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on Orthopaedic Medicine
AAOM 30th Anniversary Year
Top of Mind
Cranio–Cervical Junction Syndrome (CCJS)

From Dr.'s Scott Rosa and David Harshfield

Dr. HarshfieldNot surprisingly, the cranio–cervical junction (CCJ) is an area more often than not both misunderstood and very poorly imaged. Unfortunately due to the CCJ osseous and ligamentous anatomy sacrificing stability for range of motion, it is an area very susceptible to head/neck trauma. Add in the complex neuro–anatomy, complex biomechanical function and potential to contribute to a myriad of different clinical presentations, makes this area the corner stone of the spinal axis.

Our work is focused on using advanced dynamic imaging techniques utilizing the Upright MRI to reveal patho–physiological findings that might correlate with patients presenting symptoms. We believe that the most important difference of the upright MRI is that it allows for visualization of pathology that is either less obvious or completely occult in recumbent scanners. And there is rapidly evolving and mounting evidence that it is this "pathokinematics" that can only be seen with the upright scanner that reveals an adequate explanation for ongoing symptoms and disability in many post–trauma cases.

It is no longer sufficient to assume that when there is no cord or exiting nerve root compression that there is no pain; as this model leaves out an enormous cohort of patients with chronic pain conditions having nothing to do with a disc compression type of syndrome.

The good news is that through utilizing Dynamic Upright MRI with cine CSF flow studies as well as arterial/venous flow studies, we have been able to open up and observe real time assessment of patho–physiology in a way never before appreciated. These aberrances we have observed have been instrumental in helping giving patients the "dignity of a better diagnosis", and have led not just to better treatment and outcomes, but have been able to prevent patients from getting treatments that might actually be counterproductive or inflammatory.

At present, we are performing a non–invasive "Image guided Atlas Treatment" (IGAT) utilizing Dynamic Upright MRI to restore normal alignment at the CCJ. The outcomes so far have been excellent and extremely promising.

Our present and future research is being directed at better initial imaging studies to provide better working diagnoses to improve patient outcomes. We will be publishing this upcoming year not only about the benefits of the advanced dynamic imaging procedures we are using, but also on observations of the plausible connection of head/neck trauma, C1–2 mal–rotations, CTE (cerebellar tonsillar ectopia), aberrant CSF flow, and venous outflow issues with neuro–degenerative brain disease. Considering all the discussions of late about concussion and chronic traumatic injury of the brain, we are also of the opinion that we have been able to observe common threads that tie in with that venue as well.

We are extremely excited about our observations and research and we look forward to sharing our findings I April at the upcoming annual AAOM meeting in Clearwater, Florida.

The Office of el Presidente
By Paul Lieber

Paul LieberI am always amazed by the diverse group of people that we attract to AAOM meetings and workshops. The August Cadaver Workshop in Denver spearheaded by Chairman Bjorn Eek was no exception. Doctors come from near and far to attend these events, literally arriving from all parts of the globe for this two day extravaganza. Maelu, our beloved Administrative Director, worries incessantly about whether we will be able to reach fruition. It's a last minute, down to the wire, balls to the wall, kind of thing. And yet her flexibility, enthusiasm and boundless energy prevail and rule the day and for that matter, the night. The course fills up, instructors arrive, the venue takes off, the vendors come together and she pulls it off seamlessly every time.

As President, I had the pleasure of introducing the AAOM and Workshop first thing Friday morning. I remember asking about who were first timers and non–members and being elated to see many of both. I was even more pleased to learn that many participants expressed a desire to join the AAOM and were interested in attending our workshops in Guadalajara and Cancun. Only Maelu actually knows how many of you took the plunge.

There is a special and unique quality to this group that makes newcomers feel at home and a synergy that makes things happen. The energy in these events is palpable! Great and new ideas abound. People are accepted. Intellectual curiosity rules the day. We are a sharing group; a caring group where participants quickly find a home in the AAOM. But enough clichés.

