Feeding Survey

Osteopathic Center for Family Medicine – http://www.ocfm.com/blog

Jack Forbush – http://jforbush.wordpress.com

What to do before the injections

1. Avoid ibuprofen, naproxen sodium, etc. (NSAIDS) for 3 days before injections. If taking rofecoxib (Vioxx), celecoxib (Celebrex), valdecoxib (Bextra), SAM-E, Red Deer Velvet these must be stopped 5-7 days before injections.
2. Supplements in addition to eating a balanced diet are very important for optimal response to injection work. We recommend:
   1. Vitamin C 1000 mg twice per day for 48 hours before and 14 days after treatment.
   2. Zinc 30 mg per day for 3 days before and 2 weeks after injections. Change dose to every other day should a metallic taste develop or stop it entirely if side effects occur that are intolerable for either.
3. Some patients prefer to take preventive pain medications or antianxiety medications before injections. Discuss this with your doctor before injections or with your referring doctor if you are scheduled to have injections on your first visit. The medications below, should they be recommended to you by the doctor, are to be taken one hour before your procedure.
   1. Dextromethorphan can be taken (one tablespoon of Robitussin DM) to block pain receptors (NMDA) spinally.
   2. Antianxiety medications such as diazepam (Valium) or lorazepam (Ativan) can be used at the same time as the dextromethorphan. These medications require a prescription. Alternatives to this are available as well.
   3. Pain medications (non-NSAIDs, see #1) can be used as well 1 hour preinjection.
   4. Do not drive if premedicating for injections as you will be operating under the influence (oui, dwi or dui).
   5. Bring pain medications (non-NSAID) with you so post-injection pain management can be clarified.
   6. If premedicating a driver is a must, but many patients prefer having someone drive them home after injections so we suggest you consider having a driver other than yourself.
   7. If you have a long ride home (greater than 30 minutes), bring an ice pack and consider frequent stops on the way home to maintain flexibility and reduce swelling/pain.
   8. If you have a heart murmur, heart valve, heart valve disease, an artificial hip or knee (or internal prosthetic of any kind) alert your doctor as this could make you a candidate for premedication with antibiotics.
   9. Smoking cessation (quitting) permanently and at once is strongly recommended as smoking decreases the effectiveness of the injection healing, potentially increases the number of injections and could make the entire procedure unsuccessful.

What to do after injections

1. Pain is normal typically expected after injections, especially the first 2-4 days due to the inflammatory response generated by the injections that stimulate the initial healing process.
2. Avoid NSAIDS 7 days, as this will block the inflammation and subsequent healing process making the injections ineffective.
3. Continue Vitamin C and Zinc as above for 2 weeks.
4. Use pain medications as directed. If none given, over the counter acetaminophen (up to 3,500 mg per day) is acceptable. Call if problems or concerns. Lost opiate prescriptions will not be replaced.
5. Return to routine exercise, but do not initiate new exercise if not currently working out regularly. We strongly recommend you walk and return to normal activity as soon as possible to encourage good range of motion and to minimize swelling.
6. Ice is acceptable over injection area, but avoid heat for the first 3 days.
7. We advise not accessing public water sources (lakes, hot tubs, pools) for first 2 days. This is to avoid infection from these sources.
8. Call if redness/problems occur.
9. Please remember that swelling (and pain, see #1) are common, anticipated and normal…injections. This especially occurs in areas further from the heart such as the arms (elbows, wrists, fingers), legs (knees, ankles, toes) or other joints after injections. Removing finger and toe rings or other jewelery on the same side as the extremity to be injected is strongly recommended.

