Comp Med Test #1
Modern Medicine: Criticism
"master the minutiae while missing the whole" (putting band-aids on things) Not all physical phenomena is explainable by reducing matter to its smallest parts Matter has an energetic nature
Reiki
"universal energy" or "spiritual energy" Rediscovered by Dr. Mikao Usui in Japan in early 19th century Spiritual energy is channeled thru a Reiki practitioner to heal the pt's spirit Is believed to aid the body's natural healing powers Must be taught by a Reiki "master" Energy is transferred from the giver to the receiver Usually done "hands on" Practitioner places their hands lightly on or just above the pt Can be done from a distance Research has examined the use of Reiki for: Fibromyalgia Pain Cancer Depression Over-all well being Reiki is offered in >800 U.S. hospitals to accelerate the healing process and to alleviate pain - UCLA / Green Lotus Appears to be generally safe - No serious SE have been reported
Naturopathic Doctor (ND)
- Licensed PCP of integrative natural medicine - Clinical expertise in preventive medicine - Trained as family physicians - Assess causes & develop Rx plans from a system perspective Tx the "whole person", not the system Can specialize: Botanical medicine, Acupuncture, Homeopathy, Nutritional medicine, Ayurvedic medicine, Chinese herbal medicine, Midwifery, etc Licensed in 21 states & D.C - Alaska, Arizona, California, Colorado (2013), Connecticut, D.C., Hawaii, Kansas, Maine, Maryland (2014), Minnesota, Montana, New Hampshire, North Dakota (2012), Oregon, Utah, Vermont, Washington, Puerto Rico, Virgin Islands - Legislation Pending: DE, IL, MA, NC, NY, WI - Idaho was actually de-licensed April 2, 2015 - All Canadian Province either grant ND licensure or have legislation pending Scope of practice is stipulated by law
Osteopathic Techniques: Strain Counter strain
A spasming muscle is moved into a position that shortens the muscle (counter strain) & held for 90 - 120 sec, then slowly returned to original position (this is a passive ROM, practitioner doing all of the work) - Interrupts the reflex spasm loop Strain (direct) gently stretches the muscle with the same result Notes:The spasming muscle is moved into a position of comfort and the pain improves significantly
Functional Medicine
A systems-oriented medical approach that works to identify, understand and treat the underlying or root causes of a disease rather than the symptoms, by viewing the body as one integrated system, rather than a collection of independent organs.
Naturopathic Doctor (ND): Organization
AANP - American Association of Naturopathic Physicians NPLEx - Naturopathic Physicians Licensing Exam
Healing Touch
AKA Therapeutic touch Newer development in the field of Manual therapies Popularized by 2 nurses in the US: Dolores Krieger Dora Kunz Difference here - the patient is NOT physically touched - A form of "energy healing" - Practitioner's hands are thought to manipulate the flow of energy around the pt's body Clinical observations of efficacy are difficult to explain in today's clinical medicine - Bioenergetic mechanisms are believed to be responsible Works with a persons energy field to support ones natural ability to heal - Cuts pain and recovery time post-op
Acupuncture: Conditions Treated
Acne vulgaris DM Cholelithiasis Earache Herpes zoster Insomnia Labor pain Meniere's disease OA Controlled substance abuse PMS Pruritus TMJ dysfunction Tobacco dependence Wide variety of diseases
Hx of Acupuncture
Acupuncture dates back to at least 100 B.C., which is when an organized system of diagnosis and treatment using needles was first described in writing in China. During the so-called Great Leap Forward of the 1950s and the Cultural Revolution of the 1960s, China's communist leader, Chairman Mao, banned all TCM practices, going so far as to murder practioners and have thousands of years of traditional medical texts destroyed. Years later, after the 5,000 Mile March, Mao changed his mind and allowed acupuncture and other traditional medical treatments back into mainstream medicine. However, it was highly censored and only a modified version was taught in China and remains so to this day, commonly referred to as traditional Chinese Medicine or TCM. Today TCM treatments carried out in hospitals and other health care facilities in both the East and West today are not based on the same principles that were established in ancient Eastern texts.
Therapeutic Concepts of TCM (Traditional Chinese Medicine)
Addresses the condition with opposing measures -Cold is treated with heat -Heat is treated with cold -Repletion is treated by drainage Disease is treated from its root Evil influences are eliminated while supporting good influences Restore the balance of yin and yang
Goals of National Center For Complementary And Integrative Health (NCCIH)?
Advance the science & practice of symptom management. Develop effective, practical, personalized strategies for promoting health and well-being. Enable better evidence-based decision making regarding use of complementary & integrative therapies & their inclusion in health care and health promotion.
How Wellness is Achieved?
