The Goldberg Clinic – An Integrated Approach To RA – Part 1
We discuss how:
– Dr. Goldberg founded the Goldberg Clinic in Atlanta, Georgia in 1984 focusing on chronic health conditions
– Dr. Tener mentored under Dr. Goldberg since 2009
– Dr. Goldberg underwent serious illness while attending Medical and Law school and was diagnosed RA
– He went to the Natural Hygiene Institute in Florida, lived there for year and started feeling better
– He studied many different approaches, wrote his thesis and started his own clinic where he treats RA with an integrated approach
– Dr. Goldberg stresses the necessity to develop an individualized program for each person
– Doctor Google could give very confusing advice!
– Emotional and stress related factors play a key role in their approach
– Diet is only one part of nutrition
– Environmental factors also play a big part
Clint: Well it’s a great pleasure to have Dr. Goldberg, and Dr. Tener from the Goldberg Clinic in Atlanta Georgia. Thanks so much for joining us today gentlemen.
Dr. Goldberg: Hi Clint, thank you for having us here. Good to be here Clint, thank you.
Clint: Yes, well you’re both very esteemed, and I want to just read out your short bios before we begin. And then explain to our audience why we’ve got you on the show, and why we want to hear about what your clinic does. It’s certainly very relevant to the rheumatoid audience, and psoriatic arthritis audience that we have and their broader autoimmune category. And that’s because you’re both experts in this field, especially Dr. Goldberg who himself was stricken with severe rheumatoid arthritis and ulcerative colitis back in the 1970’s. His battled to regain his health served as an inspiration for his career in working with others with chronic health conditions. He has served as professor of Clinical Nutrition, Rheumatology, and Gastroenterology, at life University, from 1980 until just about nine months ago. And has established the Goldberg clinic back in 1984. His successful work with patients with auto immune rheumatoid, gastrointestinal issues, and other chronic problems brings health seekers from all around the world to come to the clinic in Atlanta Georgia to address their underlying cause and get much better health.
Clint: Alongside him is Dr. David Tener, who has a degree in psychology, and is the managing director of the Goldberg clinic, and the retreat which is nearby Brooks. He has mentor in under Dr. Goldberg since 2009. And together they have a formidable team in establishing the underlying cause of chronic health conditions, and addressing them, getting patients the best possible outcome.
Clint: So let’s go back to where it all began. And although your personal health story Dr. Goldberg is available online. Perhaps you could give us a short summary of what it was like to be inflicted with those health conditions, and how you then turn them around?
Dr. Goldberg: Thank you Clint. I think people ask me where I went to school, and how I learned, and I have a number of degrees and diplomates, By all means the best training I had was undergoing as you did as well personal, serious, illness, which I was ill prepared to handle and didn’t know which way to turn. I was attending both medical, and law school at Ohio State University in Columbus Ohio at the time. Again I have aches, and pains, and gastrointestinal distress, and went to the student clinic there I was diagnosed with having rheumatoid disease. was hospitalized, had a work up, and ultimately was given a variety of different diagnoses which included ankylosing spondilitis, rheumatoid arthritis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis.
Dr. Goldberg: Yeah, and being that I was a first year law student, a first year medical student. I was hoping that there would be some help for me there, but it turned out even though I was at a very prestigious institution Ohio State University, and Ohio State medical school, Ohio State College of Law. But they told me that basically that I would be crippled the rest of my life, and that it was just something I had to accept.
Dr. Goldberg: So I didn’t see a whole lot of joy in continuing my education and particularly it was discouraging to think I was undergoing all these years of training, only to be ill prepared to help other people, this was as best they could offer me. So, I was a drop out, I dropped out of school at the time. And I went to Florida, not too terribly far from where you are right now actually, on the other side, over on the West Coast. And I was taken in by a osteopathic physician whose name was RJ [00:04:03] Cheedam, [0.2] and [00:04:04] Dr. Cheedam [0.2] had a institute there called The Natural Hygiene Institute which was on a 9 acres of land. Beautiful place near the ocean, and near the springs, and I lived there for a year of learning principles of natural hygiene. And had the opportunity not only study it, but to live it. And by the end of about 6 months I became the health director there. And I did not undergo a total recovery there, but I started getting better, and I was very encouraged, I was very enthralled. We were not giving people treatments, we were not giving people drugs, or herbs, or anything else. We simply were providing the essentials of health for them,, sunlight, fresh air. Some people fasted, raw food, plant based diet, and I saw remarkable improvements in people’s health from a wide variety of things. Even though they were basically doing some things that were very very similar, not to treatment of disease, but simply providing the right conditions for the reversal of the chronic problems that they had.
Dr. Goldberg: At that point, I left and I went to the University of Texas, and I study rather than going into standard medical realm, I studied preventive medicine, and Clinical Epidemiology. And after that I went to work for the US Public Health Service, working communities, helping to reverse investigate chronic health issues. And then ended up getting offered a job at a chiropractic college in Marion Georgia. I came here to chiropractic degree in addition to diplomate in clinical nutrition. And started about a family and a practice at that time.
Clint: So your recovery from your conditions happened a lot in the first 12 months and then gradual improvements over time, whilst in parallel you were working with patients yourself?
Dr. Goldberg: Yes, well I was going to school at the time. And part of the beauty of being a graduate student as I was I got to work at M.D. Anderson tumor Institute. I saw a lot of things done that I decided I did not want to be a part of. And I also had the opportunity to go to libraries [00:06:16] or resulted in a [0.9] medical center in Houston, and the University of Texas at Austin, had the opportunity to study old medical textbooks. I found that there were things done many many thousands of years ago and are also very interesting to the way rheumatoid diseases in particular were addressed. And I wrote my thesis at the time which was, I called it a biolistic approach to rheumatoid disorders.
Clint: Fantastic. Now you have then gone on and set up your own clinic. Now how did that idea come to you? Was it scary at the time to set up something like this? Because I can’t imagine there was a lot of clinics that were so bold as what your clinic has claimed and has continued to claim for the last 40 odd years with great success.
Dr. Goldberg: Right. Well I was very passionate, still I am very passionate about the work that we do. So it was a natural for me to want to be involved in it, and work with people who had similar problems as I did. One of the things that came out of that was that I thought I had all the keys to help people. That time 40 years ago, 40 plus years ago, I thought I’ll just live with them the same types of things I did for myself. And as I found when you go into practice, you learn all things you have to be done differently. And learn that people are very very different from each other. So that we still have a general template of things that we do that are follow hygenic basis. Everybody needs sunlight, love, and everybody needs a proper diet. We also found that people are very very different from each other. So the challenge, part of the challenge during practice is to develop an individualized program for each person to help them evolve out whatever health issues that they’re having.
Clint: Right. Okay, and now Dr. Tener, tell us what are the sorts of patients that come to your clinic and how do they typically present? I imagine that if they’ve traveled a long way their expectations are high, they probably have conditions that have been with them for a while and that they’re probably at the end of their rope, maybe you’re a last resort. Does that how it feels a lot of, a lot of the time?
