Osteopathic Considerations in Infectious Disease

00:01 So why am I going to talk about osteopathic considerations in infectious disease? If osteopathic manipulative medicine is a musculoskeletal based specialty and infectious disease is not, what's the connection? Well, there are a lot of things to discuss here.

00:17 First of all, as an ear doc, I'm very concerned that I might take an infectious disease and misdiagnose it as a musculoskeletal disease, particularly infected joints.

00:27 So we're going to talk about infected joints.

00:29 What is an infected joint and what you don't manipulate.

00:33 We're also going to talk about the five models of osteopathy and referred issues and secondary issues, because when we think about treating a person, people live their lives on many levels at one time.

00:46 We can focus on the structural issues they have or the restless circulatory issues which are going to be separate.

00:53 The metabolic issues may be deep and they may involve multiple systems in multiple aspects of living life.

01:00 So if somebody is losing weight, it might be that they're not eating.

01:03 It might be as they're depressed, it might be, and it can overlap.

01:07 Behavioral issues, respiratory circulatory, joint and structural.

01:11 It doesn't mean that we're going to limit it and focus only on metabolic.

01:15 It means we're going to do one at a time.

01:17 And this gives us a framework for thinking about how we're doing things and what we're doing.

01:22 When we talk about infectious diseases, we can talk about the person who's, in fact, it is not just the infection.

01:30 It's a person, too.

01:32 So if we're thinking about this on a respiratory circulatory model as a place where infection occurs, how do we keep the person healthy and how do we prevent them from getting an infectious disease? What's the role of the body, specifically the diaphragm and how do we let a person heal themselves to the optimal level? Well, one thing we can do is make sure that people are functioning efficiently, that they're using their energy, that they're sleeping well, that they're able to fight off infection.

02:01 So if somebody has a good worker breathing, they are less likely to get infected.

02:06 If a patient is not breathing well, has disordered breathing.

02:10 They have more thick secretions that aren't getting cleared out.

02:14 They're more likely to become infected.

02:16 So the osteopathic concepts here are prevention.

02:20 And what can we do to maintain optimal health so people don't get infected? And I think that's increasing the efficiency of your functioning, making sure that you're able to relax and work at the same time, make sure that the ribs are working symmetrically to make sure that the diaphragm has good excursion, is working and doing what it needs to do.

02:44 How do we make sure that you have a good, sympathetic response and the sympathetic and parasympathetic are working in conjunction with each other? So you have a thinning of the secretions and a thickening of the secretions, and you go through the whole range of feelings so that your body can stay healthy.

03:00 What do you treat to make sure that people can do all this and prevent infection? And how do we make sure that the breathing is done efficiently, effectively, and not predisposing somebody to become infected? The second part is how do you keep the body able to fight off infection and able to work in an efficient manner? What are the defensive things you can do? What are the adaptive mechanisms? A person has to have and a big focus for the osteopathic physician is the financial system and the lymphatic systems.

03:39 So we will talk about the basics which are vaccination, good nutrition and the ability to fight off disease by staying healthy.

03:50 And prevention includes knowing when to get vaccines, knowing what is healthy, what is unhealthy.

03:55 When you can drink the water, when you can't drink the water, and what kind of interactions with healthy people or sick people are possible when you have to quarantine somebody and take them out of the system.

04:05 When is somebody able to be exposed to somebody else and what environmental irritants can make it more likely that you get infected? What are the factors that influence the host response and resistance? And what medications may enhance functioning? Which vitamins, which arms? Which minerals need to be taken to maintain health? And the role of activity in health is also important.

04:31 So an infectious disease lifestyle is important.

04:34 Making sure people are exercising, making sure people are aware of when they're putting themselves at increased risk by decreasing their sleep time, not getting full restorative sleep.

04:45 Those are all important.

04:46 People who are highly stressed are more likely to get ill.

04:49 And addressing that is also important.

04:52 Nutrition, eating a varied meal, making sure you get all the vitamins and minerals is another aspect, as well as the social determinants of health, which are the socioeconomic status and availability and access to medical care.

05:06 So as an ER doc, once you have a person present to you, you want to make sure you're not going to be misdiagnosing and finding someone with an infected joint and thing.

05:18 They have somatic dysfunction.

05:20 A key discriminator I use is whether or not this fever or weight loss, if they're constitutional symptoms.

05:26 If a patient comes to me with back pain and says they have weight loss as well.

05:29 I'm going to raise a red flag.

05:32 And we know that for back pain, fever, trauma or other things, I'd say look deeper before you manipulate.

05:43 The patient has had weight loss since another constitutional symptom.

05:46 That's always taken seriously.

05:48 There's a lot of overlapping, overlapping symptoms.

05:52 We know that people with infections can get pain.

05:55 They will get swelling.

05:56 They will have increased warmth and erythema.

05:58 And these are some of the similar symptoms that you will see.

06:01 And somatic dysfunction, particularly acute somatic dysfunction.

06:05 So when do we get overly concerned? Well, infectious arthritis is usually a single joint.

06:12 It's usually going to have a decrease in both active and passive motion, not one or the other.

06:18 You look for skin integrity, and if you have lesions at the area or a potential portal of entry, then you are raising your suspicion and you need to consider infectious ideologies.

06:29 So those are some of the general concepts.

06:31 If you want more information, you can evaluate the muscle status as well.

06:35 An elevated C, K or a showing tissue breakdown will give you a sense of something more important.

06:41 More serious may be going on and prior to manipulation, you need to address things that can deteriorate and cause a loss of life or loss of joint.

06:52 I often do joint aspirations in the air and osteopathic physician who is considering manipulating a knee that's warm and tender should consider a joint aspiration and an evaluation of the synovial fluid looking at the leukocyte count, looking for the presence or absence of crystals, doing a gram staining, looking for white blood cells, sending it off for culture.

07:12 And you may or may not want a glucose or LDH, depending on the look of the fluid.

07:18 But this is a good way of protecting yourself self and making sure that you've been thorough and the patient is safe.

07:24 To diagnose a somatic dysfunction that may be primary or secondary.

07:31 So the time for concern is if you have a leukocyte count greater than 50,000, if you have a lot of white blood cells there, if it's a thick, dark, synovial fluid, you may want to look deeper.

07:43 Crystals which will be present in gout or pseudo gout.

07:47 Do not exclude infection or they give you another etiology that needs to be treated so in conclusion, infectious diseases are not manipulated, but people who have an infectious process are.

08:00 You do want to make sure that you evaluate a person and get a good diagnosis before you start treating them.

08:05 But people live their lives on many levels at once.

08:08 And diseases affect the body and the person in many different ways.

08:14 Treat the whole person.

08:15 Think about what's going on and find ways that you can make life easier and more comfortable for your patient.

08:20 Thank you.