Since joining the Rittenhouse Women’s Wellness Center in July, Dr. Catherine Liebman is often asked to explain “What is Osteopathic Manipulation?” and who may benefit from it. Osteopathic Manipulative Medicine (OMM) is a medical specialty that is specific to Doctors of Osteopathy (DOs).  While all DOs get some training in OMM in medical school, others choose it as their specialty. For an OMM specialist the main focus is the musculoskeletal system. OMM is the application of manipulation to the body to address problems in the joints, muscles, nerves, connective tissues, and organs. Dr. Liebman incorporates OMM into conventional musculoskeletal medicine including orthopedic examinations, interpretation of x-rays and MRIs, managing physical therapy, injections, medications, and medical acupuncture, to create a unique and integrated approach to patient care.

OMM is based on the principle that the structure and function of the body depend on one another. During a visit Dr. Liebman assesses the patient for joints that are out of alignment, muscles imbalances, and connective tissues that are restricted. The dysfunctions that are identified are corrected with Osteopathic techniques. Many Osteopathic techniques are well known in other areas of musculoskeletal medicine, including myofascial release, soft tissue techniques, strain-counterstrain, muscle energy, and craniosacral therapy. The goal is to treat a patient with the most current clinical medical practices and to identify and correct the cause of pain, not just mask the symptoms.

As an example, a patient with low back pain may be evaluated for any organ or neurologic cause, receive a prescription for a medication and/or x-ray, and receive an OMM treatment to improve the symptoms immediately – all in one visit. It is truly integrated and holistic healthcare. Initial visits typically take one hour for evaluation and treatment and follow-up visits take 30 minutes. Depending on the situation, patients may need to return for more treatment. The treatment and management of the patient is tailored to her unique situation, and may include other modalities as well. However, the goal is to give patients the tools to feel and perform their best on their own and prevent further injuries.

Conditions commonly treated with OMM include:

• Chronic pain
• Acute pain
• Sports injuries
• Tendonitis
• Fibromyalgia
• Migraine/Headaches
• Neck pain
• Low back pain
• Joint injuries

Question: January 6th, 2014
Answered by: Dr. Linda Bullock

Question: How important is it, if you have a family history of heart disease, but are not exhibiting symptoms yourself, to have blood tests for C-reactive protein and lipoprotein A? I believe these might be better assess your risk of arterial plaque.

Answer: The U.S. Preventive Services Task Force deems these tests lacking enough evidence to use them for clinical decision making. Traditional tests (total cholesterol, HDL, triglycerides) still guide treatment.

C-reactive protein is produced by the liver and is a general marker for increased inflammation in the body. It may be associated with an increased risk for heart disease but it is not specific. Lipoprotein(a) is a circulating lipoprotein and it has been associated with an increased risk of coronary artery disease, but the added value of this test beyond measuring a lipid panel is not known at this time.

Measuring these and other tests such as the homocysteine level and the ankle brachial index may be used to guide treatment decisions in the future. Reducing risk factors is imperative, especially if you have a family history. If you smoke, please stop. If you have diabetes or hypertension, these should be treated. If you are overweight, try to reach your optimal weight. Diet and exercise are the cornerstones for risk reduction and if your cholesterol is elevated after you have maximized your healthy behaviors, you may need a cholesterol medication.

Question: December 1, 2013
Answered By: Dr. Linda Bullock

Question: “I’ve been told to get my calcium from food only, and the allergist wants me to limit my dairy. There are many “calcium fortified” food items like cereals and almond milk, but is seems to me getting calcium from these products are no different then taking a pill. Should these be avoided as well?”

Answer: Taking calcium pills may be counterproductive so current recommendations suggest food sources of calcium. while dairy products are very high in calcium, there are other foods high in calcium. dark green leafy vegetables such as broccoli, kale and collard greens, oysters, salmon, sardines, molasses, tofu, parsley, dried figs and almonds, to name a few. When it comes to fortified foods, there are several stipulations to consider (according to fitday.com). 1) calcium absorption is better at higher acidity levels in the stomach 2) products with calcium carbonate are absorbed equally as well as dairy. 3) precipitation can cause the nutrients to settle on the bottom of the container, shaking the container can improve this. 4) plant estrogen is soy can increase calcium absorption. Hope this helps.

Calcium Levels in Milk vs. Almond, Rice and Soy Milk / Nutrition / Healthy Eating

Question About Menopause: Answered by: Dr. Linda Bullock

I was asked by one of our patients what to expect from menopause. Most of the time a woman experiences some constellation of symptoms. These vary over a very wide range. Here is an overview.

