May 27, 2008

After surviving my surgical interneship at Medical College of Virginia, and getting married in May of that year, I was signed up for another year as a JRA: Junior Assistant Resident in Surgery. I had undergone quite a metamorphosis during that first year. I arrived as a “virgin” doc, still wet behind the ears, fresh from my senior year in medical school, with lots of theory jumbled up in my head and not a lick of real patient responsibility. 

Terrified that someone would suffer, or even die, as a result of what I didn’t know, massively inefficient and in a state of constant physical exhaustion, I  quickly entered a full blown anxiety reaction, which lasted for about two months. Then one day, on rounds, I was asked a question to which I actually had the answer, much to my (and the resident’s) amazement. That single incident somehow convinced me that I COULD do this. 

And from that day forward, my confidence increased.  The correct answers on rounds became the rule, not the exception. And I found that my success in the OR, where my uncommon artistic abilities translated quite well into surgical skills, was well in advance of what would be expected at my level of training. In other words, I discovered that I had “the hands” of a surgeon. 
 
Well, one thing led to the next and in about two months, I had actually advanced from anxiety ridden neophyte to downright cocky, without ever having stopped at quietly competent and confident. I’m afraid that had to wait for a bit more maturity (but that’s another story).  In any case, at that point, I had gone from believing I couldn’t do anything, to believing there wasn’t anything I couldn’t do. And, I was still aiming at a career in cardiovascular surgery. To do that, I needed more training in general surgery, so I signed up for another year.
 
As a resident, even a junior resident, I had to run the Emergency Room, with another JAR. The Medical College of Virginia Hospital was situated just outside Richmond’s answer to New York’s Harlem, Church Hill. Every Saturday night, the local “Knife and Gun Club” would keep us busy all night with various injuries. What was great about this from a young surgeon’s perspective, was that in the South, the local thugs tended to use small caliber weapons, like .22′s, .25′s or even .32′s. Therefore, they were pretty likely to live after being shot and we got to operate on them. If the same guy were shot in New York, he’d be gone, DOA, because he’d have been shot by a heavy caliber like a .38, .45 or even a magnum. So for surgical training, you couldn’t ask for more. And you must understand that to a young surgeon-in-training, operating is everything. In fact, a favorite way to discipline one of us was to threaten to keep us out of the OR. We were never too tired to go to the OR–we lived for operating.

Here’s a tip for you: if, God forbid, you’re ever shot, you want to go to the hospital in the worst possible neighborhood. Why? Because they see gunshots all the time and they know how to treat them. So forget the refined “ivory tower” setting; if you want to live, go to the “meat wagon.”
 
Case in point: my pal, Jim and I were sitting at the front desk in the MCV ER, about 3 or 4 in the morning. It had been a steady night–not too busy–but it was quieting down. We were just chatting with each other, when this young guy comes in to see us and demands a  bandaid. “OK,” I said. “What do you need a bandaid for?” “I got a scratch,” he answered. “Oh, really,” I said. “Let’s see your scratch and we’ll fix it up for you.”
 
With that, he pulled up his shirt and there it was: a black, perfectly round little hole, RIGHT OVER HIS HEART.  Not even any bleeding. I looked at Jim. He looked at me. Then we each grabbed this guy by the arms, bodily picked him up, threw him down on a gurney and started throwing IV lines into him. “Hey!” he yelled. Watch’ooall doin’?” “Here,” sign this Jim said, handing him a consent.
 
By this time, we’ had gotten x-ray to come into the ER. The pictures showed a beautiful, undeformed bullet just sitting INSIDE HIS HEART (small caliber, naturally)!  15 minutes from the time he walked in, no kidding, this patient was being rolled into the elevator on his way to the OR (Damn! We were good)! I got to scrub on this case, since it was my turn. I had this guy gassed, prepped and draped and ready for the cardiac surgical resident, St. Pete (an abbreviation of his real name), lucky for him. As it happened, Pete was a truly gifted surgeon, better by far than most of his teachers.

