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SURF  |   October 2017
My Stepping “Stone” to Osteopathic Medicine
Author Notes
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Jacqueline Segelnick, OMS III, New York Institute of Technology College of Osteopathic Medicine, 101 Northern Blvd, PO Box 8000, Old Westbury, NY 11568-8000. E-mail: jsegelnick@gmail.com
     
Article Information
Medical Education / Hypertension/Kidney Disease / Osteopathic Manipulative Treatment / Being a DO
SURF   |   October 2017
My Stepping “Stone” to Osteopathic Medicine
The Journal of the American Osteopathic Association, October 2017, Vol. 117, e15-e16. doi:10.7556/jaoa.2017.124
The Journal of the American Osteopathic Association, October 2017, Vol. 117, e15-e16. doi:10.7556/jaoa.2017.124
As osteopathic medical students, we learn to view the human body as a whole unit consisting of body, mind, and spirit. We are taught that all systems are interconnected, that structure is related to function, and that the body is self-regulating and self-healing.1 With our hands, we can improve functionality in our future patients. For most first-year osteopathic medical students these concepts are new. We tend to be skeptical, as we have not yet experienced osteopathic manipulative medicine (OMM) at its full potential in clinical scenarios. And, in my experience, my allopathic peers are often cynical when I share what I learned in my OMM laboratories. 
Despite this struggle, I am proud to be an osteopathic medical student and leave weekly OMM laboratories eager to practice what I have learned. Although I am at the beginning of my career at the New York Institute of Technology College of Osteopathic Medicine, I have begun to embrace the field of osteopathic medicine and its unique philosophy regarding the human body. This open-minded outlook has enabled me to witness firsthand the exceptionality of my education. 
One day I went to my parents’ house to find my father bent over in agony. He has a long history of kidney stones due to hyperparathyroidism. He described the pain as “a sharp knife in the back,” lasting more than a week. Despite drinking a lot of fluids, he had no luck passing the stone. I asked him if he would mind if I performed osteopathic manipulative treatment (OMT) on him; perhaps something I learned could provide relief. He agreed, so I opened my textbook and found that, for kidneys, I should look at spinal levels T12 to L2.1 I was fascinated when I performed a structural examination and found that my father was extremely rotated right and hypertonic on the right from T12 to L2. I asked him if his right side was bothering him and he replied that it was, which confirmed my initial assessment that the abnormal findings in his back might be due to his kidney stone. Following the osteopathic tenets,2 I determined that treating his back would help remove restrictions and improve the function of his kidneys. I treated these levels with facilitated positional release and muscle energy. The hypertonic muscles in this area started to feel less tense, and the rotated transverse processes of these spinal levels became more symmetrical. Thirty minutes after treatment, he jumped with joy after passing a kidney stone. His pain had subsided and my mother exclaimed with shock, excitement, and pride: “My daughter the osteopathic physician!” 
Later, I researched OMM application for kidney stones, for which there is currently limited literature. I found that it is important to consider OMT when treating patients with acute nephrolithiasis.1 Management can be oriented to balance the autonomic nervous system, maintain lymphatic drainage through the pelvic diaphragm, and improve thoracic diaphragm movement.3 Still technique, paraspinal inhibition, psoas muscle treatment, rib raising, and management of anterior Chapman reflex points are suggested to accomplish clinical goals.3 Managing the psoas and quadratus lumborum muscles can directly influence structural changes in the T12 to L3 region.4 Furthermore, increased sympathetic stimulation to the ureters from the T10 to L2 region can restrict the passage of kidney stones, and management of these somatic dysfunctions can relax the ureters and aid in the passage of stones.4 A study5 examining the relationship between low back pain and kidney mobility found that patients with low back pain and restricted kidney mobility had increased mobility and reduced pain perception when OMT was performed. Although more clinical trials investigating the effect of OMT on kidney stones are needed, there are valuable lessons to be learned from my personal experience. I realized that the tenets of osteopathic medicine are best understood by practicing and applying them to patients. These enlightening moments define us as future physicians and serve as vital stepping stones for our success. 
With the transition to a single accreditation system for graduate medical education underway, some osteopathic physicians are worried that the osteopathic medical profession will lose its distinctiveness.6 A friend of mine who wants to be an osteopathic anesthesiologist asserts that she will never perform OMT on patients. The single graduate medical education system may perpetuate this attitude because osteopathic medical students may feel there is no difference between them and their allopathic peers. Osteopathic medical students could miss opportunities to practice OMM in a clinical setting and thus miss out on enlightening moments like the one I experienced. Furthermore, osteopathic residents will be less likely to use OMM if they are trained in allopathic institutions that lack DO mentors or a commitment to continued training in osteopathic principles and practice. Thus, I believe that more osteopathic residency programs transitioning to the single accreditation system must apply for osteopathic recognition. 
As I conclude my first year of medical school, I am confident that osteopathic principles and practice will underscore my career. Osteopathic medical students’ knowledge of OMM is an irreplaceable gift that distinguishes us from allopathic physicians; therefore, I implore my classmates and future osteopathic medical students to approach OMM with an open mind and take advantage of this unique skillset. No matter which medical specialty I pursue, I will have a unique philosophy and perspective on the human body. Under the single accreditation system, I believe OMT techniques and osteopathic philosophies can continue to guide our careers in the osteopathic medical profession. 
References
DiGiovanna EL, Schiowitz S, Dowling DJ. An Osteopathic Approach to Diagnosis and Treatment. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.
Chila A, executive ed. Foundations of Osteopathic Medicine. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011:3.
Januchowski R, Dabecco R, Verdone C. Nephrolithiasis. Osteopath Fam Physician. . 2014;6(5):8-12.
Kaufman BE. An osteopathic approach to the renal and urinary system. Osteopath Fam Physician. . 2012;4(4):101-109. doi: 10.1016/j.osfp.2012.03.001 [CrossRef]
Tozzi P, Bongiorno D, Vitturini C. Low back pain and kidney mobility: local osteopathic fascial manipulation decreases pain perception and improves renal mobility. J Bodyw Mov Ther. 2012;16(3):381-391. doi: 10.1016/j.jbmt.2012.02.001 [CrossRef] [PubMed]
Hempstead LK. Single accreditation system: opportunity and duty to promote osteopathic training for all interested residency programs. J Am Osteopath Assoc. 2015;115(4):193. doi: 10.7556/jaoa.2015.040 [CrossRef] [PubMed]