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Notes from the Practice of Harold Goodman, D.O.

Live your dream.  Saturday, January 30, 2010

Today I received an e mail from a man who watched a video interview between me and another doctor. He had sought me out and asked to record an interview. It is on the net and occasionally I hear from people who watched it.

My practice here is a small one compared to almost every other medical practice in the Washington, DC area. It consists of one part-time secretary and me. A couple of exam/treatment tables, a few desks and chairs, some lights, not much else.

I have been doing this for 18 years at this point.

Over that time I have gone through a lot in my life; cancer, heart attack, etc. etc. If I had known I had to go through it I don't know if I would have been able to. Thank God, I don't know what happens next.

As I look back I really am amazed that I have made it to this point. I never realized that I was as strong as I have been. I have gone through the fire, been tempered and am here to live on another day.

I always wanted to do something worthwhile with my life.

Something that would make this a better place than I found it.

However, I had to deal with my own private demons and those of the people around me. It wasn't easy for me to trust and find peace here in this world. The alternative was so much harder that I just forced myself to keep going.

I am not really sure of what will come next. There is a part of me that craves some structure and security but life does not seem to work that way.

My work is very personal.

I want to be the doctor that I would want for me.

The one who listens, who cries with the patient, the one who does whatever is necessary to help.

I want to make a difference for each of you.

When I walk into the room I never know what to expect. I have no treatment plan or agenda. I just want to be real because, in my experience, that is our only hope for real healing.

And we all desperately need real healing.

I wrote this because I need to.

Maybe it will be helpful to someone.

I sincerely hope so.

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Organs have range of motion.  Monday, November 09, 2009

Every structure in the body has its own specific range of motion.

We learn in medical school that this is true of joints. However, few physicians understand that this is true of all the body's organs as well.

The practical application of this fact of nature is that just as a limitation in joint motion translates into a limitation in the function of that joint, since motion is the key function of the joint, so, too, does limitation of internal organ motion have a negative effect on the function of that organ.

A few recent examples from my practice:

Bladder:
A patient arrived with a lot of bladder pain following a procedure with a well-known university urologist. The procedure was done to help him with a very dysfunctional bladder. While the procedure was judged successful the patient was absolutely miserable. The doctor had counseled him to just tough it out and that eventually he would feel better.

The word eventually was left undefined.

I examined him and found that his pelvic floor was very unbalanced with the muscles on the left in spasm. In addition, the left side of the bladder was very irritated.

However, not unexpectedly, the bladder itself and the ureter were both moving in an abnormal range of motion.

When the above issues were corrected by gentle osteopathic treatment he got better.

Immediately.

He had no more pain following the treatment.

Heart:

A patient had a heart attack and received open heart surgery.
Besides feeling very weak which is natural for a while after this surgery, he also had a lot of chest pain. His breathing was compromised as was his ability to move about.

The heart range of motion was very limited. This is not something that physicians know of and even if they did how would they measure and treat it?

I released the rib heads which were jammed into his back and spine when the sternum was cracked open. I also treated his thoracic diaphragm which was in spasm.

However, the most dramatic thing was to restore the range of motion of the heart.
He was able to visit his extended family for the first time following this and is now doing much better. He is fully ambulatory and able to pretty much take care of himself, drive a car, etc.
Best of all, his entire body is functioning better than it did even before the heart attack.

I am convinced that correction of range of motion of organs can spare us all problems with those very same structures in the future.

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It sure is hard to treat a label.  Tuesday, May 05, 2009

Today I treated a man whom I had treated a few years ago for symptoms of Multiple Sclerosis. His symptoms went away for a few years and just started to return. They were all on the left side.

Boy, was I surprised and shocked to find his left sacro-iliac joint, left diaphragm, left temporal bone, left atlanto-occipital joint, left shoulder, clavicle and other joints all with major problems.

Notice a pattern here??

He talked at length about MS. I told him that I find what the body is doing that could cause this and treat it. I don't try to treat the disease; it's just a label, which is something we often forget.

