Omm Preggo Bitches

Front 1

63. What are 4 goals of OMM during pregnancy?

Back 1

1. Restore anatomic structure and function.
2. By doing so, blood flow and lymphatic drainage improves.
3. Breathing becomes more coordinate and effective.
4. Reduce pain and improve activities of daily living.

Front 2

64. What are some secondary patient complaints during pregnancy?

Back 2

Heartburn
Shortness of Breath
Low Back Pain
Numb Hands and Feet
Neck and Upper Back Pain
Nausea/vomiting

Front 3

65. What are 5 GI changes during pregnancy?

Back 3

1. Stomach position is shifted by gravid uterus
2. This changes the angle of the GE junction allowing GE reflux to occur in 45-70% of patients
3. This results in heartburn and chest pain
4. Pylorus is distorted upward and backward, slowing gastric emptying
5. Placenta secretes hormone Gastrin which increase stomach acid production and volume which lowers ph.

Front 4

66. What are the Chapman's points for the GI?

Back 4

Esophagus T2 Left paraspinal, and T2-3 Parasternal costochondral junction bilaterally.

Stomach acidity Left T5-6 costochondral junction anteriorly and Left T5 paraspinal

Remember Chapman’s points are bilateral unless designated.

Front 5

67. What are 4 hepatorenal changes during pregnancy?

Back 5

1. Renal GFR increases 50% early, returns to normal
2. This increases Creatinine Clearance and Bun runs 8-9 mg/dl and Creatinine levels run around 0.5 mg/dl.
3. Hepatic changes Serum Alkaline Phosphatase is elevated from placental secretion
4. CNS Changes Elevated Progesterone and B-endorphins

Front 6

68. What are 6 respiratory changes during pregnancy?

Back 6

1. Chest circumference increases 5-7cm.
2. Subcostal angle increases from 68-103 degrees
3. Diaphragm is pushed superiorly by 4cm but excursion increases by 1-2 cm.
4. This results in a 40% increase in Tidal Volume.
5. This causes a 30-50% increase in minute ventilation, despite resp rate being unchanged
6. ***Increased Progesterone is felt to be the cause***

Front 7

69. How do the physiologic respiratory parameters change during pregnancy?

Back 7

Minute ventilation increases approx. 50%

Due to increase in tidal volume 40%

Respiratory rate remains the same

FRC (functional residual capacity) is reduced by 20%

This gives feeling of breathlessness

Front 8

70. What is the equation for FRC?

Back 8

FRC= Residual Vol. + End Exp Reserve Vol.

Front 9

71. How does increased progesterone cause airway swelling and stuffy nose during pregnancy?

Back 9

Increase Progesterone leads to fluid retention and soft tissue edema.

This contributes to airway swelling and “Stuffy Nose of Pregnancy”

This fluid retention also contributes to carpal tunnel syndrome. *Characteristically, it is bilateral, more common at night, resolves shortly after delivery, and occasionally requires splinting.

Front 10

72. Late in the pregnancy, how does the diaphragmatic excursion change?

Back 10

Late in pregnancy the expanding uterus can *reduce* diaphragmatic excursion. This in turn reduces venous return contributing to peripheral edema, backache, constipation, hemorrhoids, and varicosities of the vulva.

Treating Diaphragmatic, Fascial and Thoracic Inlet Dysfunction is key to treating these complaints.

Front 11

73. What are 5 changes in cardiovascular parameters during pregnancy?

Back 11

1. Blood and Plasma volume increase 40%
2. Cardiac Output increases 40%. (CO = HR x SV)
3. Stroke Volume increases by 30%
4. Heart Rate increases by 15%
5. These increases can lead to innocent grade 1-2 systolic flow murmur which is transient.

Front 12

74. What are the changes in hematologic parameters during pregnancy?

Back 12

ALL clotting factors increase by at least 100% during pregnancy

Pregnant patients are hyper coaguable

Pregnant patients should be checked for venous thrombosis regularly

All complaints of shortness of breath and chest pain should be taken seriously due to pulmonary embolism and cardiac events

Front 13

75. What causes the compensatory increase in lumbar lordosis during pregnancy?

Back 13

Forward tilting of pelvis resulting in a compensatory increase in Lumbar Lordosis.

Can stretch on Dura and result in cranio-sacral strain patterns with resulting headache and low back complaints.

