Over the weekend, my father-in-law, Charlie, who I told you about last week, my wife and I went to a local restaurant for breakfast. As we were being seated, a late middle aged woman came in, on a wheeled walker, who was just gigantic. She plodded forward, one deliberate, ponderous step at a time, the saddlebags of her thighs quivering with every footfall. She leaned forward, holding the handlebars of the walker (which actually had a side view mirror on it) and I had the distinct impression that she couldn’t stand up straight, if her life depended on it.
 
“What’s wrong with her?”, my wife whispered. “Well, if I had to guess, I’d say she’s probably got arthritis of her hips. That’s what’s pulling her forward like that, so she’s bent at the hips. They can’t straighten out any more.”
 
Then, we watched as the woman slowly transferred her bulk to the chair. Since she was seated right behind me, it was kind of hard to miss this operation. Between the woman herself, the walker and maneuvering room, she easily took up three quarters of the aisle between the
tables.
 
Suddenly, we all weren’t quite so hungry.

My wife caught me smiling as I remembered a day in the OR a few years ago, that this woman brought to mind. So, naturally I had to tell Charlie and her the story. 

My assistant, Izhar, was originally from Pakistan, although when he left, it was still a part of India. He was a very fine surgeon in his own right and he was the first new surgeon on the staff that I had approved, after I became Chief of Orthopaedics. He had a very impressive CV (curriculum vitae), had written a number of scientific articles in peer reviewed orthopaedic journals and had been Chief of his own orthopaedic unit in Zambia, Africa. 

He left everything he had behind and fled that country, with his family, when Idi Amin, next door in Uganda, was shooting up the place and killing people in the streets.  He came to the States and worked as a Fellow at the Hopsital for Joint Diseases in New York City. When he
came in for his interview, he was planning to go to work for one of the early HMO’s in Long Island. I had read his CV and I liked him instantly. I told him,  “You realize, you’re vastly over-qualified for these people…” 

I was right, too. I few years later, he resigned in disgust and opened his own private practice. I sent him a number of his first patients to help get him started.  And he eventually succeeded me as Chairman of the Department, after I retired. We worked together nearly all the time. But, despite his assimilation into our society and his subsequent citizenship in the USA, he remained a product of his own culture, in many ways.
 
Above all, he was brutally honest. No smooth talk, diplomacy and fancy dancin’ for him. He’d tell you, patients, other docs and anyone else exactly what he thought, no frills. Made sense, in a way: after you’ve had bad people shooting at you, what are words going to do to you?
 
Anyway, we were operating together one day and talking about how unreasonable some patients were in their expectations and how they were all too quick to blame someone else for their symptoms and other problems. He told us (me and the scrub technician, who was part of
our team) about an enormous woman who came to see him for knee pain.

After examining her, he was about to prescribe treatment when she said, “I don’t understand it. Why is this happening to me?” Without missing a beat, he looked right into her eyes and said, “What do expect? You’re fat as a pig!” The tech and I just broke down, laughing. I mean, tears were rolling down our faces. You really had to be there to hear Izhar’s tone, his accent and his dry delivery to really appreciate this, but, man, it was funny! Not kind, but honest.
 
The truth is, when it comes to weight, with rare exceptions we are all responsible for our conditions. In this example, the woman he saw had all this mass constantly pounding her hips, knees and ankles, with every step she took. No wonder that she was having pain. But until the good doctor gave it to her between the eyes, she didn’t seem to realize the obvious–that she was causing her own problems. Remember, every extra pound in body weight translates into about three to four times body weight force on the hips and knees, when walking and up to seven or eight times, climbing stairs.
 
So, he gave her some anti-inflammatory medicine (you can try the home version, without prescription, by going to
 http://drbillsclinic.com/eliminate_knee_pain.html ),  recommended a good diet and sent her to physical therapy for a course of exercises, like those I teach at   http://drbillsclinic.com/exercise_eliminate.html/.

And to this day, I still remember him and that story, every time I see a truly gargantuan person rolling in. Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill 

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html

P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html

FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

Today, my father-in-law, Charlie, is coming over to visit us, but if truth be told, he’s probably coming over to get away from the chaos in his own house, too.  Charlie’s will be 84 his next birthday and a tougher, more self-reliant guy you’ll never meet. He’s on his third wife (having buried the other two), who was also previously married. She has a daughter, now divorced, and two granddaughters, all of whom are living with her and Charlie in a house he built with his own two hands, only a couple of years ago, if you can believe it. On the one hand, they wait on him hand and foot. But three women under one roof, yelling and screaming at each other (did I mention they’re of Italian extraction?) drives him nuts. Hence, the need for a break…
 
Charlie, like many of us, is frustrated as hell at the limitations age imposes on us all. He’s a very physical guy, whose sole goal in daily life was to get up and “have a productive day.” And produce, he did. 