Dr. Tener: Just about every time Clint. I think most of the patients they come to see as their stories are not too much unlike Dr Goldberg in terms of what he described and what he went through. Most of the patients I come in had been to just about all the kinds of clinics. Most of them have seen multiple rheumatologists. When a patient comes in with the rheumatoid issue there’s a fairly predictable course of treatment that they are commonly gone through before they come to see us. Most of them may start having symptoms, they’ll see their general practitioner, the general practitioner will refer them to the rheumatologist, the rheumatologist will give them a certain set of drugs. Dr. Goldberg mention about five or six that are commonly prescribed usually things like, steroids, and methotrexate which you have been on. And now drug such as the biologics which are becoming more and more common. At some point most patients recognize that that’s not gonna be the solution to their problems, and they’ll transition away from medicine, or conventional medicine in to a vast sea of alternatives. There’s quite a few of them available now, alternative medicine, complementary medicine, functional medicine, holistic medicine, all different forms of medicine all under the same umbrella. And in those realms they’ll typically, their sound drugs or start getting off the drugs just that they’ll end up on a whole host of other treatments. And so by the time they come and see us, they’ve been on all the medical road, they’ve been on all the alternative, functional, holistic all the other different modes or fields of medicine. And by the time they come and see us they recognise that that too is not going to be a good solution for them so they’re ready for something different.
Dr. Tener: Most of them by the time they come here, they’re ready to work hard, they’re ready to find out what’s is actually causing their problems as opposed to suppressing their symptoms. Whether they, or treating their symptoms whether it be with drugs or all the other alternatives that are offered as well. Sure Dr. Goldberg would want to extrapolate on that too.
Dr. Goldberg: Yeah. One of the biggest challenges we have Clint is that, we are confused with a lot of other things that all practitioners are doing now. When I first start practicing just to be a called a natural practitioner was actually unusual. Now everybody and their mother calls themselves a natural practitioner, what natural really means of course is different things to different people. We’re very clear you know, we don’t practice functional medicine. I’m familiar with it, I’ve used textbooks with it, I’ve lectured to those groups. We don’t practice functional medicine, we don’t practice naturopathic medicine. I have a naturopathic degree. I don’t use it, something but I’m familiar with it. We don’t do alternative medicine, as my good friend one of your countrymen actually a Dr John Fielder who lives in Cairns Australia says, we practice not alternative medicine, but an alternative to medicine, and so medicine of all types. So we don’t give treatments, and so that our map. what do you do then? We can talk about that, and we don’t apply any form of medical care whatsoever. We want to identify the causes of people’s problems, and to address those causes aggressively at their roots, and then to watch as a person evolves into better health as opposed to trying to treat disease.
Dr. Goldberg: I see that as a fundamental error of most practitioners including the people who are colleagues of mine in the osteopathic, chiropractic, allopathic, naturopathic, all these different fields are all. Many of them if not most of them are in just some form of medical or medically oriented treatments, as opposed to digging down and finding the ideological factors that are involved in each individual self issues.
Dr. Tener: (Inaudible) patients once they leave the medical field, or they leave conventional medicine and they go on to functional alternative medicine. They think they’re doing something different, and really what they’re getting is the same approach. It’s still a medical based approach as Dr. Goldberg said.
Dr. Goldberg: So whether the patient’s taking aspirin for their inflammation, or whether they’re taking willow bark which is what aspirin is derived from, is still the same thing.
Clint: Right. Yeah I understand. Right we’re still approaching the symptoms rather than the underlying cause. Right?
Dr. Goldberg: That’s right.
Clint: Right. Okay. All right. Well we’re building up to, we’re building a lot of suspense as to how your clinic may interact with unique cases as they come in. Before we dig down into that, can you give us some of the mindset challenges that you need to overcome with patients as they come in as well? I mean are they expecting certain things from your clinic? Almost like a miracle turnaround in a short period of time, potentially unrealistic expectations? And are they also holding a degree of unhelpful knowledge that has been given to them from their previous doctors or alternative therapists?
Dr. Goldberg: Yeah, those are really good questions Clint. I think the most confusing Doctor the most the patients have before they come see is Doctor Google, and although we are very happy to have the internet coz that’s the way people sometimes find out about us, we, have a website. But nonetheless, today as opposed to when I first got into health care which was actually 1976, (inaudible) as you said 1984 but began in 1976. They have looked at many many many many many many different ways of treating their disease. And so the patient comes and they basically are confused. There is a huge amount of confusion, there is a huge amount of preconceived notions as what they think they’re going to get from us. Which we try to some degree to dispel by the use of our website and by use of sending people information. But you know a sick person, is a sick person who is oftentimes desperate, and we understand that. As they say been there, done that. And so the main thing they’re looking for is, can you make me feel better? How rapidly can you do it? And what’s it gonna take to do that? And even today I can still put myself in to that mindset. And that’s an important thing to be able to do. That’s why I was saying I think my best training was having been ill, because it took me several years to really find my way back totally. So that’s a very very important part of the training.
Dr. Goldberg: So when the person comes in for a lot of them, they’re really not quite sure what to expect other than that they have heard from somebody who is a former patient that they got well with us. They’ve seen the results either personally with somebody they know, or they’ve seen our before and after on our website. Maybe they’ve read articles, had written 100 or more articles over the years, and they’ve read some of the articles I’ve written. They’ve been referred by another doctor to my clinic. All they know for sure is they hurt, and they want help, and they’re hoping that we’re the people that can help them do it.
Clint: Yes fabulous. Okay. Alright well let’s start to move now into how you actually go about it. And what we’ll do is we’ll split this into two parts. Our interview today, so we’re going to move into you know how you go about this and all the intricate details that you need to consider when treating patients who come in. And then what we’ll do. Of course it’s going to be quite a long interview. Is we’ll then split it into a second part which is where we’ll go through case studies, and you can give us live real examples of people that you’ve worked with. So let’s now move in to what you know, how does every person require a different approach and how do you handle that? I mean we all look at something like a good business model, for as bad as food as it is McDonald’s great business model. They have a system in place. You go you know, you go in they ask they you take your order and then they have a system in place behind the scenes to create the same food in the restaurant no matter where you are in the world. Now how do you systematize when you have a value structure in your business where each piece, and each person requires a unique approach? I’m just curious on how that works and how you do it?
Dr. Goldberg: Many years ago Clint, I wrote an article called Infinite Variety, which is you can, they can find on your list or find on a website under a resource section. And in that many years ago probably in the late 70’s early 80’s like for a started teaching, I was reading a biochemistry textbook written by a fellow named Lehninger. And in that Professor Lehninger was talking about the variety of our genetic makeup, all the genes that make up each person. And if you take all the genes from the mother, and you take all the genes from the father, and the zygote, the sperm, and the egg, you end up with an individual. Every individual, is about 68 billion not million but billion possible genetic variations that can occur with each and every individual. So you can go where the entire planet unless somebody is a identical twin with somebody else, you will not find two people that are the same. You may find you look very similar on the outside, but you won’t find them the same on the inside. In fact when I when I read that I went home and I mentioned to my wife I said very proudly choices you know, I am the only individual on the planet you’ll find exactly like me. Nobody else is exactly like me. And she thought about that for a sec and she said Yes thank God. And she turned around and went somewhere else. But the point is on the last that you will not find two people that are the same.