Alterations in our normal ligamentous and spinal disc posture lead to a compensatory increase in muscle activity to aid in counterbalance and the fight against gravity (erector spinae, quadratus lumborum and iliopsoas muscles)

As the pregnancy continues and abdomen distends, the muscles begin to lose their ability to aid in this counter balancing act. (Pregnant women could not perform a single sit up).

Front 14

76. What are the major and minor transition zones of the spine?

Back 14

Spine is designed to resist gravity through 3 transition zones (curves) in the spine:

Major transition zone is L5-S1

Minor transition zones are C7-T1 and T12-L1

Transition Zones act like springs and transfer forces longitudinally.

Front 15

77. What is the significance of these transition zones?

Back 15

These transition zones serve as fulcrums for upward and downward forces.

Somatic Dysfunction therefore is much more common in these areas.

These are the areas where Type II dysfunction occurs.

Front 16

78. What are the structural changes in the paraspinal muscles (specifically the iliopsoas) during pregnancy?

Back 16

Paraspinal muscles shorten while abdominal muscles stretch and weaken

Iliopsoas is the “Mainstay” in the mast system. Transition zones with their curves reduce the efficiency of iliopsoas.

Iliopsoas also acts as anchoring mechanism for Crura and aids in respiration.

Iliopsoas also stabilizes the lumbar spine during sitting, standing, and walking.

Front 17

79. How can one assess iliopsoas function in a pregnant woman?

Back 17

Thomas Test could be modified to lateral position with physician monitoring the extended leg during contralateral hip flexion in later stages of pregnancy.

*IIiopsoas weakness, (or laxity), is a major contributing factor to the low back pain of pregnancy. It contributes to increased lordotic curve with increased shear forces across facet joints and intervertebral discs. Forward pelvic rotation also occurs as a result of this.*

Front 18

80. Does pregnancy worsen scoliosis?

Back 18

Consensus is most scoliosis progresses into adulthood but is not exacerbated by pregnancy.

Front 19

81. What is supine maternal hypotension syndrome?

Back 19

Occurs after 20 weeks gestation

Enlarged uterus compresses aorta and vena cava while in supine position leading to maternal hypotension.

Symptoms include light headedness, nausea and vomiting

When patients are symptomatic, place pregnant patient in supine position and elevate right buttocks 10-15 cm with a sheet or blanket.

Or…manually distract uterus to the left

Front 20

82. What are some possible symptomatic problems caused by supine maternal hypotension syndrome?

Back 20

Maternal hypotension often results in undiagnosed fetal bradycardia due to placental hypo-perfusion and fetal asphyxia.

CPR IS TOTALLY INEFFECTIVE IF YOU DO NOT PERFORM LEFT UTERINE DISPLACEMENT WHILE PERFORMING CPR.

UTERO-CAVAL COMPRESSION PREVENTS ANY BLOOD FROM RETURNING TO THE HEART
THEREFORE NO CARDIAC OUTPUT!!!

Front 21

83. What causes low back pain during pregnancy?

Back 21

Facet pain: From increased Lordosis

Herniated lumbar disc: 1:10,000

Posterior Joint Pain: Pain over PSIS, non-radiating, felt to be from hormonal relaxation of the SI joints.

Posterior Pelvic Pain: Pain distal and lateral to lumbosacral junction and may radiate down to or below the knee. No muscle weakness or sensory deficit.

Front 22

84. What are 5 factors that increase risk of back pain while pregnant?

Back 22

1. Manual Labor
2. Smoking??
3. Parity
4. Age
5. Previous Low Back Pain with pregnancy

Front 23

85. What are 7 factors that DO NOT increase risk of back pain while pregnant?

Back 23

1. Race
2. Occupation
3. Weight gain or pre-pregnant weight
4. Exercise Habits
5. Sleep posture or mattress
6. Shoe Heel Height
7. Previous Epidural Analgesia

Front 24

86. What are 10 contraindications for OMM during pregnancy?

Back 24

1. Undiagnosed vaginal bleeding
2. Threatened or incomplete abortion
3. Ectopic pregnancy
4. Placenta Previa
5. Placental Abruption
6. Premature rupture of membranes
7. Pre-term Labor (relative contraindication)
8. Prolapsed umbilical cord
9. Severe preeclampsia or eclampsia
10. Other medical or surgical emergencies

Front 25

87. What is pregnancy induced hypertension?

Back 25

Definition of Hypertension in Pregnancy:

Systolic BP > 140mmhg or 30 mmhg increase over baseline

Diastolic BP > 90 mmhg or 15mmhg rise over baseline.