He was a bona fide member of the “Greatest Generation,” volunteering to join the Navy in WW II at age 17. He lied about his age to get into the service (just like the 17 year olds today!). He saw action on LST’s (flat bottomed amphibious landing crafts) and then joined the Air Force Reserve after the War, to complete 20 years of service to the nation. Then, he put in the next 50 years as a general contractor and mason. He built homes and office buildings and small shopping centers, mostly with his own two hands and a few paid by the day bricklayers and helpers. And his brickwork and stonework were just spectacular–and self-taught.

Though only about 5 foot seven, pound for pound, I never met anyone stronger than Charlie. Once, in the mid-1980′s, my wife and I, Charlie and my brother-in-law were trying to leave New York City, for Long Island, by way of the Queens Midtown Tunnel, when our SUV threw a bolt and stopped dead in the street, blocking traffic at the entrance. Charlie put up the hood and took a look (I was clueless–hey, I was a surgeon, not a mechanic!). Then, he jumped UNDER the hood, and with one arm, HE LIFTED THE ENTIRE ENGINE BLOCK, while he rethreaded and spun the nut onto the bolt with the other hand! This, like it was nothing. Then, he jumped out, with his arm still  smoking from the hot engine block, just swiped at the blisters on his forearm. “Ahh, this is nothin’,” he said. Second degree burns and he just blew them off.

This was just one of the nearly superhuman feats of strength that I saw over the years. The guy lived to work. If he was too full of energy at night, he’d go out and shovel a ton of sand, or dig a foundation, by hand, with a shovel, just for exercise. No exaggeration. Just shaking hands with this guy was like putting your mitt in a vice. Unbelievable. Luckily, he always liked me.
 
As it happens, I operated on Charlie’s knee over 25 years ago, for a torn meniscus. At that time, there were no arthroscopic techniques, so it was an “open” procedure (arthrotomy), although it was only about  1 – 1/2 inches long in a gentle “S” curve (this serves to give greater exposure; it has nothing to do with “branding” my patients with the Stillwell “S”, contrary to popular belief). I saw some arthritis in there, too, and I was sorely tempted to debride it, drill it, try to smooth it out, and in general, “polish the apple” a bit. 

My assistant and friend, Steve, told me, “Bill, just leave him alone. Don’t mess with it. You’ll just make him worse.” So, I did as he bade me. You see, knowing my tendency to be a perfectionist, I asked Steve to assist me, ’cause he had very good judgment. We agreed that if we had differing opinions during the case, his call would rule. And he was right. It’s tough to be objective when it’s friend or family, so I substituted
HIS judgment for mine, while I was able to execute my own technical facility for the surgery. 

The combination worked. It’s been well over a quarter century and Charlie still hasn’t needed a total knee replacement.  He did great after surgery, using the foundational knee exercises that eventually evolved into my PAIN-FREE PROGRAM (which you can see at
 http://drbillsclinic.com/exercise_eliminate.html )  He would have done even better, faster, had it been five years later, after the arthroscopic techniques had been introduced.
 
Today, his back is shot; he’s paying the price for the excessive stresses he loaded on it for all those years. And he walks with a cane. Like the rest of us,  Charlie isn’t quite what he once was, but he’s still one helluva really tough guy in my book. So I think we’ll go out for dinner and take it easy. It’s been a tough week. We can all use a break. Til next time, my friend, be well. Have a great weekend.
 
Yours for a pain-free tomorrow,
 
Dr. Bill

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to  http://drbillsclinic.com/eliminate_knee_pain.html

P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html

P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html

FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

March 27, 2008 

I’ve had a helluva day. On top of mucho aggravation late last night, wherein my car, parked for only nine days in the airport parking garage, was stone dead after our flight back to Orlando and needed a jump start, only to have the automatic transmission  stuck in high gear (so I had to drive back home at 40 mph and 4000-5000rpm), I lost my favorite cat,  BoBo, today.

BoBo was my favorite because HE adopted me. He was born in the Spring of 1997, in the front yard of my home in Nissequogue, New York. My wife had seen a little line of babies following Josey, their momma (my wife named all the cats that hung around our house). 

Tiny little things, they walked in a single line, one after another, following their mother, out of  the protection of bramble bushes near the woods.  At my wife’s urging, we went out and spirited all the little kittens into the house. Josey knew and apparently didn’t mind. She just went out and got pregnant again. (We tried a number of times to catch and spay her, but she eluded us for a number of litters, which we rescued and kept. That’s how I ended up with an insane number of cats.)