Perimenopause is the period of time before menopause when a woman gradually loses ovarian function (produce less estrogen). This usually occurs one to two years before menopause. As estrogen decreases, she can feel some menopausal-like symptoms. Normal menopause usually occurs after 40 years of age and a woman is said to be through menopause when she has not had a period for one year. There are some classic menopausal symptoms; hot flashes, irritability, insomnia, vaginal dryness & changes in sex drive, among other symptoms. These symptoms can vary widely from little or none to a high symptom burden. Symptom length also varies. Some women report weeks to months of symptoms while others have symptoms longer than this. Most women do experience some symptoms and tolerate them with no medical treatment. It’s important to remember that good nutrition (including calcium), vitamin d, exercise, cutting back on alcohol and trying to maintain good sleep patterns can help. Sometimes, estrogen (several different forms available) is prescribed to ease symptoms. Be sure to discuss your symptoms with your doctor.

What is cervical cancer?

“Cervical cancer” is a disease which causes the cells of the cervix to grow in an out of control way. The abnormal cells develop the ability to spread and invade other organs. When this occurs, cervical cancer can spread and ultimately lead to death. This can even occur in young, healthy woman.

What are the risk factors?

Most cervical cancer is caused by a sexually transmitted virus. This virus is called HPV. The virus is spread by skin to skin contact, which means that condoms may not protect you. Some strains of the virus cause genital warts, however most strains cause no symptoms at all. Most of the time, your immune system clears the virus. However, some woman remain infected, this constant infection with HPV can lead to cervical cancer. Having the virus does not mean you will develop cancer, although it does mean that you should be vigilant!

Other factors which can increase your risk of cervical cancer are:

• long-term oral contraception
• multiple sexual partners
• cigarette smoking
• immunosupression

What can I do?

Make sure to schedule your annual gynecological exam! The American College of Obstetricians and Gynecologists recommends annual pap smears for all women starting from 21 years of age.

The best way to detect cervical cancer is by having your pap smear. There are different recommendations for when to have your pap smear (from every 6 months-every 3 years), which depend on your previous results. However, even if you do not get your pap smear once a year you should schedule an annual exam to regularly reassess your risk factors, as well as to get an internal and breast exam and std testing when necessary. If you are under the age of 26, your doctor may also recommend the HPV vaccine series. The HPV vaccine is used to prevent infection with HPV types 6, 11, 16 and 18 and is covered by most insurances (please contact your carrier for additional coverage information)

Lastly, please make sure to follow through with any additional appointments that your physician recommends. Scheduling a colposcopy with a gynecologist may not sound like fun, but timely follow-up can make the difference between a small treatment procedure and extensive cancer therapy. In summary – don’t delay! If you have not had your pap smear for several years or if you have any further questions about cervical cancer, schedule an appointment with one of our physicians right away and take control of your health!

Insomnia is the most common sleep complaint in the U.S. population, affecting as many of 10% of adults at one time or another. Insomnia is defined as trouble falling or staying asleep, or feeling that one’s sleep is nonrestorative. Chronic insomnia can result in a number of problems–daytime fatigue, anxiety, feeling cranky or irritated, forgetfulness, or making mistakes, to name a few–and because of this, it can affect the relationships and work of those who experience it.

Insomnia has many causes, and determining what is causing one’s sleep problems is often the first step toward finding a solution. For example, certain medical conditions that cause pain or breathing difficulty can keep one awake. Having to get up to go to the bathroom frequently can interfere with sleep. Some medications may have side effects that make sleep difficult. And stress or anxiety–due to work issues, the death of a loved one, etc.–can make a good night’s sleep a chronically unattainable goal.

So how do we handle the inability to sleep well through the night? For starters, if you do have an uncontrolled physical symptom or medical issue causing your insomnia, talk to your doctor about it! The next step is to promote a restful sleep environment. This is referred to as “Sleep Hygiene”. First, make sure you have a set bedtime and wakeup time, and stick to them. Do not nap or doze during the day. Make sure your bedroom is dark and quiet, and kept at a comfortable temperature. Use an eye mask or earplugs, or a white noise machine, if needed. Exercise daily, but not right before bedtime. Do not have any alcohol, caffeine, or nicotine in the late afternoon or evening. And be sure to resolve any stressful issues from your day long before bedtime.

If you are still unable to sleep, then further steps may be taken. One option is to retrain your body to sleep through the night using the following method. If you cannot fall asleep after 15-20 minutes, get out of bed and do something relaxing, like reading. Do not engage in any activities that are goal-oriented or will make you more alert. When you start to feel tired, then return to your bed. If you are unable to fall asleep after another 15-20 minutes, repeat this cycle until you are able to fall asleep. Remember that even if you do not get a full night’s sleep at first, you should stick to your regular wakeup time. This may take a couple of weeks to result in a full night’s sleep, but eventually your body will adjust to the sleep cycle you are enforcing.

For those who do not respond to any of the above measures, other options–like cognitive or relaxation therapy–may be helpful. A formal sleep study, or even referral to a sleep medicine doctor, may be indicated. And as with any health concern, if your insomnia persists, you should follow up with your doctor to get to the bottom of it.