Dr. Goldberg: So when we when we label people with a certain disease whether that be rheumatoid arthritis, or psoriatic arthritis, or Ankylosing spondilitis, ulcerative colitis, or any of these many myriad of other names we have for a disease that’s not that person. That’s just the name or the symptoms they are expressing. And you can have people expressing exactly the same symptoms, where the cause of factors beneath them are very very dissimilar.
Dr. Tener: (inaudible) When I was a student of Dr. Goldberg’s, his professor when I was in school chiropractic college there was a line that he used to say within some of his lectures where it was, it’s important to know the patient that has the condition, not the condition that has the patient. And so when we work with people and we do an initial evaluation which is about it a 3 week process, we have an initial visit last about 90 minutes. Dr. Goldberg and I, sit across from that patient and interviewed so we can learn all the details of their life. All the way back when you were a child, and in some cases there were things that happen to people even when they were kids that gradually or play a role in our development of their issues later in life. And one of the things that struck me as I started to work with Dr. Goldberg initially after I graduated and got a license, was that when we sit across from people we realise just how different their stories are. The stress they’d been through in their lives, the things they’ve been exposed to immune environment, the foods they may have eaten, problems they’ve had at work or at home, and in all the different factors that can play a role in their health.
Dr. Tener: And so when a new patient walks to the door, whether they’re 5, 10, 15, 20, people with the exact same condition. I know we’ve got a brand new puzzle to solve that’s gonna take some unwinding in each case. And that we’re not going to have the same history, we’re not going to have the same exam findings, and we’re not going to have the same lab work each time. So each case has its own challenge because again we have unique individuals not just patients with so-called disease.
Dr. Goldberg: And that’s really one of the things that makes practice interesting even after over 40 years is I know every time I walk in to see a new patient it’s a whole new story, it’s a whole new experience, and it’s a whole new individual, and I can see why so many medical professionals get so bored with practice because they go in and they quickly give a diagnosis, Okay here’s your drug and you’re out the door. And as a matter of seeing the rest your wife periodically to see you know what complications are you having? What drug do we need to move you off to next? And what other specialists do we need to refer you to? So we, every patient is a new experience, is something that’s exciting for us to work for, and it keeps the practice fresh.
Dr. Goldberg: This is also Clint, a very time intensive process. When we need a new patient, we spent a good 90 minutes with them and so in a given day Dr. Goldberg and I might be here for 10 hours between the two of us, we may have seen at most 7 or 8 people. Because it takes time and a lot of effort to work with people to get to know them. And you know most people when they come in, we ask them about the experience they’ve had with their rheumatologist. One of the biggest complaints they had is that the doctor only spent five minutes with me. Asked me what my symptoms were and then gave me a drug. And it certainly takes a lot more time, and a lot more effort to really sort out the reasons why they develop the issue to really get to know them so that we can develop an individualized plan for them. I think patients sometimes are surprised when we start to talk with them. It’s not just about their disease, I wanna get to know about them a little bit first. So we talk a little about see how we can bond or whatever is going on.
Dr. Goldberg: Just like you and I were talking before we started this interview, and it turns out you live in Jupiter, and I was living in Hobe Sound. So we try to find some common ground there. And then we go back all the way to the patient’s childhood, who is the mom? Who is dad? What did they do for a living? What was a child’s, did the patient’s childhood like? What did they like to do in elementary school? What was middle school like? What was high school like? What interests did you had? Did you place (inaudible)? Were we on the debate team? And it now really kind a breaks the ice that these are important things for us to know because we’re looking at the pace why they’re telling us this, we’re observing the way we feel, we’re looking for changes in their emotions as we talk about what went on in high school? What happened happen in your 1st of three marriages? When did you have that kid? Were there complications in your kid? How did you like your job? How do you like your home life? Do you spend much time outside?
Dr. Goldberg: And so, we try to keep it relaxed but in some ways of patience some of them probably feel like they’re under that they’re being interrogated. Because of that, we are all relaxed, we are trying to find out what really makes our person up.
Clint: Excellent. Okay I love it. Now tell us, what are you specifically looking for, other than getting to know the patient which is wonderful and so forth? But what little sort of hot buttons are you looking for in their responses, that will enable you to guide the treatment that follows?
Dr. Goldberg: Okay. So there’s, although we have all these billions, probably even trillions of differences between people. There are two major categories. One is what’s a person’s background? Like in terms of their genetics. What do they have a predisposition to? So what about the family history a little bit? The other thing is, what are the environmental factors that have contributed to build up their disease? So what was the template that the person started with? Their genetics. And what are the environmental situations that have played upon those genetics to make those things go from just being a genetic factor, to actually being manifested? (inaudible) on top of it. So that’s what we’re looking for.
Dr. Goldberg: Now, if have to say there’s 2 basic things in terms of environment that we’re looking for and that there are more than 2. But one of those is what is the person’s home life like? The other is what is the person assuming that they are employed and they’re working outside the house, or they’re working inside the house, they’re a caretaker for kids. What is that like for them? And those are 2 very important preliminary factors, because if a person doesn’t have a good home life. If a person or, and/or the person doesn’t have a good work like, we have a very very challenging situation. It’s going to require quite a bit of extra work on our part. So, you know if you hate where you work, and you hate when you go back home too, how do you get a person well? That’s a very difficult situation. So we want to uncover it out immediately. Now if the person maybe very sick, but if they have a good home life. They get along with their spouse, or they live alone but they’re happy living alone, or they live with their dog, or their cat, but they’re fine with that, that’s good. And if they like their job, which is that’s great to. So if a person likes their occupation, and they like their home life, we have a good foundation level upon which to build I can put that to one side.
Dr. Goldberg: Person is going through a very difficult situation socially where they’re going through a divorce, or they contemplating a divorce, or they hate their husband, or they hate their wife, and/or they hate their job. They’re not happy when they’re away from home, they’re not happy when they’re at home, and there’s nothing I can do in the office until we get that situation at least partially rectified, or at least we see we bring to the patient’s observation that those things are going to need to be addressed.
Clint: What’s coming through really much louder than I had anticipated that’s fascinating to me, is how much of this is non physical,non what you eat, non what you exercise, but emotional and stress related. This is obviously a great percentage of importance in how you treat the patient. Right?
