Session Descriptions

Venous Insufficiency: The Vascular Disease Costing Billions that No On Teaches About
Thomas Eidson, DO; Atlas Vein Care
In this session the focus will be on the most common vascular disease in the United States that very few people have heard of, and even fewer actually understand, Venous Insufficiency. You will come away from this with an understanding of just how common vein disease is, and just how devastating it can be if missed and left untreated. That this common, easily diagnosed, and very treatable medical condition is costing the US medical system and economy billions. The good news is that you will also come away with the education, knowledge and realization that you can be the hero in your patient's lives by understanding and recognizing this vascular disease and help to get them the care they need.

Upon completion of this presentation, participants will be able to:

1. To understand what vein disease is and the full spectrum of symptoms and problems it can cause their patients.
2. To easily be able to recognize vein disease in their patients regardless of stage of the disease.
3. To have knowledge and understanding on how vein disease is diagnosed, managed and ultimately treated to give patients a better quality of life and prevent worsening of clinical symptoms.

The rate of obesity continues to be on the rise across all ages and demographics. While this is not a surprise to many, it is less well known the vast extent which weight management has been identified as first line treatment modalities for chronic diseases. The ACC/AHA guidelines have advocated for weight management as a means of controlling hypertension. Efforts to decrease rates of hepatocellular carcinoma have suggested that lifestyle modification can be the greatest step in preventing HHC and liver-related mortality. Even with this evidence and much more, patients continue to struggle with weight management. The Glucagon Like Peptide-1 (GLP-1) agonists have gained attention for their ability to promote significant weight reduction. But what is the mechanism to their impressive weight reduction ability, and what other clinical benefits may this class provide? This topic will discuss this and more.

Upon completion of this program, participants will be able to:

1. Discuss the prevalence of obesity and the protective benefits which weight management has on multiple systems.
2. Discuss current FDA approved weight management options, with focus on GLP-1 mechanism of action.
3. Identify the barriers which patients suffering with obesity face and ways in which we can help with long term success.

Refreshment Break

Double Trouble: The Opioid Epidemic Meets COVID-19 ^(OPIOID)
Sahar Soliman, RPh, PhD; SHSU-COM
The opioid epidemic has posed a significant public health challenge in the United States for decades, with the COVID-19 pandemic further complicating the crisis. Despite extensive efforts to reduce opioid overdose deaths, the death toll continues to rise. In this presentation, we aim to explore the impact of the pandemic on the opioid epidemic, including the disruption of access to prevention, treatment, and harm reduction services, the disproportionate impact on vulnerable populations, and the changes in drug market dynamics resulting in riskier drug use behaviors. The purpose of this presentation is to identify the urgent need for effective prevention and treatment strategies that address the complex social, economic, and behavioral factors driving the opioid epidemic.

Upon completion of this program, participants will be able to:

1. Recognize the economic, health, and societal impact of the opioid epidemic before and after the COVID-19 pandemic.
2. Identify the challenges caused by the COVID-19 pandemic to programs and initiatives aimed at addressing the opioid epidemic.
3. Examine the interplay of the pandemic and social determinants of health, disproportionately escalating the opioid epidemic in vulnerable populations.

Marching to the Beat of their Own Drum: The Unique Primary Care Needs of the Performing Artist
James Aston, DO; UNTHSC-TCOM
We have all been inspired by their work on stage, enjoyed watching their movies, or sat listening, enthralled by their music. Performing artists are the center of the entertainment that lightens our mood, fulfills our desire for adventure, scares our pants off, or makes us laugh uncontrollably. Life without their work would be continuous drudgery, and so we pay for them to make our lives enjoyable. But behind that spectacular clear-as-a-bell soprano voice, that impossibly graceful ballerina or the deeply soulful jazz pianist is a person driven to perform. They perform despite injuries that physicians are unable to diagnose. They perform despite low pay or no insurance. And they do it for us. Join me, the world's first performing arts medicine fellowship trained primary care physician as we discuss this underserved patient population. You will learn why these folks are not your normal primary care patients, what makes them unique, and how to provide care that addresses their particular needs.