Preeclampsia, triad of hypertension, proteinuria, and edema.

Eclampsia, all the components of preeclampsia and including a tonic clonic seizure.

Chronic hypertension is persistent or pre-existing hypertension before 20th week.

Front 26

88. What is gestational hypertension?

Back 26

Gestational hypertension is hypertension not accompanied by proteinuria or generalized edema.

Front 27

89. What is the definition of somatic dysfunction?

Back 27

Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements.

Somatic dysfunction is treated using OMT.

Front 28

90. How do you introduce OMT to a patient who is unfamiliar?

Back 28

OMT is a complete system of medical care with a philosophy that combines the needs of the patient with current practice of medicine, surgery, and obstetrics, that emphasizes the interrelationship between structure and function and that has an appreciation of the body’s ability to heal itself

OR:

“I am an Osteopathic Physician, in addition to the types of treatment you have had in the past, I use my hands evaluate your muscles and bones and can use manipulation as part of your treatment plan. It will help you feel better sooner. We can start treatment now."

Front 29

91. What are the rules on sequencing treatments?

Back 29

Treat :
-Axial skeleton before extremities
-Proximal before distal dysfunction
-Promotes lymphatic drainage.
-Acute changes last
-Facilitating dysfunction before primary dysfunction.

Any somatic dysfunction is significant until determined otherwise.

Upper cervicals and sacrum are related.
-Treatment of one may correct the other

Front 30

92. What are 6 RED FLAG's you should look for on a hospital pt's chart?

Back 30

1. Past medical history (i.e. Cancer, Osteoporosis, Disc herniation, Hypercoagulable states, PE , DVT)
2. New Chest pain undiagnosed
3. New Orders to rule out DVT, PE, MI
4. Abnormalities on Telemetry monitoring over night
5. Fluctuation in vital signs
6. Radiologic tests, EKG’s and Labs

Front 31

93. What are the 10 most common hospital consults?

Back 31

(1) Pneumonia
(2) COPD
(3) Asthma
(4) Bronchitis
(5) GI Motility
(6) ileus
(7) Constipation
(8) LBP
(9) Neck Pain
(10) Swelling

Front 32

94. What is Spurling's test?

Back 32

Tests for narrowing of neural foramina

Sidebend and backward bend head; add compression

*Positive if pain radiates to ipsilateral arm*

Front 33

95. What is Underburg's test?

Back 33

Test for vertebral artery insufficiency

Supine, backward bend, rotate, WAIT 30 seconds

*Positive with dizziness, nausea, lightheadedness*

Front 34

96. What are Dr. Graham's goals for OMM?

Back 34

(1)* PREVENTION of many of the common problems and complications of hospitalization and surgery (pneumonia, atelectasis, ileus, etc)

(2) *RETURN TO FUNTION- to their pre-surgery, pre-hospitalization, and pre-trauma (quickly get them back on their feet to prior health baseline

(3) *Guidelines are not designed to address a lifetime of somatic dysfunction, but to provide help to beginning students/practitioners to learn how to begin their approach to common clinical problems found in the hospital setting

Front 35

97. What are Dr. Graham's 3 criteria for OMM success in hospital settings?

Back 35

(1) Must therapeutically benefit the patient
-clinical efficacy of OMM in the hospital setting has long been established.

(2) Must save the hospital money
-guidelines designed to reduce common complications
(ICU, surgical, bedfast patient)

(3) Must be simple, efficient, time sensitive (so large numbers of patients can be treated)

Front 36

98. Summary of 3 guidelines (have no idea what's going on)

Back 36

(1) Improve the overall functional ability and capacity of the hospitalized patient to respond to the compromised condition that resulted in their hospitalization by improving the functional ability of their ANS, arterial, venous, lymphatic, nervous, fascial, myofascial, musculoskeletal, and visceral systems.

