A 61-year-old African American female presents to an outpatient family health center with a hyperpigmented nodular rash of 2 months’ duration. The rash first appeared on her abdomen before spreading across her upper arms, lower leg, back, face and scalp. She has a history of controlled type 2 diabetes mellitus, cerebral aneurysm rupture, Sjögren’s syndrome, asthma and a left below-the-knee amputation due to osteomyelitis. She smokes cigarettes but does not use alcohol or illicit substances. She has also noticed a dry cough with mild dyspnea on exertion over the past 6 months. On physical exam, hyperpigmented nodules are palpable in both the intradermal and subcutaneous layers of the skin. Nodules are firm, mobile and nontender. Alopecia is noted where scalp nodules are present. Her lungs exhibit diminished air movement throughout, with scattered, end-expiratory wheezing.
{"title":"Hyperpigmented nodular rash in a 61-year-old African American female","authors":"Danielle C. Ware","doi":"10.33181/13059","DOIUrl":"https://doi.org/10.33181/13059","url":null,"abstract":"A 61-year-old African American female presents to an outpatient family health center with a hyperpigmented nodular rash of 2 months’ duration. The rash first appeared on her abdomen before spreading across her upper arms, lower leg, back, face and scalp. She has a history of controlled type 2 diabetes mellitus, cerebral aneurysm rupture, Sjögren’s syndrome, asthma and a left below-the-knee amputation due to osteomyelitis. She smokes cigarettes but does not use alcohol or illicit substances. She has also noticed a dry cough with mild dyspnea on exertion over the past 6 months. On physical exam, hyperpigmented nodules are palpable in both the intradermal and subcutaneous layers of the skin. Nodules are firm, mobile and nontender. Alopecia is noted where scalp nodules are present. Her lungs exhibit diminished air movement throughout, with scattered, end-expiratory wheezing.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47153697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: America is in the midst of a substance use disorder (SUD) epidemic, which has only worsened in the current COVID-19 pandemic. SUD is a public health crisis that affects an everincreasing proportion of the population and is extraordinarily difficult to treat. Misused substances induce neuroplastic changes that not only predispose individuals to relapse but also persist after completing treatment recommendations.
{"title":"Emerging non-invasive neuroplastic-targeting therapies for substance use disorder treatment","authors":"P. St. George, Christina Kinnevey","doi":"10.33181/13064","DOIUrl":"https://doi.org/10.33181/13064","url":null,"abstract":"Context: America is in the midst of a substance use disorder (SUD) epidemic, which has only worsened in the current COVID-19 pandemic. SUD is a public health crisis that affects an everincreasing proportion of the population and is extraordinarily difficult to treat. Misused substances induce neuroplastic changes that not only predispose individuals to relapse but also persist after completing treatment recommendations.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41463613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leonard Powell, DO, MS, CMD., Chad Richmond, D. Cooley
Giardiasis is an acute infection caused by Giardia lamblia, which produces profuse secretory diarrhea that can lead to dehydration and electrolyte derangement. Musculoskeletal manifestations resulting because of giardiasis occur due to prolonged inflammation and viscero-somatic reflexes of the pathophysiology for this disease process. By treating the parasitic infection with an antiparasitic agent, as well as treating the somatic dysfunctions with osteopathic manipulative treatment, analgesics and a home exercise program, the patient in the following article experienced an uneventful course of treatment and a complete recovery including resolution of the pain.
