EAST STREET CLINIC
11.1.2013 Day 1 in East Street
I was really delighted to find out that for the whole term during fridays i am going to practice in east street clinic. I have been treating patients there once already and I always felt I had some autonomy in there and the way the things are being done there would be perhaps the same as in my own practice in the future.
I have been paired up with my male colleague MH and all together we saw some interesting cases. He treated a young unemployed guy with mild learning difficulties that presented with LBP and lordosis from LS segment up to CT!!! I have never seen back like that! No kyphosis in it at all. I wondered if there are perhaps some neurological deficits that led into such an unusual curvature of the back.
The patient we saw next was a NP that came in with the pain down her leg posteriorly. I took the case history and on the examination it was pretty obvious that there was also involvement of the hip (we diagnosed OA) and LB degeneration with pronounced inflammation of the LSp joints.
I also saw the patient I saw once before. Really lovely lady of the italian origin that seems to have some parkinsonian changes such as tremor. However I keep arguing with my tutor each time we talk about her that intension tremor she has is related to cerebellar dysfunction and tremor in rest would be more related to the parkinson disease.
I also had a chat about the attitude to the patients. It is important to show them respect, love and compassion and i believe they will get better as words have massively healing power. It was interesting to watch my colleague after this conversation how he was trying to spark the conversation with his patients and it did not seem natural for him to keep chatting as he was too concentrating for the technique.
I have been paired up with my male colleague MH and all together we saw some interesting cases. He treated a young unemployed guy with mild learning difficulties that presented with LBP and lordosis from LS segment up to CT!!! I have never seen back like that! No kyphosis in it at all. I wondered if there are perhaps some neurological deficits that led into such an unusual curvature of the back.
The patient we saw next was a NP that came in with the pain down her leg posteriorly. I took the case history and on the examination it was pretty obvious that there was also involvement of the hip (we diagnosed OA) and LB degeneration with pronounced inflammation of the LSp joints.
I also saw the patient I saw once before. Really lovely lady of the italian origin that seems to have some parkinsonian changes such as tremor. However I keep arguing with my tutor each time we talk about her that intension tremor she has is related to cerebellar dysfunction and tremor in rest would be more related to the parkinson disease.
I also had a chat about the attitude to the patients. It is important to show them respect, love and compassion and i believe they will get better as words have massively healing power. It was interesting to watch my colleague after this conversation how he was trying to spark the conversation with his patients and it did not seem natural for him to keep chatting as he was too concentrating for the technique.
18.1.2013 Day 2 in East Street
Today I worked with my male colleague AD which I don't know very well from the professional side so I was curious to learn something new from him. As the weather was very bad a lot of patients cancelled their appointments so we ended up treating only 3 patients between us in the whole afternoon. I treated a lady with severe fibromyalgia. She undergone a series of abdominal surgeries in the recent years and even though very young, she wears walking stick and is completely flexed in her spine as her abdomen is very tender and straightening up aggravates it. It was interesting to hear her saying that coming to see osteopath she consideres as having a beauty massage as she does not want to feel that this treatment is medicalised. I told her about the visceral osteopathy how she could possibly benefit from it, however I realised that performing it without experienced osteopath and without knowing all the details of the surgeries would not be safe nor acceptable. I told to the patient about the osteopaths that do treat viscerally so she could have a look at it. It is frustrating to know about a treatment but not being really able to do it as only a small sample has been shown to us in the visceral technique elective. On the other side it was a example of where it would be very suitable and thus I will be thinking of taking up visceral course studies as CPD in the future.
I also seen the patient I met back in summer and he was my new patient then, the bus driver from sudan. He is still suffering from the lower back pain and also complained about the numbness in his left foot. I found it very frustrating that I did not have enough time to discuss with him his foot complain in more detail as he mentioned it half way through the treatment. Perhaps he is systemically unwell.... he does not look well or happy, has worries about the abducted nephew that might be killed for organs.... It was upsetting to listen to him and I felt sorry for him a lot. even though we provide the osteopathic treatment for free, the continuity of seeing one patient by the same practitioner is almost impossible and this perhaps causes the fact that majority of the patients in the GP clinic do not get better. They also seem to have very complex lives and unhealthy lifestyle that does not promote the healing.
