The beginning of wisdom is to call things by their right names. (Unknown)
As the AAOM moves on to it's 31st year we face many challenges. The world of medicine is changing, new techniques emerge and are developed, new understanding of disease processes are uncovered. In this changing dynamic world of medicine, we have had little structure for naming things, compared to some of the other sciences.
Science has guidelines in the biologic world for naming plants and animals, a taxonomy that is very descriptive. The field for naming newly developed medical techniques and procedures has lagged behind. Traditionally procedures were named after the person developing the technique or procedure–just consider all the names of various tests in the process of physical and musculoskeletal examination. This has moved to more descriptive naming approaches but there are no absolute rules on how to name a new medical procedure.
Does it really matter how we name things? How important are labels and names? Doctor, Physician, Provider, Clinician, Professor, Teacher, Lecturer; Orthopedic Medicine, Orthopaedic Medicine; Adviser, Counselor; Agreement, Contract; Law, Rule, Regulation, Policy, Guideline; Partner, Spouse, Mate; Adjustment, Manipulation, Manual Therapy, Osteopathic Treatment, Chiropractic Treatment; Prolotherapy, Ligament Reconstruction Therapy, Regenerative Injection Therapy; Treatment, Therapy; Procedure, Technique; Educate, Train; Neural Therapy, Neural Prolotherapy; Joint Injection, Intra–articular Injection.......and the list goes on and on. Each word creates a different or similar mental image, varying flavors and nuances.
In the medical world the name of a procedure linked with a number, that in turn is associated with words that identify or name certain conditions or symptoms, is how insurance companies determine payment. Patients search for Doctors who perform certain procedures or who treat certain conditions using key words. Web rankings and search results of key word specific. Names are important.
Thus, it is important to create a language and nomeclature of new procedures that we can use consistently within our professional community and in discussions with our patients.
Thanks to Andrew, Dean and Brad, our nomenclature committee from the Board of Directors for their intensive efforts on putting together the document on nomenclature. Please read it carefully and send back your comments. Outcomes from this discussion are already in evidence as Dr. Lyftogt's next scheduled course is titled "Perineural Injection Technique Conference".
This will not be my usual monthly addition to the Newsletter. I have planned a bunch of different articles, but they will have to wait. As a part of my plan to help advance the organization and to get you, its members more involved, I will outline the committees which have been proposed and the purpose of each committee. Ideally, each committee will have about 6 members which will participate in advancing the organization as a whole. If you see a place that you fit in or just want to get involved, please get in touch with either myself or Maelu and we will make it happen. The AAOM appreciates you expertise and willingness to pitch in.
All for Now.
Purpose: The Marketing Committee develops marketing programs for the AAOM and the AAOM programs.
Tasks: To find appropriate venues to expose and educate the public, media and professional associations about the programs, mission and benefits of the AAOM.
(Development) Committee and Bachrach Lecture Fund
Purpose: The Development Committee leads the AAOM in development and fundraising.
Tasks: The committee develops policies, plans, procedures, and schedules for fund raising. It helps educate members about the organization's program plans and the resources needed to realize those plans.
Purpose: The Membership committee looks at AAOM membership classifications per the Bylaws, evaluates and recommends membership pricing, membership benefits and programs and approves membership in questionable situations.
Tasks: The committee develops policies, plans, procedures, and schedules for membership, membership benefits and programs.
Purpose: The Certification committee provides oversight for the AAOM Certification program.
Tasks: The Certification committee looks at the AAOM Certification Program evaluates and recommends needed content changes. The Certification committee looks at the AAOM Certification Program applications and recommends approval according to the existing criteria.
Purpose: The Newsletter committee provides oversight for the AAOM e–newsletter.
Tasks: To develop 10 E–newsletters per year. To encourage content contributors, To expand the newsletter content and section areas.
Purpose: The Website committee provides oversight for the AAOM Website.
Tasks: The Website committee looks at the AAOM Website and evaluates and recommends needed content changes.
Purpose: The Educational Program committee evaluates current programming design to ensure it remains relevant, provides speaker, content, cme and timeline oversight to assure the AAOM Annual Conference and Workshop are on time, on budget and have appropriate and timely content.
Tasks: The committee meets regularly to provide feedback to the Conference and Workshop Chairs.
and Standards of Practice Committee
Purpose: The Workshop Protocols and Standards of Practice Committee develop Regenerative Injection Therapy Protocols and Standards of Practice to be incorporated in the curriculums of AAOM educational programs.