{"title":"Acute giardiasis and Chapman reflexes: Musculoskeletal symptoms preceding, during and after infection","authors":"Leonard Powell, DO, MS, CMD., Chad Richmond, D. Cooley","doi":"10.33181/13060","DOIUrl":"https://doi.org/10.33181/13060","url":null,"abstract":"Giardiasis is an acute infection caused by Giardia lamblia, which produces profuse secretory diarrhea that can lead to dehydration and electrolyte derangement. Musculoskeletal manifestations resulting because of giardiasis occur due to prolonged inflammation and viscero-somatic reflexes of the pathophysiology for this disease process. By treating the parasitic infection with an antiparasitic agent, as well as treating the somatic dysfunctions with osteopathic manipulative treatment, analgesics and a home exercise program, the patient in the following article experienced an uneventful course of treatment and a complete recovery including resolution of the pain.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46535845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Physicians commonly encounter disorders of the prostate in the primary care setting, where shared decision making for prostate cancer screening should also occur. Hence, it is important for physicians to understand and differentiate the diagnoses of prostate disease. Initial evaluation should include a thorough history, physical examination, laboratory examination and imaging, if necessary. This article aims to provide a diagnostic and management approach for prostate disease.
{"title":"Prostate disorders diagnosis and management review with an osteopathic component","authors":"Elizabeth V. George, Helaine Larsen","doi":"10.33181/13061","DOIUrl":"https://doi.org/10.33181/13061","url":null,"abstract":"Physicians commonly encounter disorders of the prostate in the primary care setting, where shared decision making for prostate cancer screening should also occur. Hence, it is important for physicians to understand and differentiate the diagnoses of prostate disease. Initial evaluation should include a thorough history, physical examination, laboratory examination and imaging, if necessary. This article aims to provide a diagnostic and management approach for prostate disease.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48149741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tariq A Shaheed, Jake C. Martinez, A. Frugoli, Weldon Zane Smith, Ian Cahatol, Omid Fatemi
Atrial fibrillation is the most common postoperative arrhythmia and is associated with increased length of stay, cost, morbidity and mortality. The incidence of postoperative atrial fibrillation for noncardiac, nonthoracic surgeries ranges from 0.4% to 26%. The incidence increases to 20%–50% in cardiac surgery, occurring in approximately 30% of isolated coronary artery bypass grafting (CABG), approximately 40% of isolated valve surgeries and up to 50% of CABG plus valve surgeries. Our aim was to identify risk factors that may predispose patients to postoperative atrial fibrillation and compare the efficacy of previously developed prediction tools to a new bedside prediction tool. We sought to develop a bedside screening tool using 4 easily identifiable variables: body mass index, age, congestive heart failure and hypertension (BACH). We predicted that our model would compare similarly to previously developed and validated prediction models but would be easier to use.
{"title":"Determinants of postoperative atrial fibrillation: A retrospective evaluation of postoperative atrial fibrillation in cardiac surgery","authors":"Tariq A Shaheed, Jake C. Martinez, A. Frugoli, Weldon Zane Smith, Ian Cahatol, Omid Fatemi","doi":"10.33181/13062","DOIUrl":"https://doi.org/10.33181/13062","url":null,"abstract":"Atrial fibrillation is the most common postoperative arrhythmia and is associated with increased length of stay, cost, morbidity and mortality. The incidence of postoperative atrial fibrillation for noncardiac, nonthoracic surgeries ranges from 0.4% to 26%. The incidence increases to 20%–50% in cardiac surgery, occurring in approximately 30% of isolated coronary artery bypass grafting (CABG), approximately 40% of isolated valve surgeries and up to 50% of CABG plus valve surgeries. Our aim was to identify risk factors that may predispose patients to postoperative atrial fibrillation and compare the efficacy of previously developed prediction tools to a new bedside prediction tool. We sought to develop a bedside screening tool using 4 easily identifiable variables: body mass index, age, congestive heart failure and hypertension (BACH). We predicted that our model would compare similarly to previously developed and validated prediction models but would be easier to use.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46892808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eye pain and ringing in the ear are non-specific symptoms commonly evaluated by primary care physicians and specialists alike. The differential diagnosis for these symptoms is broad and includes musculoskeletal, ophthalmologic and neurologic considerations. Careful consideration of the differential diagnosis should include acute, potentially life-threatening pathologies such as glaucoma or intracranial masses, as well as common pathologies, including cervicalgia, headache variants (migraine, tension) and acoustic neuroma. This report describes a patient with eye pain caused by occipital neuralgia and tinnitus. Correcting the somatic dysfunctions found in the head, cervical, thoracic and rib regions with osteopathic manipulative treatment resolved the occipital neuralgia and the tinnitus for this patient. Thus, osteopathic manipulative treatment should be considered for conservative management of occipital neuralgia and tinnitus.