Dr. Goldberg: Yes, except I would say it’s not. It is nutrition related because, if you have a patient who is very unhappy with their home life, or is very unhappy with their job, is very unhappy with their neighbors who are always making noise, is very unhappy because they go into an IRS audit. Clint, you can give that person the very best diets, biochemically suited to them that you can. It’s not going to digest well and they’ll end up toxifying them. And on the other hand you know I see people who don’t eat all that well, but have happy lives at home. Their spouses are happy with their jobs, life is good. And those people oftentimes don’t even get sick, or if they do it is much easier to then go back in and just say okay we’re going to tweak this, we’re gonna tweak that, we’re gonna remove these foods, we’re gonna to put you through a little detoxification plan. We see some environmental things that need to be cleared up, a small matter of tweaking. But until we get those basic things taken care of, it’s very very difficult to help somebody.
Dr. Goldberg: So let me just introduce you to, when we talked about nutrition Dr. Tener and I, we’re not just talking about dietary factors. Diet is simply whatever you choose to eat. So if somebody lives on Coca-Cola, and Frito’s Corn chips, they’re in a Coca-Cola and Frito corn chip diet, it’s just that simple. If they live on brown rice and sprouts, then they’re on a brown rice and sprout diet. Whatever they eat that’s their diet, but that’s only, it’s a very important part of nutrition but it is only one part of nutrition. And the other parts of nutrition, are first of all digestion which includes chewing your food and all the things that are involved in taking water, in fat and soluble products, and making them water and fat soluble. So they’re broken down into smaller and smaller water and fat soluble molecules so they could be absorbed. The next step is getting that into the blood through the intestinal membrane. Third step is getting assimilated into the cell itself. And then the fourth step is getting the waste products out the cell we call that cellular excretion. And the last step is a cellular elimination rather. And then the last step is excretion through the bowels, and the kidneys, and the skin, and the breath. Now what parts of the body are involved in the nutrition process? Well everything, there’s not an organ, or a gland in the body that is not involved in the nutrition process.
Dr. Goldberg: So why see people who are giving people dietary advice that’s fine and good, but when we get down to metabolism. We not only have to be able to give dietary advice to our patients, but we must understand gastroenterology, and in some depth we must understand Immunology in some depths. We much understand endocrinology in depth. We must understand psychology in depth, and genital urinary factor. The whole body has to be involved, because the whole body is involved. And this is the term we use with patients, in transforming food into human flesh. And in most people who are sick, there is a problem somewhere along the line where that food material which came from the earth, is now being transformed into healthy cells.
Dr. Goldberg: So, when somebody comes to our office and they have psoriatic arthritis, and they’re covered with psoriatic lesions, and their joints are highly inflamed. We ask ourselves, what is it about this patient that does not allow the transformation of food that comes from the earth into healthy skin, into healthy immune cells, into healthy joint linings? There is something within this whole context of the whole nutrition process. This transformation state which is not occurring efficiently, and it’s our job to figure out what that is.
Clint: Okay good. Well we’re all excited to learn more about how that evolves in your practice. So let me recap as I’ve understood. A person comes in they’ll spend 90 minutes with both of you in most cases, you’ll ask a lot of questions about their personal history, and you’ll establish sort of predisposition factors, and genetics, and also environmental factors. So you look at how those predispositions played out in their life, and how they may have triggered them through their lifestyle. And a lot of the questions surround their happiness, and their stress levels. Both at work where they spend a lot of their time, and at home where they’ve got those interpersonal relationships. And you’ll find in most cases, I would imagine at your clinic, that people come in and they’ve got those stressful expressions at work, or at home, or both. And I imagine that people who are doing tremendously well emotionally, happy at work, happy at home, are not necessarily the sort of people that you see too often. Because they they maybe not in such a bad state.
Dr. Goldberg: Well, there are other factors that are involved to. I mean those are to, you summed up much of what I said absolute correctly. Well we’re looking for other factors to. And another big factor and it’s become more important now than it was my started practicing, is environmental factors in terms of toxicology. Part of my training in public health is in toxicology, and so we’re gonna see what has the person been exposed to? Go through their personal habbits. Simple things like alcohol, coffee, and tobacco, recreational drugs, pharmaceutical prescription drugs, and occupational hazards where they may have become involved with variety of heavy metals, and various other chemical agents that they’ve been exposed to as part of either just their living environment or their work environment. And because there are so many different agents and chemicals out there the average person, even people who were your home owned takers, and are sitting at home. Many of the ladies now are putting simply toxic things in their body spouting themselves with cosmetics. Guys just some of us too of course. And the average person is taking a variety of over-the-counter drugs, as well foods that their eating which have many additives and pesticides and so forth in there.
Dr. Goldberg: We have to track down those things too because those can also interfere with a particular with a number of enzymatic systems in the body. And they interfere with the person’s general health and their nutritional status. So that’s the interview we’re looking at social factors looking at environmental factors, we’re looking at lifestyle factors, we’re looking at the history of the person in terms of who have they been to in the past? What steps they taken? What’s helped them? What’s made them worse? And then the next step we’re gonna take is then, to do a physical examination.
Clint: Okay, okay great. And thank you for adding the toxicology aspect. When Dr. Tener and I first had our conversation on the phone to set up this interview with you both, we talked about the influence of drugs like prednisone and other drugs that are involved in the conventional Western treatment. And so we’ll get to that shortly and talk about you know, how we work with these added toxins in the body, and how your approach might enable people to get off those. But first let’s just continue the evolution of how the patient experience goes at your clinic, and let’s talk about the physical exam. So let’s continue with the example of psoriatic arthritis, and so tell us, take us a little bit further along that the patient journey with the physical exam and thereafter.
Dr. Goldberg: Okay, so our physical exam is going to involve taking all the patient’s vital signs, which would include just simple things that most doctors do in their office their height, their weight, their blood pressure, their pulse rate. We check what’s called perfusion which is my blood which is actually reaching the ends of their fingers. We’re looking at oxygen saturation.
Dr. Goldberg: And now we’re gonna start putting our hands on the patient, in terms of doing examinations of the joints, gonna look carefully to nails, an eye exam, a very careful exam with the oral cavity because we can tell a lot we’re looking at the gums, and the teeth, and the tongue (inaudible). We can tell a lot about the patient’s health by that respect, because here we have the oral cavity we can open up we don’t have to open up the person not to be invasive at all. And we can see, you know at least the beginning of the gastrointestinal track, and see what that GI track maybe we can start getting some insights there. We work right on down, we’re going to examine the thyroid. And then it is my predilection that always do a careful abdominal examination of the patient, and that means a Hands-On careful auscultation, palpation, and percussion of the abdomen. And one of the things that’s very interesting Clint is, many of my older patients, I mean people 55 and upwards. Will tell me, you know and they’ve to many doctors before they see us. It’s been decades since I last remember a doctor ever putting his hands on my abdomen, and actually doing an abdominal examination of me. listening to my abdomen, because most doctors including gastroenterologist don’t that anymore. They immediately start going through the colonoscopies, and the MRI’s, C.T. scans.