For more information

-American College of Osteopathic Pain Management & Sclerotherapy

-American Association of Orthopedic Medicine

-Prolotherarpy.org

-Prolotherapy.com

-Prolotherapy on wikipedia.org

What to do before the injections

1. Avoid ibuprofen, naproxen sodium, etc. (NSAIDS) for 3 days before injections. If taking rofecoxib (Vioxx), celecoxib (Celebrex), valdecoxib (Bextra), SAM-E, Red Deer Velvet these must be stopped 5-7 days before injections.
2. Supplements in addition to eating a balanced diet are very important for optimal response to injection work. We recommend:
   1. Vitamin C 1000 mg twice per day for 48 hours before and 14 days after treatment.
   2. Zinc 30 mg per day for 3 days before and 2 weeks after injections. Change dose to every other day should a metallic taste develop or stop it entirely if side effects occur that are intolerable for either.
3. Some patients prefer to take preventive pain medications or antianxiety medications before injections. Discuss this with your doctor before injections or with your referring doctor if you are scheduled to have injections on your first visit. The medications below, should they be recommended to you by the doctor, are to be taken one hour before your procedure.
   1. Dextromethorphan can be taken (one tablespoon of Robitussin DM) to block pain receptors (NMDA) spinally.
   2. Antianxiety medications such as diazepam (Valium) or lorazepam (Ativan) can be used at the same time as the dextromethorphan. These medications require a prescription. Alternatives to this are available as well.
   3. Pain medications (non-NSAIDs, see #1) can be used as well 1 hour preinjection.
   4. Do not drive if premedicating for injections as you will be operating under the influence (oui, dwi or dui).
   5. Bring pain medications (non-NSAID) with you so post-injection pain management can be clarified.
   6. If premedicating a driver is a must, but many patients prefer having someone drive them home after injections so we suggest you consider having a driver other than yourself.
   7. If you have a long ride home (greater than 30 minutes), bring an ice pack and consider frequent stops on the way home to maintain flexibility and reduce swelling/pain.
   8. If you have a heart murmur, heart valve, heart valve disease, an artificial hip or knee (or internal prosthetic of any kind) alert your doctor as this could make you a candidate for premedication with antibiotics.
   9. Smoking cessation (quitting) permanently and at once is strongly recommended as smoking decreases the effectiveness of the injection healing, potentially increases the number of injections and could make the entire procedure unsuccessful.

What to do after injections

1. Pain is normal typically expected after injections, especially the first 2-4 days due to the inflammatory response generated by the injections that stimulate the initial healing process.
2. Avoid NSAIDS 7 days, as this will block the inflammation and subsequent healing process making the injections ineffective.
3. Continue Vitamin C and Zinc as above for 2 weeks.
4. Use pain medications as directed. If none given, over the counter acetaminophen (up to 3,500 mg per day) is acceptable. Call if problems or concerns. Lost opiate prescriptions will not be replaced.
5. Return to routine exercise, but do not initiate new exercise if not currently working out regularly. We strongly recommend you walk and return to normal activity as soon as possible to encourage good range of motion and to minimize swelling.
6. Ice is acceptable over injection area, but avoid heat for the first 3 days.
7. We advise not accessing public water sources (lakes, hot tubs, pools) for first 2 days. This is to avoid infection from these sources.
8. Call if redness/problems occur.
9. Please remember that swelling (and pain, see #1) are common, anticipated and normal…injections. This especially occurs in areas further from the heart such as the arms (elbows, wrists, fingers), legs (knees, ankles, toes) or other joints after injections. Removing finger and toe rings or other jewelery on the same side as the extremity to be injected is strongly recommended.

For more information

-American College of Osteopathic Pain Management & Sclerotherapy
-American Association of Orthopedic Medicine
-Prolotherarpy.org
-Prolotherapy.com
-Prolotherapy on wikipedia.org

What does an “Osteopathic Treatment” consists of? Does it “hurt”?

Osteopathic Manipulative Treatment consists of two parts; the structural exam and Osteopathic treatment. Typically, your first visit is a review of your medical history, medications, allergies, etc after which your Osteopathic Physician will perform a structural exam, which is an assessment of your posture, balance, spine, muscles, joints and ligaments. Through extensive training in manipulative medicine, your Osteopathic Physician can detect changes in the way your body feels; the bones, muscles, ligaments, etc. Once the structural exam is complete, a collaborative treatment plan is established. Using a variety of techniques, your Osteopathic Physician will address the changes found on physical exam and apply specific corrective measures to relieve the areas of joint restriction and tension. Osteopathic techniques are gentle “adjustment”, however some patients experience a “clicking” sensation which is rarely painful.

