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Dr. Scott
Kwiatkowski, D.O., P.C. | 301.718.3696 | 6900 Wisconsin Ave | Bethesda, MD
20815
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Email Me
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General Questions
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Questions About My Practice
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What is a Doctor of Osteopathy?
A physician who has the training, experience, and compassion to deliver lasting
solutions to pain and injury. To become an osteopathic physician is a long
and rewarding endeavor. A person completes college, and then attends an
American osteopathic medical school, where they study the vast field of
medicine and the scientific art of osteopathy. Osteopathic medical students
spend over 1000 hours more than their MD counterparts studying functional
anatomy and biomechanics - how the body is built and how it works. After four
years of diligent study, they earn the degree, "Doctor of
Osteopathy." After graduation and completing their licensing
examinations, the doctor can specialize in any medical field by completing
three or more years of residency training. So, a doctor of Osteopathy is a
fully licensed physician who can prescribe medicine, work in a hospital, and
perform osteopathic treatments. They are fully qualified to offer you
complete care.
What is Osteopathic
Medicine?
Pioneered in the late 1800s by a frontier surgeon named Andrew Taylor Still,
osteopathic medicine is dedicated to the treatment of the entire person. Dr.
Still philosophized, "There is a unity of the body’s systems with the
mind and spirit, so that a disease in one area can affect all areas. Also,
the body has an inherent ability to heal itself, and it has all it needs
contained within it." Perhaps the most recognizable osteopathic
treatment is manipulation, where the physician uses a hands-on approach to
assure the body is moving freely.
What is Traditional
Osteopathy?
It is a distinctive way to practice medicine. It uses all the best modalities
in medicine and surgery, but prefers to use the body's natural healing first.
The philosophy of A.T.Still, the founder of Osteopathy, plays a central part
in patient care, "There is a unity of the body’s systems with the mind
and spirit, so that a disease in one area can affect all areas. The body has
an inherent ability to heal itself, and it has all it needs contained within
it."
"Traditional
osteopaths feel the Higher wisdom at work, and acknowledge the beauty and
consciousness behind our intellect." (James Jealous D.O., '95
Paraphrased)
How do Osteopathic and
Chiropractic treatments differ?
Osteopaths are fully licensed physicians, and they can include prescription
medicine in your treatment regimen when it is necessary.
Also, Osteopathic treatments can be geared to treating disease if it is
present. While both OMT and chiropractic use passive thrusting techniques,
OMT includes a variety of non-thrusting techniques to effect the muscles and
soft tissues of the body. One potent non-thrusting technique is Cranial
Osteopathy, which is used to improve the flow of fluid and charge in the body
(via the vessels & nerves respectively). Thus, OMT can be more gentle,
and the effects more profound. Remember, no simple outline can fully address
a complex subject. For further information regarding your concerns, or those
of your child, please consult your licensed physician or our office.
What happens during an
Osteopathic Treatment?
At the end of your office visit, after your concerns have been answered and
investigated, an Osteopathic treatment may be prescribed.
An Osteopathic treatment involves gentle manipulation (manual forces) to free
restricted areas in your body. They are performed fully clothed, in a seated
or lying position, and last and average of twenty minutes. A variety of
techniques may be used during treatment, depending upon what you need. Some
are overt - thrusting or stretching, while others are subtle - fascial
release or cranial osteopathy.
All of the modalities are very gentle; they are so gentle that people often
fall asleep during treatment.
What is an Osteopathic
Manipulative Treatment (OMT)?
An excellent solution for pain. It is an artform, rooted in science, where
D.O.s use their hands to examine your body for pain and restricted motion -
signs that could reveal injury or poor function. The treatment (manipulation)
uses gentle force to improve the motion of dysfunctional or injured areas.
Free body motion aids circulation, which improves tissue nourishment, and
enables repair. This translates into getting back your active lifestyle as
soon as possible.
What types of injuries
or illnesses can OMT be used for?
A study in the New England Journal of Medicine (11/4/99) showed OMT to be an
effective form of medical treatment for low back pain with lower costs &
fewer side effects as compared to medication alone. Not only can OMT can be
helpful in treating low back pain, it can help to relieve the structural abnormalities
& discomfort associated with a number of disorders.
Who can benefit from
OMT?
Through using OMT, people of all ages have found relief from injury and
illness. Many D.O.s incorporate OMT into their treatment plans for top
athletes, workers with on-the-job injuries, and people with illness (asthma,
sinus, etc.).
Cranial
Osteopathy...Does That Mean it's Just in My Head?