Allopathic medicine: ◦Uses drugs & surgery to prevent disease in those at risk and treat. It is another name for western medicine or conventional medicine. Complementary Medicine: ◦Engages the inner resources of an individual to be an active and conscious participant in maintaining his/her own health ◦Balances internal & external forces and the social environment ◦Use of other therapies in conjunction with westernized/allopathic mediciine Another thing to keep in mind when trying to management pt as a whole and be more integrative: -Be fully present & listen to the pt & his story ∗Can ascertain the Dx, the cause & the Rx ∗EMPATHY -Offer support: Enlist a psychologist's help -Create a plan: Involve & empower the pt
Traditional Chinese Medicine (TCM)
Background: Traditional Chinese Medicine (TCM) has evolved in the course of > 5,000 years in clinical practice Based on the universal principle of yin and yang - Opposing but complementary phenomena - Are always present simultaneously: Interrelated & interdependent - Are used to coordinate human health & disease - Each phenomenon will exert an influence on its surroundings that is balanced by an equal but opposing influence
Spinal Manipulation
Based on the premise that health & disease are directly related to the functioning of the neuromuscular system & proper alignment of bones, joints, muscles and associated nerves Practiced by: Osteopathic doctors (DOs) Chiropractors Physical therapists Considered to be safe Contraindications: Osteoporosis (of spinal column) Sx of nerve damage Hx of spinal surgery CVA due to carotid vascular disease Beneficial for: Mild - moderate low back pain May help relieve headache May help relieve neck pain No evidence exists for Rx of asthma, otitis media, or non-musculoskeletal conditions
Acupunture: Qi (Chi)
Critical concept of Chinese medicine Subtle & mobile forces that cause most physiologic functions Maintain health & vitality of the individual Blood is considered to flow with chi & is conveyed by it via meridians - Are linked together as a person is linked to their shadow Chi energy (and blood & body fluids) flow through this meridian or energy highway, accessing all parts of the body. Meridians can be mapped throughout the body - Meridians exist in corresponding pairs - Each meridian has many acupuncture points along its path. 'meridian' describes the overall energy distribution system of Chinese Medicine - The individual meridians are often described as 'channels' or even 'vessels' which reflects the notion of carrying, holding, or transporting qi, blood and body fluids around the body.
Integrative Medicine (IM)
Healing-oriented medicine that takes into account the whole person (body, mind, & spirit), including all aspects of lifestyle. Emphasizes the therapeutic relationship & makes use of all appropriate therapies, both conventional & alternative
Today
Health care costs over past 10 yrs: ∗Almost doubled ($391 to $668 billion) With ↑ attention to "fixing" body parts, drug costs ↑ ∗Are now 15% > any other health care cost ∗↑ subtypes of disease create the need for more drugs ↑ use of technology ∗The interaction of the mind, community and spirit have been forgotten Managed care & capitation were instituted to decrease costs, HOWEVER: ∗↑ demands on providers (paperwork) ∗↓ reimbursement ∗↓ provider autonomy (insurance reimbursement &"rules" direct care) ∗↓ pt satisfaction Both providers and pts are unhappy Deterioration of provider-pt relationship Technology overuse ↑ adverse drug reactions & medical errors Inability of medical system to tx chronic disease well Desire by the public for therapies more attuned with their values, beliefs & philosophy toward life & their health
Osteopathy: Still believed in?
Holism - all body systems are interconnected structurally and physically Advocated balance (homeostasis) ○Unimpeded arterial flow & venous/lymphatic drainage Believed in the body's inherent ability to repair itself Notes: This was before the discovery of the immune & endocrine systems. He was considered quite radical at the time
In addition to the physical body, the alternative practice also includes the mental, emotional, and spiritual aspects of health?
Holistic Medicine takes everything into consideration (as well as the physical body)
Homeopathy "similar suffering": Law of Similars
Homeopathy was developed by Samuel Hahneman in Germany in late 1700's Basic premise is the belief that "a disease can be cured by a substance if that substance can cause in a healthy person sxs similar to those of the disease." - Impossible Cure, Amy Lansky, 2002. Materia medica - used to match a patient's presentation with a corresponding homeopathic remedy: Can be a "constitutional remedy" or an "acute" remedy For example: If a person has an illness, they are missing something in their immune system, that is why they can't fight the illness/bug. Homeopath would give them something in small doses to cause the immune system to recognize and fight the illness, boosting their immune system, vs western medicine would give antibiotics to kill the bug.
Acupuncture: Directly from the NCCIH
How much do we know about acupuncture? There have been extensive studies conducted on acupuncture, especially for back and neck pain, osteoarthritis/knee pain, and headache. However, researchers are only beginning to understand whether acupuncture can be helpful for various health conditions. What do we know about the effectiveness of acupuncture? Research suggests that acupuncture can help manage certain pain conditions, but evidence about its value for other health issues is uncertain. What do we know about the safety of acupuncture? Acupuncture is generally considered safe when performed by an experienced, well-trained practitioner using sterile needles. Improperly performed acupuncture can cause serious SEs.
