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ACOI.org • American College of Osteopathic Internists
ACOI Info • March 2022
Jodie Hermann, DO, FACOI ACOI Osteopathic Manipulative Medicine Committee HERMANN Hints From Incorporating OMM Into Your Practice
My hands go to the lower left side of her chest near the sternum. Left hand on anterior aspect. Right hand on posterior aspect. I hold the heart between my hands. My R hand does a quick assessment of her thoracal costal junction with hypertonicity and limited respiratory movement. The heart does truly feel like a bag o’ worms. I console the heart into letting me hold it. Not tight. Not loose. Just right. It allows me to begin to get to know it, trusting my hands. It’s flailing wildly. My inner self grounds, centers and calmness ensues. My hands find her hearts path of least resistance. Or known to DOs as the position of ease. It’s rotated left, the medial aspect is superior, the inferior apex is posteromedial. The mid-section has torsion. She begins to respond. Her heart begins to nestle into my hands. Less flailing. Similar to a wild dog who doesn’t know you or trust you now deciding to take a leap of faith/gamble to begin to respond to your because somehow on some level it knows it will help. As she beings to settle in my hands, my R fingertips begin to release the costal vertebral attachment therefore releasing some of the sympathetic chain ganglia.
Short and Sweet.
We hold it together for a moment. My patient notices right away. The tense fearful body position eases up. Her breathing is no longer through pursed lips. The fear begins to drain from her face. Without being stimulated she voluntarily states she ‘felt that’ and ‘feels calmer’ now. Thank you. The nurse returns with the metoprolol. We give her half the dose now. The patient is becoming more comfortable. As time ticks by we do give the full dose and transfer her to the CCU to keep an eye on her. She again thanks me for not letting her take a shower.
I’m standing next to the bedside of my patient who came in for shortness of breath. Real simple: tele, rate control, O2 sat >88% in patient with COPD exacerbation. She is much improved from yesterday’s admission with the exception of that new acute onset of HR > 200. She’s 75 years old, looks 55 years old. She’s five feet tall and 120 pounds soaking wet. She’s talking to me letting me know that she’s happy I didn’t let her take a shower this morning even though her daughter was more than adamant that the “shower must be today.” My patient is smiling at me frozen in her supine position now starting to get lightheaded and somewhat short of breath. She is noting a ‘chest discomfort’ and palpitations feeling like a ‘racing heart’ now. We are not in the CCU but a regular med surg floor. Her last BP was 200/110, HR 210. I sent my nurse out for IV metoprolol STAT. Standing at the side of the bed seeing her heart gallop under her ribs, feeling her frozen position out of fear, hearing her strained but calm voice as recognition of her condition dawns on her – it feels like the nurse (who is doing her due diligence) is taking F-O-R-E-V- E-R. I know she is not.
Don’t forget we can always do something. The tools are ALWAYS with us. We just have to choose to use them. O
Believe me – it takes seconds – but feels like minutes.
I’m standing right in front of the vitals screen.
The monitor slows down. HR 130’s. BP 160/76.
Watching her. Watching it.
Health & Wellness
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