We bottle fed them (OK, my wife bottle fed them and I helped out as often as I could) every four hours, around the clock, and held them and loved them, as we watched them grow before our eyes and saw their eyes turn from the slate blue of kittenhood into the gold of maturity. They especially liked to climb our legs, with their little needle sharp claws, whether or not we happened to be wearing pants at the time. Ouch!
 
One of them was a “tuxedo” cat: black short hair, with a white chest, a black mask around his golden eyes, with white below, black nose and white paws, with black pads. Because he looked like he was in formal dress, I originally called him Beau, as in Beau Brummel (a famous British dandy of the late 19th century, who actually invented the familiar black and white tie and tails, upon which all modern male suits are based). But over time, especially since he looked so serious that he was funny, we started calling him “BoBo,” and it stuck.
 
For reasons I will never know, BoBo took a shine to me.  He would walk in front of me, even if I was walking, and  just fall over on his side, right in my path. I’ve never seen another cat do this. And he would look right into my eyes, with such a serious look, that it never failed
to make me smile. He would even pull his trademark ”falling over” trick, while he was on a table, in front of me–he just expected me to catch him. The nerve of him! But I always did.
 
Well, he and one other, a petite little black longhair we called CoCo, became “my cats.” They followed me everywhere and selected one bedroom, that they defended against all comers, to hang out in. Even though BoBo would occasionally pick on her, CoCo stuck with him.
He was a real brat! But that only made us love him the more, like the “bad boy” you know is really good-hearted.
 
Well, we had eleven good years with him. But when we came home from New York this time, we noticed that he looked skinny. And he was unusually quiet and withdrawn. He was making weird, stentorian purring sounds. We were both worried about him. This was not like him. I let him sleep with me last night–he was all curled up at my hip, and seemed to be comfortable, quietly purring with his little paw on my hip.
 
This morning, I dropped him off at the Cat Hospital for a “senior workup” and examination, rubbed and kissed his little head and told him to be a good boy. Then they took him in, while I went off to get the car serviced.  No sooner got home, and another cat, Molly, one of the senior cats and grandmother to Bobo and a number of our other cats, seemed to have an upper respiratory infection. So, we took her to another vet, closer to us, for a chest x-ray and some medicine. While we were there, I got the call.
 
BoBo had a really enlarged spleen. Not good. The vet recommended a needle biopsy for cytology (harvesting of cells for diagnosis). OK. Best to know what you’re dealing with. Another call: they got pus out–implying an infection, rather than tumor. So they recommended an
exploratory laparotomy (opening the belly) to remove the swollen spleen, and clean out the infection, so it will respond to IV antibiotics. OK. But when they got in there, they found a cancer of the gall bladder, which had spread to the spleen and elsewhere, that couldn’t be removed surgically. The pus was from the necrotic (dead cells) center of the tumor. Nothing to be done. So, since it was hopeless, and since he was already asleep, I decided to let him go….
 
God, I hate being powerless! I couldn’t save him. The vets couldn’t save him. No one could. I could only save him pain and keep him from suffering — a final gift for my poor little boy.
 
It damn near tore my heart out. Those who don’t really love animals don’t understand and may even think this is foolish. All I can tell you is that I, who, in the course of my surgical career, have had men and women die in my arms, and watched the light fade from their eyes with equanimity, could barely hold it together over a little ten pound cat. 

Maybe it’s the unconditional love they give us, or their innocence, or their complete dependence on us, or maybe, lacking children, my wife and I have invested the love we would have given a child in our pets. Who knows, really?
 
I only know that I loved him and he loved me. But he’s at peace, now, and he suffered no pain. I can only hope my own ending, when it comes, is so swift and so kind. When the sorrow ends, I will always remember him fondly. I’m grateful that I knew him and that I had him so long. Like all the ones we care for,  he enriched my life and that of my wife. And we will miss him dearly.
 
Well, life goes on. My heart hurts, but according to a good friend and mentor of mine, the surest cure for feeling down is to get the body moving. And among other exercises, you can join me in doing the very best ones for preventing or eliminating knee pain. Go to
 http://drbillsclinic.com/exercise_eliminate.html
 
So, here’s hoping your day will be better than this one of mine. Til next time, my friend, please be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill 

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to   http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html

P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

It was 1975, during my first residency year at St. Luke’s Hospital in New York, that I saw for myself, for the very first time, the destructive nature of a torn meniscus. While not as intense as internship, orthopaedic residency was still a lot of scut work for the junior guys on the team. In that year, that was me and my mates. But there were a few opportunities
for us to relax and have some fun. One of the ways was basketball games, between the orthopaedic residents and the general surgery guys.
 
