticlactobacilusacidophilusbacteria.Containsnoalcoholorman-madechemicals.


DIA

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Cas

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A63-year-oldmansufferingfromdiabetesmelitustype2duringthelast15years.ThereisafamilyhistoryofhypertensionandDM,type2.Hehasahistoryofhighuricacid,cholesterol,LDLandtrigylcerides.Herecentlyunderwentcardiacsurgeryforthreeringsplacement.Heismaintainedonshortterminsulinandlongterminsulintokeephisbloodsugarlevelnormal.InthepasthealsoreceivedOADSandacholesterol-reducingdrug.

Find

ings

ThisindividualshowspositiveUpledger-Pribadi’ssignattheCDDMtype2andCDHYT.AllCDsofpathologicpro-cesses (infection, degeneration, circulation, immunity, toxicity, hormones, neoplastic process, nutrition, spiritualdimension,tissueoxygenation)revealabnormalitiesattheenergetic,chemicalandphysicallevels,indicatingthatthediseaseinvolvedallaspectsofhumanorgans,tissues,cellsandphysiology.Mostmajoracupuncturepointsareabnormalatbioenergetic,chemicalandphysicallevels,indicatingfailureofthebioenergysystem.Allchakras,auraarepoorlydeveloped.EMFshieldisweak,indicatingheiseasilyinfluencedbyenvironmentalEMF.Strongnegativeenergyandweakspiritualforcearedetected.Thecraniosacralsystemisnotoperatingduetostresspatterns,SBScompression,OAandlumbosacralcompression.Allphysiologicalsystemsandorgansareaffectedatthebioenergetic,chemicalandstructurallevels.Autoimmunereactionsarestronglypresentinmostorgans,notablyimmunesystem,pancrea,in-trinsicfactor,eyes,skin,internalorgans,brain,nerves,heart,arteries,veins,allendocrines.Enterovirusandinfluenzavirusesinfectpancreasandtheimmunesystem,skin,allinternalorgans,tissuesandcellsaswellasthegeneticDNAandstemcells.Leakygutsyndromeispresent,mostlikelycausedbyviralinfection,intestinalcandidainfectionandheavymetalspollution.Toxinsarepresentinallstructuresofthebody.Immunesystemisinefficientwithautoimmunecomponents.Allhormonesareaffected,notablymalehormone,steroid,pineal,thyroid,insulin,growthhormone,etc.Neurotransmittersareabnormalwithnormaldopamine,lowserotonin,acetylcholine,GABA.PolyneuropathymostlikelyduetodeficiencyofBcomplex,especiallyvitaminB12,duetopoordigestionandabsorption.Notably,intrinsicfactor,digestiveenzymesandbilesaltsarepoorlyproduced.Normaluricacid,cholesterol,triglyceridewithmedica-tions.Deficiencyinmostvitamins,mineralsandaminoacidsduetopoordigestionresultsinabnormalmetabolismandineffectiveneurotransmitterproductionandregulationaswellasosteoporoticchanges.Allnutritionalcomponentsarelow,notablyvitaminsA,Bcomplex,C,D,E,K,bioflavonoids,calcium,magnesium,zinc,potassiumarelow.Natriumishigh.Lowcardiacbloodcirculationandcellularoxygenationarenoted,otherwisenormal.Cellularinsulinsensitivityispoor,endogenousproduction:60percent.Langerhansactivity:60percent.Creatinineisnormal.

Hyp

othe

sis

Theroleofviralinfectioninthepancreascannotbeignored.Influenzavirusispresentinmostpartsofthebody.Im-munityislow.Autoimmuneresponsetomostorgans,tissue,cells(especiallyLangerhanscells),intrinsicfactor,retinaisnoted.Leakygutsyndrome,causedbyintestinalcandidaandviralinfection,sensitizestheimmunesystemtowardallergensandbodycomponents.Toxinsfromvirus,candida,heavymetals,toxicmetabolitesandchemicaldrugsmayaccumulate.Thepresenceofanegativeenergyfieldandweakbioenergysystemsuggeststheroleofspiritualforces.AbnormalcraniosacralmechanismcausedbystructuralboneandconnectivetissuechangesispresentwithweakpotencyandenergyandSBScompressionandlumbosacralcompression.Combinedwithpoorassimilationofneurovitaminsandantioxidantvitamins,thecentralandautonomicnervoussystemarejeopardized.ThefailureofhomeostaticregulatoryDMtype2isprobablyanimmune-mediateddisorderaffectingthepancreaticisletcellsmediatedbyacomplexinterac-tionoftheindividual’sgeneticsandlifestylefactors.Virusmayberesponsiblefortriggeringautoimmuneresponse.Strongspiritualfactorsarepresentinthiscasebutexternalinnature.

Curr

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gs Diabetesmellitusisagroupofmetabolicdiseasesinwhichapersonhashighbloodsugar,eitherbecausethepancreasdoesnotproduceenoughinsulin,orbecausecellsdonotrespondtotheinsulinthatisproduced.48Type1diabetesmel-litusischaracterizedbylossoftheinsulin-producingbetacellsoftheisletsofLangerhanswhichisaT-cell-mediatedautoimmuneattackinthepancreas.Type1diabetesispartlyinherited,andthentriggeredbycertaininfections,withsomeevidencepointingatCoxsackieB4virus.AgeneticelementinindividualsusceptibilitytosomeofthesetriggershasbeentracedtoparticularHLAgenotypes.Type2diabetesmellitusischaracterizedbyinsulinresistance,whichmaybecombinedwithrelativelyreducedinsulinsecretion.2Type2diabetesisdueprimarilytolifestylefactorsandgenetics.49

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Extracts of panax ginseng, caselpia sappan, cataranthus rosea, camelia sinensis, sonchus arvensis, stachytarpethamutabilis,tinosporacrispa,tribulusterestris,isotomalongiflora,curcumaofficinalis,xanthorrhiza,mangga,avocado,aloevera,pineapple,avocadoinblackhoneywithroyaljelly,propolisasapreservative.Containsprobioticlactobacilusacidophilusbacteria.


24. GreggL,BarrowcloughC,HaddockG.Reasonsforincreasedsubstanceuseinpsychosis.Clin Psychol Rev.2007;27(4):494–510.doi:10.1016/j.cpr.2006.09.004.PMID17240501.

25. LargeM,SharmaS,ComptonMT,SladeT,NielssenO.Cannabisuseandearlieronsetofpsychosis:asystematicmeta-analysis.Arch. Gen. Psychiatry.2011;68(6):555–61.doi:10.1001/archgenpsychiatry.2011.5.PMID21300939.

26. SewellRA,RanganathanM,D’SouzaDC.Cannabinoidsandpsychosis.International review of psychiatry (Abingdon, England).2009Apr;21(2):152–62.doi:10.1080/09540260902782802.PMID19367509.

27. BenAmarM,PotvinS.Cannabisandpsychosis:whatisthelink?Journal of Psychoactive Drugs.2007Jun;39(2):131–42.doi:10.1080/02791072.2007.10399871.PMID17703707.

28. Kircher,TiloandRenateThienel.The Boundaries of Consciousness.Amsterdam:Elsevier;2006.ISBN0-444-52876-8.Functionalbrainimagingofsymptomsandcognitioninschizophrenia.p.302.

29. JonesHM,PilowskyLS.Dopamineandantipsychoticdrugactionrevisited.British Journal of Psychiatry.2002;181:271–275.doi:10.1192/bjp.181.4.271.PMID12356650.

30. KonradiC,HeckersS.Molecularaspectsofglutamatedysregulation:implicationsforschizophreniaanditstreatment.Pharmacology and Therapeutics.2003;97(2):153–79.doi:10.1016/S0163-7258(02)00328-5.PMID12559388.

31. CompstonA,ColesA(October2008).Multiplesclerosis.Lancet372(9648):1502–17.doi:10.1016/S0140-6736(08)61620-7.PMID18970977.

32. DymentDA,EbersGC,SadovnickAD(February2004).Geneticsofmultiplesclerosis.Lancet Neurol3(92):104–10.doi:10.1016/S1474-4422(03)00663-X.PMID14747002.

33. HoPP,KanterJL,JohnsonAM,SrinageshHK,ChangEJ,PurdyTM,etal.(2012).Identificationofnaturallyoccurringfattyacidsofthemyelinsheaththatresolveneuroinflammation.Science Translational Medicine4(137):137–73.doi:10.1126/scitranslmed.3003831.PMID22674551.

34. HarrisVK,SadiqSA(2009).Diseasebiomarkersinmultiplesclerosis:potentialforuseintherapeuticdecisionmaking.Mol Diagn Ther13(4):225–44.doi:10.2165/11313470-000000000-00000.PMID19712003.

35. MarrieRA(December2004).Environmentalriskfactorsinmultiplesclerosisaetiology.Lancet Neurol3(12):709–18.doi:10.1016/S1474-4422(04)00933-0.PMID15556803.