You can't treat a label , though many physicians still haven't figured this out apparently.

It's a lot easier to treat the body than a label. Well, at least that's my experience.

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Treatment of pregnant women.  Friday, February 27, 2009

I love treating pregnant women.

Osteopathy has so much to offer someone who is going through pregnancy. Imagine such an experience minus back pain, morning sickness, depression, and a myriad number of other things which make pregnancy unpleasant.

In addition, by balancing the entire system and restoring normal pelvic function, labor and delivery become much easier.

One of the best things about this treatment is that the child gets treated in utero. This often results in a happy, healthy neonate and avoids a lifetime of possible problems. I also turn babies who are not facing in the best position for delivery.

For moms who have had problem pregnancies in the past such as premature delivery, pregnancy related hypertension, etc., the osteopathic treatment not only normalizes things and permits the mother to reach successful termination of the pregnancy at or near their due date but also ends the cycle of problem pregnancies.

Midwives and obstetricians often remark at the ease of delivery with women treated osteopathically.

The post-partum time is also much easier.

Since newborns are very amenable to treatment designed to improve their function, I routinely offer the mothers whom I treat during pregnancy a free initial visit for the neonate in order to get the newborn started in the very best way. A child treated in utero as well as soon after delivery stands out as an unusually healthy child.

As an example of what can be done for neonates we can take the example of a newborn who has trouble latching onto the mom's breast for feeding. Osteopathic treatment of the sub-occipital area to free up the hypoglossal and other cranial nerves associated with breast feeding leads to remarkable and rapid changes.

Osteopathy has so much to offer the pregnant mom and her child.

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Update.  Saturday, September 20, 2008

Update.

I am now accepting new patients.

The initial appointment is 9:15 am and the last one in the early afternoon.

Patients of all ages are welcome; neonatal, pediatric, adolescent, adults, older patients and those who are ageless, as well.

Just contact me if you have any questions about my practice. See the e mail contact below.

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Double vision after trauma  Thursday, March 27, 2008

An eleven year old girl recently came in with double vision. It followed an episode in May, 2007, where she fell six feet off of a cliff and smashed the left side of her face against a tree trunk. Many of the facial bones were fractured. She was treated at a local children's hospital where she received plastic surgery.

After an interval of over nine months during which her double vision continued and the swelling of the face didn't change too much, she was brought to me. I examined her and noticed that the original trauma to the fascial and fluid systems ( strains) had not been addressed.

In particular, I found that the geometric angle of her optic chiasma (the place in the head where the optic nerve from each eye crosses over the other) was quite distorted. The bony orbit in which the eye resides consists of seven bones. Each is formed in membrane and remains internally connected to membrane which is continuous with the rest of the cranium and body.

Gentle treatment of these strains resulted in a major improvement in her vision which was noticed by her optometrist as well.

Judicious use of homeopathic Arnica and osteopathy also reduced most of the swelling.

She continues to do well.

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It all started with a sprained ankle  Saturday, April 21, 2007

Sprained ankles are very common. You step the wrong way and twist the ankle. Then it swells up, may get warm ( both signs of inflammation), and is painful to stand or walk on. So far, nothing unusual. What all of us know or have heard is that once you have sprained an ankle it is likely that you will sprain it again.

The typical medical advice is to keep the ankle raised, iced, wrapped or compressed and to rest it, keep off of it. Hence, the large number of people hobbling around on crutches.

Why is it that the same ankle is prone to further sprain?

To be very blunt, the reason is that the original trauma, the sprain or strained connective tissues, ligaments, tendons, fascia ( a type of connective tissue) has never been treated. The above mentioned measures do not treat the trauma. They treat the symptoms of the trauma, the inflammation.

In order to treat the trauma the actual strain pattern in the tissues must be diagnosed and removed. Only osteopathy does this.

I have had people limp into my office on crutches from a recent strain (often young men) and walk out pain free without crutches and not prone to future restraining of the tissues. I have learned how to identify and remove the strain in the tissues.