One of the senior general surgery residents was a real good, aggressive player, who was terrific at jump shots. During one game, he suddenly twisted, and spun away, in an effort to avoid the player guarding him and set up a jump shot at the basket. Suddenly, everyone heard a loud “pop,” as he screamed in pain and fell to the floor. He wasn’t able to finish the game and, in fact, had to be helped off the court by two other players.  He had real difficulty putting any weight on his knee, as well as severe pain.
 
He had to sit out the rest of the game on the sidelines, with his leg elevated and packed in ice. Later on, he was carried in to see my old professor, Dr. Bob Zickel  (a very famous guy in orthopaedic circles), or “Zick,” as he was affectionately known. In those days, there was no such thing as an MRI scan. Plain x-rays, physical exam and clinical judgment was the extent of diagnosis, at that time. And according to Zick, one of the best and wisest clinicians around, our surgical pal had really done a good job on his medial meniscus. 

Zick ordered an arthrogram for the knee, to confirm his clinical impression. This was the test that was used, before there was such a thing as the MRI scan. These were specialized x-rays, taken after the knee was injected with an iodine-containing dye. Iodine blocks x-rays, so the liquid dye would outline all the normally invisible structures inside the knee joint, and sink into any abnormal crevices, like a tear in the meniscal cartilage, thereby making it visible. You got even more contrast and greater accuracy, if you also injected air into the joint. Only problem with this procedure was that it HURT, and of course, there was a small risk of infection from the needle. But it was pretty accurate.
 
Anyway, the test confirmed that sure enough, our friend had a nice “bucket handle” tear of his meniscus, and at that time, the only treatment was to surgically remove it. Well, the man wasn’t happy, I can tell you that! He was in this great training program and he wasn’t about to lose time by having surgery. Besides, his swelling and pain had gone down, and his knee was feeling pretty good, by this time. So, he refused surgery and went about his business for the next few weeks, including our basketball sessions.
 
But three weeks later, during a game, his knee locked up in flexion, and down he went. This time, he couldn’t even stand up and couldn’t straighten his knee. He was in agony. They carried him straight up to the OR, where I assisted Dr. Zickel in operating and removing the locked and torn meniscus. Here’s the thing: in just three weeks, the torn meniscus had severely shredded the cartilage coating of the femoral condyle. In other words, he got full blown arthritis in just three weeks!
 
That’s the danger of ignoring a torn meniscus. If not treated, it can destroy your knee. Fortunately, today we have MRI scans that are noninvasive, don’t hurt, and are super accurate at diagnosis, and surgical techniques to repair bad tears, instead of just removing them. You can learn even more about these injuries and many others  in my LITTLE GREEN BOOK, which you can get at    http://drbillsclinic.com/eliminate_knee_pain.html 

Our friend ended up doing well in the short term. He worked hard at the physical therapy, the forerunner of exercises I teach in my PAIN-FREE PROGRAM today, at   http://drbillsclinic.com/exercise_eliminate.html
But, he had severe and permanent damage. I lost track of him over the years since then, but I’ll bet he has a knee replacement by now. Well, it made an indelible impression on me. And I hope it made one on you, too. The lesson is, don’t ignore a knee injury–or you may pay a higher price than you needed to, in the future. 

Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill 

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html

P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to   http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to   http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

Well, it’s a beautiful day after Easter, here in Southampton. Not a cloud in the sky and the air is crisp and clear. The traditional Easter ham was delicious, and will make good sandwiches for the rest of the week. We even had hot cross buns for dessert. 

One of the truly restful things about this place is the absence of our usual menagerie, which is still in Florida. But, as luck would have it, a pretty, buff colored red tabby cat has found and “adopted” us. That’s just how it is with cats–you really don’t own them; they own you, and allow you to care for them.

Now, you’d think we would have learned, after all this time, not to encourage this. After all, that’s how we ended up with so many in our travelling road show, to start with. But we’ve always been a couple of fools for sweet cats, and this probably won’t change.
 
My wife named her Sara, and she’s moved right in. Though a feral cat (even though we suspect that someone owned her in the past–she’s in too good a shape to be totally wild), she showed no fear of us when she showed up on the back porch, one day. We just had to give her something to eat, when she cried at us. Next, my wife got her a little, insulated igloo, to use as a shelter, out back. Then, one day, while the back door was open, she just walked in and started looking around.