In the Past
Human society/ ancient scholars/ the elders of society: Understood the human condition at the level of the experience itself Didn't think the mind and body were separate Based their explanations on the whole phenomena Knew things had "energy" They believed, and we now believe, a balance of energy is crucial for health & well being - The energy could be manipulated to maintain & restore health
Chinese Medicine: Acupuncture
Hx: 1914 - 1936: TCM (traditional Chinese medicine) came under fire and many practitioners were eliminated as Western educated reformers attempted to establish Western medicine as the dominant medical system Traditional medicine of China (yi) became "Chinese medicine" (Zhong Yi) - Nationalist & Marxist reformers disdained TCM - "unscientific" practices were discouraged - Zhong Yi exists today as a parallel to Western medicine: Integrates traditional concepts of Chinese medicine (acupuncture & herbal medicine)
Conventional AND Alternative or Complementary share (similarities)?
Ideas about the cures of disease The body can heal itself Healing comes from within Inner resources can be manipulated externally
Uses for Ozonotherapy
Immune system stimulation with infectious diseases - New research shows possibility of ozone therapy being used for COVID-19 treatment Stimulates release of growth factors to stimulate damaged joints and degenerative discs to regenerate Dramatic reduction in pain receptor activity to help reduce or manage chronic pain. Published papers have demonstrated its healing effects on interstitial cystitis, chronic hepatitis, herpes infections, dental infections, diabetes, and macular degeneration. - International Scientific Committee on Ozonetherapy (ISCO3)
Traditional Chinese Medicine
Including, but not limited to, acupuncture, herbal medicine, food therapy, moxibustion, TuiNa and fire cupping.
Chiropractic: Uses
Low back pain (with or w/o bulging discs or herniation) Migraine HA (improved sx) Neck pain (controversial due to adverse rxns: stroke) - Craniosacral therapy - effective for migraine & tension H/As According to a study by the NCCIH, Chiropractic therapy was the MC complementary therapy used for the tx of back pain. Among those who had used chiropractic therapy for back pain, 66% perceived "great benefit" from their txs. Most chiropractors today tx musculoskeletal complaints Manipulate the spine & pelvis - Use HVLA (high velocity low amplitude) technique (main concept of chiropratic therapy) - Hallmark of Rx - classic joint "pop" or "crack"
Disease/Conditions for Which CAM is Most Frequently Used Among Adults - 2007
MC: Back pain
Energy Medicine
Magnet Therapy Healing Touch Reiki
According to the NIH: NCCIH (National Center for Complementary and Integrative health)
Many Americans— >30% of adults & ~12% of children—use health care approaches developed outside of mainstream Western, or conventional, medicine. When describing these approaches, people often use "alternative" and "complementary" interchangeably, but the 2 terms refer to different concepts: **If a non-mainstream practice is used together with conventional medicine, it's considered "complementary." **If a non-mainstream practice is used in place of conventional medicine, it's considered "alternative." True alternative medicine is uncommon. Most people who use non-mainstream approaches use them along with conventional txs.
Medicine is both what?
Medicine is both an ART (opinions) and a SCIENCE ∗We practice within these 2 spheres Integrating Complementary Medicine with modern medical practice ↑ knowledge and ↑ opportunities to restore and maintain the balance of health
Examples of Naturopathic Rx
Migraine HA Identify the allergic foods: 70% or more of pts have migraines as a result of foods they cannot tolerate Magnesium supplements: Studies (Nuclear Magnetic Resonance- NMR) have measured lower Mg levels during attacks Establish normal prostaglandin balance: Decrease animal fat intake (arachadonic acid) & supplement with Omega-3s Riboflavin supplements: Can decrease the # & severity of attacks Homeopathic support as indicated Establish optimal levels of Vitamin D3 Potential involvement of herbs to balance hormone levels in women DON'T need to memorize this, just an example
Chiropractic
Much controversy existed within practitioners of chiropractic as well as allopathic MDs National Chiropractic Association (NCA) established educational standards & adopted the scientific method - Research is used to validate chiropractic theory Most practitioners treat musculoskeletal c/o - Manipulate the spine and pelvis, mainly Goal: restore spinal movement thereby, improving function ↓ back pain (getting adjusted) Adjustment: a controlled, sudden force is applied to a joint - A cracking sound may result as joint surfaces are separated (Hallmark of therapy) May also use massage, stretching, exercise, ultrasound & electrical muscle stimulation
Osteopathic Techniques
Muscle energy Technique Using post isometric relaxation - Isometric exercise (pt contracts muscle as provider resists) x 3-5 sec - Post relaxation (gently stretch muscle to increase ROM) HVLA - high velocity low amplitude ("pop") Strain counter strain
High Dose Vitamin C(IV dosing >500mg) Therapy**
Must check for a G6PD deficiency as high dose vitamin C therapy can induce acute hemolysis High dose Vitamin C has been shown to be selectively cytotoxic against cancer cells - Effective adjunct therapy but not stand alone. Ongoing Clinical Cancer Trials with High Dose Vitamin C - Kansas Univ. & Thomas Jefferson Univ (NIH/FDA) (**multiple) - Copenhagen University, Denmark - Quebec, Canada - University of Iowa (*2 separate ongoing studies)
More Osteopathic Techniques**
Myofascial release - causes muscle relaxation, breaking of fascial adhesions or fascial realignment Lymph drainage Cranial osteopathy- used primarily on kids, relieve tension by gentle pressure on scalp Visceral manipulation- gentle manipulation of vicera Articulatory technique (passive ROM)
Acupuncture Use in the US
National Institutes of Health (NIH) in 1997 - Acupuncture is being "widely" practiced - Physicians, dentists, acupuncturists, and other practitioners -For relief or prevention of pain and for various other health conditions. National Health Interview Survey (2007) - - An estimated 3.1 million U.S. adults and 150,000 children had used acupuncture in the previous year. - Between 2002 and 2007, acupuncture use among adults increased by approximately 1 million people
Alternative practice therapy that involves the body's own healing powers?