36. GhadirianP,JainM,DucicS,ShatensteinB,MorissetR(1998).Nutritionalfactorsintheaetiologyofmultiplesclerosis:acase-controlstudyinMontreal,Canada.Int J Epidemiol.27(5):845–52.doi:10.1093/ije/27.5.845.PMID9839742.(primarysource)

37. GrossJA,JohnstonJ,MudriS,EnselmanR,DillonSR,MaddenK,XuW,Parrish-NovakJ,FosterD,Lofton-DayC,MooreM,LittauA,GrossmanA,HaugenH,FoleyK,BlumbergH,HarrisonK,KindsvogelW,CleggCH.TACIandBCMAarereceptorsforaTNFhomologueimplicatedinB-cellautoimmunedisease.Nature.2000;404:995–999.doi:10.1038/35010115.PubMedCrossRef

38. MackayF,WoodcockSA,LawtonP,AmbroseC,BaetscherM,SchneiderP,TschoppJ,BrowningJL.MicetransgenicforBAFFdeveloplymphocyticdisordersalongwithautoimmune

manifestations.J Exp Med.1999;190:1697–1710.doi:10.1084/jem.190.11.1697.PMCfreearticlePubMedCrossRef9

39. KhareSD,SarosiI,XiaX-Z,McCabeS,MinerK,SolovyevI,HawkinsN,KelleyM,ChangD,VanG,RossL,DelaneyJ,WangL,LaceyD,BoyleWJ,HsuH.SevereBcellhyperplasiaandautoimmunediseaseinTALL-1transgenicmice.Proc Natl Acad Sci USA.2000;97:3370–3375.doi:10.1073/pnas.050580697.PMCfreearticlePubMedCrossRef

40. ZhangJ,RoschkeV,BakerKP,WangZ,AlarcónGS,FesslerBJ,BastianH,KimberlyRP,ZhouT.Cuttingedge:aroleforBlymphocytestimulatorinsystemiclupuserythematosus.J Immunol.2001;166:6–10.PubMed

41. CheemaGS,RoschkeV,HilbertDM,StohlW.ElevatedserumBlymphocytestimulatorlevelsinpatientswithsystemicimmune-basedrheumaticdiseases.Arthritis Rheum.2001;44:1313–1319.doi:10.1002/1529-0131(200106)44:6<1313::AID-ART223>3.0.CO;2-S.PubMedCrossRef

42. GroomJ,KalledSL,CutlerAH,OlsonC,WoodcockSA,SchneiderP,TschoppJ,CacheroTG,BattenM,WhewayJ,MauriD,CavillD,GordonTP,MackayCR,MackayF.AssociationofBAFF/BLySoverexpressionandalteredBcelldifferentiationwithSjögren’ssyndrome.J Clin Invest.2002;109:59–68.doi:10.1172/JCI200214121.PMCfreearticlePubMedCrossRef

43. StohlW,CheemaGS,BriggsW,XuD,SosnovtsevaS,RoschkeV,FerraraDE,LabatK,SattlerFR,PierangeliSS,HilbertDM.Blymphocytestimulatorprotein-associatedincreaseincirculatingautoantibodylevelsmayrequireCD4+Tcells:lessonsfromHIV-infectedpatients.Clin Immunol.2002;104:115–122.doi:10.1006/clim.2002.5238.PubMedCrossRef

44. JinY,BirleaSA,FainPR,etal.(2010).VariantofTYRandAutoimmunitySusceptibilityLociinGeneralizedVitiligo.N Engl J Med.362(18):1686–97.doi:10.1056/NEJMoa0908547.PMC2891985.PMID20410501.

45. MashaghiA,etal.(2010).PossibleassociationoftheCD4genepolymorphismwithvitiligo.Clin Exp Dermatol.35(5):521–4.doi:10.1111/j.1365-2230.2009.03667.x.

46. CoopamahM,GarveyM,FreedmanJ,SempleJ(2003).Cellularimmunemechanismsinautoimmunethrombocytopenicpurpura:Anupdate.Transfus Med Rev.17(1):69–80.doi:10.1053/tmrv.2003.50004.PMID12522773.

47. SchwartzRS(2007).Immunethrombocytopenicpurpura--fromagonytoagonist.N. Engl. J. Med.357(22):2299–301.doi:10.1056/NEJMe0707126.PMID18046034.

48. Shoback,editedbyDavidG.Gardner,Dolores(2011).Greenspan’s Basic & Clinical Endocrinology(9thed.).NewYork:McGraw-HillMedical.pp.Chapter17.ISBN0-07-162243-8.

Accepted for publication:October2013

FormoreinformationortorequestafreecopyofThe Synergopathic Disease Model Assessment Form forresearchandclinicalpurposes,contact:KrishnahariS.Pribadi,MDJalanBorneoRaya,DepokTimur,WestJava,IndonesiaEmailaddress:[email protected]



Abstract

Cutaneousdisorderssuchasacne,psoriasis,chronicwounds,hyperhidrosis,atopicdermatitisandsclerodermaareoftendifficulttotreatbecauseofcomplexpathologicalmechanisms.Currenttheorieslinkthesedisorderstophysiologicaldisturbancessuchaslocalizedtissuecongestion,stress-inducedinflammationandimbalanceoftheautonomicnervoussystem.Osteopathicmanipulativemedicine(OMM)hasalwayshadahomeintheprimarycaresector,butgrowingresearchonthephysiologiceffectsofosteopathicmanipulativetherapyonthebodyhasnowopenedthedoorforitsuseinmanyotherfieldsofmedicine,includingdermatology.Applicationofosteopathicmanipulativetreatment(OMT),suchasmyofascialrelease,ribraising,lymphaticdrainage,andcranialosteopathicmanipulativetechniquesaimtorestorebalanceandtoaidinlong-termmanagementofdermatologicaldisorders.Osteopathicmanipulativetreatmentwillbemostusefulwhencombinedwithcurrentconventionaltherapeuticoptions.However,randomized,well-controlledstudiesarenecessarytoconfirmsuchtherapeuticbenefits.

Contrarytocurrentconcepts,dermatologydoesnotcompromiseosteopathicprincipals,butratherhasthepotentialtoexemplifythoseideals.

Introduction

Osteopathicmanipulativemedicine(OMM)haslongbeenassociatedwiththesectorofprimarycareandhas,overtheyears,showntobeextremelybeneficialinthetreatmentofmusculoskeletaldisorderssuchassomaticdysfunctionsofthecervical,thoracicorlumbarspine,radialorfibularheads,andcarpaltunnelsyndrome.However,asosteopathicphysicianscontinuetogrowinnumberandfindtheirwayintootherspecialtiesoutsideofthefamilypracticeandprimarycarespectra,itisimportanttocontinuetoexploretherolethatOsteopathicmanipulativetreatment(OMT),acornerstoneofosteopathicmedicine,couldhaveinthistransition.Campbelletal.1demonstratehowOMTcanbeusedinthetreatmentofnotalgiaparesthetica,brachioradialispruritis,trigeminalneuralgia,elephantiasisnostrasverrucosaandstasisdermatitis.Inthisarticle,theauthorsaimtodemonstratehow

Potential New Dimensions in Dermatology: The Osteopathic Approach to Cutaneous DiseaseAna M. Michunovich, BS, OMS III; and Robert Stern, MD

similartechniquescanbeappliedtootherdermatologicdiseasesthatmayimprovepatientmanagement.Finally,itaimstodemonstratethatdermatologyisaspecialtythatexemplifiesmanyaspectsofosteopathicmedicalpractice.Theeffectivenessofmanyofthesetreatmentmodalitiesremainstobedemonstratedinclinicaltrials.Butthesubtexthereisthatadditionally,allopathicphysiciansshouldbeencouragedtoincorporatethemintotheirpractices.

Osteopathic Manipulative Medicine and Dermatologic Disease

Manydermatologicdisorderspresentwithamyriadoftreatmentchallengesthatcanbefrustratingforbothphysiciansandpatients.Themajorityofcurrenttreatmentmodalitiesfocusoneithertopicalorsystemicpharmaceuticalagents,mostofwhichcomewithahostofsideeffectsanddelayedbenefits.Topicalointments,creamsandlotionsoftenleavepatientswithdryskin,photosensitivity,skinatrophy,etc.,whileoralmedicationscanresultingastrointestinaldiscomfort,Cushingoidappearance,livertoxicityoraweakenedimmunesystem.Therecurrentlyisalackofresearchconcerningtheuseofosteopathicmanipulationsinthetreatmentofdermatologicaldisorders.However,emergingbreakthroughsinthepathologyofcutaneousdiseasesalongwithclinicalevidencesupportingtheuseofOMMindisorderswithsimilarmechanismssetthestageforrefreshingandcutting-edgetreatmentplans.AsummaryoftheapplicationofOMTtoanumberofdermatologicdiseasesispresentedinTable 1.