Well, we cracked this guy’s chest, Pete and I, and opened his heart. Sure enough: .25 caliber bullet, flopping around in his left ventricle. Nice and shiny, too. Question I  had was, why was he still alive? I mean, he just walked into the ER and asked for a goddam bandaid! Normally, you get shot in the heart, you’re pretty much dead. 

Pete laughed and said “This here guy’s been shot before.” Huh? Turns out, he HAD been shot in the heart before (bless those tiny bullets!) and this had obliterated his pericardial space. 

You see, there’s a bag or sac around the heart, called the pericardium. Normally, if the heart is wounded, it squirts blood into this bag, until the pressure inside the bag is higher than the pressure in the heart. Then, the heart can’t pump blood anymore and circulation stops(pericardial tamponade). You die. 

But this guy was saved. And the scar tissue, from his first gunshot to the heart and his surgery, stuck the pericardium right to the heart, therefore, no more space into which his heart could pump blood . So he would have kept pumping blood into his chest, one squirt at a time, until he literally ran out of gas! 

Well, the patient did well, and I took care of him on the ward after surgery. We got along very well. He knew he had had a close call and that we had saved him. He was very grateful.  Finally, he went home, all healed up. I felt good. Hey, we cheated Death again! We gave this guy another chance at life. What’s better than that?
 
About a month later, up on the ward, in the wee hours of the morning, I saw this same guy smiling at me, while I was making rounds. “Hi,” I called. “How’re you doin’?”  “Great doc, thanks to you all. See this?” With that, he showed me a snub nosed revolver in his pocket, probably a .38, this time. “I know who did me and I’m gonna get HIM.” He just wanted to give me a heads up. Nice of him. Like I said, he was grateful.
 
I was pretty exhausted by that time. No cops around to tell. Even if I did, he’d just disappear. I gave him good advice–forget this revenge stuff. You don’t want to end up back in here, or worse. “Listen,” I told him, “if I can’t talk you out of this, at least wait til I’m off my shift, OK? I’m just too tired and I’m on call.”  “Sure thing, doc. You got it!” He smiled, put his pistol away in his coat, and walked off the floor.
I never saw him again. But I did get to sleep that night. Yet another reason why I opted out of general surgery and became an orthopod….
 
But I still give good advice–about how to relieve your knee pain and restore your function, with the special, modified exercises in my PAIN-FREE PROGRAM. See it now at   http://drbillsclinic.com/exercise_eliminate.html    Now, aren’t you glad that I didn’t go into cardiovascular surgery? I wouldn’t be here now, to help you with your pain    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

May 23, 2008

 Here we are again at the Memorial Day weekend. It seems like it was just here. Like everything else, time seems to go faster and faster, each year.  This is the “official” start of the Summer Beach Season, although true Summer is actually a few weeks away. More important, though, Memorial Day is a special day to remember all those who gave their lives for the blessings of Liberty and Freedom that we all enjoy.
 
When I was growing up in Brooklyn, Memorial Day was a big deal. My maternal grandfather (also a Bill) was a past Commander of his Post (Reveille) of the American Legion, and my father, in his turn, was too. Grandpa was a soldier in the trenches of France, during The
First World War. He belonged to the 40/8 (the Forty and Eight), a special society, referring to forty soldiers in a horse-drawn box car and the eight horses that pulled them. My father was a submariner, a machinist’s mate, on the USS DACE, who served in the Pacific Theater during World War II. 

I remember many of the literal war stories they told me. My grandfather told about mustard gas in the trenches–I even had a WW I gas mask, that I used to play with, as a kid. I also had a real WW I bayonette.  My Dad told me about his training for the submarine service, torpedo runs and sweating out Japanese depth charges, while submerged under the Sea of Japan.
 
So, for me, growing up, respect for the military was like mother’s milk. It was a given. I was privileged to meet many gallant old warriors, friends and comrades in arms of both my grandfather and father. They took me, as soon as I could walk, and later my brother, as well, every year to see the Memorial Day Parade in downtown Brooklyn: rockets, tanks and rows upon rows of soldiers, sailors and airmen, marching along the wide avenue to Grand Army Plaza. I remember that I always got a chill down my spine whenever the American Flag went by, and saluted, as I had been taught. I still do, to this day. You see, patriotism was taught at our home. 