Clint: Okay so you’ve covered so much content in just the last couple of minutes. I’m really fascinated to learn more about each of those techniques and if you can, I’d like to you know allocate that time. I’d like to know what are you looking for in the mouth? What are signs of positive health? Are you looking for a sign of bacterial overgrowth that’s systemic and showing up in the mouth? Are we looking for you know a crack or lack of crack down the center of the tongue? The gums you talked about inflammation. Please share with us, what are you looking for, and what are the signs, and how did these translate to what might be happening further down the gastrointestinal path?
Dr. Goldberg: Well we have to take probably an hour and a half to give you, I mean that’s a lecture in itself as to what you’re actually looking for and doing an oral examination on somebody. But I can give you kind of an overview of what we’re looking for.
Clint: Yes please.
Dr. Goldberg: We’re gonna look first of all the health of the teeth. We need to know does the person have teeth, that are sufficient to chew. And I’ve had patients that come in particularly when I have a rural prep, my first practice was in a rural area in north Georgia. And I had patients come in including one I remember very clearly of a lady who had no teeth. And she didn’t have dentures and I said well where, how do you choose your food? She says I don’t. Don’t you have a set of false teeth? She said, they were so uncomfortable I couldn’t use them, I stopped using them. And so I said, so what do you live on? So she said gello, and cream of wheat. Not to many people you know Cream of Wheat as Cream of Wheat, and mashed potatoes, that’s how I remember it she was mashed potatoes from a box. And pudding, she like chocolate pudding. I said well I’m going to write a prescription, for saying before we do anything else I don’t write prescriptions perse. And I wrote a prescription to a dentist office who does dentures, I said you go there. And she came to complain to me because she had a lot of GI distress and fatigue. Well, the way she ate, and the lack of nourishment staying alive I said you get to dentures. I said you start eating whole foods a little bit before you come back and see me. And then I want you to return in two months in 60 days. So she went and this guy fix, this dentist fixed up a nice dentures for her, she was able to eat. She came back in two months, about 70% of her gastrointestinal problems were gone, and she was feeling much better. She wasn’t 100%, but she was significantly better. So that point we were able to tweak the rest of our system and get her feeling well. But there was no way that she could break down her food, transform food into human flesh, what was going on with her.
Dr. Goldberg: So we look at the teeth, we’re looking at the gums. Some rheumatoid disease patients have some degeneration of the gums. Sometimes we see a lot of recession with that, I don’t want to scare your clients. If you have receding gums, you’re brushing your teeth to hard, so doesn’t mean your (inaudible). We’re looking for the cavities that they have, carries, and how many amalgams they have. They have silver mercuries, we’re gonna make notations of that and by the way we don’t recommend people getting their silver mercuries removed just simply because they have them. We’re gonna then check and see, if they have a number of them, if they’re actually is a toxic problem. Because some people have three or four, they have toxic problem. Other people have 10, 11, 20, of them and don’t. So there’s tests we do to make that determination.
Dr. Goldberg: We’re gonna look at the tongue, are there fissures? Where are those fissures from? What is the color like? What is the coating on it like? What are the size of the papillae? Are they evenly distributed? Do they have dissipation? We have areas in the tongue, they get sore on them and some of this also give us some insight as to whether the patient have allergies or not. In our clinic in my frame of mind, Dr. Tener’s frame mind, allergies and auto immune disease are really two sides of the same coin, I don’t see them as 2 separate things. Many of our patients who have auto immune diseases not all of them, certainly many of them had significant hay fever, asthma, or other allergic problems as a child. One of the things that most doctors of course don’t do, that we do is, I also will smell the breath. The patient doesn’t know, I know I try not to make them aware of it, but as I have my stick in their mouth, tongue depressor excuse me. I have my tongue depressor in their mouth, I’m going down, and looking, I’m taking a quick whiff of it.
Dr. Goldberg: Yeah now you can’t teach somebody about smells, but I’ve been doing this for 40 plus years. And I had certain smells I can categorize what may be going on not with absolute certainty, but with some certainty as what may be going on in the gastrointestinal tract. Or could just be what they have in the last meal too. But I can tell with some degree of certainty what some of the problems may be going on there. For example, something which is well-known is that patients with diabetes, or chronic diabetes, go to ketoacidosis. And they will have a kind of a fruity, sweet smell to the breath. So I can tell that by smelling their breath. Interesting enough you know doctors used to commonly do that you won’t see doctors do that anymore. But I’m kind of old school in that regard, and I will smell the breath. Just as I know, Doctors also used to and we don’t do this by the way. They also used to taste the urine. They used to taste the urine, because they could tell from that some of these things about the patient. Thank God today we have dip sticks, other chemical reagents that we can use to analyze the urine.
Dr. Goldberg: You see a lot of things that were very commonsensical, and very straightforward that they don’t do today. And what they do instead is the order of very expensive and more (inaudible) expensive, very dangerous, and invasive, and harmful tests such as CT scans and colonoscopies, endoscopies. With that information could have been easily obtained in much safer, non-invasive ways. We’re gonna look at the general color of the gums, were gonna look at the bucal cavity, the inside of the cheeks see if there’s lesions and some sores and so forth and there. Is that enough?
Clint: That’s great, and I want to move on to next how you do your abdominal investigation and get some more insights in the same kind of vein as what we just did then but before we move out of the mouth area. Can you just enlighten me how much can you tell from a bacterial viewpoint in terms of an overgrowth of bacteria by looking in the mouth? Because this is something that’s sort of common belief but is it true?
Dr. Goldberg: Is it true that you can tell they have a small bacterial growth of the small intestine?
Dr. Goldberg: In my opinion no, I mean you might you might get some indications of it. You can’t tell, my eye can’t tell them with absolute certainty if they have a Sibo, a small intestinal bowel overgrowth occurring just simply by looking at their tongue, no. You can tell if they have thrush, if they have a lot of yeast growing in there that might be the situation.
Dr. Goldberg: But what’s going on in your duodenum as a result of a variety of factors that might lead to a small intestinal bowel growth. I certainly can’t, I don’t think you can either. You can’t really tell for certain that just by looking at the tongue.
Dr. Tener: It seems some correlation between what a patient’s tongue will look like, and what their test results look like which we can talk about it a little later. But when we look at the patients mouth, and the tongue for instance is quite foul in terms of the coating on it.
Dr. Tener: Or the breath is (inaudible) foul. And it’s a pretty good indication that food is not being digested well. And when food is not digested well, ferment or putrefied which will create a toxic environment in the gut that can contribute to disphaosis which I know you’re interested in, and bacterium and balances. And so when we see that with the patient, we oftentimes see positive test results that show us those very things. Not always but more often than that.
Dr. Goldberg: No we can’t tell exactly where that problem may be occurring or small small (inaudible) means by definition that you have an overgrowth of bacteria in the duodenum wall first couple inches after that. And the GI tract is a pretty long place, and it basically starts with the mouth and ends at the rectum and you’ve got all these you know feet of Colon and small intestines in between the accessory organs, the pancreas, that gallbladder, the liver. And so you can’t really say okay you have a bacterial overgrowth. We can say there is indication here based upon the way the breath smells, upon the way the tongue looks, and upon your symptoms that you have that there is a likelihood that you might have a small bowel overgrowth, or you have a dysbiotic state in your bowel. And therefore which will be the next step after the physical examination. We have determined by doing our case history, and by doing our physical exam what selection of laboratory tests we now want to run.