Natural Medicine Using natural remedies to fight disease
10 MC complementary health approaches among adults- 2012
Natural Products: any dietary supplements other than vitamins and minerals that are natural
What are types of Medical Systems?
Naturopathy Ayurveda: Yoga Chinese Medicine: Acupuncture Meditation Homeopathy Hx: Hippocrates: - First naturopathic doctor - Broke with the superstitious belief that disease was caused by magic or supernatural powers - Regarded the body as a "whole" - Instructed his students to prescribe only beneficial txs and avoid those that caused harm or hurt Followers of Hippocrates: - Believed everything in nature had a rational basis - Physician's role was to understand & follow the laws of the universe - Viewed disease as an effect - Looked for the cause in the air, food, water, etc - vis medicatrix naturae (wēs-ˌme-di-ˈkä-triks-nä-ˈtü-ˌrī )- the "healing power of nature", the body's ability to heal itself
What does CAM stand for?
Not commonly usedv(subjective)...Complementary and Alternative medicine Will still see used in research, but new term is Integrative medicine or health MC reason for CAM use: Prevent illness/for general wellness (ex: taking Zinc everyday for immune support)
Magnet Therapy: Principle
Principle: All living organisms have biomagnetic fields around them Electrical fields in the body can be measured by: - Condition of salty plasma: All tissues act as semi conductors The hands of healers emit electromagnetic signals in the range of 0.3 - 30 Hz Different strength magnets are required to penetrate the skin and into the tissues Magnets are placed over arteries (to carry the magnetic field farther) and are attracted to the iron in blood - Capillary walls relax when a magnet is placed on skin Are said to increase blood flow & decrease inflammation - Increased oxygenation is thought to help transport endorphins, thereby reducing pain - Accumulated pain producing prostaglandins are removed
Modern Medicine
Scientific model: ∗Pathophysiology of disease ∗Developed practices to dx & tx disease ∗Sub-specialization allowed for application of this new info Today: ∗Focus on the pieces ∗Fix problems The practice of separate parts does not work well when more than 1 body part is involved (CHRONIC DISEASE) Since all systems are interconnected, repairing one part, w/o assessing the underlying cause for its failure, provides only temporary relief ∗And may actually create a false sense of security Chronic disease: disease that is prolonged, does not resolve spontaneously & is rarely cured completely Modern medicine is based upon understanding the disease process at the cellular level This level is related to the dx, prognosis and tx
Hx of Osteopathy
Still founded the American School of Osteopathy (ASO) in Missouri, 1892 Programs developed in: Des Moines Chicago Philadelphia Kansas City Osteopathy was opposed by the AMA & MDs for perceived "competition" Educational parity was established based on the Flexner Model of Medical Education: -2 yrs basic science -2 yrs clinical rotations -Internship; residency Legal battles ensued and a "separate but equal" status prevailed - Allowed osteopaths to prescribe drugs, perform surgery, offer OB GYN services and practice emergency medicine WW II - DOs were commissioned into the armed service - Was mainstreamed into modern medicine after WW II * Shortage of MDs * Osteopaths desired mainstream medical training Full practice rights were granted in all 50 states in 1960s - Unfortunately, spinal manipulation became less emphasized * Was considered an embarrassment * Insurance reimbursement is poor
Manual Therapy
Taught by Hippocrates > 2000 yrs ago Practiced in China 3000 - 5000 yrs ago (before acupuncture) Seeks to correct structural imbalances to optimize the body's ability to correct or repair itself Use of physical force applied to the body - Correct abnormal or inefficient motion Seeks to optimize the interplay between the nervous & musculoskeletal systems to improve physical functioning Has limited potential for harm - MC SE is local discomfort - Controversial: cervical spine manipulation: Can cause stroke (~ 1 in 1 million txs) (pic)
Osteopathy: Trigger Points
Tender taut areas (knots) in muscle that produce local and referred pain AKA fibrositis, muscle callus, chronic myositis, muscular nodules Result from 3 mechanisms: Neurologic (proprioceptive-movement) response to acute muscle strain/ injury. ex: car accident now has whiplash strain injury Neurologic (nociceptive-sensory) response to visceral disease or persistent injury from lack of Rx. Reflex response from anxiety, pain - Increased sympathetic NS response
Uses of Magnet Therapy
The National Center for Complementary and Alternative Medicine (NCCAM) now NCCIH classifies magnetic therapy as a form of Energy Medicine. Arthritis (RA and OA) Fibromyalgia Repetitive strain injuries Peripheral neuropathy Pain management Insomnia Spondylosis Migraine Chronic Fatigue Syndrome High Blood Pressure Diabetes Bowel Disorders CI: pacemaker
