Frequently Asked Questions

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Osteopathy FAQs

What is the main benefit of receiving Osteopathic Treatment versus other medical interventions such as medications, surgeries or injections?


Osteopathic Manipulative Medicine treats underlying causes to get at the root of disease and pain. Other interventions mask symptoms, for a time, and then require additional interventions. The injection or medication that first alleviated the pain may not work as well over time. This explains why we have an epidemic of opioid pain medication use and abuse in this country. All drugs including injections come with side effects and complications. In the meantime, the body which is an adaptive living organism continues to compensate for the original problem which was never addressed. Surgeries carry the risk of complication, do not always work but once done can’t be reversed. Because surgery modifies the body yet rarely deals with the original cause, there is likelihood the problem will return. A 2004 article in the Spine Journal by Alan S. Hilibrand, MD, a respected orthopedic surgeon stated "several long-term follow-up studies of cervical and lumbar fusion procedures suggest that adjacent segment degeneration and adjacent segment disease are common." Dr. Hilibrand concluded within ten years of lumbar spinal fusions, 40% of patients had significant, even debilitating pain at a lumbar spinal segment above or below the original fusion. This is just one example of why more conservative approaches such as Osteopathic Manipulative Medicine should first be exhausted before engaging in more invasive approaches.




What is a “DO”, a Doctor of Osteopathic Medicine?


American trained DOs, like Medical Doctors, “MDs” are the only accredited medical professionals with an unrestricted medical license. Doctors of Osteopathic Medicine can prescribe all medications, order labs and imaging such as X-rays and MRIs, work in hospitals and even perform surgery depending on their area of specialization. DOs can be found practicing in all medical specialties including family and internal medicine, orthopedic and general surgery, OB-GYN, radiology to name a few of the many possibilities.




How does one become a DO?


In America, the process of becoming a Doctor of Osteopathic Medicine is identical to becoming a Medical Doctor with one important exception (see next FAQ, below). DO, like MD school, is four years duration. To graduate, DOs must successfully complete all course work over the four years and pass three eight-hour national osteopathic board exams. These are structured like the MD boards and DOs can take MD boards, in addition to their own, if they choose. After graduating osteopathic medical school one completes at least three years of post-graduate training in a combined hospital – clinic medical residency program and must pass one more eight-hour national board exam. Years one and two of most DO and MD medical schools are spent in the classroom studying all aspects of medicine: anatomy including cadaver dissection, physiology, biochemistry, infectious disease, pharmacology, all the systems of the body (cardiac, respiratory, GI etc.), to name some of many foundational courses. Years three and four are spent “rotating” through the main areas of medicine including family and internal medicine (both in the hospital and the clinical office setting) pediatrics, surgery, emergency medicine, OB-GYN, geriatrics and psychiatry as well as electives tailored to a student’s interest. Upon completion of the four years of osteopathic medical school one receives the degree, Doctor of Osteopathic Medicine, and can call themselves a “DO”. But in all States in America one must then complete additional post-graduate training to be able to actually practice medicine. The first post-graduate year is “intern” year. Thereafter post-grads are called “residents.” Interns and residents work under the supervision of Attending Physicians. A merger between DO and MD residency programs is in progress and due to be completed by 2020.




What is the one important difference mentioned above between DO and MD training?


Doctors of Osteopathic Medicine, unlike MDs, learn to perform Osteopathic Manual (aka Manipulative) Medicine, “OMM”. OMM is the major distinguishing factor between DO and MD training. There’s also an emphasis on a whole-person approach to treatment and care in osteopathy. DOs are trained to listen and partner with their patients to help them get healthy and stay well. Click here to learn more.




What is Osteopathic Manual Medicine “OMM”?


DO physicians use their hands to change the anatomy of the body. Changing the anatomy – the structure – of the body, improves its function. Structure and function are interrelated. If you step on a garden hose it delivers less water. If you restrict a blood vessel it delivers less blood. Less blood results in less delivery of oxygen and nutritients. Evidence Based Medical studies have proven this can have a profound effect on improving disease outcomes. For example, a study of patients hospitalized with pneumonia found that by treating the structural components of the respiratory system to work better, the diaphragm, lymphatics and the parts of the nervous system that regulate the lungs, patients got better faster. Studies showed pneumonia patients receiving OMM on average could be discharged from the hospital one day earlier than patients who did not receive OMM.




How do you, the osteopathic physician utilize their hands to change anatomy?