It's not just in the head, as the name, "Cranial Osteopathy" would
lead you to believe. The term "Cranial" refers the Cranial Rhythmic
Impulse / rhythmic coiling & uncoiling of the brain and spinal cord,
rather than to the location of the treatment (the cranium / head). The motion
of the nervous system and its fascial connections can be felt and worked with
throughout the body - and often is during a treatment. Osteopathic physicians
do not separate the body into unrelated parts, but instead treat the body as
a whole.
What is Cranial
Osteopathy?
It is one of the most subtle and profound treatments available today for
treating illness or injuries. It is a sub-specialty of Osteopathy that
originally focused on the cranium (skull) and sacrum (tail-bone). It is more
formally termed "Osteopathy in the Cranial Field" (OCF)It was
developed by William Garner Sutherland, DO, in the early to mid-1900s. Dr.
Sutherland observed a palpable movement within the body that occurs in
conjunction with the motion of the skull bones (there are many bones). The
movement is a rhythmic expansion and contraction that he termed the Primary
Respiratory Mechanism. This motion effects the entire body, and so, it can be
worked with from any part of the body. The goal of Cranial Manipulation is to
diagnose and improve the subtle motions in the skull, and entire body. These
treatments are used when there are deviations in bony motion or fluid flow,
as a way to treat disease or enhance health.
What Happens During a
"Cranial Treatment?"
At the end of your office visit, after your history and physical examination
have been obtained, an osteopathic treatment may be prescribed. A
cranial-style osteopathic treatment uses gentle pressure on areas of the body
that have restricted motion. The treatment often involves cradling the head
or the tail-bone, and uses gentle movement to improve the motion of restricted
tissues. This type of treatment can be used for any area of the body. It is
performed fully clothed and lasts an average of twenty minutes. People find
it so relaxing that they often fall asleep.
What is Cranio-Sacral
Therapy?
""Craniosacral therapy" was developed by John Upledger, D.O.,
in the 1970s. He studied Cranial Osteopathy as part of his osteopathic
medical training, and then founded a system of therapy called
"craniosacral therapy." It is defined as "a gentle, hands-on
method of evaluating and enhancing the function of the craniosacral system -
the physiological body system comprised of the membranes and cerebrospinal
fluid that surrounds and protects the brain and spinal cord." Click here for a more complete description.
Differences Between
Craniosacral Therapy and Cranial Osteopathy?
There are many similarities between the two as they grew from the work of Dr.
William G. Sutherland, who developed cranial concept and pioneered Osteopathy
in the Cranial Field (OCF).Both Craniosacral Therapy and OCF use the
cranio-sacral system for treatment,
and so the techniques appear very similar on the surface: similar hand-holds,
very gentle, etc. However, the difference between the two comes in the
approach. Only physicians can perform OCF. Only osteopathic physicians and
medical doctors have the extensive training in anatomy and embryology
necessary to give them a deep understanding of how the body works. Also,
doctors are trained to diagnose conditions, and have a broad view of what is
needed for treatment. A doctor trained in OCF is able to see the whole person
- their treatment is comprehensive. A doctor trained in OCF knows the body -
their treatment is very specific. Thus, with a comprehensive view and a
specific treatment, most people notice more rapid relief. Cranial Osteopathy
is a jewel of modern holistic care, and deserves to be experienced.
Does managed care
cover Osteopathic Treatments?
Osteopathic Manipulative Treatments are an added tool that is covered by many
managed care organizations. Typically, the physician and managed care plan
negotiate the level of reimbursement. It is usually reimbursed between 50
& 80%, depending on whether you need a referral prior to treatment.
What conditions do you
treat?
As a dually board certified family physician, I have been trained to diagnose
and treat nearly all common afflictions. However, I choose to focus on
conditions that have a largely anatomical component and will likely improve
with Osteopathic manipulation. The body responds favorably to improved motion
and circulation. Almost all stable conditions are expected to improve. Here
is a partial list of common conditions I enjoy treating:
- Back & Neck pain
- Shoulder pain
- Elbow & wrist pain
- Hand pain, including carpal
tunnel syndrome
- Leg pain (sciatica)
- Hip, Knee, Ankle & Foot
pain
- Numbness & Tingling
- Pinched Nerves
- Ligament & Muscle
injuries
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- Arthritis
- Bursitis
- Sports Injuries, including
tennis elbow & golfer's elbow
- Pregnancy pain
- Birth trauma & Newborn
poor suck
- Children's earaches
- Sinusitis
- Allergies
- Asthma
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What can I expect on
my first office visit?