I also seen the patient I met back in summer and he was my new patient then, the bus driver from sudan. He is still suffering from the lower back pain and also complained about the numbness in his left foot. I found it very frustrating that I did not have enough time to discuss with him his foot complain in more detail as he mentioned it half way through the treatment. Perhaps he is systemically unwell.... he does not look well or happy, has worries about the abducted nephew that might be killed for organs.... It was upsetting to listen to him and I felt sorry for him a lot. even though we provide the osteopathic treatment for free, the continuity of seeing one patient by the same practitioner is almost impossible and this perhaps causes the fact that majority of the patients in the GP clinic do not get better. They also seem to have very complex lives and unhealthy lifestyle that does not promote the healing.
15.3.2013 Another Friday in East Street clinic
Elderly lady looking after her schizophrenic son presented today with bilateral shoulder and elbow pain or ache when she goes to dance and when she keeps her shoulders abducted with elbows flexed for a while. Even though the presentation was bilateral that could have been suggestive of PMR, this lady started to notice it only one week ago and only on dancing and lifting the kettle. I diagnosed her with bilateral subacromial impingement due to postural changes and possible supraspinatus degeneration.
I am noticing that in this clinic is very usual to see people with complex medical history that is so convenient to have it accessible on the GP's software, but also these people have very complicated social issues that affect them entirely. in this clinic more then back in the general BSO clinic I have to think of the impact of the biopsychosocial issues on these patients and the implact on their health. This lady's only child is schizophrenic, she has divorced years ago, however she keeps on socialising by dancing and playing bingo as she does not want to get socially isolated.
I am noticing that in this clinic is very usual to see people with complex medical history that is so convenient to have it accessible on the GP's software, but also these people have very complicated social issues that affect them entirely. in this clinic more then back in the general BSO clinic I have to think of the impact of the biopsychosocial issues on these patients and the implact on their health. This lady's only child is schizophrenic, she has divorced years ago, however she keeps on socialising by dancing and playing bingo as she does not want to get socially isolated.
29.3.2013 Unusual thorax pain presentation
My new patient today presented with the history of many years of fire like feeling in her chest for which she consulted her GP and in their records they talked about unusual thorax pain presentation. On the further questioning I found out that this woman has been threaten by her partner that left her and their 2 children for a neighbour 2 doors down the street. He wanted to get custody of the children and was spying on her daily, she was so frighten and cried in the consultation room. Fearing losing her children, having type one diabetes and fainting recently with her son age 5 calling emergency services by phone to save his mum, she felt very vulnerable, thinking that she will indeed lose her kids and her expartner will use that incident against her in the court. She escaped from her flat to live with her aunty and slept on single bed all together with her 2 sons aged 5 and 3.
I recognised that i could not offer her much advise on these issues even though i was tempted to. My tutor got involved and he recognised that she suffered from stomach hypertonicity and cramps due to so much stress in her life. this lead into viscero somatic reflex or perhaps other way round (who knows). He treated her visceraly very gently and on the end applied very gentle thoracic HVT.
He explained to her what was going on to calm her down and at least have one less thing to worry about. She was not ill, and she did not have to be scared that another health issue is going to affect her fight for custody of children. She achieved instant relieve from the pain and such a significant improvement in her posture. she could stand up straight now!
It made me realise how important for her was the visit to osteo clinic in her GP practice. How important are our reassuring words for someone like her, dreading the worst....
I recognised that i could not offer her much advise on these issues even though i was tempted to. My tutor got involved and he recognised that she suffered from stomach hypertonicity and cramps due to so much stress in her life. this lead into viscero somatic reflex or perhaps other way round (who knows). He treated her visceraly very gently and on the end applied very gentle thoracic HVT.
He explained to her what was going on to calm her down and at least have one less thing to worry about. She was not ill, and she did not have to be scared that another health issue is going to affect her fight for custody of children. She achieved instant relieve from the pain and such a significant improvement in her posture. she could stand up straight now!
It made me realise how important for her was the visit to osteo clinic in her GP practice. How important are our reassuring words for someone like her, dreading the worst....
12.4.2013 - Young football player
A young football player presented today with the left knee pain after he has been training of exercising. pain is quite anterior and felt like muscle pulling. he was systemically healthy. he took football very seriously and on the questioning i found out that he plays semi professionally but aims to play on the professional level.
i examined his knee by i could not find any structures that would be injured. i stated to look further away from the knee. he was wearing socks and shorts and hoodie thinking it was only knee i wanted to see. and it would be perhaps all ok if it was a specific injury for me to examine knee only, but because his symptoms sounded a lot like compensatory picture, i got him to undress to his shorts only. and then i could see extremes levels of compensation for significantly shorter lower extremity. one of his feet had completely collapsed medial arch where else the other was in perfect anatomical shape. he had scoliotic curve and innominates shifted in compensation for shorter leg. there was also imbalance in his gluteal muscles, on one side low tone of gluteus medius and minimus. this guy needed some sort of orthotics and i do not feel i am anywhere near to advise someone on the topic. i explained to him what was happening and i could see an immediate change in his face and eyes. they became watery and he was blankly staring into the ceiling. i told him we could have a go and treat him for all the compensations his body has to amend to, but i am not sure if he was listening. Perhaps he knew from previous experiences of his friends what impact one shorter leg can have on your performance, i am not sure. He left but never came back.