I don’t think that anyone who didn’t live through WW II can quite appreciate this country as much as those brave souls of The Greatest Generation. There’s nothing that can really compare to surviving a true existential threat; nothing that can make you love your country and value it as much as defending her with your own blood, and purchasing freedom with the coin of your own life. 

When, later in life, I met my father-in-law, he too did his part in The Big One. He served on LST’s during the war, at age 17–he lied about his age to get INTO the service. He was the “baby” of the Gray Raider. I was privileged to meet a few of his old shipmates, before they died. Just regular guys, but gallant gentlemen, all.
 
These old warriors are mostly gone, now. But they have lessons to teach us, if we would only listen. Freedom isn’t free. It’s bought and paid for, in each generation, by the blood of heroes, who are willing to lay down their lives, so we who are left behind may continue to enjoy our birthright of  God-given, unalienable rights. So this weekend, between the beach parties and hotdogs and cold beers, spare a moment to reflect on those who gave their lives, that we might live free. Whatever your politics, whatever your beliefs, surely we can all agree that the honored dead deserve our respect and our deepest thanks for their sacrifice.
 
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

May 22, 2008

I’m continually amazed at how some people deal with potential or actual medical problems. Far too many take the “Ostrich Approach,” when it comes to dealing with information that could help them live longer and happier lives. They’d rather not know if they have a problem, as if the problem won’t really exist if they don’t acknowledge it, or pretend it isn’t there. 
 
That approach doesn’t work out so well for the ostrich either. If he sticks his head in the sand, his butt is still hanging in the breeze, for any preditor to come take a bite out of it. I had a cat once who did the same thing: if he wanted to hide from you, he would squinch up his eyes closed, as if to say, “You can’t see me,” because HE couldn’t see. This approach is fine for a child, reflecting magical thinking, just like my cat. But in the real world, such behavior can KILL you. You see, it’s what you DON’T know that’ll hurt you.
 
This was brought to mind just recently by one of the guards at the gate to our community. He apparently had gone for a yearly physical and, as a matter of course, the doctor had sent off some routine blood tests. His hemoglobin (the red pigment in red blood cells) was borderline low, meaning he was barely anemic, without any discernable cause. 

What was his approach to this? Not to return to see the doctor, because he didn’t want to get any bad news. Incredible. This, from an otherwise mature, rational person.
 
I took some time to point out that this was most likely a result of lack of dietary iron, especially since he had given up eating red meat for the past half year or so. Many people make sudden, or drastic changes in their lives, diet, activities and exercises, without the slightest knowledge or interest in the consequences of their actions. 

They just make a change, in his case, because he decided to try to lower his cholesterol, without any real understanding of the compensatory measures that a change like that may require, to maintain balance and good health in the body. And there’s always the
Law of Unintended Consequences, as well as Murphy’s Law to contend with.
 
So, in this case, iron deficiency is the most likely cause of his anemia. But it could also be a result of a “slow leak,” like a very slow, minimal GI bleed,  from weeping hemorrhoids, or a small, asymptomatic ulcer, that is bleeding very slightly. Wouldn’t it be better to KNOW that you have a problem and deal with it early, before it becomes a big problem that’s much harder to deal with?
 
And what if everyone’s worst fears were true in this case? Suppose he turned out to have a silent cancer growing in his bowel? This is a cancer that can be cured in almost all cases, if it’s found early. But it’s lethal in a high percentage of cases, if found too late, after it’s spread. In this case, IGNORANCE CAN KILL YOU. In fact, as a general rule, ignorance and stupidity in Nature are regularly punishable by death. That’s how Mother Nature gets rid if the dumb ones, in every species.
 
And look at knee pain. How many people have a pain that they ignore, instead of trying to learn what it’s from, and what could they do to stop it? If you ignore it, you may condemn yourself to arthritis and a major surgery that you could have avoided, had you only known what to do, early on. 