Clint: Right, yeah exactly. I see, I see, Okay. All right. There is so much to cover.
Dr. Tener: Clint one more thing, you asked about abdominal.
Clint: Yeah I’d love to. I’d love to learn more about that.
Dr. Tener: I’ll tell you all about that. There’s one thing that we often look for in that, I see Dr. Goldberg do it quite frequently to people. So percuss the abdomen, and you can based on the sound that’s given from doing that you can tell whether another person has got a lot of gas, or a lot of bloating in their GI tract. And we’ll also listen to the bowels as well, and that can also be an indication in conjunction with some of the other signs and symptoms we hear from patients that a test like a bacterial overgrowth test might be appropriate for them.
Clint: Right. Okay what else are you looking for there? Are you looking for any compaction, or what else is going on with the physical exam of the abdominal?
Dr. Goldberg: Well the first I’m going to do is of course the patients’ in a supine position we have the abdomen exposed. We’re going to just kind of look at it from the side, tangentially to see where the contours of it are. The second thing is that we’re going to auscultate, meaning listening to the abdomen with our stethoscope. And Clint we do that first because once we start putting our hands on the patient’s abdomen, we will change the bowel sounds to small at least a small degree. So we’re gonna listen with the with the stethoscope first in every quadrant. We’re going to listen to, basically what I’m listening to or for is normal bowel sounds normal, we call Borborygmi. Sounds within the intestines themselves. I want to hear that there’s a normal pattern of low going on down there.
Dr. Goldberg: The second thing is, that we’re going to go in there and percuss the patient and that’s just going to involve taking my fingers, and just hitting one finger upon another. And listening for the bowel sound coming back to me, and that will reflect we have a pocket of air. Do we have a pocket of something more solid or semi solid? And also we can get kind of an outline of the size of some of the organs there and see if there approximately normal or not. Particularly the liver, the liver’s one that I looked for pretty carefully. And I can outline that, it’s almost songs like sonar in a submarine. I can kind of outline it by using percussion. And then, the last thing I’m gonna do is to go a little deeper, and to use palpation. And I’ll do both a superficial palpation. First, I’m gonna cover the entire abdomen with the person. I’ll tell them to let me know if anything I’m doing causes any discomfort. And if the white palpation causes no discomfort for them, I’ll go a little bit deeper with my fingertips. And in this regard, having done these for 40 years plus, also having a degree as a chiropractor. Our fingertips, both myself and Dr. Tener are pretty sensitive. You know when you’re when you’re chiropractic, they train you so you can feel a dime through you know 50 or 60 pages of phonebook, because you need to, if you’re your palpating is (inaudible) structural changes. So we’re going to feel very carefully the abdomen, and I taught this way when I taught at the chiropractic college or any areas that are tender and we’re gonna make notes of that. Any areas that we feel may be compacted or impacted. Any areas may feel warm to us, that there’s a particular heat.
Clint: Right, yup. Wow okay well fascinating. Fascinating stuff and thanks for thanks for indulging me in going through the physical exam. It’s fascinating you know as I said you know certainly a line of treatment that is lacking for 99.99% of people with rheumatoid or other inflammatory arthritic conditions, is to have their mouth examined then their abdominal area examined. These are completely overlooked, and even if we do see natural therapists in conjunction with medical practitioners it’s still an area that that is rarely considered. So it was fascinating for me and I think you know very interesting.
Dr. Goldberg: We just, we hit the highlights of those are not the only areas we’re looking at. We look at the ears, inside the ears, we look at the eyes. will palpate the thyroid gland, and then of course if patients have joint pain we will palpate the joints. And then part of what we also do on, not all of our patients but most of them will do what’s called biomechanical analysis. So in which case you’re going to be looking at their spine, not so much just from a view point of a chiropractor or an Osteopath. But what is a general biomechanical lay out of the spine. And part of what we’re doing for us to see if there are areas that may be contributing to or, are being affected by whatever disease process is going on the patient.
Clint: Right. Okay. Alright thank you. Now as we move forward now and we look at the next step in the treatment order. You then mentioned earlier about these toxic elements in their life, whether it be you know five coffees a day, they’re drinking alcohol. And we talked, mentioned earlier about certain drugs there on. I’m interested to know if someone’s taking some of these counterproductive medications that have been prescribed from their rheumatologist. Particularly the discretionary ones like non-steroidal and inflammatory drugs, and prednisone. Can you give us some information about how you work with those patients who are on those medications? Because we know that those two that I mentioned are counterproductive for the gastrointestinal tract causing leaky gut, inflammation, and so on. Interested in your comments around this area.
Dr. Goldberg: When the patient comes in Clint, we ask them to bring with them a chronological history including a drug history of what they what they take, and then also currently with what they’re on. And that is a very important part, and a very challenging part of the practice. And one of the important things and I know you appreciate this is that, when the patient sitting before us with these various pains, and discomfort, and fatigue, and gastrointestinal symptoms, joint problems, whatever symptoms they maybe having. That patient is not just that patient today that we’re seeing. If that patient is 45 or 50 years old, then we’re seeing the accumulation of 45 to 50 years of living sitting before us. And the patient patients don’t think like that, because they’re used to going to a doctor. Doctor says, what’s bothering you? I said, I have a headache, I have this rash. And doctor says, okay here take this. So it is for that symptom is, your treating that today.
Dr. Goldberg: We’re now looking at the patient like that, that patient is let’s say 48 years old. They have 48 year history of emotions, they have a 48 year history of taking drugs, they have a 48 year history of eating habits, they have 48 year history of working, they have a 48 year history of emotional ups and downs, and thousands and thousands of meals. All that makes up their cells are today. And so that was sitting before us, not just what they’re taking right now but all the things are in the background as well. And we try to explain that to patients because otherwise they don’t really, it’s hard to understand that we’re not just going to address that patient as they sit there today on you know whatever the date is that day. They are 48 years of accumulated habits, insults, that have now make up the composition of their cells including whatever drugs they are currently taking. And so the patient they say this, I took this drug, and that drug, I stopped that a week ago. As if that’s no longer problem. But I say Okay, so you haven’t taken steroids and how many days? It’s been at least four days since I took any of that stuff. And how many years did you take it? Well I’d taken you know probably 30 or 40 courses over the past 20 years, but I don’t take it anymore. But we’re gonna have to work with that patient and help them to understand, that that is part of their makeup at this point that we’re going to have to dress in order to try to reverse whatever (inaudible) health issue that they have.