This however made me think about how are we supposed to address these cases. In my opinion this guy was always going to have issues with his back and knees unless there was orthotics fitted. as a sport person he puts his body in so much stress and forces and i was not sure if his body would be able to take years of it.... he was only 19 and with quite significant differences between left and right. I know that we should try to treat person like him but i dont believe that ttt we would provide on some 4 to 6 appointment would change something that was there possibly since his birth. at least he would get relieve for some short time but not for years to come. I started to question for myself if the choice of his carrier was appropriate and if honest opinion, however painful, would save him from wasting his time and opportunities he might have at the moment. However not having any experience with such patients and presentations, i was not sure even what to think about it. My tutor did not give me satisfying answer either, he prescribed to this guy to do hip rotation movement clock wise and anticlockwise on the shorter side. I did not agree with this approach but i did not have any other ideas....
i examined his knee by i could not find any structures that would be injured. i stated to look further away from the knee. he was wearing socks and shorts and hoodie thinking it was only knee i wanted to see. and it would be perhaps all ok if it was a specific injury for me to examine knee only, but because his symptoms sounded a lot like compensatory picture, i got him to undress to his shorts only. and then i could see extremes levels of compensation for significantly shorter lower extremity. one of his feet had completely collapsed medial arch where else the other was in perfect anatomical shape. he had scoliotic curve and innominates shifted in compensation for shorter leg. there was also imbalance in his gluteal muscles, on one side low tone of gluteus medius and minimus. this guy needed some sort of orthotics and i do not feel i am anywhere near to advise someone on the topic. i explained to him what was happening and i could see an immediate change in his face and eyes. they became watery and he was blankly staring into the ceiling. i told him we could have a go and treat him for all the compensations his body has to amend to, but i am not sure if he was listening. Perhaps he knew from previous experiences of his friends what impact one shorter leg can have on your performance, i am not sure. He left but never came back.
This however made me think about how are we supposed to address these cases. In my opinion this guy was always going to have issues with his back and knees unless there was orthotics fitted. as a sport person he puts his body in so much stress and forces and i was not sure if his body would be able to take years of it.... he was only 19 and with quite significant differences between left and right. I know that we should try to treat person like him but i dont believe that ttt we would provide on some 4 to 6 appointment would change something that was there possibly since his birth. at least he would get relieve for some short time but not for years to come. I started to question for myself if the choice of his carrier was appropriate and if honest opinion, however painful, would save him from wasting his time and opportunities he might have at the moment. However not having any experience with such patients and presentations, i was not sure even what to think about it. My tutor did not give me satisfying answer either, he prescribed to this guy to do hip rotation movement clock wise and anticlockwise on the shorter side. I did not agree with this approach but i did not have any other ideas....
19.4.2013 - 9th appointment of patient with LBP
Mr H was my patient since the beginning of my experience in east street. he came with lower back pain and mid tsp pain. all were of mechanical nature. This time he came before his trip to syria as journalist, to have some more ttt on his back pain that has improved but was still niggling there. My tutor was slightly annoyed that young man needs 9 appointments for ordinary LBP and helped me to understand a classical osteopathic concept that sacrum likes to follow the position of the occiput. so if i thrust lumbar spine, i have to check and thrust csp in order to achieve long lasting results in pain relieve. he showed me techniques for scanning for lumbar spine and spine torsion and restriction and asked me to manipulate lsp and neck of mr H. On the re examination mr H did not have any symptoms.
I find it quite frustrating that our teachers have so much relevant knowledge and despite that they are very reluctant to share it with us as it is no BSO way of doing things. I do not care what way it is, if it works, it works. I have been again amazed by this approach and am planning to go and visit my tutor in his practice to see how he treats his patients in order to learn something new again.
I find it quite frustrating that our teachers have so much relevant knowledge and despite that they are very reluctant to share it with us as it is no BSO way of doing things. I do not care what way it is, if it works, it works. I have been again amazed by this approach and am planning to go and visit my tutor in his practice to see how he treats his patients in order to learn something new again.