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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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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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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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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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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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