You see, new blood is very important to an organization like ours, preventing us from becoming too stodgy and complacent. We need new members to vitalize and continually revitalize our organization with new ideas and constantly challenge old ones. Years ago, I remember Jeff Patterson saying something like, "today's dogma will be tomorrow's dog doo". At times, nothing could be truer! Tantamount to our group is the ability for the young to learn from the not so young in an atmosphere of collegiality and unselfishness; the degree of which I have not experienced elsewhere, ever!

The embodiment of this philosophy for me was Brian Lemper's impromptu luncheon lecture. Nebulized PRP! Who would have thought? Think of the possibilities! The guy was humble and self–effacing, but brilliant! So much of what happened at out Denver Workshop; though planned was spontaneous magic.

So we can chalk up another success. Another chapter closed. We can all breathe a sigh of relief and rest on our laurels for at least a nanosecond. Feeling enriched and nurtured, we get to go it again real soon. Are you ready Maelu? And are you all ready for Guadalajara, Argentina, Cancun and what's beyond.

Thanks for listening.

Gemeinschaft
By Ken G. Knott, M.D.

Dr. Ken KnottIs described as a spontaneously arising organic social relationship characterized by strong reciprocal bonds of sentiment and kinship within a common tradition; also: a community or society characterized by this relationship.

How does this apply to the lives of physicians and patients? Think in terms of the standard of care and the reluctance of physicians to speak out against any aspect of those standards. Whether we like it or not, we have been subjected to operant conditioning by the very force that sets those standards. As physicians, we are conditioned to have a certain mindset that precludes us from asking questions in regard to that conditioning or gemeinschaft. It is a very strong and undeniable force that penalizes the free and critical thinker.

For those of you who prefer to think that you have not been subjected to this pervasive phenomenon, then stand up at your next hospital staff meeting and demand that prolotherapy be recognized as a safe and viable alternative to pharmaceuticals, surgery and physical therapy. We all realize and have proven that prolotherapy works better than those alternatives for most enthesopathies, yet it remains classified as "experimental". Why is that? Do science minded physicians prefer to live in denial because of this force? Or, do they not realize what has happened to their ability to be objective? Is the answer a combination of these and other factors such as liability issues? Do we not take an oath to do our very best to help those who are sick or injured? In regard to the liability issue, isn't it more logical that the better the outcome for a patient, the less likelihood of being sued? I think if you follow the reasoning, you will find that the liability issue has little, if anything to do with prolotherapy remaining in the shadows. It has more to do with standard of care and the all pervasive gemeinschaft of medicine. Of course, another factor are the vested interests that oppose prolotherapy purely upon economic grounds. If you believe that is not a factor, I would advise you to contact the orthopedic surgeons in your community and suggest they send you their shoulder and knee patients who are not surgical candidates. Oh, be sure to mention that you intend to perform prolotherapy on those patients. No doubt your practice will be overrun in a matter of days.

If you remain neutral or unconvinced that the gemeinschaft phenomenon is alive and well in medicine, perhaps another example will persuade you to consider a change of opinion. The standard of care dictates that doctors order a standard thyroid profile (TSH, free T4 and T3 uptake) in order to assess thyroid function. In fact, the TSH is a very unreliable test that results in doctors missing the diagnosis of hypothyroidism in the vast majority of cases. As a result, many people in dire need of treatment, go untreated and suffer the many consequences of hypothyroidism not the least of which are depression, hypertension, skin lesions, fatigue and high cholesterol. They remain untreated because doctors have been programed to rely upon unreliable tests while ignoring the patient. Is that truly the practice of good medicine? Why do most doctors remain hesitant to simply look at the patient and use laboratory tests as a simple guide? The gemeinschaft in medicine is so powerful, that even the most astute and competent doctors refuse to consider what is right in front of them. Instead of allowing that type nonsensical control to continue, why not exercise a degree of common sense by considering the patient’s symptoms and ordering the correct test instead of the supposed "gold standard" testing? I have seen literally hundreds of patients that were told that they were not hypothyroid and did not need treatment. Treatment that is critical for maintaining good health is being denied millions of people simply because the wrong tests are being performed and the patient is being forgotten. Critical thinking will always be the answer to many of life’s problems, but the gemeinschaft phenomenon will continue to interfere with unrestricted free thinking.