If I were present at a football game and one of the players sprained their ankle I could have them back in the game, playing within 20 minutes. This is rarely the case with team physicians or sports medicine doctors. Also, the player would be less likely to resprain the same ankle.

I mention this because someone recently told me that a car ran over their foot. They have been receiving acupuncture for some time ( I am a licensed medical acupuncturist, so I believe I am qualified to speak about acupuncture) but were still in quite a bit of pain.

I told them that I often treat such problems with a lot of success. I treat the strain and the symptoms ( read: pain) go away. It is really quite simple and logical. Strains will not show up on imaging studies ( X rays, MRI, CT, etc.). The patient is given the same instructions mentioned above, anti inflammatory medications, and, if they are still complaining, sent to a physical therapist. The problem, the strain, is never treated.

I treat strains. I find them in almost every patient including babies. They result from traumas to the system. How can a new born have a trauma? Being born is quite traumatic. The neonate must travel through a passage which is not large enough to accomodate the body.They have to twist around to get through, their head gets squished which is why it is still soft in parts when the child is born. This is natures way of dealing with the trauma of birth. If the child is large the birth can be even more traumatic. Many obstetricians routinely do an episiotomy where they will cut the muscles so that there will be more give in the mother's tissues to accomodate the child. If this were not done then the muscles might be torn as the large mass ( the neonate) emerges from the relatively small canal. Labor is not called labor for nothing.

People come in with back pain, neck pain, numbness, tingling in their arms or legs, headaches, eye problems, jaw pain, infections, asthma, and so many other problems. In every case I find strains. The strains are removed and the symptoms disappear. It's a no brainer but, unfortunately, something which is not taught and virtually unappreciated outside the community of osteopathic physicians who practice osteopathy in the cranial field.

Incidentally, this is not taught to cranio-sacral therapists, chiropractors and message therapists all of whom receive good training and help many people in need. How do I know they don't receive this training? Because I treat them and they are fascinated to learn what I am doing.

If you have a question on this or anything related to my work, don't hesitate to contact me. I am always happy to answer questions.

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Chronic ear infections in children  Saturday, March 24, 2007

About 30% of my patients are children. Since I treat a lot of pregnant women to get them through pregnancy with a minimum or absence of problems ( back pain, morning sickness, premature labor, etc.) I have long offered a free first visit for the newborn to get the child started off on the right foot. Often this first visit reveals many structural and functional problems ( feeding issues, irritability, reflux and spitting up, asymmetrically shaped heads, asthma and other respiratory problems, etc. etc.) which can be easily treated and quickly reversed.

As the children age they may display delayed development, frequent infections and other common pediatric problems which osteopathic and homeopathic treatment can solve. There are two local pediatricians who have been referring such children to me for many years. Also, word of mouth among moms has been one of my best means of letting people know what osteopathy has to offer these young ones.

By far, the most common pediatric issue I see is the child who suffers from serous otitis media or ear infections. These children receive many rounds of antibiotics and may or may not improve but inevitably come down with yet another infection. At some point the parents are told that the child must receive tubes. This is often when I see the child.

Usually I find that the base of the cranium and especially one or more of the temporal bone are malfunctioning. This impairs normal drainage of the inner ear via the eustachian tube which, in turn, renders the child vulnerable to infections. Hence the ineffectiveness of antibiotics. This is a structural problem which must be treated structurally and will not be cured with a biochemical ( antibiotic) approach.

Often it takes just a few treatments for the pediatrician to notice that the ears look clear. The parents, especially if the child has been in pain, pulling or boring its ear or complaining, will notice earlier. I am able to then discharge these patients. They usually don't require much further treatment unless there is an additional problem.

In 2003 The Archives of Pediatric and Adolescent Medicine, an MD journal published by the AMA, did a study on osteopathic treatment of ear infections.
This is the link which you can paste into your browser to examine:
http://archpedi.ama-assn.org/cgi/content/extract/157/9/852
The authors concluded that there was a significant positive correlation between children who received osteopathic treatment for ear infections and the subsequent improvement in their health. This was welcome news indeed since I realize many people rely on such sources for their knowledge of medicine.