(2) Treat functional visceral and musculoskeletal conditions that may result in hospitalization

(3) Prevent and treat complications of other functional pathophysiologic processes that might arise with hospitalization

Front 37

99. Celiac gangion innervates...?

Back 37

Stomach, Liver, Gallbladder, Spleen, portions of Pancreas and Duodenum (foregut)

Front 38

100. Superior mesenteric ganglion innervates?

Back 38

Portions of Pancreas, Duodenum, Jejunum, Ileum, Asc. Colon, Prox. 2/3 of Transverse Colon. (midgut)

Front 39

101. Inferior mesenteric ganglion innervates?

Back 39

Distal 1/3 Transverse Colon, Desc. Colon, Sigmoid, Rectum (hindgut)

Front 40

102. T12-L2 viscerosomatic levels correspond to what organs?

Back 40

T12-L2:

Left Colon
Bladder
Prostate
Lower Extremity

Front 41

103. What are the 4 OMM technique guidelines for the ICU, Critically Ill, or Bedfast Patient?

Back 41

1. Perform an O/A/CB Decompression and Release
2. Perform Rib Raising to the Thorax
3. Perform Lumbosacral Pelvic(L/S/P) Soft -Tissue and Articulation and/or Lumbosacral Pelvic Decompression and Release
4. Perform Thoracic Diaphragm Soft-Tissue and Myofascial Release

Front 42

104. What is the kidney pump?

Back 42

When this pumping action is performed in the area of ribs 10-12 it can help restore normal physiologic functioning to the kidney.

In cases of acute renal failure(hypovolemic shock, drug toxicity, etc) involving acute tubular necrosis, the kidney becomes inflamed and congested with damaged cells and fluid in response to the damage. This pumping/milking action promotes urine flow and removal of dead cells, inflammation, and congestion by direct mechanical stimulation, and increase venous and lymphatic drainage and circulation to the area.

Front 43

105. What can cause failure of extubation, and how can OMM techniques help?

Back 43

Failure of extubation often occurs when thoracic diaphragm has become atrophied and “lazy” (ventilator has taken over responsibility for breathing)

If patient has CHF, Pneumonia, or is in end-stage COPD, extubation becomes more of a process than an event.

Be patient, but assertive with this process

OMM is designed to stimulate the diaphragm to resume its pumping action

Techniques should be performed throughout intubation period, immediately before and after extubation, then at routine intervals after extubation

Front 44

106. What are the 4 OMM technique guidelines for Ventilator Extubation of the ICU Patient?

Back 44

1. Perform O/A/CB Decompression and Release
2. Treat any Cervical Dysfunction with Articular Muscle Energy, Counterstrain, or Myofacial Release
3. Perform Rib Raising
4. Perform Rib Walking to the Anterior Thorax
5. Perform Thoracic Diaphragm Soft-Tissue and Myofascial Release

Front 45

107. Which step is often the key to stimulating the diaphragm to return to a more normal level of functioning?

Back 45

Thoracic Diaphragm Soft-Tissue and Myofascial Release

Front 46

108. What are the 5 OMM technique guidelines for Improving Lower Respiratory Tract Functions in Patients Presenting with Asthma, Atelectasis, Poor Respiratory Effort, Pneumonia, and Bronchitis?

Back 46

1. Perform O/A/CB Decompression and Release
2. Perform Rib Raising and Rib Walking
3. Perform Thoracic Diaphragm Soft- Tissue and Myofascial Release
4. Perform Lymphatic Pump Procedures
5. Perform Muscle Energy, Myofascial, Counterstrain, and/or HVLA Technique to the Cervical and Thoracic Spine, Thoracic Outlet and Diaphragm and Ribs

Front 47

109. What is the single most important thing you can do to improve a pt's lower respiratory function?

Back 47

Perform Thoracic Diaphragm Soft- Tissue and Myofascial Release

*Soft tissue stretching and inhibitory pressure both have the effect of stretching the annulospiral system causing reflex inhibition (relaxation) of the myofibrils and fascicular bundles resulting in decreased contracture and relation of the diaphragm*

Front 48

110. What are the 5 OMM technique guidelines for Improving Lower Respiratory Function in Patients Presenting with COPD?

Back 48

1. Perform an O/A/CB Decompression and Release
2. Perform Rib Raising to the Thorax
3. Perform Rib Walking to the Anterior Thorax
4. Perform Thoracic Diaphragm Soft-Tissue and Myofascial Release
5. Perform Muscle Energy, Myofascial, Counterstrain, and/or HVLA Technique to the Cervical and Thoracic Spine, Thoracic Outlet and Diaphragm, and Ribs

Front 49

111. Work of breathing assoc with lung disease, increases total body energy by how much?

Back 49

Work of breathing assoc with lung disease, increases total body energy 3 to 33%. (can breath yourself to death)

Heavy exercise, increases total body energy output to only 6 %

Front 50

112. 5 techniques for the post-surgical pt?