Yep. Ignorance is the most expensive luxury there is, sometimes costing you a whole lot more than you counted on. But this is a common human behavior. So to help those who would like to be helped, I wrote DR. BILL’S LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN,  available now with an upgrade to a full length CD narration of the entire book, at
 http:drbillsclinic.com/eliminate_knee_pain.html
 
Well, my friend was convinced. He’s starting an iron supplement, then rechecking with his doctor in a few weeks to see if the iron has made a difference and improved his anemia. I’m betting it will. 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

May 21, 2008

Now that my career as a surgeon is effectively over, I sometimes remember with fondness those who helped me achieve what I did in the beginning. When I was in Medical School, my first clinical rotation, ie., real patient contact on the wards, was in Medicine at Metropolitan Hospital in New York City. I was assigned to a resident and several interns under him as an extern (a medical student on clinical rotation).
 
The resident, who was a really good guy, as well as a really good doctor, had a great sense of how to forge disparate individuals into a functioning unit. Each of us had a nickname, and together we were The Team. They called me “Little Joe,” because, according to the rest of the Team, and especially the resident in charge, I resembled the character, Little Joe (Michael Landon) from Bonanza. I never
saw the resmblance myself (I should be so lucky!), but they apparently did, so “Little Joe,” I was.
 
One day near the start of my rotation, the resident assigned me to draw blood, for the very first time, from this unsuspecting patient, who became my very first “victim.” He was a fairly young to middle aged black man, with a fairly dark complexion, who was tall and thin, with “thin skin” that showed every vein he had in his arms, like an anatomy chart.  Turns out he was also a very nice and extremely patient man, luckily for me. I forget his name and what he was in the hospital for, but he needed his blood drawn and I was assigned to do it.
 
Now, drawing blood, or venipuncture, as it’s technically termed, is an art that is only developed by practice.  In Medical School, we first learned to use needles by puncturing oranges. Then, we worked on each other, taking turns in drawing our own blood, in special classes
where we’d pair up for this purpose. But it’s a whole different thing when you do it for real, in a real clinical setting for the first time. For one thing, you’re trying to be professional and look like you know what you’re doing–which, of course, you DON’T.  For another, the eyes of the patient are on you, watching every move you make, which adds a little pressure, as you might imagine. And of course, you also want to look good in front of your resident.
 
So, with all this in mind, I collected the vacuum tubes I would need (they’re color coded, depending on what test is required), the syringes and the needles, as well as the hollow rubber tubing we used as a tourniquet. I introduced myself to the patient, explained that I was there to draw his blood for tests that were needed, and set up my stuff. I saw that he had great veins, even before I put on the tourniquet and tightened it. After it was tightened, they practically jumped out at me.  “Great,” I thought. “They’re right here. I don’t have to hunt for them. This should be easy.”
 
So, I aligned the needle, just like I’d been taught, popped it through the skin, right over the big, juicy vein…and it ROLLED sideways, away from the needle!  So, I tried again…same thing.  And again…and again.  By now, sweat was dripping from my mid-back to my butt,
from near panic, as I continued to try. That poor man sat still for thirteen sticks. Finally, though, he was exasperated.  He collared the resident, who was passing by: “Hey, how ’bout gettin’ me somebody that knows what they’re doin’,” he said. I could have died from
mortification, but the guy was right. The resident apologized, explained that I was new, reapplied the tourniquet and drew blood with the very first stick.
 
I profusely apologized to the patient, who was very relieved that his ordeal was finally over. The man was a saint. He understood that I was just starting out, and he was OK with that…but he pointed out that I should have asked for help sooner. Feeling completely humbled and shamed (not comfortable or familiar emotions for me), I was forced to agree. It was my stupid pride that caused him to suffer more
than he needed to. I SHOULD have asked for help sooner.  It would have spared my patient quite a few of my bumbling attempts. 

I learned an important lesson that day–not just how to deal with rolling veins (today, I could have hit that guy’s vein from across the room), but never to let a patient suffer, if my skills weren’t up to the task at hand. Right then and there, I resolved to make my skills the very best; but to always ask for help, or refer a case, if someone else’s skills were better for a particular job.
 
