Rancho Cucamonga, CA – Fall 2025 – The Journal of the American College of Osteopathic Family Physicians of California (JOFPCA) showcases a practical, ready-to-use Patient Education Handout (PEH) for point-of-care use: “Breast Cancer Screening: Current Guidelines.”

Featured Patient Education Handout

Breast Cancer Screening: Current Guidelines

Haley Sims, OMS-IV; Madeline Linn, OMS-II; Larry Witmer, DO, FACOFP
Downloadable PDF for clinicians to share directly with patients

This concise, clinic-ready handout summarizes current guidance on breast cancer screening to support shared decision-making. It is designed for primary care and women’s health visits, providing clear, plain-language explanations patients can take home.

What’s Inside

• Screening Overview: Purpose of screening and how it helps detect breast cancer earlier.
• Age- and Risk-Informed Screening: Simplified guidance to discuss timing and frequency based on individual risk.
• Screening Methods: Brief descriptions of mammography and supplemental imaging considerations for higher-risk patients.
• Shared Decision-Making Tips: Conversation starters to align screening plans with patient values and preferences.
• Practical FAQs: What to expect, how to prepare, and when to follow up.

Explore more resources in the Fall 2025 issue at JOFPCA.com.

Rancho Cucamonga, CA – Fall 2025 – The Journal of the American College of Osteopathic Family Physicians of California (JOFPCA) showcases a clinically challenging case report that informs multidisciplinary care for immunodeficient patients: “Difficulty in Treatment of Inflammatory Arthritis in a Patient with Common Variable Immunodeficiency: A Case Report.”

Featured Article

Difficulty in Treatment of Inflammatory Arthritis in a Patient with Common Variable Immunodeficiency: A Case Report

Trung Nguyen Dang, OMS-IV; Dominic Dizon, MD
DOI: 10.58858/040303

Abstract
Background: Common Variable Immunodeficiency (CVID) is the most common primary immunodeficiency in adults. Autoimmune complications occur in up to 30% of patients, including inflammatory arthritis that often resembles rheumatoid arthritis. Standard management typically involves immunoglobulin replacement, combined with disease-modifying antirheumatic drugs (DMARDs) and corticosteroids, which are effective in most cases.

Case Presentation: We present a 55-year-old male with CVID who developed progressive inflammatory arthritis refractory to multiple regimens. His management was complicated by methotrexate-induced leukopenia, corticosteroid-induced osteoporosis, and limited specialty continuity. Despite therapy with immunoglobulin, DMARDs, and corticosteroids, his joint symptoms persisted and worsened.

Discussion: This case underscores the challenges of treating autoimmune complications in immunodeficient patients. It highlights the importance of careful monitoring for drug toxicities, vigilance for secondary complications, and coordination across specialties.

Conclusion: Inflammatory arthritis secondary to CVID is often responsive to immunoglobulin therapy and standard regimens but may prove challenging to treat when complications or contraindications limit treatment.

Keywords: Common Variable Immunodeficiency, Inflammatory Arthritis, Primary Care, Case Report

Key Highlights

• Autoimmunity in CVID: Inflammatory arthritis can mimic rheumatoid arthritis and complicate management decisions.
• Therapeutic Complexity: Refractory symptoms despite immunoglobulin, DMARDs, and corticosteroids.
• Safety Monitoring: Illustrates real-world toxicities (e.g., methotrexate-induced leukopenia; steroid-induced osteoporosis).
• Care Coordination: Emphasizes continuity across specialties and vigilant follow-up in immunodeficient patients.

Explore more in the Fall 2025 issue at JOFPCA.com.

Rancho Cucamonga, CA – Fall 2025 – The Journal of the American College of Osteopathic Family Physicians of California (JOFPCA) features an insightful case report: “Neuropsychiatric Manifestations in a Patient Identified as a Premutation Carrier of the FMR1 Gene Linked to Fragile X Syndrome.”