Tenets of Manual Therapy
The body is a unit Structure & function are interrelated Body has an inherent ability to heal itself Disease may ensue when normal adaptations are interrupted
Acupuncture: Research
The placement of needles is thought to stimulate fine nerve endings that activate endogenous monoamines & neuropeptides This prompts the activation of electromagnetic signals that may direct immune cells & other neurohormones to the area of injury Meta-analysis showed positive impacts on pain reduction - Chronic low back pain - OA
Magnet Therapy: What to Avoid
Unlike electroconvulsive therapy (ECT), rTMS (repetitive transcranial magnetic stimulation) rarely causes seizures and does not require sedation with anesthesia. AVOID magnet therapy in pts with: - Implanted cardiac & other medical devices ´Pacemakers, defibrillators, E-stimulators, insulin pumps, etc
Complementary Medicine
Use is highest among post baby-boomers Need arises with increasing age ∗Used to manage medical conditions ∗More prevalent among older Americans Best predictor of use: Those with higher education (have to go seek it) ∗Have more disposable income ∗Have ↑ knowledge, self awareness ∗Have different attitudes Many HMOs offer at least 1 type of Complementary Medicine ∗Acupuncture ∗Massage ∗Nutritional therapy Up to ½ of all pts do NOT tell their providers about their use of Complementary Medicine (fear of being judged?) ↑ use with: ◦Cancer (esp breast cancer) ◦Neurological disease ◦Psychiatric disease ◦Physical disabilities ◦Psoriasis ◦Diabetes Has gained ↑ attention in the prevention of chronic disease ∗Much evidence notes the effectiveness of Complementary Medicine in TREATMENT, not disease prevention yet ∗More studies need to be done Much of what is called Complementary Medicine or CIM in the US, represents primary care for 80% of the world's population*
Transcranial Magnetic Stimulation
Uses brief electromagnetic pulses to alter brain activity Has been approved by the FDA for use in individuals with depression unresponsive to drug therapy A large electromagnetic coil is held near the forehead, usually on the left side. An electric current creates a magnetic pulse that travels thru the skull. - The current stimulates nerve cells involved in mood regulation & depression. - Research being conducted regarding benefits toward bipolar and schizophrenia
The state of attaining and maintaining health?
Wellness (social, emotional, intellectual, environmental, physical, occupational, spiritual)
How Does Acupuncture Work?
Western scientists have been trying to study the mechanism of acupuncture for years and have come up with several hypotheses. The classical Chinese explanation is that channels of energy run in regular patterns through the body and over its surface. These energy channels, called meridians, are like rivers flowing through the body to irrigate and nourish the tissues. An obstruction in the movement of these energy rivers is like a dam that backs up in others; the acupuncture needles unblock the obstructions at the dams, and reestablish the regular flow through the meridians. Acupuncture treatments can therefore help the body's internal organs to correct imbalances in their digestion, absorption, and energy production activities, and in the circulation of their energy through the meridians. The modern scientific explanation is that needling the acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain. These chemicals will either change the experience of pain, or they will trigger the release of other chemicals and hormones which influence the body's own internal regulating system. The improved energy and biochemical balance produced by acupuncture results in stimulating the body's natural healing abilities, and in promoting physical and emotional well-being.
Pulse Taking in TCM (Traditional Chinese Medicine)
Whether your pulse races or slugs along, apractitioner can determine your health There are 29 distinct pulses A Normal Pulse reflects good Heart Qi and Blood.
Correspondence of Traditional Chinese Medicine: Yin & Yang
Yang Light Heaven Sun Day Spring Summer Hot Male Fast Up Outside Fire Wood Yin Dark Earth Moon Night Autumn Winter Cold Female Slow Down Inside Water Metal
One of the MCC of nervous system disruptions is
subluxation - joints that are locked up, fixated, and not moving properly. Chiropractic care includes gentle massage and manipulation of the spine and extremities to restore proper joint function and strengthen supporting muscles and soft tissues
How do DOs, MDs, Chiropractors, & Naturopaths Compare? (chart)
understand what makes them difference Difference: Chiropractic and Naturopaths don't have to take MCAT or do a residency Difference:: Chiropractors are not allowed to prescribe drugs or do surgeries Main difference between Osteopathic & Allopathic: Osteopathic is trained in spinal manipulation where as allopathic is not Osteopathic are more trained in preventive medicine
Healing occurs outside the body-mind and is viewed as something done to the pt?