In the same way, many people today suffer needlessly with knee pain, just because they won’t ask for help.  It was with those people in mind that I wrote my book,  DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, which you can get right now at    http://drbillsclinic.com/exercise_eliminate.html   By choosing from the exercises I teach, those that
work best for you, you can help yourself to prevent or eliminate your knee pain, just like the title says.  But you still have to ASK for the help that’s available.  Click on the link and order your copy today. You’ll be glad you did and your knees will thank you.
 
Well, that’s the trip down memory lane for today. 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

May 20, 2008

When I was ana intern in 1973, I was at the Medical College of Virginia, the “Harvard of the South,” in Richmond Virginia. I was chosen by the matching program to serve my straight surgical internship there. It was a superb teaching program, especially in surgery, and was world reknowned for its organ transplantation service. It was headed up by a very famous surgeon, with an international reputation,
Dr. David Hume. 

As it happens, I was one of the very last class of interns, hand-picked by Dr. Hume. Shortly before my arrival as a brand new, still wet-behind-the-ears intern, Dr. Hume, who was a pilot, accidentally flew his two engine plane into a mountain. They found parts of him scattered over a quarter mile radius, or so I heard tell. The hospital, where he had been a driving force for years and the house staff
(residents and interns) who he had trained had absolutely loved this guy. It was a real cult of personality. So, his death threw the place into full blown pandemonium, as you can imagine.
 
It also engendered a rather bizarre form of self-flagellation among the house officers, especially the senior residents, who ran the show. They would run us all into the ground, with work and with making endless rounds, “for Dr. Hume,” presumably dedicating our exhaustion and demonstrated toughness to said icon. 2:00 o’clock in the morning, we’re trudging up staircases, floor to floor, making rounds on patients  (who, I am certain, thought we were all nuts), “the ‘Red Machine’ (Dr. Hume’s Vascular Service) Grinds ON!”   Absolutely crazy. Every day, every night, for months, like this.

As an intern, you were expected to get the patient ready for surgery, collect the x-rays, get the blood work, start the I.V., write the orders, get the patient to the OR, scrub into surgery, then hold onto the retractors (bent metal paddles designed to hold the surgical incision apart, so the surgeon can see, to do the surgery), shut up and stay out of the surgeon’s way.
 
As you might imagine, we were all pretty tired, to say the least. Near death from exhaustion is closer to the truth. And it was even worse for us interns because we were so inefficient, at first, that we wasted time and effort and energy, and so got even less sleep. One of us
was a good ol’ southern boy named Sweet. He wanted to be a neurosurgeon. Poor old Sweet was so exhausted all the time, that he would literally fall asleep, while holding retractors for the surgeons, while they were doing surgery. We all did. Then the surgeon would yell at us,  and we’d awaken with a start (called a myoclonic jerk) and rededicate ourselves to holding the retractors (a truly boring job–you can’t see anything).
 
But Sweet raised this to such an art form that one of the senior residents created a rather sardonic “Sweet Index,” as a measure of the disturbance of the surgical case that the intern’s sleep-during-surgery would cause. For example, a “Sweet Five” was when the intern would jerk awake after falling asleep, and bump the operating surgeon, pretty much pi$$ing him off. A “Sweet Nine,” on the other hand, was when the intern would fall so deeply asleep that he would fall right down onto the floor, in a heap, unconscious. A “Sweet Ten” raised the ante, because not only would the intern fall down, but he would pull the surgeon down with him.
 
For the longest time, it seemed that this was the very pinnacle of the Sweet Index. But just once, this was exceeded by the “Sweet Eleven,” when the sleeping intern (who happened to be Sweet himself) pulled the surgeon AND the patient down onto the floor with him. Ouch!  Now, I wasn’t there, so this story could be apocryphal, but I have it on good authority that this actually DID happen.

Both Sweet and the patient survived this, despite everything. The patient did well after all, though  admitedly, this wasn’t great sterile technique.  Sweet went on to become a resident, though the surgeon did threaten to kill him…understandably, given the circumstances.
 