Upon completion of this program, participants will be able to:

1. Describe at least 3 common performing arts environmental stressors that negatively impact a performer's health.
2. Describe what elements of an artist's performance history should be added to an H&P.
3. List mental illnesses common to performing artists.
4. List commonly used medications that should be avoided by performers

Lunch on your own

Pediatric Obesity: A Multi-Disciplinary Overview of the Evaluation and Management
Natalie Slater, MD; Jessica Bradley, PhD, and Rob Slater, MD; UIW-SOM
This session will explore the evaluation and management of pediatric obesity from the perspectives of a family and integrative medicine physician, pediatrician, and physiologist. By using the recently

released clinical practice guidelines from the American Academy of Pediatrics (AAP) as a framework and by reviewing advances in the understanding of the underlying basic science of pediatric obesity,
healthcare providers will be equipped with knowledge and skills to provide holistic, patient-centered care for children and adolescents with obesity.

Upon completion of this presentation, participants will be able to:

1. Summarize the current clinical practice guidelines for the evaluation and management of pediatric obesity.
2. Relate the underlying pathophysiology of pediatric obesity to its evaluation and management
3. Discuss evidence-based, holistic patient-centered management of pediatric obesity, with an emphasis on specific lifestyle approaches.

To Code or Not to Code: That is the Question
Martha Danhof, DO
There is great deficiency in dealing with end of life care, patients and families understanding of CODE situations. Many physicians have resistance to discuss code status with patients and families. Students and residents are not taught how to address. The problem is present in office and hospital situations. Education for doctors and families regarding  consequences  of coding patients needs to be advanced. We need  to be empathetic and realistic when medical situations present difficult decisions for physicians, medical staff, families, and patients.

Upon completion of this presentation, participants will be able to:

1. Discuss ethical issues associated with codes, advanced directives
2. Become familiar with ways to address end-of-life care with patients and families.
3. Understand how to review codes, DNR, limited DNR and full code.
4. Discuss what really happens during a code with patient and family
5. Discuss expectations and review survivability of coding
6. Review CPR and associated beneficence, nonmaleficence

Refreshment Break

Introduction to Ayurveda
Jim Davis, DO
During this presentation, the speaker will present a very brief history of Ayurveda. Next, the speaker will applying the principles of ayurveda to the physiology and the concept of Bio- Individuality (body types). Dietary recommendations for each of the body types will be given as well as general recommendations for an Ayurvedic Daily Routine to create a balanced lifestyle. Brief examples of Ayurvedic treatments to restore balance to the physiology will be presented.

Upon completion of this program, participants will be able to:

1. For Osteopathic Physicians to become aware of one of the major forms of Alternative Medicine that their patients may be using.
2. Present a potential avenue for interested DOs to expand their own use of an Integrative Medicine model in their practice.
3. To present a potential avenue for interested DOs to utilize these principle of Natural Medicine to improve health in their own lives.

Insecurity, Broccoli, and a Professional Life in Medicine ^(ETHICS)
W. Robert Kiser, MD; UIW-SOM
Through the use of narrative, humor, and shared experience, this session will focus on identifying and overcoming the fears and anxieties common amongst physicians (and physicians in training.)  The session takes a full hour, is suitable for both medical professionals and their families (if desired), and works best if there is an opportunity for Q&A afterwards. 

Upon completion of this program, participants will be able to:

1. To normalize the experience of professional security in medicine
2. To identify survival strategies for physicians and physicians in training
3. To develop and foster sense of community within the profession

Stats and Guidelines in Pain Management: “Where have we been and where are we going?” ^(OPIOID)
Kathleen Farrell, DO; Veteran's Administration
Patients who have been on opioids behave differently than patients who have the same pain diagnosis and are opioid naïve. Many patients who are taking full agonist opioids or have stopped opioids can get depressed, anxious, and even commit suicide when their opioids are changed or stopped. This is starting to be recognized and guidelines are changing.

In this session we will look at the morbidity and mortality statics affecting Patients on Opioids so we can understand why the guidelines are changing. We will put the Opioids Crisis in perspective and look at how we can improve the care of our patients who are on or have been on opioids. We will look at alternatives like Buprenorphine and why it behaves differently in patients than full agonist opioids. Highlighting the CDC guidelines that were released in November or 2022 we will look at how they can be used in clinical practice.

Upon completion of this program, participants will be able to:

1. Understand the need for addressing pain management in primary care and in all medical practices.
2. Put the Opioid Crisis in perspective
3. Look at why Buprenorphine is different than full agonist opioids.
4. Learn guidelines for pain management, emphasizing the November 2022 CDC Clinical Practice Guidelines for Opioids Pain Management for Pain Management

What's the One Exam, Again? 
Malinda Hansen, DO; UNTHSC-TCOM
In this session, the speaker will give a review of the highest yield, evidence-based MSK exams with sensitivities/specificities from head to toe with corresponding algorithms for nonoperative and ‘when to refer’ indications. 

Upon completion of this program, participants will be able to:

1. Apply common MSK exams in a clinical context
2. Incorporate evidence-based treatment algorithms for MSK injuries
3. Integrate information into daily practice with common MSK presentations.

Refreshment Break

OMT Without a Table
Scott Leggoe, DO; UIW-SOM
The practice of osteopathic manipulative treatments is beneficial to patients and physicians on my levels, however, the actual employment techniques can be limited by time and space. This workshop seeks to teach practical, office-based techniques that can be performed in many environments and efficiently so that time and space are not as much of a limiting factor. We will discuss adaptations for different office setups and anatomy/habitus of the patient and practitioner as well as billing & coding practices to justify the time and effort taken.

Upon completion of this program, participants will be able to:

1. Become more comfortable incorporating OMT in the standard office visit for many common complaints
2. Learn new ways to become more ergonomic, effective and efficient with OMT skills given the limitations of a typical office setup
3. Justify the practice of OMT on a routine basis via updated billing/coding practices and EBM benefits for both practitioner and patient.

TOMA/TXACOFP Installation/Awards Luncheon

Just Like Riding a Bike...
Malinda Hansen, DO; UNTHSC-TCOM
This will be an audience driven (by vote) of upper extremity vs. lower extremity exams to be reviewed. There will be a presentation and techniques ready for whichever is chosen by the group. Whichever session is chosen will review five (5) high-yield techniques to review with a partner.

• UE: shoulder, ribs, cervical exaggeration technique, ribs FPR review, thoracic HVLA review
• LE: activation patterns, lumbar exaggeration technique, lumbar HVLA review, foot/ankle articulatory techniques

Upon completion of this program, participants will be able to:

1. Demonstrate OMM techniques for common upper extremity somatic dysfunction
2. Utilize functional tests to determine the biomechanical likelihood of success of OMM
3. Clinically integrate OMM into common MSK presentations.

Break

Human Trafficking: Training for Healthcare Professionals ^{(HUMAN TRAFFICKING)}
Muriel Lanford, MSN, RN, TCRN; Ransomed Life
This session will provide an in-depth overview of what human trafficking is, how to differentiate human trafficking from human smuggling and consensual commercial sex. In addition, the speaker will explain the scope of the problem, provide insight on how to recognize vulnerabilities, risk factors, and indicators. Finally, the speaker will provide detail on how healthcare providers can apply patient-centered interventions.

Upon completion of this program, participants will be able to: 

1. Differentiate human trafficking from human smuggling and consensual commercial sex
2. Recognize vulnerabilities, risk factors, and indicators of human trafficking
3. Apply patient-centered interventions and strategies for healthcare providers.

Management of Anomalous Coronary Arteries
Devin Haney, DO; UTHSC at Tyler
This session will provide a comprehensive literature review of current consensus on managing coronary anomalies following a case presentation.

Upon completion of this program, participants will be able to:

1. teach the different types of coronary anomalies
2. Understand which anomalies are benign and require intervention
3. Understand medical management of the disease

Having performed the first in-utero repair of a spina bifida patient in Texas, Dr. Fletcher has performed more than 150 of these operations since 2011. The rationale, technical aspects of the surgery, and long term management in conjunction with primary care providers will be discussed. This is one entity where excellent coordination between the neurosurgical and the primary care team are crucial to maximizing the long term outcomes of this complex medical problem. The problem list and it's changes from infancy to adulthood are discussed.

Upon completion of this program, participants will be able to:

1. Review the wide range of clinical problems in patients with open neural tube defects
2. Discuss the primary care management in this complex patient group from childhood into adulthood
3. Review the impact of the new technology of in-utero surgery and how it dramatically altered the outcomes of these patients.

Taking the Stress Out of Pain Management: Healing Relationships in Pain Management ^(OPIOID)
Kathleen Farrell, DO; Veteran's Administration 
Patients are on opioids and it is not my fault. However, it is our responsibility as an Osteopathic Physician to address the health concerns of the whole patient and this includes pain and the management of opioids. In our busy Medical Practices it can be difficult to address all the concerns our patients bring to us. Patients who have been on or are on opioids can be time consuming and create provider and staff anxiety which can lead to burn out.  