Back 50

1. Perform an O/A/CB Decompression and Release:
2. Perform Rib Raising for the Thorax
3. Perform Lumbosacral Pelvic (L/S/P) Soft-Tissue and Articulation and/or Lumbosacral Pelvic Decompression and Release
4. Perform Thoracic Diaphragm Soft-Tissue and Myofascial Release
5. Perform a Pedal Fascial Pump Procedure

Front 51

113. Guidelines recommended to address problems of GI tract?

Back 51

1. Perform an O/A/CB Decompression and Release
2. Treatment of any Somatic Dysfunction found in the Thoracic Spine, Thoracic Diaphragm, Lumbar Spine, and/or Pelvis
3. Perform Lumbosacral Pelvic(L/S/P) Soft Tissue and Articulation and/or Lumbosacral Pelvic Decompression (lumbar roll)

Front 52

114. Relaxation of the upper cervical muscle spasm and myofascial tension through O/A/CB Decompression and Release will do what?

Back 52

Relaxation of the upper cervical muscle spasm and myofascial tension through O/A/CB Decompression and Release will remove facilitation and stress on the vagus nerve

- allowing PANS tone to return to normal functioning in entire GI system

Front 53

115. Parasympathetics Pelvic Splanchnic Nerve (S2, S3, S4) supply parasympathetics to...?

Back 53

Lower ureter and bladder

Uterus, prostate and genitals

Descending colon, sigmoid and rectum

Front 54

116. 4 OMM Guidelines for Improving Overall Anatomic and Physiologic Functioning of the ICU, Critically Ill or Bedfast Patient:

Back 54

1. Perform O/A/CB decompression
2. Perform rib raising
3. Perform L/S/P soft-tissue and articulation, X’s 2 and/or L/S/P Decompression and Release
4. Perform thoracic diaphragm soft-tissue and myofascial release

Front 55

117. Diaphragm (innervation, insertion, attachment, functions)

Back 55

Innervation: Phrenic nerve (C3-C5)

Contraction causes cyclic pressure gradient changes.
o Negative intra-thoracic pressure: Inhalation
o Positive intra-thoracic pressure: Exhalation

Attachments
o Xiphoid/Sternum
o Ribs 6-12
o Anterolateral surface of T12-L3

Apertures:
o Aorta
o Lymphatics/Cisterna chyli
o Inferior vena cava
-Opens in inhalation
o Esophagus (Hiatal hernia)
-Closes in inhalation

Front 56

118. What is trephining?

Back 56

TREPHINING, the boring of holes into the skull to release evil spirits or toxins was used during Neolithic times.

Coca leaf wrapped with guano and lime used to release alkaloid cocaine used for trephining.

Front 57

119. What causes abdominal pain?

Back 57

Although pain is perceived via both somatic, (peripheral) and visceral, (autonomic) nervous systems, abdominal pain is primarily transmitted through autonomic system.

Noxious stimuli perceived are stretch, distention, inflammation, and ischemia.

Cutting and burning are imperceptible.

Visceral Afferents refer to fibers which receive nocioceptive impulses and transfer them to the brain. Their course is very similar to that of sympathetics, but are not specifically identified as sympathetic or parasympathetic.

Front 58

120. What makes up the enteric nervous system?

Back 58

Network of sympathetic and parasympathetic nervous system within the bowel wall.

Auerbach’s Plexus (outer) layer. Controls motility

Meisner’s Plexus (inner) layer. Controls GI secretions and blood flow.

Therefore, noxious stimuli can affect bowel function. E.g., Peritonitis can result in an ileus.

Front 59

121. What is ileus, and what are the 3 groups of ileus?

Back 59

Ileus: diminished or absent bowel function.

1. Adynamic or inhibition ileus: diminished or absent motility secondary to inhibition of neuromuscular apparatus. Ex. Peritonitis.
2. Spastic Ileus: Contracted bowel musculature inhibits propulsive motility.
3. Ileus of vascular occlusion: Dead or ischemic.

Front 60

122. What are the most and least freq forms of ileus?

Back 60

Spastic Ileus: Rare.
Usually secondary to organophosphates, heavy metal poisoning, porphyria, and occasionally uremia.

Adynamic or inhibition Ileus: Most common. Usually secondary to peritonitis, appendicitis, surgical manipulation, anastomotic leakage, pancreatitis, retroperitoneal disease such as ureteral stones, sepsis, electrolyte imbalance and opioids.