In time, we all got better. We learned to be awesomely efficient and also to become “sleep sponges,” able to fall alseep and absorb incremental rest at any time, in any place, for any available length of time–a skill I retain to this day (much to the annoyance of my wife).
We learned machine-like precision and dexterity and, as we became surgeons ourselves, we discovered that it’s much easier to stay awake if you’re doing the surgery,  rather than just standing there, holding retractors.
 
Sweet went on to become the neurosurgeon he always wanted to be. I learned that cardiovascular surgery wasn’t for me–I had the hands and the skill, but I didn’t care for it as much as I thought I would. Instead, I fell in with the buccaneers of the Surgical Services: the orthopds. And the rest, as they say, is history…. From MCV to St. Luke’s in New York, to the New England Baptist in Boston, I learned at the hands of masters,  til I became one myself.
 
Thinking back on these early experiences, I remember that every master surgeon started as a novice once. That’s really true in every field. When aptitude and desire meet education and training, mastery can result. That’s why I wrote HOW TO ELIMINATE KNEE PAIN–ONCE AND FOR ALL! THE ADVANCED MASTERS COURSE. Go see it at http://drbillsclinic.com/advanced_masters.html     I wanted to put everything I’ve learned at the disposal of other physicians, chiropractors, physical therapists and nurses, trainers, both personal and athletic, and the interested athlete. This is an invaluable resource for everyone who wants to know it all–but in everyday layman’s English. Available in 12 monthly Lessons, in continuity, to make it affordable and accessible, or in one large volums, at a discount, this is the last word in cutting edge knee treatments. Do yourself a favor
and get your copy now! That’s it for today, my friend.  Til next time, 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

May 19, 2008

It was early 2001 when I was first confronted by an attack of the cyberchondriacs. I was in my office, going from room to room, seeing patients, as was usual in the afternoon. Because I had such a busy surgical schedule, I had office hours normally only two days a week.  The waiting room was full, as usual, watching our office TV, reading or chatting with the girls at the front desk. By and large, my patients were all pretty tolerant of waiting. While I tried my best, I was almost always behind. 

But most of them understood that I was one of very few doctors who would give each patient the time he or she actually needed, not just the 15 minute time slot they were signed up for. And all of them knew that when their turn came, I would do the very same with them.
Add in the occasional emergency, and it’s not too hard to get behind. But, like I said, they understood that.
 
And if I was really behind, I would come out into the waiting room, apologize to all present for being behind, explain why I was running late and offer to reschedule anyone who couldn’t or didn’t want to wait. My attitude was that their time was important, too. But I made it
clear that I would not compromise anyone’s care just because I was running behind. And they responded to that.
 
Only rarely did some self-important executive make a public fuss. I remember one young woman who was carrying on because she had to wait for 20 minutes. 20 minutes!?  I wait longer than that for both my dentist and my vet! She apparently wasn’t satisfied with my very reasonable explanation of the delay and didn’t appreciate my gently pointing out that in many other offices, people were waiting for 3 hours and more, never mind 20 minutes.  But she wouldn’t be mollified. She was not going to be patronized, dammit! She was going to be taken seriously!
 
I seriously advised her that she would be much happier in another office, since I doubted that I could measure up to her standards. She was dumbfounded. But I refused to see her. No way, after that, could I possibly make her happy. Who needs the agita? Hey, life is too short….
 
Anyway, the interesting thing was that once someone who had been waiting out there actually got in to the exam room, they would put down roots! Like I had all the time in the world to chat with them. You’d think they would have some consideration for their pals, still in 
the waiting room, but nooooooo….
 
Well, one day this guy comes in who has been referred to me for a joint replacement by his rheumatologist.
 
Ironically, though I did everything anyone could do to help my patients AVOID surgery, this resulted in an enormous number of referrals FOR surgery. It seems patients and their doctors wanted someone who would only do surgery when it was really warranted. So this guy comes in, having already had the full course of non-operative treatments by the rheumatologist, with end stage disease, ie., bare bone. So for him, this case is kind of open and shut.