Recommended Reading
From The AAOM Newsletter Editor

By D.L. Harshfield, Jr. M.D., M.S.

Dr. Harshfield

What Matters?

To most humans, living sustainably on this planet is all that really matters. But for us physicians, it would appear that the definition of the edges around and defining the truly "important things" seem to have become a little blurred.

Maybe by reviewing the societal, cultural and historical perspectives of Medicine we can bring into focus that with which physicians should be occupying their time. Toward that end, let's review the pertinent existing literature on the topic, Read more >

Download the Case of the Month >

AAOM Member Want Ad Section
Private Practice – Pain Clinician Wanted, Chicagoland

Join a 20 year–old internally known pain clinic in the beautiful suburb of Oak Park, Illinois just outside of Chicago. The clinic specializes in regenerative injection therapy (Prolotherapy). The clinic has an international referral base and is looking for an innovative physician that desires long–term ownership in his/her own practice.

Consider the following benefits of this job:

  • Competitive starting salary, with potential option for ownership share after 2 years.
  • Work regular hours, no weekends. Plenty of vacation.
  • As little stress as a private practice can have. Great patient base.
  • Mentoring/training by one of the best known Prolotherapists (Dr. Ross Hauser)
  • Curative rate for chronic pain for the clinic is outstanding (see www.prolotherapy.org for papers/results from the clinic)
  • Opportunity for research (clinic has produced over 20 scientific papers)
  • Opportunity for teaching (clinic regularly has visitors, students rotating)
  • True private practice, 100% payment at time of service, so there is no insurance billing, no accounts receiveable. You get to do what you do best which is to practice medicine
  • Every type of pain is treated including sports injuries
  • Have your own newsletter to get your name well known around the world
  • No prior experience in Prolotherapy is needed, just a desire to do curative pain management
  • Learn natural medicine. The clinic assists patients to regain their health through diet, faith, resolution of stress conflicts and of course interventional pain techniques, the main one being Prolotherapy (regenerative injection therapy)

To view information on this practice opportunity please go to www.caringmedical.com

Please send resumes to Mandi Jones at jonesm@caringmedical.com, or call her at 708-848-7789

Lucrative Prolotherapy Practice Opportunity

West NY – NR. Buffalo – Beautiful Area

Physician planning retirement is offering to sell his excellent (20+ years) highly successful practice and to stay on to train and introduce a suitable candidate. He specializes in pain free wellness through prolotherapy/stimulated ligament & tendon repair; platelet rich plasma prolotherapy; biocelular and neural prolotherapy, osteopathic manipulative therapy, and nutrition. The practice produces gross receipts of $780K with personal net income of $450K+. The office lease is transferable and overhead is very low. The practice accepts patient payments of cash, checks and credit cards, but no insurance. For information contact: Gary N. Wiessen (631) 281–2810 or email at website: buysellpractices.com

AAOM News Section
The AAOM is Again Named Official Prolotherapy Training Partner in Guadalajara

Guadalajara, Mexico. November 2 – 9, 2013

Guadalajara 2013

The AAOM traveled to Guadalajara, Mexico to provide medical care and education about Injection Therapy/Prolotherapy to 20 US physicians and 9 Mexican residents. The instructors were Andrew Kochan, MD, Neil Kirschen, MD, Paul Lieber, MD, Jonathan Fenton, DO, Wajid Burad, MD and Miguel Zarate, MD. The AAOM was supported by the medical community of the Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde, the AAOM physicians were able to see over 700 patients over the course of 5 days and we provided over 900 treatments. Our Physicians were welcomed by the General Director of the Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde, Hector Raul Perez Gomez, MD, and by the Directors; Dr. Benjamin Becera Rodriguez and Dr. Francisco Preciado Figueroa and the Director of the PM&R Department Dr. J. Jesus Gonzalez Jaime.