Front 61

123. What is the course/order of abdominal pain?

Back 61

1. Bowel dilates
2. 1st order nerves,(symp afferents) stim
3. Enter dorsal horn
4. 2nd order nerve to contralateral spinothalamic tract & spinoreticular
5. Ascend to Pons/Medulla Thalamus
6. 3rd order n. to cortex
7. Conscious perception of pain,(spinothalamic)
8. Limbic Stimulation, (spinoreticular)
9. AVERSE RESPONSE

Front 62

124. Why is abdominal pain mostly vague and dull?

Back 62

Many fewer visceral afferents than somatic afferents. Therefore pain is not sharp.

Front 63

125. How does appendicitis cause pain?

Back 63

There can be a somatic component of abdominal pain. Appendicitis can cause inflammation of parietal peritoneum. A-delta fibers then transmit this into right lower quadrant pain.

This is why early appendicitis presents with periumbilical pain, then later localizes to right lower quadrant because of peritoneal irritation.

Front 64

126. What happens during surgery?

Back 64

Cardiovascular Effects:
Decreased BP, Decr. Contractility, vasodilatation.

Positive press ventilation instead of normal negative press ventilation causing decr. Venous return.

Treatment?? Usually IV fluids, occ. vasopressors

Muscle relaxation: Tracheal intubation, surgical relaxation. DECREASE LUMBAR LORDOTIC CURVE

Front 65

127. Symptoms of tracheal intubation?

Back 65

Tracheal Intubation: Hoarseness, dislocated arytenoid, vocal cord granuloma, shortness of breath from paralyzed cord. Dislocated Hyoid.

Front 66

128. Symptoms of atelectasis?

Back 66

A total or partial collapse of the lung. Can be entire lobe or microscopic alveolar collapse. Secondary to hypoventilation from modest tidal volumes during surgery, sedatives or splinting from pain post op. Airway collapse causes inflammation and believed to contribute to post op temp. increase.

Front 67

129. What happens to the cardiovascular system when the anesthetic effects wear off?

Back 67

IV Fluid volume to fill dilated blood vessels and augment cardiac filling.

What happens when anesthetic effects wear off? *Transient fluid overload can occur. Resulting edema and CHF.*

Remember to check bladder for distention if patients post op are hypertensive or complain of abdominal pain.

Swelling from surgical trauma. Resolves in 24-48 hrs.

Front 68

130. What happens to the respiratory system when the anesthetic effects wear off?

Back 68

Emergence from anesthesia. Excitement stage.

Opioids reset CO2 receptor and apneic threshold.

Hypercarbia from opioids and anesthetics can cause catecholamine release.

This is felt to contribute to post op low grade fever and increased sympathetic tone.

Front 69

131. What does the study by Walter J. McConathy,Phd. , et. al on the Hemodynamic Effects of OMM measure?

Back 69

The measured reproducible hemodynamic parameters before and after OMT in patients immediately post op CABG surgery.
They measured Thoracic Impedance,( gross measure of intrathoracic central fluid volume), Cardiac Index, and Mixed Venous Oxygenation, (SvO2%)

Front 70

132. What does Dr. Seifert like about the study by Walter J. McConathy,Phd. , et. al?

Back 70

One of few studies to measure physiologic effects of OMT and surgical patients

One of FEWER studies to suggest OMT improves measurable changes in physiology

Performing OMT on sedated patients removes any “Hands On” Placebo effect.

A GREAT spring board for further investigation

Front 71

133. What does Dr. Seifert NOT like about the study by Walter J. McConathy,Phd. , et. al?

Back 71

Small sample size

Did not randomize control with OMT patients

Did not know pre op C.I. or E.F.

Treatment was not standardized, it varied

Did not mention filling pressures, PaP, CVP, or measure SVR.

Front 72

134. What is dysmenorrhea?

Back 72

Painful menses in the absence of organic disease. Diagnosis of exclusion.

Secondary: Acquired. Painful menses associated with pathology. Uterine fibroids, polyps, IUD’s, pelvic congestion assoc. with retroverted uterus,PID, ovarian cysts, ectopic pregnancy, etc..

Front 73

135. What are the symptoms/treatment of PMS?

Back 73

Symptoms occur around 7-10 days prior to menses.

Headache, bloating, abd. Swelling, irritability, food cravings, anxiety/depression in severe forms.

Treatment is balance sympathetics, thoracic inlet and diaphragm release to enhance lymphatic flow, uterine inhibition from sacral rocking to relieve cramping.

Occasionally anti-depressants are required.