But he presents me with a ream of articles, I mean like 50 pages printed from the internet, on every arcane point and potential complication on his surgical procedure you could imagine. And he proceeds to attempt to cross examine me on this arcana. And he has every symptom that’s listed, both real and imagined.  And he wants me to go through all of them, right now. Screw the other people in the waiting room.
 
That was my first attack from a cyberchondriac–a  patient who has managed to acquired every scrap of  information from the web on his particular disorder and manifests every symptom listed. I would come to dread this subspecies of patient. Problem was, they wouldn’t believe you when you explained to them that not everything on the web is gospel. It was like they were feeding their paranoia with unfiltered cyberinfo.  There was no way to win with them…and a whole lot of wasted time. 

With this guy, first thing I did was, take all his papers away and promise to read them (which, I really did–since I knew what was legitimate and what was mostly crap, it was fairly quick for me). Then, I put him on specialized exercises, like those I teach at
 http://drbillsclinic.com/exercise_eliminate.html, “to get the tissues ready.” Then I sent him off and had him come back in a few weeks for reevaluation. By that time, he had calmed down and had begun to trust me. He finally had his surgery and he did great!
 
You have to understand that at the core of every cyberchondriac is…FEAR. They desperately need to be in control, but they simply CAN’T be. That’s why they spend all those hours searching the net and why they feel they have to challenge the doctor. It’s their way of trying to exert control. Understanding this, I  first gave them something positive to do, while putting off the dreaded surgery. In this way, I could get them to know me and hopefully trust me, so that ultimately, I could help them.
 
But, it was really an investment of time and effort, I can tell you. And not a whole lot of really qualified, top flight surgeons will put up with that stuff, believe me. They have neither the time, nor the inclination to indulge any psychodrama. They’ll throw them out!
 
If you ever find yourself in that position, by all means, look up anything you want to on the net. But DON’T bring ALL your articles to your doctor–he/she doesn’t want to see them! Instead, summarize the main points of your reading, then write down a few pertinent
questions, which you will HAND to the doctor. DO NOT READ THEM OUT LOUD. It takes too long and you’ll just try to embellish them. The doc can scan and answer all your concerns better and more quickly if you just hand over the list. Your doctor will appreciate it and you’ll  be marked as an intelligent and considerate patient.  And that’s the best way to get great care!
 
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

May 16, 2008

For the last few years I was in private practice, my patient numbers were growing exponentially.
And this was highly improbable, since I had a very unique practice, specializing as I did in hip & knee surgery. I did no trauma, no general orthopaedics, no emergency call, no Medicaid (I did indigent people for free, because getting nothing was preferable to having it COST me to treat someone, which is how Medicaid works, in practice). I actually gave away hip fractures who had requested me to my colleagues, ’cause I just didn’t want to do any trauma, despite the fact that hip fractures actually involve the hip joint, which was my area of expertise.
 
The weird fact is, the more difficult I made it for patients to get into my office, the more people wanted to get in. I guess this is another example of the natural perversity of human beings–we all want what we’re told we can’t have. But it wasn’t always that way…. 

When I first started out in practice, I did everything. I lived in the ER and the OR. Over 70% of my income was fractures from the Emergency Room. Whether I was on call, or off made no real difference: I got home every night at 12 or 1 AM, or later. My associates (I was originally part of
a group of orthopaedists) would feed me cases in my area of interest, or cases they were too busy
to do, or just cases they wanted to give to “the new guy.” That’s how a practice is built–one patient at a time, while your skills are continually evaluated by nurses, OR techs, the ER staff and other docs in the community, and your reputation is slowly forged. 

Well, I started off going like Gangbusters. My associates were happy. The patients were happy.
The hospital was happy. And I was happy. Right up until the time the bride informed me that
this was not what she bargained for, this was not a relationship, and if I wanted to stay married to her, I’d better do something about it. Uh-oh. Talk about an offer you can’t refuse. Didn’t count on this. What now?
 