Part of what makes a visit to my office so rewarding is the way you are
treated. You'll receive a warm welcome. You won't be rushed. All of your
questions will be answered and your concerns addressed. I am dedicated to
giving you excellent care, and will spend up to sixty minutes with you on
your first visit. I'll spend time learning about your injury or illness,
discussing your treatment options, and truly listening to your assessment of
the problem. I will perform a thorough physical examination to investigate
your concerns and help formulate a diagnosis. I'll then create an effective
program to relieve your specific condition and achieve optimum health. When
an initial Osteopathic treatment is performed, it usually lasts thirty
minutes, and is followed by a short period to either review your program or
rest.
What can I expect on
my follow-up office visits?
I am dedicated to giving you excellent, consistent, care and will spend up to
thirty minutes with you on any following visits. I'll spend time listening
any new concerns you have and reviewing the program we created. I'll want to
know how your condition has changed. I will also perform an examination to
evaluate your progress or investigate any new concerns. When a follow-up
Osteopathic treatment is performed, it usually last 20 minutes, and is
followed by a short period to either review your program or rest.
What should I do after
a treatment?
You must pamper yourself. It takes 3 days for the body to finish responding
to a treatment. You must be gentle with yourself during this 3 day window and
treat yourself as if you had a flu - it takes about as much energy repair
from each circumstance. So, drink an increased amount of fluid, perform only
light exercise, and have restful activities. It is true that not everyone
will require this type of pampering after a treatment, but it is best to give
yourself the opportunity until you're certain what your body needs. Between
treatments you will be asked to keep track of your activity and well-being to
monitor your response to treatment. You may be given therapeutic exercises to
do. The exercises, while simple, are crucial to maintain the benefits of
treatment...you may even progress further. If you have questions about what
you're experiencing after a treatment, please call my office. If it is
after-hours or a weekend, please call your primary doctor, and contact me as
soon as possible.
How long will it take
to get better?
Some new conditions may resolve after three or four treatments. If it takes
longer, then we may focus on your lifestyle & activities to see if you
are exposed to chronic injury. Problems that have been with you longer than
one month may take a lifestyle change in order to heal. These conditions
often take seven to nine treatments to notice lasting change. Laboratory
tests or imaging studies will be ordered only if needed to make a diagnosis.
What kind of
therapeutic exercises do you give?
They are not like what you would do in the gym or at a physical therapist's
office. They may look similar to things you already do, but there will be a
qualitative difference that will help you to achieve much greater results.
The exercises, while simple, are crucial to maintain the benefits of
treatment...you may even progress further.
What do you mean by
Pain Management?
It is a broad term that includes an emerging medical specialty that focuses
on treating pain. While allied health practitioners (Chiropractors,
Acupuncturists, Physical Therapists, etc.) also treat pain, it is crucial to
use a physician who has a more in-depth understanding of the body, and can
prescribe medicine or tests when necessary. While many people are familiar
with drug therapies prescribed by most doctors, and surgical treatments
offered by orthopaedists, many people would like to understand and experience
other approaches to pain management. One of the best kept secrets of pain
management is Osteopathic Medicine. Osteopathic Medicine is performed by a
doctor of Osteopathy (D.O.). A D.O. is a fully licensed physician who can
prescribe medicine, work in a hospital, and perform osteopathic treatments.
They are fully qualified to offer you complete care. Osteopathic treatments
have been shown to be an effective alternative to medicine alone in treating
pain. A study in the New England Journal of Medicine (11/4/99) showed OMT to
be an effective form of medical treatment for low back pain with lower costs
& fewer side effects as compared to medication alone. Osteopathic
treatments are an excellent solution for pain, and are wonderful to
experience. I provide 30 minutes of one-on -one care for each patient in a
peaceful office setting, and his treatments are so gentle that people often
fall asleep. The power and gentleness of osteopathic treatments are a jewel
of modern pain management and deserve to be experienced.
What are your hours?
Because being in pain is inconvenient enough, I try to make my care as easy
and convenient as possible. I have patient-friendly appointments scheduled in
my Bethesda office from 8am to 4pm, Monday through Wednesday, and evening
hours on Thursday until 6:30pm. Visits are by appointment, and we have a 24
hour cancellation policy so that other patients may use your visit if you are
unable. Other arrangements can be made on an individual basis.
Why are your
treatments for allergies and sinusitis so successful?
Dramatic changes can be seen on physical examination, in the amount of
medicine consumed, and how easily a person can breathe. I believe it is
because I consider the whole condition during work-up and the whole person
during the treatment. Allergies and sinusitis effect so much of the body
beyond the face. Here are some basic problems seen:
- Lining of the nose and sinus
cavities are inflamed.