Acne. Acnevulgarisisoneofthemostcommonskindisorders,affectingadolescentsandadultsalike.2Itisaninflammatorydisordercharacterizedbyareasofskinwithseborrhea,comedones,papules,pustulesandnodulesandcanpotentiallyresultinhyperpigmentationandpermanentscarring.2Inadditiontophysicalblemishes,prolongedstruggleswithacnehavebeencommonlylinkedtopsychologicaldisturbances.2Tidman2findsthatcomplicationsofacnevulgariscanincludebothphysicalandemotionalscarring.Disfigurementfrominflammation,aswellaspigmentationchangesandscarringoftencauseembarrassment,canundermineconfidenceandlowerself-esteem.Acnecaninducemoreseriouspsychologicaldistress,resultinginanxiety,depression,


andsocialwithdrawal.Thepathogenesisofthisdisorderisacomplexinteractionofmultiplefactors,bothinternalandexternaltothepilosebaceousunit,includinginfectionwiththeGrampositivebacteriaPropionibacterium acnes,excessandrogensecretion,highglycemicloaddiets,andpolymorphisminTNF-α(tumornecrosisfactor-alpha),IL-1(interleukin-1),andCYP1A1(CytochromeP450,family1,subfamilyA,polypeptide1)expression.3-6Acnevulgarismayfurthermorebeexacerbatedbystress,2,3,7-9bygreasytopicalpreparationsthatencourageblockageofthepores,bytraumaorahumidclimate.2

Currenttreatmentmethodsincludetopicalretinoids,oralisotretinoin,topicalandoralantibiotics,oralcontraceptivesandlaserorlighttherapy.However,

giventhestrongcorrelationbetweentheworseningofacneandincreasedstresshormonelevels,itcanbeinferredthatOMTtechniquesthatdecreasesympatheticnervoussystemresponsesandrelaxthemindandbodywouldbebeneficialadditivestothesetreatmentprotocols.Assuch,myofascialrelease,ribraisingatT1-4orcranialosteopathicmanipulativemedicinewouldbebeneficial,aswouldbetechniquesthatdecreaseinflammationsuchasfacialeffleurage.Theuseofribraisingtechniquesdecreasessomaticdysfunctioninthatareaofthesympatheticchainganglion,andthusnormalizeexcessautonomicoutput.10,11

Compressionofthefourthventricle(CV-4),acranialOMTmaneuver,alsorestoresproperautonomic

Table 1. Summary of Dermatological Diseases and Applications of OMT

Disease Clinical Features Pathophysiology Suggested Treatment RationaleA

cne

Seborrhea,comedones,papules,pustulesandnodules

P. acnes,excessandrogens,stress,dietandgenetics

Myofascialrelease,ribraising,cranialosteopath-icmanipulativemedicineandfacialeffleurage

Normalizeautonomicnervoussystemoutputandnormalizelymphaticflowtoreduceinflamma-tion

Psor

iasi

s

Sharplydemarcated,erythematous,raisedlesionscoveredwithasilverywhitescale,com-monlyaffectingtheexten-sorsurfacesoftheknees,elbows,trunkandscalp

Stress,genetics Ribraisingandcranialosteopathicmanipulativemedicine

Normalizeautonomicnervoussystemoutput

Chr

onic

w

ound

s Woundsthatfailtohealorhealthenreappear

Lymphaticandvenousinsufficiency

Lymphatictechniques(pedalpump,thoracicpump,effleurageandpectorallift)

Removalofblockageoflymphaticandvenousflow

Hyp

erhi

-dr

osis

Excessivesweatingatthepalms,maxillaeandsoles

Heritablehyperfunction-ingofsudomotorsweatcontrolsystem

Cranialosteopathicmanipulativemedicineandribraising

Normalizeexcessivesympatheticoutputtosudomotorsweatcontrolsystem

Ato

pic

der-

mat

its

Xerosis,lichenification,andeczematouslesions.Excoriationsandcrustingarecommon.

Geneticlossoffunctionmutationinfilaggrin,infectionwithS. aureus,andautonomicnervoussystemdysfunction

Cervicalmyofascialre-lease,cranialosteopathicmanipulativemedicineandribraising

Normalizetheexcessivesympatheticandparasympathetictone

Scle

rode

rma

Damagetothecellsliningthewallsofsmallarter-ies,dilationoflymphaticvessels,destructionoflymphaticvessels,andanabnormalbuildupofscartissueeitherlocallyorsystemically

Autoimmunityandgeneticmutations

Lymphatictechniques(pedalpump,thoracicpump,effleurageandpectorallift)

Increasedclearanceoflymphaticfluid


responsebymeansofmanipulationoftheskullsutures,aswellasenhancingfluidexchange.12Furthermore,alymphatictechnique,facialeffleurage,mayhelptocalmsomeoftheinflammationseeninacnepatients.Suchlymphatictechniqueshavebeenlinkedtothemobilizationofinflammatorymediatorsintothecirculation.13

Psoriasis. Psoriasisisamultisystem,chronic,inflammatorydisorderinwhichpatientsexperiencerepeatedboutsofred,pruritic,scalypatchesofskin.Themostcommonformofpsoriasis,plaquepsoriasis,ischaracterizedbysharplydemarcated,erythematous,raisedlesionscoveredwithsilverywhitescalesthatcommonlyaffectstheextensorsurfacesofknees,elbows,trunk,andscalp.Thepathogenesisofpsoriasisinvolvesgeneticandenvironmentalfactors.Amongtheseinfluences,emotionalstressisconsideredtoplayanespeciallyimportantroleinitsonsetandexacerbation.14IthasbeenproposedthatactivatedTH1cellsarerecruitedintotheskinandsecreteinflammatoryIFNΥ(interferongamma)whichinturninduceslocalantigen-presentingcellstosecreteIL-1andIL-23topromotetheexpansionofIL-17expressingCD(clusterofdifferentiation)4+andCD8+Tcells.15Thepathogenesisofpsoriasis,similartoatopicdermatitis,hasbeenlinkedtoabluntedHPA(hypothalamus-pituitary-adrenal)axisinpsoriaticssensitivetopsychologicalstressors.16Currenttreatmentmodalitiesincludetopicalcorticosteroids,VitaminDanalogues,Anthralin,topicalretinoids,oralmethotrexate,oralcyclosporine,calcineurininhibitors,salicylicacid,coaltarandmoisturizers.However,similaritytotherolethatthedisruptionoftheautonomicnervoussystemplaysintheexacerbationofbothacnevulgarisandpsoriasis,suggestsOMTtreatmentmodalitiespreviouslystatedforacnevulgariswouldalsohelppsoriaticpatients.Thesetreatmentsincluderibraisingandcraniosacraltechniques.

Chronic Wounds.Chronicwoundsareclassifiedasthosethatfailtoproceedthroughthehealingprocessinanorderlymannerandthatlastforextendedperiodsoftimeoroccurrepetitively.17,18Thesewoundsareduetoanumberoffactors,butaremostcommonlylinkedtoatherosclerosis,diabetesmellitus,hypertensionandvenousinsufficiency,withincidenceincreasingwithageandobesity.17-19Properwoundhealing,arebuildingofdisruptedanatomicarchitecture,isinitiatedbyplatelet-inducedinflammationandcarriedoutbycellularinfiltrationwithneutrophils,macrophages,Tlymphocytes,fibroblastsandendothelialcells.

Problemsarisewhensuchmediatorscannotreachsitesofinflammation.Chronicvenousinsufficiency

andlymphaticinsufficiencyareassociatedwithchroniculcers.Abreakdowninthelymphaticsystempredisposestoinfectionandcompromiseswoundhealing.20-23Furthermore,MacdonaldandMayrovitz22findthatmanaginglymphedemaatawoundsiteenhancesthewound-healingprocessinindividualswithandwithoutvenousinsufficiency,furtherstrengtheningthelinkbetweenproperlymphaticflowandwoundhealing.

Currenttreatmentprotocolsforchronicwoundsincludehyperbaricoxygentherapy,infectiousdiseasemanagement,nutrition,painmanagement,surgeryandeducation.However,duetotheimportantrelationshipbetweenproperlymphaticflow,bloodflowandwoundhealing,itcanbehypothesizedthatOMTaimedatimprovinglymphaticflowwillhelpinthepreventionofchronicwounds.24,25Thesetechniquesincludethepedalpump,thoracicpump,effleurageandpectorallift.