Conventional Medicine something done to the pt, does not take into consideration what happens inside of the mind & body
Magnet Therapy: Studies
2 studies showed: Pts with diabetic neuropathy (Stage II or III) who constantly wore static magnetic (450 G) shoe soles x 4 months showed statistically significant reductions in burning, numbness and tingling, and exercise induced foot pain 90% of pt with diabetic neuropathy reported positive outcomes after using a magnetic footpad insole device (475 G) constantly x 4 mos
Development of Complementary Medicine
2004: Institute of Medicine (IOM) Published a review of Complementary Medicine ∗Attempted to create a better understanding so Complementary Medicine could be integrated into conventional practice ∗Recommended medical academic institutions incorporate info on Complementary Medicine into their curriculum. - To provide competent advice In 1999, AAPA adopted a policy that supported integrating Complementary Medicine into PA education. In 2014, the AAPA revised its policy: "When a pt asks about an alternative therapy, the PA has an ethical obligation to gain a basic understanding of the alternative therapy being considered or being used and how the tx will affect the pt.If the tx would harm the pt, the PA should work diligently to dissuade the pt from using it, advise other tx, and perhaps consider transferring the pt to another provider."
Chiropractic Therapy: Daniel David Palmer
A "magnetic healer" - Cured a man of deafness by adjusting his thoracic spine - Established Palmer School of Chiropractic: mid 1890's, in Davenport, Iowa - Believed in "vitalism": The universe & its inhabitants possess an innate intelligence, which accounts for a self-healing capacity Developed "one cause, one cure" theory Postulates all disease is due to vertebral subluxations - Spinal nerve entrapment resulted at neural foramina - Restricted movement in the spine may lead to pain & ↓ function All disease can be cured by chiropractic adjustment
What is Acupuncture?
A complex system of complementary medicine that involves pricking the skin or tissues with needles, used to alleviate pain and to treat various physical, internal and emotional conditions. Originating in ancient China, acupuncture is now practiced worldwide.
Physical Therapy
A health care specialty involved with evaluating, diagnosing, and treating disorders of the musculoskeletal system. The ultimate goal of physical therapy is to restore maximal functional independence to each individual patient. Involves the use of exercise, heat, cold, electricity & massage. Physical Therapist Licensed health care professionals with a masters or doctorate in physical therapy. Evaluate, diagnose, & manage the PT ts plan, customizing it to each individual's needs. Through pt & therapist interaction, PT can help restore movement & function helping pts return to their prior level of independence.
Integrative Medicine
A healthcare approach that focuses on the whole person and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines available to achieve optimal health and healing in the most non-invasive, cost-effect way whenever possible.
COVID 19 and IV Vitamin C ***
A recent RCT showed that Sepsis related ARDS had better outcomes with administration of IV Vitamin C Study currently being conducted in Wuhan China on effects of IV vitamin C on COVID 19 pts in the ICU Currently ID doctors in the states are administering high dose Vitamin C to COVID 19 pts
Today's Acupuncturist
An acupuncturist is both a specialist and a primary care physician in the state of Florida. Much like an ND, the scope of practice varies from state to state; however, as more and more research is being conducted, the scope of practice is broadening. The acupuncturist of today, also much like an ND is a doctor who blends modern scientific medical practice and knowledge with natural and traditional forms of medical treatment. TCM (Traditional Chinese Medicine) and acupuncture are not synonymous; however, most acupuncturists also practice TCM, which refers to the use of traditional herbal formulations for the treatment of disease. Education - Formal schooling requirements: 3 years (2413 hours including 600 clinical); 1155 hours of traditional Oriental acupuncture diagnosis and treatment (including 705 hours of Oriental medical theory, diagnosis and treatment in acupuncture and related studies and 450 hours of herbal studies). - This is a master's level program, though there are several doctoral programs. - A series of four board examinations are also required (Point Location, TCM Foundations, Bio-Med and Herbology.)