Dr. Goldberg: Now, I’m gonna go back just a second if I can Clint. We did a physical exam after the case history. The next step we’re going to do is to decide with the patient, Dr. Tener and I we usually go in the other room. We’ll talk about the patient for a moment, and come back with the patient and suggest on what laboratory tests we need to run. And from that we’ll have some, not a complete necessary. But we have some understanding of the toxicity issues the patient has, we have an understanding on what specific things are going on the GI track. We’re going to complete dietary history on the person. We’re gonna do temperature charts, diet histories, functional workup of how we’re digesting fats, and carbohydrates, and proteins. We’re gonna be looking at do they have some patients that have small bowel overgrowth going on, what’s the degree of it? How are their adrenal glands functioning? I mean there’s literally hundreds and hundreds of tests we have to select from what we’re going to do. Including standard tests that involved looking at inflammatory indices, such as a high sensitivity cardiac reactive protein and SED rate. Blood chemistries, blood counts, lipid profiles and so forth. So we have to come back, when we come back with the patient after we collected all the information that the patient agrees to go forward, which was a period about three weeks during the patient and for collecting this information. At that point, we’re gonna start talking with your question which is about the drugs and how are we gonna address that. Because some point, and some patients are on 2 or 3 drugs. Some of our patients, we have 1 on record patient was on 33 different prescription drugs all at one time. Now when they get like that we don’t even know what we’re looking at exactly, what we do a physical exam. The patient, or just like the drug reaction of the patient.
Dr. Goldberg: That is a lot to sort out. And here Clint, I’m hoping nothing too verbose but there is something else to understand here too. It’s not just the patients taking 1 drug or 3 drugs or 10 drugs or 33 drugs. It’s that they’re taking a total load of this many different things in addition to the foods they eat, the water they drink, the air they breathe, and the emotions they had. And all that is what a concept I used to teach my students, we called it the total load. What is that total load on the patient? And they’re only taking 3 different drugs. It’s still not just three drugs. It’s one drug times the 2nd drug times the 3rd drug. So it becomes exponential.
Clint: Wow okay. That’s interesting. That’s interesting..
Dr. Goldberg: The patients are thinking 10 or 15 or 20 drugs which is not uncommon for us to see they’re taking one drug times two times three times four times five. You can look up any of these drugs and they have many many manifestations, many many bad side effects. And what are this. What are the side effects when a patient is taking all these drugs together. A pharmacist cannot answer that question for you. Nobody can because it’s just that they can’t just look at drugs. All these drugs are interacting with the patient’s own personal biochemistry as well. So this is a this is a very very complex situation that not everybody not every patient understands that we have to try to sort it out at that point but at that first reported findings and everything is presented to the patient. We are insane.
Dr. Goldberg: This is something that we need to start addressing. How are we going to address this. How are we going to go about it. What are you willing to do.
Clint: Yes. Yes and to most of them go ahead.
Dr. Goldberg: Yes yes. By that time patient has made a commitment. We run laboratory tests and so it is very rare but that’s what we’re representing all the findings to the patient to back out that point. But most people by the time they’ve seen us they’ve been multiple other doctors sometimes 20, 30, 40 other doctors before we see them and we wish we’d seen them first. We couldn’t imagine these things getting from so far advanced complicated and so they’re going to go ahead. So we can’t tell the patient get off this drug or get off that drug. We can only educate them as to how some of their symptoms maybe all their symptoms and it’s sometimes a case may be related to the taking of these drugs and how these drugs will complicate them from getting well. And then we have different categories of drugs and one that you’re interested in is talking about this Prednisone which is a huge monkey on our backs in our patients’ backs and it has to be done very carefully both for clinical reasons and legal reasons and the way that we help the patient to try to get off them. So we’re going to put certain ideas in the patient’s mind we’re also going to tell them we can’t tell you to take a drug or get off it because we didn’t prescribe it for you.
Dr. Goldberg: But we’re gonna suggest to you that to get well, we’re going to give you..need to gradually that maybe overnight which you’re going to need to gradually reduce these drugs. We’d like you to work with us and your physician prescribe these drugs to get off them. You want to help them out. The patient is going to get it on those drugs for so long and now years later she’s finally gotten them off.
Dr. Tener: Oh yeah. There’s a patient that we work with, she came about three or four years ago. Both of us we really like this woman she was a very nice lady. And when she presented, she was on 10 different pharmaceuticals and she had been on them for 30 years. These are all these are all for depression and anxiety,10 different ones, all prescribed by a psychiatrists. 10 different drugs 30 years. So this was three years was when she first presented and we the last we saw her was about six months ago or so. And during that time we worked with her and she gradually as we were supporting her from a nutritional, biochemical and metabolic standpoint gradually with her doctor’s guidance reduced the drugs over a long period of time about two years and after its two year period, she had, she gone off all of them. But the interesting thing about that is that you know once you get off the medications, they just it’s not like they just you’re done with all the accumulated residues of all those drugs were still stored up in her tissues.
Dr. Goldberg: So even though she had gotten off those drugs there was still a considerable withdrawal period that she was going to go through. And she, one of the biggest complications that she had was she got up and getting off the drugs which is a severe amount of nausea which is a common side effect of a lot of the drugs in and a common symptom of people who go through and they have drug withdrawal and she experienced severe or severe nausea for about a six to eight month period and gradually as she continued, she’s one of the most persevering patients we had, she is not about to give up. And she had accomplished so much. She gradually over time the nausea at day and night, just got a call from her a couple days ago and she said she’s drug free, still drug free, doing well and has..This was a three year old patient, this woman had a lot of patient and are willing to stick it out that long and again she had a 30 year history of drugs so if you’re under 30 years and you have to give back three years of your life to get well and then live the rest of your life drug free. She made the decision that that’s what she wanted to do and she’s successful. She’s a relatively young woman she was, she first came to us in a (inaudible).
Clint: Do you always see the rule of thumb playing out which is that the longer that someone has had a condition, the longer it takes them to heal?
Dr. Goldberg: As a general rule that’s a topic for (inaudible) how long it takes those patients, and what are the variables are involved in overcoming or reversing a chronic disease. One of them is going to be how many drugs that they’ve been on and how long have they been on them for.
Clint: Interesting. Yeah.
Dr. Tener: So there’s a great article on our website along with top of the website goldbergclinic.com. There’s a comment on the menu bar. There’s a chap called our recommended reading.. resources. You’ve got a dropdown menus of recommended reading and if your audience or you click that link, it will take you to a page it has a list of articles there and there’s an article there called the time factor and recovery which discusses a lot of those factors. Dr Goldberg which is (inaudible) and I think would be a good educational resources on that topic.
Clint: Awesome! Awesome, and there is also the one on there that we discussed off line which is about the prednisone. And it is about how you have coined the phrase to the extent of you know it’s good for the moment but you will pay like hell later. And I think that everyone should spend the time to read that article which is you know it’s very raw isn’t it. It’s very in your face look at this. This drug isn’t going to be contributing to your overall health in fact it’s probably working against you. And if you want to improve to the extent that you probably do, it’s easier to do so when you’re not taking that drug and so you know we have this conundrum where the drug is alleviating the symptoms but contributing to the underlying cause and you know it is as you said a difficult decision for the patients to make but one that needs to be talked about right?