Featured Article

Neuropsychiatric Manifestations in a Patient Identified as a Premutation Carrier of the FMR1 Gene Linked to Fragile X Syndrome

Aaron Bautista, OMS-IV; Marissa Tran, OMS; Amreen Maniar, DO; Nikhil Sinha; Emily Fu, MD
DOI: 10.58858/040302

Abstract — This case presentation delves into the multifaceted clinical assessment and intervention of an 8-year-old male, born prematurely, exhibiting challenging behaviors such as leaving school premises without notification and displaying verbal and physical aggression towards peers. Initial diagnoses of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) led to the initiation of guanfacine treatment, yielding minimal benefits for ADHD symptoms. Subsequent genetic analysis revealed the patient to be a Fragile X premutation carrier, prompting further investigation into the complex interplay of genetic factors influencing behavior. However, assessments by the geneticist failed to fully explain the observed behaviors, emphasizing the need for a comprehensive understanding of overlapping symptoms. This case study underscores the significance of ongoing research in child psychiatry, which facilitates the refinement of therapeutic strategies and the implementation of targeted interventions tailored to the unique genetic and behavioral profiles of each patient.

¹ Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, CA
² Loma Linda University Medical Center, Loma Linda, CA

Key Highlights

• Genetic Insight: Identifies FMR1 premutation as a contributing factor in behavioral manifestations.
• Behavioral Complexity: Illustrates overlapping presentations between ASD, ADHD, and Fragile X premutation.
• Clinical Challenge: Demonstrates limitations of current diagnostic frameworks in explaining multifactorial neuropsychiatric symptoms.
• Future Direction: Highlights the importance of precision medicine and targeted behavioral interventions in pediatric psychiatry.

Explore more in the Fall 2025 issue at JOFPCA.com.

Rancho Cucamonga, CA – Fall 2025 – The Journal of the American College of Osteopathic Family Physicians of California (JOFPCA) highlights a compelling case report: “A Rare Case of Spindle Cell Carcinoma of the Lung with Targetable MET Exon 14 Skipping Mutation.”

Featured Article

A Rare Case of Spindle Cell Carcinoma of the Lung with Targetable MET Exon 14 Skipping Mutation

Alene Lai, OMS-IV; Adriana Eslamian, MD; Josebelo Chong, MD
DOI: 10.58858/040301

Abstract — Background: Spindle cell carcinoma (SCC) of the lung is a rare, poorly differentiated variant of non–small-cell lung cancer (NSCLC) characterized by aggressive behavior and limited therapeutic options.

Case Presentation: A 78-year-old man with prior rectal cancer presented with back pain, altered mental status, dyspnea, and chest pain. Workup revealed hypercalcemia of malignancy, metabolic encephalopathy, and prerenal acute kidney injury. Imaging identified a 7.6 × 5.1-cm right upper-lobe pulmonary mass with metastases to bone, liver, and adrenal gland. Endobronchial ultrasound showed >90% obstruction of the right upper-lobe bronchus. Transbronchial biopsy confirmed SCC (keratin AE1/AE3 positive; HMB45/CD45 negative). Next-generation sequencing demonstrated a MET exon 14 skipping mutation. The patient received palliative spine radiation and capmatinib 300 mg twice daily, with improvement of hypercalcemia after intravenous fluids and zoledronic acid. Given advanced disease and clinical decline, care transitioned to hospice.

Conclusion: This case underscores the aggressive course of pulmonary SCC and the clinical importance of identifying targetable alterations such as MET exon 14 skipping.

¹ Touro University California College of Osteopathic Medicine, Vallejo, CA
² St. Joseph’s Medical Center, Stockton, CA

Key Highlights

• Rare Histology: Pulmonary spindle cell carcinoma with aggressive clinical course.
• Extensive Disease: Large primary mass with multi-organ metastases and bronchial obstruction.
• Actionable Genomics: MET exon 14 skipping mutation guiding targeted therapy (capmatinib).
• Clinical Relevance: Reinforces value of molecular profiling to uncover treatment avenues in NSCLC variants.

Explore more in the Fall 2025 issue at JOFPCA.com.