Meditation
Ancient practice One of the MC complementary practices used by people to manage cancer & other chronic diseases - CDC 2009: chronic disease affects > 133 million Americans - "Generally incurable and ongoing" - 2009 - Financial burden of treating chronic disease accounts for > 75% of total medical costs in US - "Almost 1/3 of population has >1 chronic disease" Realigns the mind-body connection - the conscious with the physical body - The 2 are intertwined - Creates a more harmonious interaction Many have descended from religious practices - India, China, Japan May benefit: Allergies Anxiety disorders Cancer Depression Heart disease/ HTN Pain Sleep problems Overall - Stress Management Purpose was originally spiritual or religious Now is used to reduce mental and physical stress Is a self directed practice -Can focus on a single thought or word -May focus on a physical sensation (breath) -May focus on visual(candle flame) or auditory (sound of running water) Objective: to still the mind & direct the focus inward
History
Aristotle (384 - 322BC): early holistic physician ◦Believed a person was a combo of physical & spiritual properties ◦No separation between mind & body ◦Rx was based upon experience, observation and reflection on humanity
Essential Oilscontraction of the original term "quintessential oil"
Aristotle's 4 elements of matter - 5th element is quintessence - The "spirit" or "life force" Distillation and evaporation - believed to be removing the spirit from the plant 3 means of use: - Topical: Most essential oils must be diluted before application to skin - Inhalation - Ingestion Drug interactions - little published research. - However, given the complex chemistry of essential oils, however, it makes sense that this is possible or even likely Resins and complex chemical compounds are produced by the plants to act as natural antimicrobials, antifungal and antibacterial compounds. National Association for Holistic Aromatherapy
Uses of Healing Touch***
Asthma Carpal tunnel syndrome End-of-life care Neck pain Prostatitis Recurrent abdominal pain in children Stroke prevention Stress reduction
High Dose Vitamin C therapy Side Effects and Warnings ***
Can induce hypoglycemic effects Can interfere with blood thinning effects of anti-coagulation therapy (e.g. Warfarin) Definite concerns with pts with renal impairment
Naturopathic Doctor (ND) Program Encompasses
Clinical nutrition - use of diet as therapy Botanical medicine Homeopathic medicine Traditional Chinese medicine: Acupuncture Physical medicine - therapeutic use of touch, heat, cold, electricity & sound Detoxification Spirituality Counseling Health psychology Lifestyle modification
What is considered "GOOD MEDICINE"?
Complementary Medicine + Mainstream (conventional) Medicine
Conventional (mainstream) medicine along with alternative medicine?
Complementary Medicine: is a collection of therapies, many have a similar philosophy
Naturopathic Doctor (ND): Education
Completion of a conventional premed program - Degree in Biological Science Followed by 4 yrs of Naturopathic curriculum - 2 yrs - standard biological sciences, basic Dx sciences, intro to Rx modalities - 2 yrs - clinical Dx & Rx with emphasis on preventive Dx
Flower Essences
Developed by Dr. Edward Bach (1886 - 1936) He developed an interest in immunology and initially studied homeopathy - felt dissatisfied with the way doctors were expected to concentrate on diseases and to ignore the people who were suffering them.. He believed that illness is the effect of disharmony between body and mind. Sxs of an illness are the external expression of negative emotional states. Corrects emotional imbalances where negative emotions are replaced with positive Typically taken orally-mixed in glass of water Dr. Bach's Original Flower Remedies, a system of 38 Flower Remedies Rescue Remedy and Rescue Cream are probably most well known products Safe for everyone, including children, pregnant women, pets, and the elderly Recommended by both Dr. Phil and Dr. Oz
Idea of Homeopathy: "Like cures Like"
Dilution of the original compound (like vaccine) Succussion (shaken) between each dilution Imprinted through the unique molecular nature of water Extremely thorough hx & interview required to match the presentation of the pt - to try to identify the simillimum - the homeopathic remedy that produces the set of sxs most like that which the disease produces; ideally exactly congruent. Hahneman (and many others since) found that the Ultradilutions were often the most beneficial At this level, there is no possible remaining molecule of the original substance.
Meridians
Don't have to memorize Just know they are pairs
Meditation: Emotional Benefits & Types
Emotional Benefits: - Gaining a new perspective on stressful situations - Learning coping skills - Increase self awareness - Focus on the present - Reduce negative emotions Types: - Guided imagery (visualization) - Mantra - repeat a calming word - Mindfulness - broaden your conscious awareness - Qi gong - Tai chi - Transcendental - a repeated mantra helps you achieve a perfect state of stillness & consciousness - Yoga
Osteopathy
Focuses attention on the intention to heal through the "laying on of hands" Founder - Andrew Taylor Still, in 1874 Involved the concept of "vital energy" - Many medicines used at this time were toxic: Mercury, arsenic* - Leeches, bleeding, purging - Rxs of the day Believed in "drugless healing" Personal tragedy (loss of family to meningitis) and a dislike of current medical practices led Still to study human anatomy in detail, particularly the bones Concluded disease would develop if the bones were not in proper alignment or could not move properly as other body systems would be affected by this misalignment Developed an emphasis on spine mobilization - osteopathy
Osteopathy Today
Focuses on the whole person (mind & body), not just a set of sx Combines allopathic medicine with spinal manipulation, proper posture & body positioning Rhythmic manipulation aids the body to return to normal function in order to heal itself - Manipulation is designed to put the pt in touch with their body in order to aid in healing
Healing occurs within the body-mind and requires active participation of the pt?
Integrative Medicine
Combining Conventional Medicine w/ Complementary Medicine?