I use a wide range of hands-on techniques depending on the specific needs of individual patients. Most are very gentle. Patients rarely experience pain or discomfort and many even fall asleep as their nervous system treats and resets improving other systems in the body, most notably the GI and musculoskeletal systems. Some patients require a gross “mechanical intervention” to move a particular structure that is “stuck” back to its normal position. More often patients require more subtle treatment that help their bodies reorganize. This is at the heart of the Altar of Creation work which serves as a “GPS” to help locate and guide the patient’s body back to a much earlier map of perfection first laid down in embryology. In almost every treatment patients receive Cranial Osteopathic Manipulative Medicine (see related FAQ, below) which works with five major phenomena in the body to release structure and set up treatment protocols using the body’s own inherent wisdom and natural tendency towards health. Utilizing these skills, a bone, ligament, tendon, blood supply, lymphatic chain even an organ can be brought into perfect balance releasing all tension upon it and improving its function. The return of blood, lymphatics, nutrients and oxygen to a region or system better supports health. The fascia, also known as connective tissue is a “shrink wrap” around almost every structure in the body, from large anatomical structures like muscles and organs down to the cellular level. It too can be released to improve health.




How long will it take to resolve my condition?


New conditions often resolve as quickly as they occurred depending on their severity. Most patients see some difference at the end of the first treatment or a day or two afterwards. Old, chronic conditions may take multiple treatments to notice lasting change. Someone who has had back pain or a similar condition for years or decades should commit to four to six treatments at a minimum. How quickly one treats is dependent on the severity and duration of the injury, their overall health and the stresses they continue to place on the injured area.




Does the body continue to treat after the treatment is over?


Yes. I often have patients tell me they noticed the greatest benefits and changes a day or two or even three after their osteopathic treatment. This is in contrast to massage, chiropractic, physical therapy and other modalities where you often feel about as good as your going to from that treatment when you first get off the table.




What is the role of a physician in providing treatment?


All physicians provide their patients with resources that they believe have the best potential of helping them to feel better. A drug or a surgery is a resource. Osteopathic Manipulative Treatment, (OMT) is also a resource that has the potential to treat underlying causes reestablishing the body’s own natural ability to self-heal and self-correct. The resources OMT provides can also act as a catalyst for the body to set up a treatment protocol that is often far more sophisticated than any brought to bear by outside forces such as drugs and surgeries. Too often drugs and surgeries end up managing symptoms versus providing resources for the individuals return back to health – back to normal. “The goal of an osteopathic treatment is to affect a more efficient interchange between all the fluids of the body and across all their tissue interfaces.” —William G. Sutherland, D.O., founder of Cranial Osteopathy.




What is normal in patients?


As an osteopath practicing OMM, I am looking to restore “Normal” in patients. Normal is the optimal functioning of all parts and all systems of the body. The body strays from Normal for many reasons such as a physical, emotional or other types of trauma. It can be an attempt by the body to develop a compensatory mechanism to prevent even greater damage to the body or the body’s attempt to restore balance (homeostasis). A good example where the body is well intended but in which its own efforts to self-heal and self-correct can end up exacerbating a problem is the inflammatory cascade. The body needs inflammation to initiate healing but overdoing the inflammation leads to excessive swelling (edema) and stagnation, preventing the inflamed area of the body from getting the good things it needs to heal. OMM can help the body to find homeostasis in an inflammatory cascade out of control.




Do you "crack" backs like a chiropractor?


The technique described is High Velocity Low Amplitude “HVLA” adjustment. With the patient’s prior approval, I will do this, judiciously from time-to-time. It has its place when something is blocked, requires greater force and a more subtle technique is insufficient to move it. It is most effective in healthy individuals with an acute – new onset – problem. I have found it to rarely be beneficial in long term chronic situations. Though it offers the fastest and most sudden dramatic change, I find this fleeting and the structure will revert back just as quickly unless the underlying issue is addressed or the body is given enough resources to hold the change. Patients are often gratified by the “pop” they hear when HVLA is performed but the sound itself has no therapeutic benefit and some structures move without sound.




What is the difference between a DO and a Chiropractor


Chiropractors are independent health care practitioners with a limited license to practice spinal manipulation and other forms of manual therapy. A Doctor of Osteopathic Medicine, DO understands how to treat all the systems of the body including the medications and surgeries typically prescribed with each condition. In addition to four years of medical school, DOs, unlike chiropractors, go through a minimum of three years of additional training as a resident in the hospital setting. Here, DOs learn to manage complex cases and understand how a whole medical team of multiple providers works together, when tests and imaging are appropriate and referrals to another specialty are warranted. Unlike DOs or MDs, chiropractors cannot prescribe medications, admit patients to the hospital, or perform surgery. The philosophy and manipulative techniques used by Chiropractors are very different than that of Osteopaths.




What is Cranial Osteopathy


It is the use of five basic phenomena first articulated by William Sutherland, DO to resource a primary therapeutic force that affects metabolism within the body allowing it to return to health. These five phenomena include an inherent motion – “motility” - of the central nervous system defined as the brain and spinal cord. Science does not yet understand why or how this seemingly self-perpetuating motion occurs but it is routinely observed in surgeries of the spinal cord and brain. The other four phenomena include mobility of the cranial spinal fluid, the dural membranes surrounding the central nervous system (the dura), the cranial bones of the head and the sacrum on the pelvis. Together the five phenomena are the “primary respiratory mechanism”. It is primary because it is the first “Breath” starting in embryological development before we are born. It occurs before diaphragmatic-lung breath. It is respiratory in the sense it is a metabolic process capable of affecting all metabolism within the body.