What is the difference between Osteopathy and Craniosacral Therapy?

Osteopathy in the Cranial Field (OCF) is an expansion of the traditional Osteopathy philosophy and approach, founded by Dr. Andrew Still, and arose out of the clinical research by Dr. William Sutherland. This form of Osteopathic Manipulation utilizes the inherent motion and mobility of the of the cranial (head) bones and sacrum (tailbone).

Osteopathy in the Cranial Field or Cranial Osteopathy is the application of the Osteopathic Approach to the structures of the head. It is an expanded portion of traditional Osteopathy and is only practiced by an Osteopathic Physician, trained in all aspects of Medicine and Surgery. Craniosacral Therapy describes the philosophy and approach of Dr. John Upledger, who teaches this modality to many non-Physicians.

What is the difference between Osteopathic Medicine and Chiropractic?

Although many Chiropractors relieve such ailments as low back pain and headaches, there are distinct differences between the two professions. To begin, Osteopathic Physicians (DO’s) are fully licensed Physicians having graduated from an accredited Osteopathic Medical College and fulfilling all requirements for unrestricted medical practice and licensure. Osteopathic Physicians are found within all specialty fields of Medicine and Surgery.

Although the majority of Osteopathic Physicians are Family Doctors, many are Obstetricians, Pediatricians, Surgeons, Neurosurgeons, Emergency Department Doctors, Cardiologists, etc. Osteopathic Physicians are required to complete an internship and residency which varies between 3-8 years depending upon the area of specialization. Osteopathic Physicians perform surgery, prescribe medication and diagnostic testing when necessary and appropriate. Speaking specifically of the “manipulative” component, unlike Chiropractic which focuses mainly on spinal manipulation, Osteopathic Manipulative Medicine includes all parts of the body; spine, joints, muscles, ligaments, tendons from head to toe.

Osteopathy, Osteopathic Manipulative Treatment and Insurance

Typically, there are no insurance reimbursement issues with Osteopathic Manipulative Treatment as it is one of the many procedures provided by physicians. As with all procedures, please review your individual policy for the details of your coverage.

Learn more

For additional resources, please visit:
The Maine Osteopathic Association
American Academy of Osteopathy
Sutherland Cranial Teaching Foundation
The Cranial Academy

Before your appointment…

NEW PATIENTS: You must fill out our medical release form, sign it and deliver it to your previous physician’s office if you are transferring care, or to your primary care physician’s office if you are seeing Dr. Forbush for a consultation. Also, print and sign our HIPPA consent form and bring this to your appointment, review our Notice of Privacy Practices, and complete our pre-appointment questionaire.

We kindly ask all patients to arrive 10 minutes before their appointment time to complete any necessary paperwork. Out of respect for other patients, you will be asked to reschedule your appointment if you arrive more than 15 minutes late.

We require a 24 hour notice for any appointment cancellation. If you do not provide us with a 24 hour cancellation notice, you will be charged a $50 “no show” fee.

“In recent days, I have come to regret not being a specialist. If I was then I would be able to afford the care being recommended by the dermatology oncologist I saw yesterday. I had an unusual place come up on my cheek a few months ago. Just like a blackhead that wouldn’t go away. Finally got it biopsied and as everyone suspected, turned out to be basal cell carcinoma. So I went to see the dermatologist because the plastics guy next door who took care of the biopsy for me recommended that I get a MOHS procedure to have the lesion removed. While I was setting up the appointment for the procedure I asked what the charges would be and was told the average lesion ran $2800 but the cost could range from $1300 to $7800 depending on how many passes were needed. I asked how long the procedure took and was told that I would be there for about 3 hours but I should bring a book or something because most of that time was waiting and that the whole procedure was done in about 20 mins total doc time. The doctor doing mine does 6 at one time. So even if he only gets the average for the 6 patients he is making over $16800 for approximately 2 hours of work. Meanwhile, I am supposed to be satisfied with $1700 on average for 9 months of prenatal care, delivery and 6 weeks post-partum care. Unfreaking believable. What does this doctor do that makes his services worth $650160 for 9 months on this one procedure and mine is only worth $1700. Something has got to give”

Questions or comments?