Integrative Medicine - Newer term - More accurate term as Americans use alternative medicine as an ADJUNCT to, NOT a replacement for, conventional medical care
Research Supports Efficacy of Acupuncture
One of the largest studies to date on acupuncture and chronic pain — a meta-analysis of 29 well-conducted studies involving nearly 18,000 patients and published in October 2012 in the Archives of Internal Medicine found that acupuncture is effective for treating chronic pain and therefore is a reasonable referral option. PubMed has numerous journal articles on research findings in support of acupuncture. The analysis found that "[s]ignificant differences between true and sham acupuncture indicate that acupuncture is considerably more effective than a placebo."
Areas of Specialization for Acupuncture & Chinese Medicine
Pain (Chronic, neuralgia, musculoskeletal, migraines, lumbosacral, sciatica, cervical and shoulder disorders) Digestive Disorders (Post gallbladder removal, bowel issues, malabsorption, etc.) Autoimmune Disorders (Hashimoto's, fibromyalgia and rheumatoid arthritis) Women's Health (Irregular or painful cycles, bladder issues and hormone dysregulation) Stress Management (Anxiety, insomnia, headaches, 'adrenal fatigue' and weight gain)
Why Complementary Medicine?
Part of being a medical professional includes evolving and adapting to new materials, methods, and approaches These changes occur for 2 reasons: ∗As our knowledge of diseases improve, new txs evolve ∗The epidemiology of illness also changes in response to social and cultural conditions Studies by Harvard Medical School & New England Journal of Medicine report: -1/3 of adult Americans regularly use some form of Complementary Medicine ∗It is not covered by insurance ∗People pay for it themselves
Osteopathy - Trigger Points: Pathophys**
Pathophysiology: Pro-inflammatory & vasoconstrictive chemical mediators accumulate (histamine, prostaglandins, bradykinin, potassium)→ influx of calcium ions→ overstimulation of muscles→ neurologic reflex arc→ painful bands of taut muscle (like a spasm) Formed when acute trauma or repetitive microtrauma leads to the development of stress on muscle fibers. - Associated with myofascial pain syndrome - Refers pain to other areas when touched Etiology: Acute injury (car accident) Repetitive strain (lifting) Imbalanced muscle use (injury on left, lean on R) Visceral disease Chronic stress Tension
Magnet Therapy
The use of a low-level magnetic field to treat illness and disease states First documented 2500 - 3000 BC Studied since the 1500's Studies have been inconclusive - Therapeutic use remains questionable - Newer research shows magnetic strength must be > 800 gauss/ 80 mili tesla *MRI is 15,000 Gauss or higher *Exposure must be at least 24 - 48 hrs for efficacy Gauss (G) - the unit of measurement of a magnetic field. The electromagnet used in an MRI machine is 15,000 G or higher Tesla - the General Conference on Weights and Measures for the International System of Units dedicated the term "tesla" to the SI unit measure for magnetic field strength.
What is Ozonotherapy?
The use of medical grade ozone, a highly reactive form of pure oxygen, to create a curative response in the body. So what is Ozone? - basically is a highly unstable oxygen compound → O3 - Dissociates in the body to O2 + (O) Most popular route of administration of Ozone is O3-Aht (Autohemotransfusion) Take your own blood out, expose it to Ozone, replace it Ozone (after converting to Peroxide in the blood) will ultimately cause a release of antioxidants.
What Is Occupational Therapy?
The use of txs to develop, recover, or maintain the daily living & work skills of pts with a physical, mental or developmental condition. Helps with relearning daily activities Common OT interventions include: - Helping children with disabilities to participate fully in school and social situations - Helping people recovering from injury to regain skills - Providing supports for older adults experiencing physical and cognitive changes. Occupational therapy services typically include: - An individualized eval, during which the client/family & occupational therapist determine the person's goals - Customized intervention to improve the person's ability to perform daily activities and reach the goals - An outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan OT services may include: - Comprehensive evals of the client's home & other environments (e.g., workplace, school) - Recommendations for adaptive equipment & training in its use, - Guidance and education for family members and caregivers. OT practitioners have a holistic perspective, in which the focus is on adapting the environment to fit the person, and the person is an integral part of the therapy team.
Acupuncture
Therapeutic goal is to regulate chi When chi flows unimpeded, the body is in a state of health - Illness and pain can occur with interruption in the flow of chi - Acupuncture removes the obstruction (flow of chi)
NCCIH Stance on Homeopathy
There are very few studies establishing the safety of homeopathy - Some products labeled as homeopathic may contain substantial amounts of active ingredients & could cause side effects and drug interactions (we don't know) There's little evidence to support homeopathy as an effective tx for any specific health condition
Normal Spine & Subluxated Spine
This is really common. Will see these degenerative changes in pts all the time. This is showing misaligned vertebra with a swollen disc, in turn leaning to nerve interference and inflamed joint. Muscles tighten in response to nerve interference
Differences in Healers
Times past ∗Use outer resources to help mobilize the body's inner resources ∗The body heals itself and maintains it's own health Now ∗Study dead cells and tissues ∗Use drugs to affect receptors ∗Cut out parts that don't work or are unwanted. ∗Replace failing parts