Next thing I know, she’s fast asleep on our new couch. And just last night, I found her peacefully sleeping on the heat register, in the floor behind the couch,  just bathing herself in the warm air flow. Not too dumb, this cat. She definitely knows what she likes.
 
So, now we’ve managed to get ourselves adopted, yet again. And I have to admit, she IS real sweet. But if she’s going to be part of the family, she has to be checked out by the vet, de-wormed, cleaned and spayed, if she isn’t already. We have an appointment with the local vets today at 11:30 AM. Now, the problem is getting Sara to cooperate with the plan.
 
She’s out back, right now, patrolling the back yard and the neighborhood. We have about an hour to get her to return to the house, so we can get her in a crate, and get her in to the vets, on time. Since she hasn’t been in a crate before, AND she has all her claws, this should be very amusing. I think I’ll let the bride do the honors, while I supervise. Heh-heh.
 
I remember during my residency at St. Lukes, a guy came in to see one of our Internal Medicine consultants, with some hard lumps in his groin. Based on this finding, he was told, sorry, but you have cancer. But then, as the patient was getting ready to leave, the consultant noticed a partially healed scratch on his leg and asked him about it.

The patient, understandably feeling pretty depressed, said, “Oh, that’s just a recent gift from my cat.” The consultant leaned back in his chair and got a big smile on his face and said, “Never mind what I just said.  Go on home and relax. You’ve got cat scratch fever,  not cancer!” Seems a viral infection from his cat had caused the lymph nodes in his groin to swell, looking for all the world like cancer.
 
We didn’t have it then, but today, whenever we get nailed by cat claws, we wipe a little HIBICLENS on the scratch. This stuff is great: 4% chlorhexidine gluconate, available in your drug store, without a prescription. Kills everything, bacteria, viruses (including hepatitis and HIV), except for fungal spores, in about two minutes flat. I switched to this as a prep for my surgical patients in 1982 and used it exclusively thereafter.  Every home should have a bottle for lacerations,
abrasions, and, yes, cat scratches. It only costs about eight bucks, it’s cheap insurance against infection, especially if the cut is over a joint, like your knee.

This is just one of the many tips I reveal in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN, which you can get at    http://drbillsclinic.com/eliminate_knee_pain.html   There are plenty more where that came from–simple tips, using over the counter, cheap and easy to find meds to relieve pain, prevent problems, and restore function.
Go on over to the web site and check it out.
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill 

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html

P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to  http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to  http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

Given the significance of the Easter Season that culminates this weekend with Easter Sunday, I thought it only appropriate to tell you about a friend of ours who’s literally “walking on water.” Of course, the ”water” is in both her knees, not under her feet.  And it’s a sign of some significant internal knee problems that need to be identified and treated.

Water on the knee, as I’ve mentioned before, is a sign of an internal derangement (think “torn meniscus“), until proven otherwise, unless it immediately follows a specific injury, or is associated with a known disease, like Rheumatoid Arthritis. That’s especially true if the “water,” or joint fluid, accumulates gradually, without pain. A painless effusion is an
indication that something is wrong inside the joint.

I’ve also mentioned before that menisci can tear just from chronic degeneration, ie. getting older, from the thousands of repetitive stresses applied to the cartilage structures over the decades. So, it’s not just the sudden injury that can tear the menisci. The reason this is important to understand is that many non-orthopaedist physicians, though well-meaning, try to treat the effusion, often by aspirating the joint (sucking out the fluid through a needle), rather than addressing its underlying cause.

Now, I’m not a big fan of aspirating a swollen knee, unless it’s so tensely swollen that it’s causing the patient severe pain, or if joint fluid is needed for accurate diagnosis, especially if infection, gout, or one of the inflammatory arthridites (Rheumatoid Arthritis, etc.) is suspected, or the swelling is due to massive bleeding into the joint. 

Why? Well, any time you stick a needle into a joint, even under strict sterile conditions, you take the risk of introducing bacteria into a previously sterile joint (ain’t no such thing as a completely sterile field). That can lead to disaster, should an infection result. A rip-roaring staph infection can destroy all the articular cartilage in the joint in 48 hours–the enzymes, produced by the bacteria, just dissolve it.  And once gone, the cartilage isn’t coming back. 

Even worse, a history of infection is a relative contraindication to a total knee replacement.  So, if this happens, you’re potentially screwed. In this situation, an ounce of prevention is worth a few tons of cure. 
 