Hyperhidrosis and atopic dermatitis. Hyperhidrosisisacommondisorderthatcauseshyperfunctioningofthesudomotorsweatcontrolsystem.Thisresultsinincreasedsweatsecretionatthepalms,axillaeandsoles.26Primaryhyperhidrosisappearsinadolescenceandisthoughttobeanautonomicdominantdisorder.27Secondaryhyperhidrosis,however,iscausedbyothermedicalconditions.Theexactpathophysiologyofhyperhidrosisisunderinvestigation.However,alackofsweatingatnightsuggestsastrongemotionalcomponent.28Additionalresearchpointstolocalizedhyper-functioningofsympatheticfiberspassingthroughtheT2andT3ganglia.29Atopicdermatitisisadermatologicconditioncharacterizedbyxerosis,lichenification,andeczematouslesions.30Thepathogenesisofthediseasehasbeenlinkedtoageneticloss-of-functionmutationinfilaggrin,infectionwithS. aureus,andmostrecently,anautonomicnervoussystemdysfunction.31Anotherstudyfindsthatatopicsubjectsexhibitanoveractivesympatheticresponsetoitchingandscratching,whiletheparasympathetictoneispersistentlyandrigidlyelevated,indicatingalackofadaptabilityinresponsetostress.31

Currenttreatmentforhyperhidrosisincludesprescriptionandover-the-counterantiperspirants,iontophoresis,oralmedicationsandbotulinumtoxininjections.Thoseforatopicdermatitisareequallyvariedandincludetopicalcorticosteroidcreams,antibiotics,oralantihistamines,phototherapyandimmunomodulators.However,OMTtechniquessuchascraniosacralandribraising,whichtargettheautonomicnervoussystem,mayaidintreatingthesepatients.


Sympatheticnervefibersemergefromthoracolumbarvertebrae,andtheirganglialieintheparavertebralregion.Duetotheproximityofthesympatheticganglion,OMTdirectedtowardthevertebralbodiesandribsprotrudingfromthemmaynormalizesympatheticoutputattheleveloftheganglion.Occipitalrelease,aformofmyofascialrelease,mayalsobeuseful,asitaugmentstheoutputoftheparasympatheticnervoussystemandmayhelptorestorebalance.Finally,cranialmanipulationmayalsohaveeffectsontheoutputofsympatheticactivity.1

Scleroderma. Sclerodermaisararediseasemarkedbydamagetothecellsliningthewallsofsmallarteriesandanabnormalbuildupofscartissue.32Thisdisordercanbelocalizedtothehandsandfaceorcausesystemicsclerosisandbeassociatedwithcalcinosis,Raynaud’sphenomenon,esophagealmotilitydysfunction,sclerodactylyandtelangiectasia.Thepathogenesisofsclerodermaisnotknownbuthasbeenattributedtoautoimmunitywithageneticabnormalitytriggeredbypossibleenvironmentalfactors.33Currentresearchhasalsonotedthatscleroticcutaneouslesionsshowselectivedilationofsomelymphaticvesselsanddestructionofothers.33Whilethereasonforthisselectivityisnotknown,astrongcorrelationexistsbetweenthesefindingsandtheedematousphaseandsubsequentfibrosis.32-34

Ithasbeenpostulatedthatdilationoftheselymphaticvesselsoverloadsthelymphaticsviaeitheranincreaseininterstitialfluidduetothepathologicprocessand/ortheoverallreducedcapacityoflymphdrainagecausedbythedecreasednumberoflymphvessels.33Assuch,itcanbepostulatedthattheuseofOMTtechniques,suchasthepedalpump,pectorallift,effleurageandthoracicpumpcouldaidintheclearanceoflymphaticfluidandthusdelaytheprogressionofdisease.

Conclusion

Asthefieldofosteopathicmedicinecontinuestogrowandexpand,itisonlynaturalthatosteopathicphysicianswillcontinuetoenterotherspecialtiesandbringwiththemuniquetreatmentmodalitiestophysiologicaldiseases.Asdiscussed,onesuchfieldofmedicineinwhichtheosteopathicapproachhasthepotentialtobeextremelyusefulisdermatology.

Theauthorsmaintainthatcommondermatologicconditionssuchasacnevulgaris,psoriasisandatopicdermatitis,aswellasotherdisorders,includingchronicwounds,hyperhidrosis,andscleroderma,canbetreatedaseffectivelyifnotmoreeffectivelythroughthisintegrationofOMTintodermatology,ascommonly

practiced.Thoughtheauthorshavenothaddirectexperiencewithpatientswithdermatologicdisorders,theybelievethatthroughthisunion,physicianswillbeabletoprovidetheultimateincomprehensivepatientcare.FurtherstudiesconcerningtheapplicationofOMTinthetreatmentofdermatologicdisordersareneededinordertoconfirmsuchbenefits.

Finally,itmustbeemphasizedthatdermatologyisaclinicalspecialtythatexemplifiesthebestaspectsoftheosteopathicmedicalprofession.35Infact,allopathicphysiciansshouldbeencouragedtoincorporatesuchapproachesintheirowntreatmentpractices.Theymaybemissingmajoreffectivemodalitiesintheirusualapproachtodermatologicdisorders.

References1. CampbellSM,WinkelmannRR,WalkowskiS.Osteopathic

manipulativetreatment:novelapplicationtodermatologicaldisease.J Clin Aesthet Dermatol. 2012;5(10):24-32.

2. TidmanMJ.Prompttreatmentofacneimprovesqualityoflife.Practitioner. Jun2012;256(1752):15-17,12.

3. TaylorM,GonzalezM,PorterR.Pathwaystoinflammation:acnepathophysiology.Eur. J. Dermatol. 2011;21(3):323-333.

4. SmithRN,MannNJ,BraueA,MakelainenH,VarigosGA.Theeffectofahigh-protein,lowglycemic-loaddietversusaconventional,highglycemic-loaddietonbiochemicalparametersassociatedwithacnevulgaris:arandomized,investigator-masked,controlledtrial.J. Am. Acad. Dermatol. 2007;57(2):247-256.

5. FerdowsianHR,LevinS.Doesdietreallyaffectacne?Skin Therapy Letter. 2010;15(3):1-2,5.

6. SpencerEH,FerdowsianHR,BarnardND.Dietandacne:areviewoftheevidence.Int. J. Dermatol. 2009;48(4):339-347.

7. PalatsiR,ReinilaM,KivinenS.PituitaryfunctionandDHEA-SinmaleacneandDHEA-S,prolactinandcortisolbeforeandafteroralcontraceptivetreatmentinfemaleacne.Acta Derm. Venereol. 1986;66(3):225-230.

8. FischerH.SkinandtheAutonomicNervousSystem.Arch. Phys. Ther. (Leipz.). 1963;15:137-152.

9. PetersEM,LiezmannC,KlappBF,KruseJ.Theneuroimmuneconnectioninterfereswithtissueregenerationandchronicinflammatorydiseaseintheskin.Ann. N. Y. Acad. Sci. 2012;1262:118-126.

10. EhrenfeuchterW.Softtissue/ArticulatoryApproach.Foundations of Osteopathic Medicine.3ed.Philadelphia,Pennsylvania:LippincottWilliams&Wilkins;2011:763-785.

11. KorotkovK,ShelkovO,ShevtsovA,etal.StressreductionwithosteopathyassessedwithGDVelectrophotonicimaging:effectsofosteopathytreatment.J. Altern. Complement. Med. 2012;18(3):251-257.

12. ChaitowL.OsseousandSoftTissueApproaches.Cranial Manipulation Theory and Practice.London,England:ChurchillLivingstone;1999:116.

13. SchanderA,DowneyHF,HodgeLM.Lymphaticpumpmanipulationmobilizesinflammatorymediatorsintolymphaticcirculation.Exp Biol Med (Maywood). 2012;237(1):58-63.

14. HellerMM,LeeES,KooJY.Stressasaninfluencingfactorinpsoriasis.Skin Therapy Letter. 2011;16(5):1-4.



Archer, Jamie B. DOInthehandsofanangel.Vol.23,No.2,June2013,pp.19-22

Baker, Charity D. DOOsteopathicmanipulativetreatmentforLymedisease-inducedBell’spalsy:acasestudy.Vol.23,No.1,March2013,pp.12-15

Baker, Joshua P. DO, FAAFPTreatment of a posterior rib utilizinga multimodal sequence of osteopathicmanipulativetreatments.Vol.23,No.2,June2013,pp.10-13

UseofOMTtotreatpatientwithRamsayHunt syndromeandHIV:a case study.Vol.23,No.4,Dec.2013,pp.8-12

OsteopathicmanipulativetreatmentforLymedisease-inducedBell’spalsy:acasestudy.Vol.23,No.1,March2013,pp.12-15

Berkowitz, Murray R. DO, MA, MS, MPHRef lections on our recent past andthoughtsaboutour future.Vol. 23,No.2,June2013,pp.4,7

View from the Pyramids: New gradu-ate medical education opportunitiesfound—andlost.Vol.23,Issue1,March2013,pp.4,7

Bertucci, W. PhDStabilometric platform as a diagnosissupport for pain? Example of chroniclowbackpain.Vol.23,No.1,March2013,pp.44-45

Blumer, Janice U. DODistance learningandosteopathicma-nipulativemedicine.Vol.23,No.2,June2013,p.9