- Drainage from the face is
poor - feel stuffy or packed full. Nervous system out of balance -
parasympathetic dominant
- Endocrine system fatigued -
little of body's own steroid (cortisol) available for use - high demand
uses available stores in the allergic states.
The medications used to
treat allergies varies, but they generally dry or shrink the lining of the
nose or sinus cavities in order to help drainage. However, this approach has
moderate side effects and neglects the other problems of the endocrine and
nervous systems. That is why people with moderate to severe disease are so
difficult to treat and often stay uncomfortable. The solutions for the
problems we mentioned above are simple when using osteopathic treatments. The
ribs, diaphragm, an neck fascia can be released to improve drainage from the
head. The irritation of the sympathetic nerves to the face and adrenals can
be addressed and reduced, thereby balancing the nervous system and opening
the sinus passages. Blood and nerve flow to the adrenal glands can be
improved, likely enhancing the availability of cortisol and reducing
inflammation (many parameters of adrenal function are measured to monitor
treatment response). The results are usually less reactive sinus tissue and
the ability to breathe more freely... leading to happy patients and
physicians.
Why are your
treatments for asthma so successful?
Dramatic changes can be seen on physical examination, in the amount of
medicine consumed, and on pulmonary function studies (a special test for
lungs). I believe it is because I consider the whole condition during work-up
and the whole person during the treatment. Asthma effects so much of the body
beyond the lungs. Here are some basic problems seen in asthma:
- Airways of the lung are
inflamed
- Can't take a deep breath -
stuck in inhaling position with raised ribs & flat diaphragm.
- Nervous system out of balance
- parasympathetic dominant
- Endocrine system fatigued -
little of body's own steroid (cortisol) available for use.
Almost all of the
medication available to treat asthma is directed at opening the airways in
the lungs, but neglects the other problems. That is why people with moderate
to severe disease are so difficult to treat and often get worse. The
solutions for the problems we mentioned above are simple when using
osteopathic treatments. The ribs and diaphragm can be released to return to
an optimal position. The irritation of the sympathetic nerves to the lungs
can be addressed and reduced, thereby balancing the nervous system and
opening the airways. Blood and nerve flow to the adrenal glands can be
improved, enhancing the availability of cortisol, and also reducing airway
inflammation. The results are less reactive lung tissue and the ability to
breathe more deeply...happy and satisfied physicians and patients.
Do you treat Otitis
and Ear Aches?
Young children are pre-disposed to collecting fluid in the middle ear because
the eustacean tubes that drain a child's ear are nearly horizontal until
about age 5. The fluid collection behind their ear drum can become infected
and cause an "Otitis" or "ear infection."
Prolonged fluid pressure in the middle ear, as in "glue-ear" /
"otitis medial with effusion" can cause hearing loss and require
drainage tubes (T-tubes) to be surgically placed through the ear drum. The
problem: Poor fluid drainage leading to infection and possibly increased
fluid pressure. The treatments:
- Antibiotics have limited use
- they rarely improve ear drainage, they only kill bacteria (which cause
only 50% of ear infections), and they have unpleasant side-effects.
- T-tubes improve drainage of
the ears, don't prevent infections, are only indicated when hearing loss
is shown, and controversial in treating acute infections. (little
benefit has been shown http://www.utdol.com
v11.2).
- Tonsillectomy +/- Adeniod
removal - little to no value for recurrent acute infections (JAMA 1999
Sep 8;282(10):945-53).
- Osteopathic Treatments are
gentle, are nearly free of side-effects, and can improve drainage of the
middle ear as seen on a tympanogram - a test for eardrum motion.
By improving the
circulation in the upper-back, neck, & head, the middle-ear fluid can
drain more easily and is likely reduce the incidence of infection and hearing
loss.
Do you do Nutritional
Testing?
In 2001, The Journal of the American Medical Association reversed a
long-standing anti-vitamin policy and advised all adults to take at least one
multivitamin pill each day. Scientists' understanding of the benefits of
vitamins has rapidly advanced, and it now appears that people who get enough
vitamins may be able to prevent such common chronic illnesses as cancer,
heart disease and osteoporosis, according to Drs. Robert Fletcher and
Kathleen Fairfield of Harvard University, who wrote the new guidelines. We
are helping people live better through improved nutrition. Although many
conditions such as being over weight, rapid bone loss, and fatigue can be
helped through simple dietary changes, it's often hard to know which changes
to make. In order to eliminate the guess-work, we are now using the services
of the various companies to provide in home lab testing and personalized
nutrition plans based on those results. If supplementation is necessary,
a pharmacy grade product will be available for you.
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