This is just one reason why you should have some understanding of what conditions within your knee cause what signs and symptoms. You and your family doctor could both benefit from the information and advice in my LITTLE GREEN BOOK. See what I mean at    http://drbillsclinic.com/eliminate_knee_pain.html

Our friend is seeing an orthopaedist and, if you suspect a real internal joint problem, you should insist on a referral to a specialist. That’s your best chance for an accurate diagnosis, appropriate treatment and not wasting your time, or prolonging your pain. Remember that in Medicine today, the HMO or insurance company will resist that, ’cause it costs them more money. But it’s YOUR health and YOUR body. Insist.

Anyway, he has started her on an anti-inflammatory med to reduce the swelling. I’m sure he’s also recommended a cane, to keep her from falling, if the knees give out.  But she’s stubborn, like lots of folks, and probably won’t use it. Hell, she’s read my book, but she doesn’t do the things I recommend. Reading it is not enough. It doesn’t work through osmosis. You have to DO what is recommended. Otherwise, it can’t help you.
 
It’s like the old saw, “You can lead a horse to water, but you can’t make her drink.”
 
She will probably need an MRI scan, which can disclose tears in the menisci, with an accuracy up to about 95%,  on the inner, or medial, side of the knee. Just so you know, NOTHING is 100% accurate. Even arthroscopic examination, the most accurate of all, is said to be 99% accurate–1% is subtracted, just for potential human error.
 
Based on these results, she may well need surgery, after many years of neglect. Had she been doing the exercises I recommend in my PAIN-FREE PROGRAM, which you can see at   http://drbillsclinic.com/exercise_eliminate.html
she might not be in this situation today. These are the same exercises that I prescribed for my patients with knee pain and the same ones I used myself for my own knee problems. So, when I tell you that they work, I know what I’m talking about. If you have knee pain, or want to prevent it, give these a try. You won’t be sorry.
 
And if you are one of the many who celebrate it, have a Happy Easter! Til next time, my friend, be well.

Yours for a pain-free tomorrow,
 
Dr. Bill
 
 
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to    http://drbillsclinic.com/exercise_eliminate.html

P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to   http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

It was rainy today in Southampton, so every latent ache and twinge was magnified into significance. As I’ve  mentioned before, this is a real phenomenon, due to the low barometric pressure that accompanies the rain.  Ah well, a little pain lets you know you’re still alive. Far as we know, the dead feel no pain.
 
During our morning ablutions, my wife said from the shower, “You know, if I only knew then what I know now,  I would have taken the trouble to knock off some of this excess weight.”
 
“What do you mean,” I replied.
 
“Well, you know, I just let it happen over the last twenty years and I didn’t think that it would do much more than make me need bigger clothes. I never realized that it would have real health consequences, and affect how I feel,” she said.
 
“Heh. That’s how we ALL feel when we’re young–we don’t think at all about the later consequences of  our actions,”          I said. 

And that’s the truth, isn’t it? When we think about it at all, we don’t really believe that we’re ever going to be old. When we’re young, we feel invincible and immortal. It’s not til we feel the first twinge of joint or back pain, for no apparent
reason, that we finally see that it’s the first sign of the Autumn of life.
 
I used to tell my patients, “If you’re over forty, and you wake up in the morning and nothing hurts–you’re dead!” That invariably brought a rueful smile. Deep down, we all know. We just don’t like to think about it. And we like to DO something about it even less. But, unless you want that Autumn to slip quickly into a real long Winter, you have to take action.

Past a certain point in your life, it just doesn’t come easy any more. It takes effort. It takes action.  It takes commitment. And that’s what I told her.
 
Well, the bride decided she was going back on the wagon: watching the diet, and regular walking. I suggested that she add some strengthening exercises, as well, like those I teach in my PAIN-FREE PROGRAM
 http://drbillsclinic.com/exercise_eliminate.html     After all, she lives with the source. 

And these exercises, though specially modified to prevent or eliminate knee pain, have beneficial metabolic effects on your entire body. You could do a lot worse than using them as a foundation for a fitness regimen. They do affect the largest muscle groups in the body, encourage deep breathing and stimulate the entire cardiovascular system. So their  health benefits extend far beyond their pain relieving qualities. 

The important thing is to do something. Our bodies are like “meat machines,” and like any other machines, they require regular use and maintenance, or they fall into disrepair. That’s what disease is. So, really, we’re all responsible for our own maintenence. It’s our responsibility. In the end, how we live and how we feel is really up to us.
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill 

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to  http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to    http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to   http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

My wife picked me up at the airport the other day, after my flight to New York. It was good to see her.  Especially since I had worn a green polo shirt, in honor of St. Patrick’s Day and it was COLD outside the airport, if you’re used to Florida temperatures. Once inside the nice, warm car, with the butt warmers on, I settled in for the road trip to Southampton.
 