{"title":"An osteopathic approach to occipital neuralgia and tinnitus","authors":"A. Aiman, Joy Skaug, Regina K. Fleming","doi":"10.33181/13056","DOIUrl":"https://doi.org/10.33181/13056","url":null,"abstract":"Eye pain and ringing in the ear are non-specific symptoms commonly evaluated by primary care physicians and specialists alike. The differential diagnosis for these symptoms is broad and includes musculoskeletal, ophthalmologic and neurologic considerations. Careful consideration of the differential diagnosis should include acute, potentially life-threatening pathologies such as glaucoma or intracranial masses, as well as common pathologies, including cervicalgia, headache\u0000variants (migraine, tension) and acoustic neuroma.\u0000\u0000This report describes a patient with eye pain caused by occipital neuralgia and tinnitus. Correcting the somatic dysfunctions found in the head, cervical, thoracic and rib regions with osteopathic manipulative treatment resolved the occipital neuralgia and the tinnitus for this patient. Thus, osteopathic manipulative treatment should be considered for conservative management of occipital neuralgia and tinnitus.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49527955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Insomnia affects a large percentage of American adults and is among the most commonly treated medical conditions in the outpatient clinical setting. The psychological, medical and financial impact of insomnia is substantial. Research indicates that pharmacologic treatment is associated with significant risk, and clinicians should consider other modalities including cognitive behavioral therapy before prescribing medications for the treatment of insomnia. Other complementary treatments including yoga, stress management and traditional Chinese medical therapies are promising, but more research is needed. The osteopathic family physician plays an important role in diagnosis and management. An osteopathic approach to patient care is highly beneficial and includes a multifaceted evaluation when taking a patient history and osteopathic manipulative treatment (OMT) to balance autonomic tone and correct associated somatic dysfunction.
{"title":"Insomnia diagnosis and management: an osteopathic approach","authors":"Cody Homistek, Heather C. Doty","doi":"10.33181/13055","DOIUrl":"https://doi.org/10.33181/13055","url":null,"abstract":"Insomnia affects a large percentage of American adults and is among the most commonly treated medical conditions in the outpatient clinical setting. The psychological, medical and financial impact of insomnia is substantial. Research indicates that pharmacologic treatment is associated with significant risk, and clinicians should consider other modalities including cognitive behavioral therapy before prescribing medications for the treatment of insomnia. Other complementary treatments including yoga, stress management and traditional Chinese medical therapies are promising, but more research is needed. \u0000\u0000The osteopathic family physician plays an important role in diagnosis and management. An osteopathic approach to patient care is highly beneficial and includes a multifaceted evaluation when taking a patient history and osteopathic manipulative treatment (OMT) to balance autonomic tone and correct associated somatic dysfunction.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46577481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Larry D. McIntire, Kindall Martin, Kunal Shah, Lauren Malinowski, J. Paulson
Background: Vertigo is defined as an illusion of motion caused by a mismatch of information between the visual, vestibular and somatosensory systems. The most common diagnosis associated with whirling vertigo is benign paroxysmal positional vertigo (BPPV), which affects approximately 3.4% of patients older than 60 years of age. Objective: This paper aims to educate primary care providers on how to diagnose BPPV by performing canalith repositioning maneuvers at the initial point of care. Timely treatment of BPPV in the primary care office is believed to reduce healthcare costs by way of limiting unnecessary diagnostic testing and lowering referrals for specialty care. Immediate treatment is also believed to improve the quality of healthcare delivery for the vertigo patient by reducing morbidity and resolving the condition without the need for referrals or imaging. Population Health: A review of the literature finds that delayed diagnosis and treatment of BPPV is associated with a host of deleterious effects on patients. Population health impacts include increased rates of anxiety and depression; loss of work and/or change of career paths; inappropriate use of medications or emergency care resources; decreased access to healthcare services; increased healthcare costs; and reduced quality of care. Diagnosis: A history of positional vertigo and evidence of nystagmus with Dix-Hallpike positioning confirms the diagnosis. A detailed description of the performance of this test is elucidated. Treatment: The observed nystagmus is analyzed and classified based on directionality. Treatment can be initiated immediately with canalith repositioning maneuvers.