It was also reassuring that such a study appeared in a prominent MD specialty journal. This lends additional credibility to what many osteopathic physicians witness on a daily basis; osteopathy ( and, I would add, homeopathy) are a veritable God-send to a sick child.

What I regularly have witnessed over the years is that children treated in this way are healthier overall, develop better than their peers, and need far fewer doctor visits. It is the most valuable foundation that can be given them for future health.

We have a saying in osteopathy. As the twig is bent so grows the tree. Imagine a small sapling that is bent over. When the twig is small there is not much to notice. When it grows into a tall tree its "bentness" becomes more obvious. However, then it is harder to reverse what formerly could be treated in just a few visits. The earlier we can get to these bent twigs the easier will their lives be. There are few investments with such enormous and long term benefits.


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How a head injury can lead to abdominal problems  Thursday, March 22, 2007

Did you ever see a spider web? They are actually quite intricate in design. Starting from one point the spider creates an enormous mosaic of crafted spittle. Sit and contemplate the web. It is really a work of art. These insects build them to catch other insects.

The web must be of a certain size. Some are quite large. It must have a great degree of bounce. If a fly crashes into it the web must not break. It must absorb the kinetic energy generated by the impact and deftly imprison the hapless fly. The fly must be trapped, unable to escape. The web is designed with all of this in mind. For what it does it functions perfectly.

Consider the human body as a vast spider web. If you pull on a part of the web the entire web responds. It will conform to the impact and absorb it. The web, if pulled at one point, will change shape to accommodate itself to the deformation. Say you grab one piece and gently shift it around in space. The entire web rearranges itself. Every single piece of the web shifts. It works as a single unit.

This is exactly how the human body functions. The body is actually a vast web. The various pieces of the web have many shapes and different tissues. However, they are all part of the same web. If one piece is shifted, every part is shifted no matter how far away from the point of impact or seemingly unrelated.

A blow to the head effects the membranes which make up the skull. Originally, the skull is membranous. The outer layer of membrane becomes bone. The inner layers remain membrane. They have the consistency of shoe leather. They can be bent, twisted, and moved about. They cannot be stretched without tearing which really takes an enormous amount of force. So, in the normal course of life, the membranes get twisted and strained a lot. We call this cranial membranous strain or sprain. It is like a sprained ankle ( which remains vulnerable to reinjury even after the swelling, pain, and other acute symptoms are gone) . You can have these membranous or tissue strains anywhere in the body. They always are accompanied by body dysfunction.

So, again, imagine the spider web. If one piece is twisted upon itself or pulled asymmetrically the entire web mirrors and compensates for this. It's health in action, always finding a perfectly balanced response to the stressor.

The cranium is struck. The membranes in the gut follow suit. The person, sooner or later, experiences gastrointestinal and pelvic problems. No one but a trained-osteopath realizes the connection. No one but a classical osteopath is trained to think, diagnose and treat in this way.

I have seen hundreds of such cases over the last seventeen years. It just reaffirms the intrinsic somatic - visceral connection for me. The body works like a big spider web. Tweak one part, everything else responds.

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Robert Fulford - My teacher and respiration  Friday, March 09, 2007

I studied with Robert Fulford, DO for close to ten years. One of the things he most emphasized was the quality of thoracic respiration in the patient. Like so many things the teachings of osteopathy are like seeds that once planted grow over the years. When they mature they are amazingly potent.

Dr. Fulford once saw my father walking toward him at a course. It was the only time the two ever met but my father has never forgotten him. Dr. Fulford was that kind of man. Unforgettable. Dr. Fulford sent me a holiday card and told me how much he enjoyed meeting my father. He said that he was a gentle, sensitive soul. How true.

