I had the opportunity to learn from a young patient with asthma recently.\u00a0 Although it is not his real name, I will refer to him as Bill.\u00a0 Bill is African-American, bright, athletically built and currently in middle school.\u00a0 He has taken a number of different asthma meds, none of which achieved the miraculous results of making his asthma go away, but all of which have helped to some degree.\u00a0 He currently takes Flovent.<\/p>\n
When Bill presented to the office he was having some difficulty breathing.\u00a0 I could see the fear in his eyes that I have noticed is common when a person is having difficulty taking in enough air.\u00a0 I worked with his pediatric nurse practitioner (PNP) to get a baseline peak flow before treatment of any type.\u00a0 The result was 350.\u00a0 Rather than give the inhaler right away, I asked Bill if I could treat him first and that we could use the inhaler if the treatment did not work.\u00a0 He agreed.<\/p>\n
I screened Bill out to look for the place to begin.\u00a0 I noted the rib cage was the place that had the most restricted somatic dysfunction.\u00a0 I treated in order:<\/p>\n
1)\u00a0\u00a0\u00a0\u00a0 Left rib 1 expired – functional method.<\/p>\n
2)\u00a0\u00a0\u00a0\u00a0 Angle of Louis (the joint between the manubrium and the sternal body) \u2013 functional method.<\/p>\n
3)\u00a0\u00a0\u00a0\u00a0 Right rib 4 transversus thoracis muscle \u2013 direct inhibitory pressure combined with muscle shortening.<\/p>\n
4)\u00a0\u00a0\u00a0\u00a0 Left rib 2 transversus thoracis muscle \u2013 direct inhibitory pressure combined with muscle shortening.<\/p>\n
5)\u00a0\u00a0\u00a0\u00a0 Right ribs 3-10 expired \u2013 muscle energy.<\/p>\n
6)\u00a0\u00a0\u00a0\u00a0 Respiratory diaphragm \u2013 myofascial release with respiratory assist.<\/p>\n
After each of the above numbered treatments, I would ask Bill to take a deep breath.\u00a0 With each breath he took, I could hear ribs audibly \u201cpop\u201d as they were able to return to their normal articulations.\u00a0 As the treatment progressed, I also noticed that Bill\u2019s fear was diminishing rapidly, that his respiratory rate was not as rapid and that his chest wall movement was noticeably improved.\u00a0 Bill and I were both satisfied that the treatment had resolved his symptoms and that he did not need to use his inhaler at this time.<\/p>\n
We talked for a few moments before retesting his peak flow.\u00a0 I was anticipating a wonderful improvement.\u00a0 I felt like I had worked with Bill to achieve at least today\u2019s resolution of his symptoms.\u00a0 Everyone around him could see that he was breathing better.\u00a0 The retest value was 350 \u2013 the same as before the test.\u00a0 It was not what I expected.\u00a0 OK, so it may have been 355 if I read it with the unit tilted just the right way. \u00a0I asked Bill to test again \u2013 still 350.\u00a0 This placed him in the yellow zone on the asthma chart for his age and weight.\u00a0 Even though he was visibly breathing better, I felt like I had failed in my treatment.\u00a0 After all, I did not have numbers that could validate what I had done.\u00a0 That is what evidence-based medicine is all about.<\/p>\n
I heard Dr. Ed Stiles talking in my head.\u00a0 I hear his words often when I \u201cget stuck\u201d during a treatment.\u00a0 Being one of his students has been one of the biggest blessings in my life.\u00a0 Dr. Stiles encouraged us to think osteopathically and to apply everything we had learned in treating patients.\u00a0 It then dawned on me that medically asthma\u00a0IS<\/span>\u00a0a problem in the smaller airways.\u00a0 Nothing I had done thus far had directly addressed that aspect of Bill\u2019s symptoms.\u00a0 I decided to treat the airways by treating the lungs viscerally.\u00a0 I screened viscerally and found the left lung to be more restricted.\u00a0 I treated that first and then had Bill do another peak flow.\u00a0 This time it was 380.\u00a0 Still in the yellow zone, but improved!\u00a0 After treating the right lung, the peak flow crept up to 400.\u00a0 This placed Bill in the green zone.<\/p>\n After hearing more of Dr. Stiles\u2019 advice in my head my pharmacological advice was clear.\u00a0 In Bill\u2019s case, we needed to assist his airway size.\u00a0 Without running expensive tests, it seemed to only make sense that if the rib cage was moving well but the peak flow remained unchanged that I had some very usable results.\u00a0 If I remember my physics correctly, Poiseuille’s Law is used to calculate fluid flow through a cylindrical pipe.\u00a0 The applicable portion here is that the fluid flow is related to the radius of the pipe to the fourth power \u2013 thus a small change in the radius of the pipe can make a large change in the flow of fluid.\u00a0 Poiseuille’s Law is why there are two large bore IV\u2019s started on any trauma patient \u2013 so fluid can be moved rapidly.\u00a0 Bill\u2019s air could not get in and out because of the narrowing of the bronchioles. \u00a0I believe that is why the visceral treatment achieved the desired increase in peak flow \u2013 it changed the size of the smaller airways.\u00a0 Using this as my treatment rationale, I stepped up his inhaled steroid dose for one week to reduce any inflammatory component and recommended to the PNP to follow him with his smaller airways in mind.<\/p>\n Patients like Bill continue to teach me how to apply the osteopathic principles to effectively manage their complaints and diseases.\u00a0 Many thanks to Dr. Stiles and Dr. Still for encouraging us as a profession to \u201cDig On\u201d.<\/p>\n","protected":false},"excerpt":{"rendered":" I had the opportunity to learn from a young patient with asthma recently.\u00a0 Although it is not his real name, I will refer to him as Bill.\u00a0 Bill is African-American, bright, athletically built and currently in middle school.\u00a0 He has taken a number of different asthma meds, none of which achieved the miraculous results of […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":634,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","footnotes":""},"class_list":["post-644","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/pages\/644","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/comments?post=644"}],"version-history":[{"count":2,"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/pages\/644\/revisions"}],"predecessor-version":[{"id":838,"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/pages\/644\/revisions\/838"}],"up":[{"embeddable":true,"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/pages\/634"}],"wp:attachment":[{"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/media?parent=644"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}