{"title":"Improving diagnosis and treatment of benign paroxysmal positional vertigo","authors":"Larry D. McIntire, Kindall Martin, Kunal Shah, Lauren Malinowski, J. Paulson","doi":"10.33181/13058","DOIUrl":"https://doi.org/10.33181/13058","url":null,"abstract":"Background: Vertigo is defined as an illusion of motion caused by a mismatch of information between the visual, vestibular and somatosensory systems. The most common diagnosis associated with whirling vertigo is benign paroxysmal positional vertigo (BPPV), which affects approximately 3.4% of patients older than 60 years of age.\u0000\u0000Objective: This paper aims to educate primary care providers on how to diagnose BPPV by performing canalith repositioning maneuvers at the initial point of care. Timely treatment of BPPV in the primary care office is believed to reduce healthcare costs by way of limiting unnecessary diagnostic testing and lowering referrals for specialty care. Immediate treatment is also believed to improve the quality of healthcare delivery for the vertigo patient by reducing morbidity and resolving the condition without the need for referrals or imaging.\u0000\u0000Population Health: A review of the literature finds that delayed diagnosis and treatment of BPPV is associated with a host of deleterious effects on patients. Population health impacts include increased\u0000rates of anxiety and depression; loss of work and/or change of career paths; inappropriate use of medications or emergency care resources; decreased access to healthcare services; increased healthcare costs; and reduced quality of care.\u0000\u0000Diagnosis: A history of positional vertigo and evidence of nystagmus with Dix-Hallpike positioning confirms the diagnosis. A detailed description of the performance of this test is elucidated.\u0000\u0000Treatment: The observed nystagmus is analyzed and classified based on directionality. Treatment can be initiated immediately with canalith repositioning maneuvers.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48920892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samanatha N. Baxter, Alexandra Millhuff, Gautum J. Desai, Dennis J. Dowling
Carpal tunnel syndrome (CTS) is a common cause of medical and workforce-related expenses in the United States. It is also frustrating for patients who have difficulty using the affected hand, impairing their activities of daily living and decreasing their quality of life. By utilizing the philosophy of osteopathic medicine, providers can better implement a treatment plan by working with the patient to find one that incorporates all aspects of the patient’s environment. By using the practice of osteopathic manipulative therapy (OMT), osteopathic physicians can often effectively treat the patient’s symptoms without side effects found in medications. This is especially useful in patients who may be unable to take certain medications, such as pregnant patients. Other treatment modalities are also reviewed in this manuscript.
{"title":"An osteopathic approach to carpal tunnel syndrome","authors":"Samanatha N. Baxter, Alexandra Millhuff, Gautum J. Desai, Dennis J. Dowling","doi":"10.33181/13054","DOIUrl":"https://doi.org/10.33181/13054","url":null,"abstract":"Carpal tunnel syndrome (CTS) is a common cause of medical and workforce-related expenses in the United States. It is also frustrating for patients who have difficulty using the affected hand, impairing their activities of daily living and decreasing their quality of life. By utilizing the philosophy of osteopathic medicine, providers can better implement a treatment plan by working with the patient to find one that incorporates all aspects of the patient’s environment. By using the practice of osteopathic manipulative therapy (OMT), osteopathic physicians can often effectively treat the patient’s symptoms without side effects found in medications. This is especially useful in patients who may be unable to take certain medications, such as pregnant patients. Other treatment modalities are also reviewed in this manuscript.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48235657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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