Anyway, when we came over together to Dr. Fulford he looked at my father and said, "He's not breathing!" I wasn't sure what to make of this. Of course he was breathing. Otherwise, he would be dead. Later, years later, I discovered that Dr. Fulford was able to distinguish subtle thoracic respiration down to the cellular level. He was able to identify areas where it was diminished and to what degree. Inevitably, when he restored respiration to these areas they would flourish and the patients would usually remark how wonderful they felt. Incidentally, their symptoms would be alleviated or gone.

Recently I have been developing both the skill to identify respiration and its lack throughout the body as well as to restore it where diminished. This has been rejuvenating for both me and the patient! I feel wonderful that the patient is doing better and it deepens my understanding of how the body and its intrinsic Health function.

Today I worked with someone where I was able to identify several of these areas. Both of us were able to appreciate the change that total body breathing makes.

Just take a moment to appreciate how you feel when a part of you (physically, emotionally, spiritually) is shut down. It isn't a pleasant experience as I can attest. However, it can be remedied as I have explained. It makes such a wonderful difference when you feel well. Health is not just the absence of symptoms. It is an actual force like gravity, magnetism, electricity and others all of which have an integral role in body physiology. This immediate grasp of the body's needs without lab tests, imaging studies and other medical workup which was what I was taught in medical school and residency is part of what makes the practice of osteopathy so rewarding for me. It is one of the most powerful ways of which I know to work with the patient as they actually are on all levels.

When every cell breathes you will know it!

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Osteopathy is just common sense  Wednesday, March 07, 2007

Over sixty percent of the body mass is comprised of the musculoskeletal system. This system not only functions as the primary support for everything else but also is what allows us to perform actions and express ourselves. Whether it's vision, eating( one of my favorites),moving about, hearing, speaking, or just about any activity including digestion, elimination, and so on, the musculoskeletal system does it. It also connects everything else in the body. We might expand it to call it the neuromusculoskeletal system.

You might guess that an important system like this would be a central focus for physicians. Guess again. It's not. Medicine, as you will have noticed, concentrates on the organ systems ( heart, lungs, liver,etc.). Also, the medical paradigm, the way medicine views patients and the world is reductionistic. That of course reflects the entire attitude of almost all areas of our society. Things are separated from one another and seen as unique, vaguely related entities. Then we have specialists for the heart, the glands, the liver and so on. Unfortunately, the body was never informed of this and it operates as one unit. What a drag!

The body just doesn't get it. It just doesn't understand that it is supposed to operate as a bunch of separate parts. Obviously, God is inept. Right? I don't think so. Maybe we, as physicians, need to pay more attention to what the body actually does....on its terms and in its language, not our own conceptual overlays.

So, along came Andrew Taylor Still, MD, a nineteenth century physician and surgeon. He lost three kids to spinal meningitis. It was a horrible experience for him and his family. The best doctors were called and the children all died. Dr. Still was a very spiritual man. He asked, Is it possible that God has created man to suffer like this? Maybe there is something for us (him) to learn in all of this.

Of course, great discoveries always happen in this way. A single wo(man) asks an obvious question. Unlike others, they are propelled to actually seek out an answer. Dr. Still quit medicine and decided to start from scratch. Just to study and learn from the body as it actually functions. To let Nature be his teacher.

He quickly realized that the body in its unhindered state was quite able to function and repair itself as need arose. It was complete. It lacked nothing as far as function. In medical school I was taught that over 80% of all illness will resolve on its own. This is the work of the body. It has been around awhile and knows what it is doing.

The body is run by an Intelligence which unites all of us. Dr. Still realized that each of us is somehow linked to this Intelligence. Without it we couldn't exist for a second and, furthermore, would never even have been brought into existence. Man is not just a bunch of physical components. We are something more. We smile, laugh, cry, create great music, experience love and so much more. There is something more going on here than the biochemical explanation of the medical world. Dr. Still realized this.

He found that the neuromusculoskeletal system is the gateway to accessing human function. It is linked to everything, without exception, that goes on in our body. It tenses when we are nervous. It relaxes when we listen to beautiful music or see the face of our beloved. It is the mirror of every aspect of man.