The extinction of manipulative medi-cine?Vol.23,No.3,Sept.2013,p.5

Burns, Denise K. DO, FAAOOsteopathic management of a familywithinheritedcervicaldystonia.Vol.23,No.3,Sept.2013,pp.30-37

Byrnes, Jr., Thomas DOBook Review—Charlotte Weaver: Pio-neer in Cranial Osteopathy, Edited byMargaretSorrell,DO.Vol.23,No.3,Sept.2013,pp.12-13

Capalbo, Gina OMS IVOsteopathic manipulative treatmentofpesanserinebursitisusingthetripletechnique:acasereport.Vol. 23,No. 1,March2013,pp.34-38

Chan, Vivian OMS IITheeffectoftheStudentAmericanAcad-emyofOsteopathy summerpreceptor-ship program on students’ perceptionofosteopathicmanipulative treatment.Vol.23,No.4,Dec.2013,pp.14-20

Channell, Millicent King DO, FAAOEvaluatingteachingmethodsandassess-menttoolsofhighvelocitylowamplitudetechniques for undergraduate osteo-pathic manipulative treatment of thespine.Vol.23,No.1,March2013,pp.24-32

Chmielewski, Richard MS, DO, FA-CEPOsteopathic manipulative treatmentofpesanserinebursitisusingthetripletechnique:acasereport.Vol. 23,No. 1,March2013,pp.34-38

Cloud, John BS, MS IVFractureasaresultofvolcanoboarding.Vol.23,No.3,Sept.2013,pp.15-20

Covington, J. Daren OMS IVReliefofpersistentjawpainwiththeuseof osteopathic manipulative medicine.Vol.23,No.2,June2013,pp.15-17

Crow, Wm. Thomas DO, FAAOSensoryintegrationsyndromeordevel-opmentalcoordinationdisorder:acasereport. Vol. 23, No. 1, March 2013, pp.8-10,15

Cymet, Tyler DOFractureasaresultofvolcanoboarding.Vol.23,No.3,Sept.2013,pp.15-20

Davidson, Ross BS, OMS IIFractureasaresultofvolcanoboarding.Vol.23,No.3,Sept.2013,pp.15-20

Deason, J. ScB, MS, PhG, DOFromtheArchives:StructureandFunc-tion.Vol.23,No.3,Sept.2013,pp.22-24

Ely, Rachel MHA, OMS IIITreatment of a posterior rib utilizinga multimodal sequence of osteopathicmanipulativetreatments.Vol.23,No.2,June2013,pp.10-13

Flaum, Theodore B. DOUsefulnessof video learning forosteo-pathic manipulative medicine (OMM)techniquesintheeducationalandclini-calsetting.Vol.23,No.3,Sept.2013,pp.24-30

Huard, Yannick DO, ScMStabilometric platform as a diagnosissupport for pain? Example of chroniclowbackpainVol.23,No.1,March2013,pp.44-45

Jung, Min-Kyung PhDUsefulnessof video learning forosteo-pathic manipulative medicine (OMM)techniquesintheeducationalandclini-calsetting.Vol.23,No.3,Sept.2013,pp.24-30

Kravchenko, Tamara I. PhD, DOThe liquorodynamic model of the pri-maryrespiratorymechanism.Vol.23,No.2,June2013,pp.24-29

Lipton, James A. DO, CSPOMM, FAAO, FAAPMR, DAOBPMRTheuseoforthoticsinthereductionofself-reported pain scores in a VeteransAffairspopulation:aretrospectivestudy.Vol.23,No.3,Sept.2013,pp.9-12

Reliefofpersistentjawpainwiththeuseof osteopathic manipulative medicine.Vol.23,No.2,June2013,pp.15-17

Litman, Randy G. DO, FAAONormalization of thoraco-abdominalfascialandautonomictone:acasestudyforthediagnosisandtreatmentofatypi-calchestpain.Vol.23,No.1,March2013,pp.20-22

Sequelae of traumatic closed-head in-jury:acasereportofa71-year-oldmaleseen40yearslater.Vol.23,No.1,March2013,pp.17-18,22

Mancini, Jayme D. DO, PhD, FAWMOsteopathic management of a familywithinheritedcervicaldystonia.Vol.23,No.3,Sept.2013,pp.30-37

Marberry, Kevin MDFractureasaresultofvolcanoboarding.Vol.23,No.3,Sept.2013,pp.15-20

McCaffrey, Kate DOMillenialTimes:Womeninosteopathicmedicine.Vol.23,No.1,March2013,pp.5,7

ViewfromthePyramids:Inyourhandsnow!Volume23,Issue3,September2013,p.4

View from the Pyramids: It takes anosteopathicvillage.Vol.23,No.4,Dec.2013,p.4

View from the Pyramids: Osteopathicmedicineandspirituality.Vol.23,No.2,June2013,p.7

Meghpara, Melissa K. OMS IIIUsefulnessof video learning forosteo-pathic manipulative medicine (OMM)techniquesintheeducationalandclini-calsetting.Vol.23,No.3,Sept.2013,pp.24-30

The AAO Journal 2013 IndexBY AUTHOR


Michunovich, Ana M. BS, OMS IIIPotentialnewdimensions indermatol-ogy: theosteopathic approach to cuta-neousdisease.Vol.23,No.4,Dec.2013,pp.34-37

Moskalenko, Yuri E. DSc, DO (Hon.)The liquorodynamic model of the pri-maryrespiratorymechanism.Vol.23,No.2,June2013,pp.24-29

Palmer, Tiffany R. BS, MS IVFractureasaresultofvolcanoboarding.Vol.23,No.3,Sept.2013,pp.15-20

Pena, Nicole OMS IVOsteopathic manipulative treatmentofpesanserinebursitisusingthetripletechnique:acasereport.Vol. 23,No. 1,March2013,pp.34-38

Pribadi, Krishnahari S. MDThe application of the cranial conceptin the investigationofbafflingmedicaldisordersand their treatment:a syner-gopathicmedicaldiseasemodel.Vol.23,No.4,Dec.2013,pp.20-33

Stern, Robert MDPotentialnewdimensions indermatol-ogy: theosteopathic approach to cuta-neousdisease.Vol.23,No.4,Dec.2013,pp.34-37

Terzella, Michael J. DOUsefulnessof video learning forosteo-pathic manipulative medicine (OMM)techniquesintheeducationalandclini-calsetting.Vol.23,No.3,Sept.2013,pp.24-30

Uhrig, Lawrence DOAtaleoftwosisters:anosteopathicstory.Vol.23,No.4,Dec.2013,p.7

Vardy, Terence C. DOThe liquorodynamic model of the pri-maryrespiratorymechanism.Vol.23,No.2,June2013,pp.24-29

Vazzana, Kathleen M. OMS IVTheeffectoftheStudentAmericanAcad-emyofOsteopathy summerpreceptor-ship program on students’ perceptionofosteopathicmanipulative treatment.Vol.23,No.4,Dec.2013,pp.14-20

Weinstein, Gustav B. PhDThe liquorodynamic model of the pri-maryrespiratorymechanism.Vol.23,No.2,June2013,pp.24-29

Wenzel, Charles JD, OMS IVTheeffectoftheStudentAmericanAcad-emyofOsteopathy summerpreceptor-ship program on students’ perceptionofosteopathicmanipulative treatment.Vol.23,No.4,Dec.2013,pp.14-20

Worden, Katherine A. DO, MSLookingbackandlookingahead.Vol.23,No.4,Dec.2013,p.5

Yao, Sheldon C. DOTheeffectoftheStudentAmericanAcad-emyofOsteopathy summerpreceptor-ship program on students’ perceptionofosteopathicmanipulative treatment.Vol.23,No.4,Dec.2013,pp.14-20

Usefulnessof video learning forosteo-pathic manipulative medicine (OMM)techniquesintheeducationalandclini-calsetting.Vol.23,No.3,Sept.2013,pp.24-30

AcnePotentialnewdimensions indermatol-ogy: theosteopathic approach to cuta-neousdisease;Michunovich,AnaM.BS,OMSIII;RobertStern,MDVol.23,No.4,Dec.2013,pp.34-37;

Alzheimers’s diseaseThe application of the cranial conceptin the investigationofbafflingmedicaldisordersand their treatment:a syner-gopathicmedicaldiseasemodel;Pribadi,KrishnahariS.MD;Vol.23,No.4,Dec.2013,pp.20-33;

Angel’s RestInthehandsofanangel;Archer,JamieB.DO;Vol.23,No.2,June2013,pp.19-22;

Atopic dermatitisPotentialnewdimensions indermatol-ogy: theosteopathic approach to cuta-neousdisease;Michunovich,AnaM.BS,OMSIII;RobertStern,MDVol.23,No.4,Dec.2013,pp.34-37;