While we were catching up on events, I noticed that she was squirming in her seat. I asked what was the matter and she said “My butt is sore.” Turns out that she’s noticed this just the past few days,  just about the time that her new car was delivered and she started driving it. Hmmmmm…. 

Well, further questioning revealed that what was actually sore was her right greater trochanter.  It just seems like her butt to her because the trochanters, the hard bony lumps at the outer upper part of the thighs, that lay people often refer to as their “hips,” actually roll backwards, toward your butt, when you sit. To make matters worse, and what was probably the cause the onset of this pain, the new seats have a deep “bucket” profile, moreso than the car she’s been driving, til now.
 
So the side walls of the bucket seat press in on the trochanters, which roll backwards, right into the “bucket.” This extra pressure rubs the bursa, a sac of fluid that normally lies over the prominence of each trochanter to allow gliding of the soft
tissues over the bones. This extra pressure causes inflammation, a bursitis. Once started, the bursitis is worsened by any additonal pressure or friction.
 
If you develop trochanteric bursitis, for whatever reason, there are things you can do to relieve your symptoms. First, avoid that activity that’s aggravating the symptoms. In this case, a pillow or gel pad in the seat can cushion the trochanters and raise the level of the seat, to eliminate the sidewall contours of the bucket seats and the pressure they apply. Next, rest and sleep with the legs apart, to relax the soft tissues over the bony prominences. Often the best way to do this is to place two or three pillows between the knees. Finally, you need to reduce the inflammation, by using OTC medications, Advil or Aleve, applying local heat, and using the various alternative measures. Although it’s directed primarily at the knee, a complete discussion of all the methods to eliminate inflammation is described in greater detail in my LITTLE GREEN BOOK. See what I mean at   http://drbillsclinic.com/eliminate_knee_pain.html
 
Oh yeah. One more thing–while you’ve got pain, use a cane in the opposite hand. This will reduce the pull of the hip abductor muscles on the tender greater trochanter and allow it to heal more readily. I’ve not only treated many people, besides my wife, for this condition, but I’ve had it myself, as well. So I can tell you, first hand, that these measures work.  If you ever suffer from this problem, they’ll work for you, too. Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,

Dr. Bill 

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to  http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to   http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to    http://drbillsclinic.com/advanced_masters.html

FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

 Yesterday, I flew to New York to have the traditional St. Patrick’s Day meal of corned beef and cabbage, with boiled potatoes, parsnips, onions and celery, with my wife. This meal is like a heart attack on a plate, so  I limit myself to once a year, but it’s really good. Ever notice that the things that you’re not supposed to do are always the most attractive, or taste the best?
 
She had flown on ahead, because we’re having some work done in the Southampton house. But this meal is one of our traditions. Has to be. So, I braved the airport by myself this time. Luckily, it wasn’t too crowded; the heaviest flights are the ones coming TO Orlando, to visit “The Mouse.” Those are jammed. Back to New York, not so much.
 
Anyway, I was able to get a bulkhead seat, which allows me to keep my arthritic knee out straight and also gives me room to move and exercise my legs. This is especially important on plane flights. Here’s why.
 
Sitting for long periods of time, in a tight seat, with your legs sharply bent at hip and knee, makes you a prime candidate for a DVT, or deep vein thrombosis.  This is a potentially lethal problem, though more often it causes painful swelling of the calf and/or thigh, sometimes accompanied by redness and tenderness. It’s caused by abnormal clotting of the blood inside the veins. The problem occurs when the flow of blood is obstructed, and when the blood is “thickened” by dehydration. 

The clot of blood is initially very fragile, and can easily break free. This is the real danger: if  a piece of clot breaks free, it can whip up through the heart and lodge in the capillaries of the lungs.  This occurrence, called a pulmonary embolus, causes chest pain, shortness of breath, sometimes a pink foam on the lips and EKG changes. If it’s big enough, it can block a larger blood vessel and actually cause a reflex cardiac arrest. In other words, a big one is a potential killer.
 
Here’s what I do to prevent this problem:
1. Take an aspirin before the flight; I use a baby aspirin on a daily basis myself, but one regular aspirin is OK, too. Aspirin “poisons” every platelet in your blood stream, “thinning” your blood, so its less likely to clot. Platelets are the sticky cell
fragments that initiate clots. So the aspirin is good prophylaxis.
2. Do NOT drink alcohol on the plane–it dehydrates you and therefore thickens your blood. “Thick” blood is more likely to clot.
3. Drink water or other non-alcoholic drink to rehydrate your blood and “thin” it, again making it less likely to clot.
4. Exercise in your seat, especially your legs.  Curl your toes, move your ankles up and down and tighten your calves, thighs and buttocks, in that order. Do this every 15-20 minutes to keep the venous blood flowing through your legs.
5. Finally, get up out of your seat and walk up and down the aisle, or visit the restroom, if this is practical, every half hour or so.
 