Upon completion of this program, participants will be able to:

1. Improving communications with patients on Opioids
2. Learn how to triage pain patients in an osteopathic practice
3. How to use the Buprenorphine alternative

Break

The Menopause Star: A New Paradigm for Teaching Menopause Management
Deanah Jibril, DO

This session outlines a new graphic which simplifies the identification and treatment of the onset Menopause symptoms. Using the Star model, a physician can easily identify which clusters of symptoms are related to menopause and can help women navigate the continuum of Menopause transition more effectively in a concise, easy to learn manner.

Upon completion of this program, participants will be able to:

1. Identify distinctions from early to late onset of menopause
2. Understand treatment options
3. Learn how to navigate the transition of menopause more effectively.

Cornering Depression: Update in the Diagnosing and Treatment of Major Depressive Disorder
Nathan Johnston, DO; Phoenix Mental Health
With the ongoing shortage of psychiatrists and other mental health providers across the country, the onus of mental health treatment is falling largely onto primary care physicians and non-psychiatric specialists. The purpose of this presentation is to increase the knowledge and confidence of non-psychiatric providers in the diagnosing and management of major depressive disorder (MDD) using a variety of evidence-based treatments. This presentation will start with a brief review of MDD diagnostic criteria and pathophysiology, will then move on to a review of the clinical details of classic pharmacological MDD treatments (i.e. antidepressants, augmenting agents), and will conclude with a discussion of the clinical details of newer interventional treatment modalities (i.e. psychedelics, transcranial magnetic stimulation, and electroconvulsive therapy).

Upon completion of this program, participants will be able to: 

1. Review the diagnostic criteria for Major Depressive Disorder (MDD) and briefly discuss its proposed pathophysiology.
2. Review the mechanisms of action of classic MDD treatments (i.e. antidepressants, augmenting agents), their safety and efficacy, and when their use is indicated /@ should be considered.
3. Discuss the proposed mechanism of action of interventional MDD treatments (i.e. Psychedelics, Transcranial Magnetic Stimulation (TMS), Electroconvulsive Therapy (ECT)), their safety and efficacy, and when their use is indicated /@ should be considered.

Box Lunch 

Communicating with Patients' Family and Friends ^(ETHICS)
Charles Kels, JD; US Department of Homeland Security, Office of Health Security
Family and friends play an integral role in patient care, but restrictive privacy laws are often cited as a barrier to information-sharing. This session seeks to dispel myths surrounding privacy laws and explain the legal parameters and best practices in communicating with patients' family, friends, and others involved in their care. The session will provide osteopathic physicians with key concepts and practical examples critical to both protecting patient privacy and engaging in commonsense communications with patients' loved ones to advance patient care.

Upon completion of this presentation, participants will be able to:

1. Describe the circumstances in which privacy laws permit the sharing of protected health information (PHI) with patients' family, friends, and/or caretakers.
2. Describe the circumstances in which privacy laws prohibit the sharing of PHI with patients' family, friends, and/or caretakers.
3. Discuss how understanding the professional discretion afforded to clinicians under health privacy laws can optimize patient care and improve patient-physician communication.

Culinary Medicine: Practical Applications of Lifestyle Modifications for Weight Loss in Patients
Scott Leggoe, DO; UIW-SOM
Most al clinical guidelines for common conditions such as diabetes, hypertension, coronary artery disease, etc., include lifestyle modification as the first line recommendation, however, we are hard pressed for time and, frankly, lack of a good knowledge base to educate patients other than the age-old adage of "eat less, move more."

This discussion seeks to shed some light on the culinary landscape outline that patients flock to as an alternative, often leading them astray into further detriment to their health, and shows how you can incorporate some of this into your own practice to teach sustainable and evidence-based weight loss education for patients from a diet & exercise standpoint.

Upon completion of this program, participants will be able to:

1. Discuss caloric balance and how it can be practically discussed with patients as an effective weight loss tool
2. Discuss realistic exercise recommendations for patients including the reality of its effect on weight loss, but also other health benefits
3. Overview practical employment of diet and exercise discussions in the office setting including billing/coding and justifying its usage in the busy practice environment.