Tasks: The International Workshop Protocols and Curriculum Committee develop Regenerative Injection Therapy Protocols and Standards of Practice.
Emerging Procedures and Techniques has led to a need to clarify how we name what we do.
Rationale for recommendations on terminology.
Proper nomenclature is necessary and desirable for a number of reasons.
The Nomenclature Committee has examined the issue and we are recommending adoption of the following guidelines for naming of procedures and techniques. This system is descriptive for maximum clarity and accuracy with corresponding proposed acronyms that are easy to remember.
|Regeneration of tissue|
Whole blood Platelets
|Regeneration of tissue|
Perineural Subcutaneous Injection
|Subcutaneous sensory nerves (i.e. nerves in the superficial fascia/fat)||
|Reduction of neurogenic inflammation|
Perineural Deep Injection
|Nerves deep to the superficial fascia/fat||
|Reduction of neurogenic inflammation|
|Entrapped nerves deep to the superficial fascia/fat||
|Mechanical hydrodissection around nerve (ultrasound guided procedure)|
Perineural Deep injection in Caudal Space
|Reduction in neurogenic inflammation|
|Corticosteroid||Reduction in prostaglandin based inflammation|
Substance or Tincture
|Dependent upon mixture injected|
|Procaine||Neurogenic, via normalizing autonomic neuron signaling|
|Acupuncture needle||Neurogenic, via activation of autonomic NS pathways|
Trigger Point Injections
|Muscle Trigger points||
|Neurogenic, via mechanical disruption of abnormal neuromuscular junction|
Live or Apitoxin
|Neurogenic via modulation of CNS adrenergic pathways|
Perineural Topical Application
|Subcutanous and cutaneous nerves||
|Reduction in neurogenic inflammation|
We propose that in official AAOM documents, advertising and meetings the suggested names or a reasonable facsimile be used. The name can be expanded to include more specificity if the mechanism for a procedure becomes known. We suggest that, at a minimum, the suggested names be used. During the transition to this nomenclature, colloquial names could be referred to with quotations.
Of course, any colloquial name can be used in private and unofficial communication between orthopedic medicine specialists. However, the use of accepted nomenclature will facilitate communication and prevent the confusion caused by several different procedures having the same name or one procedure having several different names.
"After reviewing this document I would like to make several observations. I hope you will share this with the authors.
Dr. Reeves Response: "Thanks Mark. Appreciate your feedback very much.
Because ozone is being promoted as prolozone and combined with dextrose, we included it in the proliferative category. I certainly agree the mechanism of ozone alone is unclear. Lack of clarity in mechanism is why we are looking at generic descriptions of interventions.
Phenol become destructive to nerves at about 2.5%. Reeves KD. Mixed Somatic Peripheral Nerve Block for Painful or Intractable Spasticity: A Review of 30 Years of Use. Am Jnl Pain Mgmnt 1992; 2:205–210. Below that its effects are somewhat unclear. I don't dispute the analgesia but I note that with nerve destruction with phenol you have work and work with phenol to kill all nerve fascicles and there is never an analgesia that keeps the motor nerves from conducting. Including any anesthetic with phenol renders the nerve non stimulatable.
Myofascial seems to be a typo.
PTA would included vitamin D with similar proposed effect. I don't know what you mean by ultrasound? There are certainly a number of skin applictions such a magnets, etc, that may have an effect on the subcu nerves."
Professional Dialogue is essential as medicine faces multiple challenges ahead. Be part of the dialogue!
Fascia is a significant organ system of interest in the practice of Orthopaedic Medicine.
Be sure to read the July issue of the Journal of Bodywork and Movement Therapies, vol. 17 issue 3 fascia section for Dr. Thomas Findley's article:
FASCIA SCIENCE AND CLINICAL APPLICATIONS: HISTORICAL PERSPECTIVE Fascia Research Congress Evidence from the 100 year perspective of Andrew Taylor Still
Thomas W. Findley, MD PhD, Mona Shalwala, MS–IV
Summary: More than 100 years ago AT Still MD founded osteopathic medicine, and specifically described fascia as a covering, with common origins of layers of the fascial system despite diverse names for individual parts. Fascia assists gliding and fluid flow and is highly innervated. Fascia is intimately involved with respiration and with nourishment of all cells of the body, including those of disease and cancer. This paper reviews information presented at the first three International Fascia Research Congresses in 2007, 2009 and 2012 from the perspective of Dr Still, that fascia is vital for organism's growth and support, and it is where disease is sown.