Rancho Cucamonga, CA – Spring 2025 – The Journal of the American College of Osteopathic Family Physicians of California (JOFPCA) proudly features the original article “Osteopathic Family Physicians and the Care of Children in Special Education: A Whole-Person Approach to Medical, Psychological, and Long-Term Needs” by Steven Kamajian, DO, CMD, FACOFP, of the Westminster Free Clinic and Community Care Center in Thousand Oaks, CA.

Featured Article

Osteopathic Family Physicians and the Care of Children in Special Education

Steven Kamajian, DO, CMD, FACOFP
This article addresses the complex needs of pediatric patients in special education programs. Key facts include:

• Heterogeneous Needs: Children with special education needs often face coexisting medical, psychological, and developmental challenges.
• Holistic Assessment: Integrated evaluations at the Westminster Free Clinic combine family history, behavioral observations, and interprofessional insights.
• Long-Term Planning: Emphasizes continuity of care, school collaboration, and caregiver support to optimize lifelong outcomes.
• Psychological Support: Incorporates counseling referrals and mindfulness techniques adapted for pediatric patients.
• Osteopathic Interventions: Gentle cranial and myofascial techniques support neurologic and musculoskeletal function in children.

Through case vignettes and outcome data, Dr. Kamajian demonstrates how a whole-person approach can improve quality of life and educational engagement for children with special needs.

doi:10.58858/040202

Read the full article

Rancho Cucamonga, CA – Spring 2025 – The Journal of the American College of Osteopathic Family Physicians of California (JOFPCA) is proud to highlight the compelling case report “Use of Nair in Treating Refractory Palmoplantar Keratoderma” by Aaron Bautista, OMS-IV; Marissa Tran, OMS-IV; and Abby Tyagi, MD. This innovative report explores an unconventional adjunctive therapy for treatment-resistant PPK.

Case Report Overview

Use of Nair in Treating Refractory Palmoplantar Keratoderma

Aaron Bautista, OMS-IV; Marissa Tran, OMS-IV; Abby Tyagi, MD
Background: Palmoplantar keratoderma (PPK) presents as thickened skin on palms and soles, often unresponsive to standard treatments. This case follows a 65-year-old Hispanic female with long-standing, refractory PPK. Despite therapies like Apremilast, Soriatane, Secukinumab, and steroids, symptoms persisted.

Case Presentation: In a novel approach, the patient applied depilatory cream (Nair) to affected areas, achieving immediate but transient relief in hyperkeratosis, fissuring, and pain. Symptom recurrence within 1–2 days underscores the cream’s short-term efficacy without curative effect.

Discussion: This report introduces depilatory cream as a potential adjunct for symptomatic relief in refractory PPK. The exfoliative action of Nair may explain temporary improvements, though mechanisms remain unclear. Further controlled studies are recommended to assess long-term safety and effectiveness.

Conclusion: Depilatory cream provided immediate symptomatic relief in this challenging PPK case, warranting additional research into its role as an adjunctive therapeutic option.

doi:10.58858/040201

Read the full case report

Rancho Cucamonga, CA – Spring 2025 – The Journal of the American College of Osteopathic Family Physicians of California (JOFPCA) is proud to shine a spotlight on “A 12-Step Framework to Support Resilience in Osteopathic Family Physicians” by Habib Sadeghi, DO. According to the 2024 Medscape Physician Burnout and Depression Report, 49% of physicians report experiencing burnout—and osteopathic family physicians (OFPs) are no exception. This article presents a comprehensive, evidence-based framework to help OFPs build resilience and prevent chronic stress.

Featured Article

A 12-Step Framework to Support Resilience in Osteopathic Family Physicians

Habib Sadeghi, DO
Grounded in osteopathic principles and behavioral science, Dr. Sadeghi’s framework incorporates mindfulness-based stress reduction, gratitude practices, movement-based interventions, and technology-enabled wellness tools. Core to the model is self-directed OMT—highlighting Suboccipital Release, Thoracic Inlet Release, Rib Raising, and Pectoral Traction—to relieve tension, regulate autonomic function, and promote lymphatic and respiratory health. doi:10.58858/040203
Read the full article

Key Highlights

• Burnout Insight: 49% of physicians face burnout; OFPs are particularly vulnerable.
• Behavioral Science Integration: Utilizes self-determination theory and growth mindset psychology.
• Practical OMT Techniques: Four self-directed manipulative treatments for immediate relief.
• Holistic Resilience: Combines mind-body strategies with technology tools for sustainable well-being.