Dr. Still realized that by studying the interrelationships of all parts of the body as the operation of One system he could better aid his patients. He then found how he could use his hands in very gentle ways to work with the body's own reparative forces and promote normalized function. This translates into an absence of symptoms. It comes about when the body finds balance.

He called this approach osteopathy. He said that he discovered osteopathy. Osteopathy includes all of the contributions of medicine and surgery and integrates them in a way that genuinely respects the body's Intelligence in design and function. It is a complete and humanistic approach to helping people who ask for help. It is based on the laws of Nature, not those promulgated by medical theoreticians. And, as I have found over the last seventeen years of practice, it works.

In short, osteopathy is the practice of really trusting that the body's Intelligence knows what it is doing and has created the symptoms with which the patient presents as a means to find balance. What we label disease ( the lack of ease) is really an Intelligent response to stressors. It is the best the body can do given its current resources. The osteopath understands and respects this. We listen to the body and allow it to guide us in helping it to find its perfect homeostasis or balance.

Based on the body of knowledge accumulated by medical science over the years the osteopathic physician attends to the patient as they actually are. He does not consider them as sick, damaged, diseased. He knows that Health is not the absence of symptoms. Health is a Force which is always finding our perfect balance in every situation no matter how stressful.

The osteopath seeks Health. We do not concentrate on "disease". The body doesn't know it has a problem. It just knows that in this situation it, too, desires balance. The osteopath uses his trained hands and well honed understanding of human anatomy and function ( physiology) to support the system in its perfect balance.

It is quite simple. Osteopathy is just common sense applied to the practice of medicine.

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Learning and Relearning Osteopathy  Saturday, March 03, 2007

I recently returned from Orlando,Florida where I helped teach a five day course in Cranial Osteopathy for 21 physicians, residents and medical students. I have helped teach this course before and will be helping to teach a similar course in Tucson, Arizona in June, 2007.

Maybe you have had the experience of reading the same book more than once. I have done this several times. Each time, it seems, it is like reading a totally new book. Of course, it is me that has changed, not the book. It is not the same person reading the book.

It is the same thing with teaching and medical practice in general. Every time I help teach a course I experience it differently. This last time I was taking a lot of notes. Most of the students I had around me were sitting and quietly listening. Few were taking notes. When they were it was somewhat sparingly.

One of them leaned over and asked why I was taking so many notes. " I am so excited by what I am learning. I want to write down enough to jog my memory so that I can carry this back to my practice," I told him. He was surprised, he said, that someone who has been in practice for 17 years doing this work full-time would have so much to learn from what was billed as an introductory 40 - hour course. I explained to him that it is precisely because I do this on a daily basis that I find these lectures and presentations by my colleagues to be so valuable. They are sharing what they do. We are all supposedly doing the same thing but we are all doing it in our own unique ways. I find this amazingly creative and inspiring.

When I returned to the office I thought, My patients are in for a real treat! And, indeed, patient after patient related to me how satisfying these treatments were. I told them that I had learned things which enabled me to go deeper with what I was doing.

The human skull (cranium) is formed in cartilage and membrane. The base ( bottom) is formed by compressive forces in utero in cartilage. The rest (the vault) is formed in membrane. All of the 12 cranial nerves that come from the brain and which essentially control the rest of the body function exit the bottom of the skull via the membrane. The same goes for the blood supply to and from the brain.

Because the base of the skull is formed by compressive forces it can become very hard. Osteopaths can feel the relative hardness of the bones of the skull. The harder they are, especially in the base, the more problems that patient will have in many areas of life and body function. Using very gentle cranial manipulation I am able to get these areas of the skull to soften enough so that the patient can finally begin to really feel like a human being instead of someone who is trapped in an unyielding box.

Besides compressive in utero ( before birth) forces such hardness and jamming of cranial bones can also come about from traumas both physical and emotional. The release of this tension brings tremendous relief.

When I returned to my office I found several new patients both adult and children who had extremely hard heads. The work that I was able to do was immediately noticed by the patients. I know that these people will go on to do well.

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