When you say Cranial Osteopathy, Osteopathy in the Cranial Field and Cranial Osteopathic Manipulative Medicine are you talking about the same group of techniques and procedures?


Yes.




What is Cranial Sacral Therapy and is there a difference between this and Cranial Osteopathy?


The difference between the two, in one word, is specificity. Cranial sacral therapy was taught to lay people such as massage therapists, physical therapists and other professionals by an American osteopathic physician who felt not enough Doctors of Osteopathic Medicine were performing cranial osteopathic manual medicine. It is possible to take a single 24 hour course over a few days and say one has trained in cranial sacral therapy. Cranial sacral therapists do not learn all the principles and practices of cranial osteopathy nor do they have the anatomical or medical knowledge of a Doctor of Osteopathic Medicine practicing Cranial Osteopathy.




What is the Altar of Creation Work you do and how can this help me?


Altar of Creation is an algorithm developed by Dr. Steven Weiss, a DO, whose practice is based in Manhattan in New York City. It was originally conceived to help patients who developed pain, and muscular and skeletal issues following the trauma of 9/11. These complaints were often a manifestation of Post Traumatic Stress Disorder referred to as PTSD. Going back to embryology, Dr. Weiss traced our unfolding, developing specific handholds to help the body “re-member” itself from the perfection at our creation through embryological development. I often find utilizing Altar of Creation helps the body to reestablish its own organizational map. My patients will often tell me other treatments having limited benefit last longer or permanently after receiving Altar of Creation. Patients have even experienced drugs and other therapies working better after giving their bodies this framework to organize around. Related Links: Dr. Weiss’ Website Altar of Creation Interview with Dr. Weiss





Information about the practice FAQs

What age groups do you see?


I have treated babies within 24 hours of their birth up to patients 95 years of age. I am looking forward to treating my first centenarian.




What should I wear to an osteopathic treatment?


Ideally wear loose or stretchy clothing such as sweats or yoga pants. Please avoid denim and skirts.




Should I bring any pertinent medical information to the appointment?


Yes. Please bring imaging reports and key tests related to your condition.




How can I get the most from my appointment with you?


Please come prepared. Fill in the new patient paperwork prior to arriving at the office. If possible fax or email it back to the office before the appointment as well as bringing it with you. Consider the most important issues you want addressed and the relevant history, when it started, why it started, what have you done to try and resolve the issue to date, etc. Osteopathic physicians are often told they’re the first physicians to fully listen to a patient’s story and we take pride in that. However, some patients get lost in story or attach a story to every question, even minor ones asked. Consider what information will best give me an understanding of your case as our valuable time together is finite.




How long do initial appointments last?


First appointments are at least one hour but please allow 90 minutes if you have a complex health history.




How long are follow-up appointments?


30 minutes.




Do you have a rescheduling and cancellation policy?


Yes. If you need to change your appointment please do so 48 hours in advance. If you do not give 48 hours notice the office will bill your credit card on file $100.00. If you miss more than two appointments you will be billed $180.00 for each appointment missed.




What is your payment policy?


The office requires payment for services at the time they are rendered. Your balance must be paid in full at the end of each visit. Our office gladly accepts checks, cash, Visa, Mastercard and American Express. Services may also be covered by your Health Savings Account.




Do you accept insurance?


I am not a member of any insurance plans and am therefore an “out-of-network” provider. We do not bill insurance in our office, however we will provide you with the information you need to personally bill your insurance. Your insurance may have a deductible that must first be met for in-network as well as out-of-network medical care.




Is there help for military families and patients on Tricare?


Should you have Tricare Standard coverage please contact my office at (858) 587-1822 and ask to speak with my office manager, Frank Cyr, for more information.




Do you accept Medicare?


Should you be a Medicare recipient please contact my office at (858) 587-1822 and ask to speak with my office manager, Frank Cyr, for more information so the policy can be explained.




Why don’t you take insurance?


One single physician in any discipline of medicine typically has to maintain a billing office of two to four people to keep up with insurance providers, submitting and re-submitting claims, making appeals and arguing with health insurance companies on patient’s behalf. Ultimately, the doctor is not the insurers customer—you, the patient, are. The insurance company has everything to gain financially by not paying the doctor and nothing to lose by refusing a doctor’s claim. All this contributes to a model of medicine that puts volume first, having to see a new patient every 10 to 15 minutes to support the overhead of the back office. I chose to serve my patients rather than the system.





 

© 2020 by Walter Cohen, DO.