Dr. Goldberg: Yeah. So,you’re right. We tell them that taking steroids is enjoying our pay later or as I say pay like hell later because you’re going to pay very very big time.
Dr. Goldberg: And one of the ways that we address it Clint, is simply to have the patient go to the Internet and look up the side effects of steroids. There’s nothing good there…there’s diabetes, mental confusion, thinning of the skin adrenal atrophy, osteoporosis, the list just goes on and on and on. But it’s a very convenient way for medical physicians of any kind just simply say Here take this and the pain she goes home in a couple days later. It’s not always frequently they’re feeling much better. They don’t realize that they’re going to pay for that tremendous two three folds easily for the little bit of relief that they had.
Clint: Yeah. And not wanting to really labor this to death. But before we take a break and we we allow our listeners to also take a break. Would you please just give us an example of what might happen if someone were to take off their prednisone and over what period of time do you normally advise them to talk to their doctor who prescribe that drug to them to try and come off that drug?
Dr. Tener: Yeah. So people who have come to our clinic have taken prednisone for varying lengths of time in varying quantities. We just had a patient come just recently that was in the hospital and given how it was? it was methylprednisolone how much…a thousand or 1000.. 5000.. 5000, 5000 milligrams of methylprednisolone a day which is a humongous amount of methylprednisolone is prednisone on steroids. And they were given intravenously Of course they had a tremendous kickback as soon as they left the hospital start getting off of that. So the average patient usually starting whether it’s an inflammatory bowel disease or rheumatoid disease, they’re generally starting somewhere between 20, 30, 40, 50, 60 milligrams a day and they’re going through a what’s called a Medrol pack. Yeah. What they’re going to be gradually tigering down by a two and a half 5 mg every few days until they get down to a certain level and then the physician will either keep them on base level perhaps five to 10 mg or get them off completely until they have the next surge of symptoms or exacerbation and then put them back on again and many of our patients are on and off and on and off and on and on and off. Yeah. Some other patients were dealing with rheumatoid arthritis and have been on continually. (inaudible) amounts of it, not when I was first practice there just by itself. Now it’s usually accompanied by some type of (inaudible) Enbrel and Remicade along with that. So we tell them in conjunction with their medical position to see about starting to lower their dosage gradually. You don’t want them to just go from 60 milligrams a day. They’ve been out for three weeks you got to nothing because you can literally throw their system shock. Generally it’s considered safe to draw probably five at most. Eight or ten milligrams per week.
Dr. Tener: We get them off as quickly as they can but in a safe way. I think the key when we when we work with people who’s been on Prednisone is that as they’re starting to withdraw with the guidance of their doctors, we’re working with them at the same time to support them so that they can they can gradually meet all of it successfully. I mean if a patient were to just gradually get off prednisone and not make any changes to what their doing. Patients regardless of whether we’re working with them or not there is going to be some kickback when they get off drugs, they’re going to have some discomfort because the symptoms have been suppressed from the drug. So how can we be as supportive as possible to try to minimize any of the withdrawal they’re going to have as much as possible sedation get over that hunk and start rebuilding themselves? So we usually we work with people pretty intensely during that time. The other thing I think is important too just like my experience working with people that are withdrawing from prednisone is that they not only need to have the right guidance but they need to have..they need to have their hand held throughout the process so they understand what to expect. A patient that understands the steps they’re going to be going through, the bombs that they’re going to have along the way and then have the right support and guidance is much more likely to be successful than a patient going through it on their own. So I think that we’re having you know practitioners like Dr. Balbriggan in our corner can really make the difference between being successful and getting off prednisone and getting well or relapsing and having to get back on prednisone and starting the process all over again.
Dr. Goldberg: Yeah that’s a really great point Dr. Tener is making and patients are because we keep ourselves so that the patient has access to us with ease. Dr. Tener is this a normal thing I’m going through. What should I be expecting and to have somebody who you will turn into is very important and as Dr. Tener very rightly pointed out we’re holding our hand but we’re also trying to shorten things to do and are not that complicated such as we need to get to bed early, we get them not to push themselves too hard while they’re getting off prednisone, get as much rest and sleep as they can, to get some sunlight exposure. We usually have these patients because of the fact that prednisone has steroids, have all the connective tissue the body basically causing it to break down. We want them to usually be on some level of vitamin C during that time was it bioflavonoids and so forth. So giving all the support in that fashion. And as I mentioned getting out the sun and fresh air is very important and to understand that this is a stress they’re going through and so they need to try to back off other stresses that they’re on during that time and issues with the best intentions will do things are oftentimes quite contraindicated such as well, I felt so good while I’m taking steroids. I’m going to start lifting weights. Okay. And all for a healthy person lifting weights when you have somebody where you have a steroid which is catabolic and this activity mean it’s breaking down tissue to go out there and start doing barbel curls and bench presses and squats is totally contraindicated that we’re going to put in there some risk of damaging themselves.
Dr. Goldberg: So we say, Well for right now you got to retreat from the battle to come back and win the war. So you’re going to have to rest and this is a difficult thing for people to understand and if they understand it is difficult for them to employ because people usually think of the discipline as being like a Rocky movie. Remember the (inaudible) man who they call a Rock, gets up in the morning, drinks a dozen eggs. Tan, tan,ta–tan. He punch the bag, he’s running, he’s lifting weights. He’s sparring. And the scenario is you’re following him along as on his road to become the next heavyweight champion. But that’s not what real discipline is about necessarily that kind of discipline. Lots of people have to go and do something like running and jumping and lifting weights and boxing. Lots of people can do that but what takes much greater discipline in our minds is not to do anything, to do very little to allow your body to recover because rest in almost any kind of health issue, Clint I’m sure you know this, is the single most important thing. They have physical and emotional rest and to just back off because people are constantly patience want to do something they want to take something, they’re wanting to exercise, they want to get.. they want to eat more, they write things that they want to eat and we tell patients “Look we want you to just spend a lot of time in bed, we want you to get out in the sunlight. And we don’t want you to do a whole lot of atuff right now. That’s a very bitter pill for most people to swallow and that is what requires a lot of discipline.
Clint: And probably ties in very well with your retreat right to enable people to have that experience as well. You’ve got the retreat at Brooks which we’ll talk about on the next episode which can also tie into helping patients get well to enable them to have a place to go where they can be calm, they can spend some time outdoors and they can connect again with nature. Correct? Yes. Yeah. Okay great. All right. Well thanks so much. Let’s wrap up this episode here as we’ve covered all of the ways in which you handle patients when they come to your clinic looking at all of their background through a long conversation and gathering that information, physical exam and then following that up with ordering from a large selection of different certain tests, finding out the right tests for them and then having a hard conversation with them about the toxicity that is in their life and how eliminating some of that toxicity might advance their healing. Thank you so much and we’ll chat again on the next episode. Thank you.