A.T. Still UniversityLookingBackandLookingAhead;Wor-den,KatherineA.DO,MS;Vol.23,No.4,Dec.2013,p.5;

Book reviewBook Review—Charlotte Weaver: Pio-neer in Cranial Osteopathy, Edited byMargaretSorrell,DO;Byrnes,Jr.,ThomasDO;Vol.23,No.3,Sept.2013,pp.12-13;

Case studyNormalization of thoraco-abdominalfascialandautonomictone:acasestudyforthediagnosisandtreatmentofatypi-cal chest pain; Litman, Randy G. DO,FAAO; Vol. 23, No. 1, March 2013, pp.20-22;

Osteopathic management of a familywithinheritedcervicaldystonia;Burns,DeniseK.DO,FAAO;JaymeD.Mancini,

DO, PhD, FAWMVol. 23, No. 3, Sept.2013,pp.30-37;

OsteopathicmanipulativetreatmentforLymedisease-inducedBell’spalsy:acasestudy; Baker, CharityD.DO; Joshua P.Baker,DO, FAAPVol. 23,No. 1,March2013,pp.12-15;

Osteopathic manipulative treatmentofpesanserinebursitisusingthetripletechnique:acasereport;Capalbo,GinaOMSIV;RichardChmielewski,MS,DO,FACEP;NicolePena,OMSIVVol.23,No.1,March2013,pp.34-38;

Sensoryintegrationsyndromeordevel-opmentalcoordinationdisorder:acasereport;Crow,Wm.ThomasDO,FAAO;Vol.23,No.1,March2013,pp.8-10,15;

Sequelae of traumatic closed-head in-jury:acasereportofa71-year-oldmaleseen 40 years later; Litman, Randy G.DO, FAAO;Vol. 23, No. 1,March 2013,pp.17-18,22;

Cell theoryFromtheArchives:StructureandFunc-tion;Deason,J.ScB,MS,PhG,DO;Vol.23,No.3,Sept.2013,pp.22-24;

Cerro Negro, NicaraguaFractureasaresultofvolcanoboarding;Cloud,JohnBS,MSIV;TiffanyR.Palmer,BS,MSIV;RossDavidson,BS,OMSII;TylerCymet,DO;KevinMarberry,MDVol.23,No.3,Sept.2013,pp.15-20;

Charlotte WeaverBook Review—Charlotte Weaver: Pio-neer in Cranial Osteopathy, Edited byMargaretSorrell,DO;Byrnes,Jr.,ThomasDO;Vol.23,No.3,Sept.2013,pp.12-13;

Chest painNormalization of thoraco-abdominalfascialandautonomictone:acasestudyforthediagnosisandtreatmentofatypi-cal chest pain; Litman, Randy G. DO,FAAO; Vol. 23, No. 1, March 2013, pp.20-22;

Chronic woundsPotentialnewdimensions indermatol-ogy: theosteopathic approach to cuta-neousdisease;Michunovich,AnaM.BS,OMSIII;RobertStern,MDVol.23,No.4,Dec.2013,pp.35-39;

Clinical ExposureTheeffectoftheStudentAmericanAcad-emyofOsteopathySummerpreceptor-ship program on students’ perceptionofosteopathicmanipulative treatment;Vazzana, KathleenM. OMS IV; VivianChan,OMSII;CharlesWenzel,JD,OMSIV;andSheldonC.Yao,DOVol.23,No.4,Dec.2013,pp.14-20;

BY SUBJECT


Closed-head injurySequelae of traumatic closed-head in-jury:Acasereportofa71-year-oldmaleseen 40 years later; Litman, Randy G.DO, FAAO;Vol. 23, No. 1,March 2013,pp.17-18,22;

Cranial osteopathyBook Review—Charlotte Weaver: Pio-neer in Cranial Osteopathy, Edited byMargaretSorrell,DO;Byrnes,Jr.,ThomasDO;Vol.23,No.3,Sept.2013,pp.12-13;

Craniosacral Acupuncture Palpatory MethodThe application of the cranial conceptin the investigationofbafflingmedicaldisordersand their treatment:a syner-gopathicmedicaldiseasemodel;Pribadi,KrishnahariS.MD;Vol.23,No.4,Dec.2013,pp.20-33;

Craniosacral Allergy Screening TestThe application of the cranial conceptin the investigationofbafflingmedicaldisordersand their treatment:a syner-gopathicmedicaldiseasemodel;Pribadi,KrishnahariS.MD;Vol.23,No.4,Dec.2013,pp.20-33;

Craniosacral Digital Diagnostic MethodThe application of the cranial conceptin the investigationofbafflingmedicaldisordersand their treatment:a syner-gopathicmedicaldiseasemodel;Pribadi,KrishnahariS.MD;Vol.23,No.4,Dec.2013,pp.20-33;

Craniosacral Nutritional Assessment MethodThe application of the cranial conceptin the investigationofbafflingmedicaldisordersand their treatment:a syner-gopathicmedicaldiseasemodel;Pribadi,KrishnahariS.MD;Vol.23,No.4,Dec.2013,pp.20-33;

Craniosacral Pathological ProfileThe application of the cranial conceptin the investigationofbafflingmedicaldisordersand their treatment:a syner-gopathicmedicaldiseasemodel;Pribadi,KrishnahariS.MD;Vol.23,No.4,Dec.2013,pp.20-33;

Craniosacral Tele-Diagnostic MethodThe application of the cranial conceptin the investigationofbafflingmedicaldisordersand their treatment:a syner-gopathicmedicaldiseasemodel;Pribadi,KrishnahariS.MD;Vol.23,No.4,Dec.2013,pp.20-33;

DermatologyPotentialnewdimensions indermatol-ogy: theosteopathic approach to cuta-neousdisease;Michunovich,AnaM.BS,

OMSIII;RobertStern,MDVol.23,No.4,Dec.2013,pp.34-37;

Developmental coordination disor-derSensoryintegrationsyndromeordevel-opmentalcoordinationdisorder:acasereport;Crow,Wm.ThomasDO,FAAO;Vol.23,No.1,March2013,pp.8-10,15;

DiagnosisStabilometric platform as a diagnosissupport for pain? Example of chroniclowbackpain;Bertucci,W.PhD;YannickHuard, DO, ScMVol. 23, No. 1,March2013,pp.44-45;

Normalization of thoraco-abdominalfascialandautonomictone:acasestudyforthediagnosisandtreatmentofatypi-cal chest pain; Litman, Randy G. DO,FAAO; Vol. 23, No. 1, March 2013, pp.20-22;

Distance learningDistance learningandosteopathicma-nipulative medicine; Blumer, Janice U.DO;Vol.23,No.2,June2013,p.9;

Edna LayLookingBackandLookingAhead;Wor-den,KatherineA.DO,MS;Vol.23,No.4,Dec.2013,p.5;

Extinction of manipulative medicineThe extinction of manipulative medi-cine?;Blumer,JaniceU.DO;Vol.23,No.3,Sept.2013,p.5;

From the archivesFromtheArchives:StructureandFunc-tion;Deason,J.ScB,MS,PhG,DO;Vol.23,No.3,Sept.2013,pp.22-24;

Guillain-Barre syndromeThe application of the cranial conceptin the investigationofbafflingmedicaldisordersand their treatment:a syner-gopathicmedicaldiseasemodel;Pribadi,KrishnahariS.MD;Vol.23,No.4,Dec.2013,pp.20-33;

HeadacheInthehandsofanangel;Archer,JamieB.DO;Vol.23,No.2,June2013,pp.19-22;

High velocity low amplitude tech-niquesEvaluating teaching methods and as-sessment tools of high velocity lowamplitude techniques for undergradu-ateosteopathicmanipulativetreatmentof the spine; Channell, Millicent KingDO, FAAO;Vol. 23, No. 1,March 2013,pp.24-32;

HIVUseofOMTtoTreatPatientwithRamsayHuntSyndromeandHIV:ACaseStudy;

Baker,JoshuaP.DO,FAAFP;Vol.23,No.4,Dec.2013,pp.8-12;

HyperhidrosisPotentialnewdimensions indermatol-ogy: theosteopathic approach to cuta-neousdisease;Michunovich,AnaM.BS,OMSIII;RobertStern,MDVol.23,No.4,Dec.2013,pp.34-37;

Inherited cervical dystoniaOsteopathic management of a familywithinheritedcervicaldystonia;Burns,DeniseK.DO,FAAO;JaymeD.Mancini,DO, PhD, FAWMVol. 23, No. 3, Sept.2013,pp.30-37;

Jaw painReliefofpersistentjawpainwiththeuseof osteopathic manipulative medicine;Covington, J. DarenOMS IV; JamesA.Lipton,DO,FAAO,FAAPMRVol.23,No.2,June2013,pp.15-17;

Koch’s postulatesThe application of the cranial conceptin the investigationofbafflingmedicaldisordersand their treatment:a syner-gopathicmedicaldiseasemodel;Pribadi,KrishnahariS.MD;Vol.23,No.4,Dec.2013,pp.20-33;