Published by Elsevier Ltd.
Dextrose, a key component of prolotherapy solutions is hard to find in our core concentration of 50%.
A survey of the board members led to the following resources and information in finding dextrose and coping with the shortage. The shortage is directly related to FDA inspections and changes that needed to be made to the manufacturing process, pulling multiple products out of production. Any of the pharmacy sources were called on 7/1/2013 to verify the availability. Here are some options:
1. Some have been using 5% dextrose in their prolo solutions from IV bags available still from most medical suppliers.
2. Some have used plain lidocaine.
3. Torrance Company has bags of 30% Dextrose in 500ml bags (verified on 07/01/2013) 800 Lenox Ave., Portage, Michigan 49024
Nationwide: (800) 327-0722, International: (269) 327-0722, FAX: (269)327-0763
4. College pharmacy compounds D50 and is able to do it now. (verified on 7/1/2013)
3505 Austin Bluffs Parkway, Suite 101
Colorado Springs, CO 80918
Tel: (800) 888-9358/(719) 262-0022
Fax: (800) 556-5893/(719) 262-0035
Patient Email: firstname.lastname@example.org
Practitioner Email: email@example.com
5. Bjorn offered that he can still get 50% dextrose from Park Pharmacy in Orange County California – 949 551 7195.
6. Dean: 50% dextrose in 500 ml bags has been available for use from some time. However, even these are in short supply and if they are used, they can't be stored and used intraarticularly unless not only a hood is available but also a proper class entry room due to compounding regulations. With governmental issues as they are, compounding has become an issue, something perhaps worth talking about to AAOM members. So, I am not sure that this information will help anyone.
a. However, here is what I know from the manufacturer as of today, verbatim. (Manufacturer is Hospira):
*The shortage is due to increased demand and a manufacturing delay. *Amphastar has a shortage of dextrose 50% syringes due to increased demand for the product.
*The Amphastar shortage has resulted in increased demand for Hospira's dextrose 50% syringe presentations.
*The increased demand from the Amphastar shortage has created a shortage of Hospira's dextrose 50% syringe presentations.
*The shortage of dextrose 50% syringe presentations has now forced usage to the dextrose 50% and 70% IV flexible container.
*The increased demand of the dextrose 50% and dextrose 70% flexible IV container presentations has created a shortage in those presentations.
*The increase in demand coupled with a manufacturing delay is creating a short term backorder for the dextrose 50% IV flexible container.
*The next delivery for this product is the week of August 5th and this item is expected to fully recover the week of August 19th."
In addition: Estimated Resupply Dates
Hospira has dextrose injection 50% Ansyr II Luer–lock syringes, 50 mL Lifeshield syringes, and 50 mL vials on back order and the company estimates a release date of mid–June 2013 for the Lifeshield syringes and early–July 2013 for the 50 mL vials and Ansyr II syringes.
Amphastar (IMS) has dextrose injection 50% 50 mL Luer–Jet syringes on intermittent back order and the company is releasing product regularly.
b. Bottom line, is this appears to NOT be permanent issue. For placing orders it is probably good to "get in line" via whatever intermediary you use.
7. The same supplier (Hospira) makes the D50 bottles. Here is their response when asked specifically about the 50 ml flip top D50 bottles that come 25 to a case: "6648–02 is manufactured on a line that carries several critical products. For this line, Hospira worked closely with the FDA to prioritize the molecules made on this line and it the FDA requested that we prioritize the micronutrients. We're expecting the next delivery of 6648–02 in mid July. We just received a very small delivery and hospitals received partial orders."
The AAOM continues to raise the bar in education in Regenerative Orthopaedic Medicine:Learn from world–renowned experts–
Learn and Network with experts about the latest research, procedures and protocols in Orthopaedic Medicine. This 2–day event will include lectures and labs on regenerative orthopaedic medicine, PRP, Prolotherapy, Stem Cells, Soft Tissue Pain Injections for Pain, Manual Medicine, MRI, Ultrasound and Topographic Anatomy for diagnosis.
Register Now at www.aaomed.org
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. We are pleased to announce the scheduled dates for both Guadalajara and Cancun. Each week–long workshop will have a Faculty of just five teachers allowing us to have only 20 student spots at each venue. If you have interest in making this trip to either Guadalajara or Cancun, I urge you to sign up immediately as we are 50% full for Guadalajara and only 12 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 the Mexican towns of Guadalajara and 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.
Mark your calendar for November 2 – 9, 2013 and 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).