This trip has allowed us to provide a medical education and training for pain treatment services, heretofore unavailable, while providing an intensive educational experience for our students. The AAOM was able to introduce Prolotherapy to the patients and Mexican physicians and Residents, thereby ensuring the continued care of these patients for follow–up. According to Paul Lieber, M.D., President of the AAOM and instructor on this trip, "It was a gratifying experience for all who participated. This trip provided an incredible experience, living and learning in Mexico and it really allowed us to get to know the medical community of Guadalajara. Everyone we treated was so grateful, it just felt good that we were there delivering this care to them. As well, it was great seeing the progress of the students, who went from novices to competent Prolotherapists. They really had the experience of a lifetime, being able to learn and give back at the same time"

This trip marked the 10th time the AAOM has made the journey to train and teach in Mexico. This trip was again a landmark trip for the AAOM; as we were again named as the official Injection Therapy/Prolotherapy Teaching entity for Guadalajara.

For information about the 2014 trip, please see the AAOM Website. We will begin scheduling the 2014 trip next immediately. We have included a link to the Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde website link www.hcg.udg.mx and some photos of the trip to share the experience with you. If you are interested in the next trip, contact the AAOM at 888 687 1920 or check on the AAOM website at WWW.AAOMED.org

AAOM Upcoming Events
AAOM One Week Mexico Prolotherapy Workshop

Many of you, who are reading this newsletter, are aware of the tremendous success of the AAOM Prolotherapy Workshops offered in Mexico. The opportunity to learn and sharpen injection therapy skills is abundant. Every student physician was grateful for the learning opportunity and many said it was the best course they had ever attended. Our week–long workshop will have a Faculty of just five teachers allowing us to have only 20 student spots available. If you have interest in making the trip to Cancun, I urge you to sign up immediately as only 6 spots out of a total 20 remain available for Cancun. Once the spots are filled, the course will be closed to further applicants and you will miss this unusual and wonderful opportunity to learn while providing a service to inhabitants of Cancun.

39.5 CME category I credits are being offered for participants who sign–up for either trip. So, don't delay if you have an interest in this trip. Make sure you have all of the prerequisites in order.

  1. Participation in either AAOM Annual Conference or AAOM Annual Workshop
  2. AAOM Membership – MD or DO
  3. Current Medical License
  4. Current CV
DATES: Cancun – February 1 – 8, 2014
TUITION for CANCUN is $3495.00

  • 7 nights lodging AAOM Host Hotel Cancun
  • All Meals (Breakfast/Lunch/Dinner daily)
  • 39.5 Category 1 AMA Credit
  • Experienced Faculty
  • Medical Supplies
Participant Expenses:
  • Airfare to/from Cancun is at participant's expense
  • Transfers to/from Airport

Mark your calendar for February 1 – 8, 2014.
Remember, the AAOM Mexico Workshops fill up fast so if you want to go to Mexico, call ASAP 888.687.1920 or 970 626 4441 (outside of the USA).

31st AAOM Annual Conference and Scientific Seminar

Sports, Spine and Beyond – Latest Advances in Regenerative Orthopaedic Medicine
Clearwater, Florida April 9–12, 2014

The AAOM annual meeting is not just the same–old topics that you can hear at every other medical conference. If you want "out of the box, cutting edge" thinking and information, come to the AAOM – you will not find this type of program and the camaraderie to share ideas anyplace else.

The field of Orthopedic Medicine is exploding! Though this explosion is quite positive for our burgeoning field, it is important to be able to navigate around the technological advances, to avoid the pitfalls and be able to get what you need to enhance your patients and your practice. To that end, I've worked to combine topics from the not so traditional Interventional Pain Medicine, Sports Medicine and Regenerative Orthopedic Medicine. We will also explore advances in Manual Medicine, Nutrition, Physical Examination and Physical Therapy. We will have several workshops that include Musculoskeletal Ultrasound, Stem Cell Extraction from Adipose, Prolotherapy 101 – A Primer, Bioidentical Hormone Replacement Therapy, to name a few. The goal of this conference is to bring you state of the art techniques and technologies that can help our patients now.

Learn more >

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