Leaky gut syndromeThe application of the cranial conceptin the investigationofbafflingmedicaldisordersand their treatment:a syner-gopathicmedicaldiseasemodel;Pribadi,KrishnahariS.MD;Vol.23,No.4,Dec.2013,pp.20-33;

Liquordynamic modelTheliquorodynamicmodeloftheprima-ryrespiratorymechanism;Kravchenko,TamaraI.PhD,DO;YuriE.Moskalenko,DSc, DO (Hon.); Gustav B.Weinstein,PhD;TerenceC.Vardy,DOVol.23,No.2,June2013,pp.24-29;

Long-term care benefitsAtaleoftwosisters:anosteopathicstory;Uhrig,LawrenceDO;Vol.23,No.4,Dec.2013,p.7;

Low back painStabilometric platform as a diagnosissupport for pain? Example of chroniclowbackpain;Bertucci,W.PhD;YannickHuard, DO, ScMVol. 23, No. 1,March2013,pp.44-45;

Lyme disease-induced Bell’s palsyOsteopathicmanipulativetreatmentforLymedisease-inducedBell’spalsy:acasestudy; Baker, CharityD.DO; Joshua P.Baker,DO, FAAPVol. 23,No. 1,March2013,pp.12-15;


Margaret SorrellBook Review—Charlotte Weaver: Pio-neer in Cranial Osteopathy, Edited byMargaretSorrell,DO;Byrnes,Jr.,ThomasDO;Vol.23,No.3,Sept.2013,pp.12-13;

Medical EducationTheeffectoftheStudentAmericanAcad-emyofOsteopathySummerpreceptor-ship program on students’ perceptionofosteopathicmanipulative treatment;Vazzana, KathleenM. OMS IV; VivianChan,OMSII;CharlesWenzel,JD,OMSIV;andSheldonC.Yao,DOVol.23,No.4,Dec.2013,pp.14-20;

View From the Pyramids: New gradu-ate medical education opportunitiesfound—and lost; Berkowitz,MurrayR.Do,MA,MS,MPH;Vol.23,Issue1,March2013,pp.4,7;

Millenial TimesMillenialTimes:Womeninosteopathicmedicine;McCaffrey,KateDO;Vol.23,No.1,March2013,pp.5,7;

Multimodal sequenceTreatment of a posterior rib utilizinga multimodal sequence of osteopathicmanipulative treatments;Baker, JoshuaP.DO,FAAFP;RachelEly,MHA,OMSIIIVol.23,No.2,June2013,pp.10-13;

NYIT-COMTheeffectoftheStudentAmericanAcad-emyofOsteopathySummerpreceptor-ship program on students’ perceptionofosteopathicmanipulative treatment;Vazzana, KathleenM. OMS IV; VivianChan,OMSII;CharlesWenzel,JD,OMSIV;andSheldonC.Yao,DOVol.23,No.4,Dec.2013,pp.14-20;

Usefulnessof video learning forosteo-pathic manipulative medicine (OMM)techniques in the educational andclinicalsetting;Flaum,TheodoreB.DO;MelissaK.Meghpara,OMSIII;MichaelJ.Terzella,DO;Min-Kyung Jung, PhD;SheldonC.Yao,DOVol.23,No.3,Sept.2013,pp.24-30;

OrthoticsTheuseoforthoticsinthereductionofself-reported pain scores in a VeteransAffairspopulation:aretrospectivestudy;Lipton,JamesA.DO,CSPOMM,FAAO,FAAPMR, DAOBPMR; Vol. 23, No. 3,Sept.2013,pp.9-12;

Osteopathic Manipulative TreatmentTheeffectoftheStudentAmericanAcad-emyofOsteopathySummerpreceptor-ship program on students’ perceptionofosteopathicmanipulative treatment;Vazzana, KathleenM. OMS IV; VivianChan,OMSII;CharlesWenzel,JD,OMS

IV;andSheldonC.Yao,DOVol.23,No.4,Dec.2013,pp.14-20;

Parkinson’s diseaseThe application of the cranial conceptin the investigationofbafflingmedicaldisordersand their treatment:a syner-gopathicmedicaldiseasemodel;Pribadi,KrishnahariS.MD;Vol.23,No.4,Dec.2013,pp.22-34;

Pes anserine bursitisOsteopathic manipulative treatmentofpesanserinebursitisusingthetripletechnique:Acasereport;Capalbo,GinaOMSIV;RichardChmielewski,MS,DO,FACEP;NicolePena,OMSIVVol.23,No.1,March2013,pp.34-38;

Posterior ribTreatment of a posterior rib utilizinga multimodal sequence of osteopathicmanipulative treatments;Baker, JoshuaP.DO,FAAFP;RachelEly,MHA,OMSIIIVol.23,No.2,June2013,pp.10-13;

PreclinicalTheeffectoftheStudentAmericanAcad-emyofOsteopathySummerpreceptor-ship program on students’ perceptionofosteopathicmanipulative treatment;Vazzana, KathleenM. OMS IV; VivianChan,OMSII;CharlesWenzel,JD,OMSIV;andSheldonC.Yao,DOVol.23,No.4,Dec.2013,pp.14-20;

Primary respiratory mechanism (PRM)Theliquorodynamicmodeloftheprima-ryrespiratorymechanism;Kravchenko,TamaraI.PhD,DO;YuriE.Moskalenko,DSc, DO (Hon.); Gustav B.Weinstein,PhD;TerenceC.Vardy,DOVol.23,No.2,June2013,pp.24-29;

PsoriasisPotentialnewdimensions indermatol-ogy: theosteopathic approach to cuta-neousdisease;Michunovich,AnaM.BS,OMSIII;RobertStern,MDVol.23,No.4,Dec.2013,pp.35-39;

Ramsay Hunt SyndromeUseofOMTtoTreatPatientwithRamsayHuntSyndromeandHIV:ACaseStudy;Baker,JoshuaP.DO,FAAFP;Vol.23,No.4,Dec.2013,pp.8-12;

ReflectionsLookingBackandLookingAhead;Wor-den,KatherineA.DO,MS;Vol.23,No.4,Dec.2013,p.5;

Ref lections on our recent past andthoughts about our future; Berkowitz,MurrayR.DO,MA,MS,MPH;Vol. 23,No.2,June2013,pp.4,7;

Saint’s RestInthehandsofanangel;Archer,JamieB.DO;Vol.23,No.2,June2013,pp.19-22;

SclerodermaPotentialnewdimensions indermatol-ogy: theosteopathic approach to cuta-neousdisease;Michunovich,AnaM.BS,OMSIII;RobertStern,MDVol.23,No.4,Dec.2013,pp.35-39;

Self-reported pain scoresTheuseoforthoticsinthereductionofself-reported pain scores in a VeteransAffairspopulation:aretrospectivestudy;Lipton,JamesA.DO,CSPOMM,FAAO,FAAPMR, DAOBPMR; Vol. 23, No. 3,Sept.2013,pp.9-12;

Sensory integration syndromeSensoryintegrationsyndromeordevel-opmentalcoordinationdisorder:Acasereport;Crow,Wm.ThomasDO,FAAO;Vol.23,No.1,March2013,pp.8-10,15;

SpiritualityView from the Pyramids: Osteopathicmedicine and sprituality; McCaffrey,KateDO;Vol.23,No.2,June2013,p.7;

StabilometricStabilometric platform as a diagnosissupport for pain? Example of chroniclowbackpain;Bertucci,W.PhD;YannickHuard, DO, ScMVol. 23, No. 1,March2013,pp.44-45;

Still, A.T.Inthehandsofanangel;Archer,JamieB.DO;Vol.23,No.2,June2013,pp.19-22;

Structure and functionFromtheArchives:StructureandFunc-tion;Deason,J.ScB,MS,PhG,DO;Vol.23,No.3,Sept.2013,pp.22-24;

SwingInthehandsofanangel;Archer,JamieB.DO;Vol.23,No.2,June2013,pp.19-22;

Synergopathic Herbal FormulasThe application of the cranial conceptin the investigationofbafflingmedicaldisordersand their treatment:a syner-gopathicmedicaldiseasemodel;Pribadi,KrishnahariS.MD;Vol.23,No.4,Dec.2013,pp.20-33;

Teaching methodsEvaluating teaching methods and as-sessment tools of high velocity lowamplitude techniques for undergradu-ateosteopathicmanipulativetreatmentof the spine; Channell, Millicent KingDO, FAAO;Vol. 23, No. 1,March 2013,pp.24-32;


Thoraco-abdominal fascial and auto-nomic toneNormalization of thoraco-abdominalfascialandautonomictone:Acasestudyforthediagnosisandtreatmentofatypi-cal chest pain; Litman, Randy G. DO,FAAO; Vol. 23, No. 1, March 2013, pp.20-22;