A few simple measures like these can really reduce your risk of DVT. They’re cheap insurance against this danger that’s specifically associated with flying. And, who knows, they could even save your life. Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to    http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to   http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

It’s that time of year again, what I always thought of as the “unofficial” start of Spring, when everyone is Irish for the day (as it happens, I am at least half Irish, on my mother’s side). Sons and daughters of the Emerald Isle strut their stuff to the skirling drone of bagpipes, down New York’s Fifth Avenue, the center line of which is painted green for the day, and parade down many Main Streets, throughout the USA.  Many gallons of green beer and many tons of corned beef  cabbage and Irish Soda Bread are consumed today in an  annual rite shared by millions, in honor of the  Children of Erin.
 
It’s St. Patrick’s Day and top o’ the mornin’ to ya!
 
During my medical school years, during my clinical clerkship at Metropolitan Hospital, I drew the short straw one time and had to cover the Emergency Room for St. Paddy’s Day, all night long, with a few of  my school mates. What a freak show that was! The whole place reeked of cheap booze and vomit.
 
The ER was swamped with drunks, the DT’s, GI bleeds, fractured hands (from punching walls, or other drunks), diabetic comas, auto wrecks, stab wounds (no gun shots that I recall, but then, this was the seventies), fractured ankles (from falling off curbs), psychotic breaks, you name it….I was busy as could be, not to mention exhausted. The interns, residents and attendings kept us all hopping. 

But the standout from that memorable St. Patrick’s Day night was a young couple carried in on a stretcher, from an ambulance, under cover of an olive green army blanket (kind of fitting for the day), yelling for all they were worth. They were…uh…stuck together, if you get my drift. Since he was “riding bare back,” it seems his, uh…extra skin on “that certain part of a man’s body” got snagged on her IUD internally, and they couldn’t separate. Someone called the cops, who called the ambulance, and here they were. They’d apparently had a little too much Irish cheer,  as well. Gives today’s term, “hookup,” a whole new meaning.
 
Now, from a professional standpoint, this was a serious medical and logistical problem, not to mention painful (for them, not us). But, we were
only students after all, so our nascent professionalism didn’t last three heartbeats–we HOWLED with laughter! We were almost falling down, we laughed so hard (even now, I’m tempted to giggle a bit.) I mean, it was a serious problem, but hell, it WAS funny! 

Our teachers, took a pretty dim view of our mirth, though, scolded us and then locked us out of the exam room. So we couldn’t see anything when the consulting urologist arrived. But, boy, we could HEAR it! Seems the GU guy had to do an intravaginal circumcision, without anesthesia, to disconnect the happy couple. Why? Because he couldn’t get AT the affected parts,  if you can visualize this, to inject local anesthetic and he couldn’t use general anesthesia, because the guy was loaded with alcohol. 

YIKES! You could hear the poor man’s screams all over the ER and far down the hall. We weren’t laughing by that time. Hit too close to home, if you know what I mean. The lovers were parted and sent to separate hospital rooms, with strategically placed ice packs, and IV’s for antibiotics and pain medicine, for observation and further treatment. I always wondered whatever happened to them….
 
At dawn, things finally started to calm down. All of us were shell-shocked from the night’s labors. Things stabilized and then, we were allowed off duty, to get on home and collapse into bed. So, all in all, I think that was probably my most memorable St. Patrick’s Day.
 
And since it’s a day for the wearin’ o’ the green, and all things green, I thought I’d explain why my LITTLE GREEN BOOK is actually GREEN. (See for yourself, at  http://drbillsclinic.com/eliminate_knee_pain.html )   I mean, why not the little RED book? Well, the color
was suggested to me by a good friend, because GREEN  is a healing color, the color of nature and all growing things. And since the purpose of the book is to help you heal your knee pain, in as natural a way as possible, I chose green, to communicate that ideal.
 
And when my medical office was open, the entire place was covered with a deep emerald green plush carpet, the walls were a deep Lafayette Green, and I even had a deep green marble bathroom. All for the same reason. And it complemented the mahogany panelling throughout, as well.  So there’s a bit of tradition and continuity in it, too. And that’s why the LITTLE GREEN BOOK is GREEN.
 
Funny thing is, my favorite color is RED….
 
Oh well, have a safe and happy St. Patrick’s Day, my friend, and be well. Til next time….
 
Yours for a pain-free tomorrow,
 
Dr. Bill
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved