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Silver Spring, MD
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Notes from the Practice of Harold Goodman, D.O.

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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HOW TO GET TO MY OFFICE  Wednesday, March 21, 2007

My office is located at 8609 Second Ave., Suite 405-B, Silver Spring, Maryland, 20910.
Our phone is 301.565.2494. If you leave a message always leave your current phone even if you think we have it. Of course, tell us your name. Speak slowly and clearly so we can be absolutely sure who you are and what all of the numbers are.

COMING FROM DC OR VIRGINIA
If you're coming from DC or Virginia get on 16th St. and take it North. When you go around the traffic circle continue North past 410 until the next light. That's Spring. Make a right and then another right at the next light on Second Ave. I'm across from the post office. See directions below for entering the building.

COMING FROM MARYLAND
Get to Silver Spring. You can come around the beltway (495) and get off at the Silver Spring/Georgia Ave. exit going South until you come to Spring and then take a right, go to next light and take a left at Second Ave. and follow directions below for parking.

You can also get here by 16th st (see above) or if you're coming from East Montgomery County (Bethesda, Potomac, Rockville) you could take EastWest Highway make a left at 16 St and follow directions above.

You could also do MapQuest or just call us at 301.565.2494. We'll make sure you get here somehow.

THE HARDEST PART - GETTING FROM THE STREET TO OUR OFFICE

OK. You have actually gotten to our building. It's a red-brick courtyard maze across from the post office. When you stand ( or lie) in front of the building you will see three entrances. The middle one has the number 8609 over it. Walk under that number until you arrive at a starway on the left. Take it up two flights. You will then be almost in front of our office, number 405-B. Just come right on in and say Hello. You made it!

There is also an elevator across from the stairway. Should you take it, press 4. Then find the office when you get out. I recommend the stairs ( come on, we all can use the exercise).



PARKING

You may either park (put in more money than you will be here - I may not be on time! and no one is here to feed your meter) at one of the parking meters on Second Ave or on Spring St or continue on to the pubic parking garage further along Second Ave. (it's on your left). You will have to prepay when you leave your car. Park on one of the upper floors ( more time) and put in more time than you think you need.
Never park in the post office lot across from us. You will be towed (it has happened every time). Also, don't park under our building.

VERY IMPORTANT INSTRUCTIONS IF YOU PARK IN THE PUBLIC GARAGE.
How to work the public parking garage machine


Because of numerous complaints about the public parking garage automated pay machines ( corner Second Ave and Cameron) I spent some time with the local go-to person, Scott Reinmann, 301.585.9470, to better understand the system.


Park your car above level two ( these are long term spaces).

Remember the space number.

When you get to the machine type in the space number. Press OK.

Insert bills or coins.

At present, the machines will only allow you to insert money in increments of one hour.
So, if you want to park for two hours, put in, say $2. The screen will give you one hour =60 cents, and offer the option of extending the expiration time. The machine will accept bills up to $20 and coins.

If you want to extend the time PRESS THE BUTTON NEAREST THE LINE ON THE SCREEN THAT READS EXTEND.

THESE LINES DO NOT EQUAL THE LABELS NEXT TO THE BUTTONS! ( I KNOW IT'S CRAZY. JUST FOLLOW THESE INSTRUCTIONS.)

YOU WILL NOW SEE THE TIME INCREASE FOR YOUR SPACE.

If you still want more time, do the above over again. You will be credited with another hour if you put in enough money.

When you are happy with the time (put in at least two hours in case we don't get started on time) then press OK. You will receive a receipt.

PRINT THIS OUT AND TAKE IT WITH YOU FOR REFERENCE.




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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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