Triple techniqueOsteopathic manipulative treatmentofpesanserinebursitisusingthetripletechnique:Acasereport;Capalbo,GinaOMSIV;RichardChmielewski,MS,DO,FACEP;NicolePena,OMSIVVol.23,No.1,March2013,pp.34-38;

Upledger-Pribadi’s signThe application of the cranial conceptin the investigationofbafflingmedicaldisordersand their treatment:a syner-gopathicmedicaldiseasemodel;Pribadi,KrishnahariS.MD;Vol.23,No.4,Dec.2013,pp.20-33;

Veterans AffairsTheuseoforthoticsinthereductionofself-reported pain scores in a VeteransAffairspopulation:aretrospectivestudy;Lipton,JamesA.DO,CSPOMM,FAAO,FAAPMR, DAOBPMR; Vol. 23, No. 3,Sept.2013,pp.9-12;

Video learningUsefulnessof video learning forosteo-pathic manipulative medicine (OMM)techniques in the educational andclinicalsetting;Flaum,TheodoreB.DO;MelissaK.Meghpara,OMSIII;MichaelJ.Terzella,DO;Min-Kyung Jung, PhD;SheldonC.Yao,DOVol.23,No.3,Sept.2013,pp.24-30;

View from the PyramidsViewfromthePyramids:Ittakesanos-teopathic village; McCaffrey, Kate DO;Vol.23,No.4,Dec.2013,p.4;

ViewfromthePyramids:Inyourhandsnow!;McCaffrey, KateDO;Volume 23,Issue3,September2013,p.4;

View From the Pyramids: New gradu-ate medical education opportunitiesfound—and lost; Berkowitz,MurrayR.Do,MA,MS,MPH;Vol.23,Issue1,March2013,pp.4,7;

Volcano boardingFractureasaresultofvolcanoboarding;Cloud,JohnBS,MSIV;TiffanyR.Palmer,BS,MSIV;RossDavidson,BS,OMSII;TylerCymet,DO;KevinMarberry,MDVol.23,No.3,Sept.2013,pp.15-20;

Women in osteopathic medicineMillenialTimes:Womeninosteopathicmedicine;McCaffrey,KateDO;Vol.23,No.1,March2013,pp.5,7;

15. KryczekI,BruceAT,GudjonssonJE,etal.InductionofIL-17+TcelltraffickinganddevelopmentbyIFN-gamma:mechanismandpathologicalrelevanceinpsoriasis.J. Immunol. 2008;181(7):4733-4741.

16. Buske-KirschbaumA,EbrechtM,KernS,HellhammerDH.EndocrinestressresponsesinTH1-mediatedchronicinflammatoryskindisease(psoriasisvulgaris)--dotheyparallelstress-inducedendocrinechangesinTH2-mediatedinflammatorydermatoses(atopicdermatitis)?Psychoneuroendocrinology. 2006;31(4):439-446.

17. SenCK,GordilloGM,RoyS,etal.Humanskinwounds:amajorandsnowballingthreattopublichealthandtheeconomy.Wound Repair Regen. Nov-2009;17(6):763-771.

18. FonderMA,LazarusGS,CowanDA,Aronson-CookB,KohliAR,MamelakAJ.Treatingthechronicwound:Apracticalapproachtothecareofnonhealingwoundsandwoundcaredressings.J. Am. Acad. Dermatol. 2008;58(2):185-206.

19. CaseyG.Chronicwoundhealing:legulcers.Nurs. N. Z. 2011;17(11):24-29.

20. MortimerPS.Evaluationoflymphaticfunction:abnormallymphdrainageinvenousdisease.Int. Angiol. 1995;14(3Suppl1):32-35.

21. MoutaC,HeroultM.Inflammatorytriggersoflymphangiogenesis.Lymphat. Res. Biol. 2003;1(3):201-218.

22. MacdonaldJM,SimsN,MayrovitzHN.Lymphedema,lipedema,andtheopenwound:theroleofcompressiontherapy.Surg. Clin. North Am.2003;83(3):639-658.

23. TabibiazarR,CheungL,HanJ,etal.Inflammatorymanifestationsofexperimentallymphaticinsufficiency.PLoS Med. 2006;3(7):e254.

24. NelsonKE,SergueefN,GlonekT.Theeffectofanalternativemedicalprocedureuponlow-frequencyoscillationsincutaneousbloodflowvelocity.J. Manipulative Physiol. Ther. 2006;29(8):626-636.

25. AnglundDC,ChannellMK.Contributionofosteopathicmedicinetocareofpatientswithchronicwounds.J. Am. Osteopath. Assoc. 2011;111(9):538-542.

26. VorkampT,FooFJ,KhanS,SchmittoJD,WilsonP.Hyperhidrosis:evolvingconceptsandacomprehensivereview.Surgeon. 2010;8(5):287-292.

27. RoKM,CantorRM,LangeKL,AhnSS.Palmarhyperhidrosis:evidenceofgenetictransmission.J. Vasc. Surg. 2002;35(2):382-386.

28. EisenachJH,AtkinsonJL,FealeyRD.Hyperhidrosis:evolvingtherapiesforawell-establishedphenomenon.Mayo Clin. Proc. 2005;80(5):657-666.

29. ShihCJ,WuJJ,LinMT.Autonomicdysfunctioninpalmarhyperhidrosis.J. Auton. Nerv. Syst. 1983;8(1):33-43.

30. RybojadM.Atopicdermatitis.Arch. Pediatr. 2012;19(8):882-885.31. TranBW,PapoiuAD,RussonielloCV,etal.Effectofitch,

scratchingandmentalstressonautonomicnervoussystemfunctioninatopicdermatitis.Acta Derm. Venereol. 2010;90(4):354-361.

32. MonroeJR.Isthisedemaandfirmingoftheskinaseveresign?Scleroderma.JAAPA. 2011;24(10):27.

33. RossiA,SozioF,SestiniP,etal.Lymphaticandbloodvesselsinsclerodermaskin,amorphometricanalysis.Hum. Pathol. 2010;41(3):366-374.

34. LongPR,MillerOF,3rd.Linearscleroderma.Reportofacasepresentingaspersistentunilateraleyelidedema.J. Am. Acad. Dermatol. 1982;7(4):541-544.

35. CampbellSM,SammonsDL,Sarsama-NixonRM,HolsingerJM,StephensonS,WalkowskiS.Dermatology:aspecialtythatexemplifiestheosteopathicmedicalprofession.J. Am. Osteopath. Assoc.2011;111(5):335-338.


Address correspondence to:RobertStern,MDDepartmentofBasicBiomedicalSciencesTouro-HarlemCollegeofOsteopathicMedicine230West-125thStreetNewYork,[email protected]



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Component Societies and Affiliated Organizations Calendar of Upcoming Events

December 14, 2013Gentle Techniques for the Upper Body:

Head, Neck, and ThoraxCourse Director: R. Paul Lee, DO, FAAO, FCA

Rocky Vista UniversityCollege of Osteopathic Medicine, Parker, COCME: 4 Category 1-A AOA credits anticipated

Website: 2dockanze.wix.com/rockymtnaao#!events/crrl

February 15-19, 2014Midwinter Introductory Course in Osteopathy in the

Cranial FieldCourse Director: Zina Pelkey, DOHoliday Inn, Lake Buena Vista, FL

CME: 40 Category 1-A AOA credits anticipatedPhone: (317) 581-0411 Fax: (317) 580-9299

Email: [email protected]: www.cranialacademy.org

February 21-23, 2014Key Elements in Effective Osteopathic Practice

Course Director: Rachel Brooks, MDHoliday Inn, Lake Buena Vista, FL

Phone: (317) 581-0411 Fax: (317) 580-9299Email: [email protected]

Website: www.cranialacademy.org

April 10-13, 2014Orthopedic Neurology

Course Director: Maurice Bensoussan, MD, DO, FCAAssociate Director: R. Paul Lee, DO, FAAO, FCA

Holiday Inn, Lake Buena Vista, FLPhone: (317) 581-0411 Fax: (317) 580-9299


June 14-18, 2014June Introductory Course in Osteopathy in the Cranial Field

Course Director: Eric J. Dolgin, DO, FCASheraton Indianapolis City Centre, Indianapolis, IN

Phone: (317) 581-0411 Fax: (317) 580-9299Email: [email protected]

Website: www.cranialacademy.org

June 19-22, 2014Osteopathic Cranial Academy Annual Conference: Beyond

Sutherland’s Minnow: Anatomy, Perception and TreatmentConference Director: Melvin R. Friedman, DO

Sheraton Indianapolis City Centre, Indianapolis, INPhone: (317) 581-0411 Fax: (317) 580-9299


Documents

The AAO F For JOURNALc919297.r97.cf2.rackcdn.com/ocktiqlit24os7msqonq0avxrnhgsa-opti… · integration of osteopathic principles, practices and manipulative treatment in patient care