Discover how this 12-step plan can transform your approach to self-care and professional longevity.

Explore the Spring 2025 issue and download your resilience roadmap at JOFPCA.com.

Rancho Cucamonga, CA – March 20, 2025 – The Journal of the American College of Osteopathic Family Physicians of California (JOFPCA) is pleased to announce the Spring 2025 issue. Among a range of insightful articles, one highlight is OMT for the Busy D.O. which delivers practical, time-efficient osteopathic manipulative treatment strategies tailored to today’s high-demand family physician.

Featured Article Highlight:

OMT for the Busy D.O.

Victor Nuño, D.O.
Dr. Nuño presents a streamlined protocol for integrating osteopathic manipulative treatment into a packed clinical schedule. From rapid soft-tissue release techniques to in-chair muscle energy maneuvers, this article offers actionable steps, helping DOs enhance patient comfort, improve functional outcomes, and reduce strain. doi:10.58858/040204

Why You Can’t Miss This

With detailed step-by-step photo guides, Dr. Nuño’s article transforms traditional OMT workflows, helping practitioners maximize therapeutic impact in minimal time.

Read the full article and download at JOFPCA.com.

Spring 2025 JOFPCA Issue Highlights Advancements in OMT, Resilience, and Special Education Pediatric Care

Published by the Journal of the American College of Osteopathic Family Physicians of California (JOFPCA)

Rancho Cucamonga, CA – Spring 2025 – The Journal of the American College of Osteopathic Family Physicians of California (JOFPCA) announces the release of its Spring 2025 issue, featuring clinical innovations, and educational resources that reflect the evolving practice of osteopathic family medicine. Topics include advancements in osteopathic manipulative treatment (OMT), physician resilience strategies, and whole-person approaches to special needs pediatric care.

Table of Contents

Original Articles

OMT for the Busy D.O.

Victor Nuño, DO
Nuño V. OMT for the Busy D.O. J Am Coll Osteopath Fam Physicians Calif. 2025;Spring. doi:10.58858/040204

A 12-Step Framework to Support Resilience in Osteopathic Family Physicians

Habib Sadeghi, DO
Sadeghi H. A 12-Step Framework to Support Resilience in Osteopathic Family Physicians. J Am Coll Osteopath Fam Physicians Calif. 2025;Spring. doi:10.58858/040203

Osteopathic Family Physicians and the Care of Children in Special Education: A Whole-Person Approach to Medical, Psychological, and Long-Term Needs

Steven Kamajian, DO, CMD, FACOFP
Kamajian S. Osteopathic Family Physicians and the Care of Children in Special Education: A Whole-Person Approach to Medical, Psychological, and Long-Term Needs. J Am Coll Osteopath Fam Physicians Calif. 2025;Spring. doi:10.58858/040202

Case Report

Use of Nair in Treating Refractory Palmoplantar Keratoderma

Aaron Bautista, OMS-IV; Marissa Tran, OMS-IV; Abby Tyagi, M.D.
Bautista A, Tran M, Tyagi A. Use of Nair in Treating Refractory Palmoplantar Keratoderma. J Am Coll Osteopath Fam Physicians Calif. 2025;Spring. doi:10.58858/040201

Patient Education Resource

Move Better, Feel Better: The Power of Self-OMT

Humza Baig, OMS-III
Baig H. Move Better, Feel Better: The Power of Self-OMT. J Am Coll Osteopath Fam Physicians Calif. 2025;Spring.
Download the handout (PDF)

To access the full Spring 2025 issue, including downloadable patient resources and full-text articles, visit JOFPCA.com.

Media Contact: editorial@jofpca.com

About JOFPCA

The Journal of the American College of Osteopathic Family Physicians of California (JOFPCA) is a peer-reviewed publication dedicated to advancing osteopathic family medicine through scholarly research, case reports, and practical tools that support whole-person care and professional development.