Well, I went to talk to the senior associate, the guy who hired me, quite by accident (I’ll tell you that story another time) and laid the problem out for him. My wife’s point was that, at that time, I was the first and only fellowship trained joint surgeon on the Island, and that qualified me to limit myself, as a super-specialist. Problem was, no one in town had ever attempted that before. Of
course, no one had that level of training either, but still…it was pretty nervy. Fortunately, I had more nerve than brains at the time and, filled with the belief in my own invincibility (lack of
confidence has never been one of my failings), I was willing to try it. It was either that, or get used to sleeping alone.
 
My senior associate, Stu, who was a very canny guy, in addition to being one of the sharpest orthopods I would ever meet, believed in me too. He agreed with my wife and gave me his blessing to give it a try. So, I did.
 
Well. 

When the word leaked out into the community, the other competing orthopaedists sadly shook their heads at my folly and sagely predicted that I’d be starving within three months. They confidently pronounced that “no one can do that and survive.”  Then, they settled down and watched, waiting for me to meet my comeuppance. They waited… and waited….
 
Meanwhile, here’s what happened. Little by little, I began to attract more and more hips and knees.
My practice (and income) went from 70% trauma to almost zero trauma. It went from an emergency,  nighttime practice, with low fees and high liability, to an elective, daytime practice, with high fees and less liability. And because I was a specialist, I began to command better OR times, even higher fees and a certain respect among my peers, as well as the hospital staff, that was very disproportionate to my length of time on staff, or my actual experience.  In short, my entire life was positively transformed.
 
Oh. And I stayed married. Anyone that smart I wanted to stay right beside me, always.
 
And all those guys who were predicting my early demise?–all divorced, except one. Several of them now on their fourth wives (which suggests they didn’t learn anything the first three times).
 
Meanwhile, my reputation continued to grow. Five years after arriving, I was appointed Chief of the Department. Shortly thereafter, I was also appointed Medical Director of Physical Therapy, where I developed many of the very exercises taught in my PAIN-FREE PROGRAM
 http://drbillsclinic.com/exercise_eliminate.html   Then, after my initial teaching appointment, I was promoted to Associate Professor at the University. At the peak of my career, I had built what was arguably the finest orthopaedic department on Long Island, and was  generally acknowledged as THE regional expert in my field. Far cry from “starving after three months.” And all of this happened, because I listened to my wife….
 
All of that is gone now, faded dreams of former glory. Yet, through it all, she has always been the one on whom I could depend. Even now, she is always here for me, to give me comfort, guidance and support, in all I try to do. You know, when we were first married, they gave us only six months to last. Yet, here we are now, at 34 years and counting… our Anniversary, this very Sunday. There’s been a lot of water under the proverbial bridge, by now. We’ve faced a lot together;
through all Life’s triumphs and tragedies, she has been the central constant, chief advisor, soul mate, inspiration, friend and lover. She gives me roots; I give her wings–she completes me. I can’t imagine what my life would have been without her. I could not have asked for a better companion on Life’s great adventure than my darling girl, my one true love. I am the lucky one. I’ve been truly blessed, I know it.  And I’m as grateful as can be….
 
Til next time, my friend, be well. And 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

May 15, 2008

I dropped by to visit an old friend of mine today. In fact, he was the very first customer of Dr. Bill’s
Clinic, having bought the first copy of DR. BILL’S LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN    http://drbillsclinic.com/eliminate_knee_pain.html
Among his other avocations, he’s a marathon man–always in training for a long run, or running one. He tells me that he’s been doing many of the specially modified knee exercises that I teach at
 http://drbillsclinic.com/exercises_eliminate.html  , as well as other measures to help his knees out. And so far, he’s been doing very well.
 
Naturally, as often happens, while in his office, the usual questions came up about running and its
effect on developing arthritis. These came from his secretary, since he himself has already read my
book and therefore, knows the answer. It’s funny how often this scenario plays out–it seems everyone knows someone with arthritis, even if they don’t have it themselves. And even allowing for the usual degree of exaggeration, this woman’s friend sounded like he was really in trouble: completely bare bone exposed, inability to walk without severe pain, the works.
 
Of course, THIS guy she was talking about wasn’t running–far from it. But she knew this man, with this bad case of arthritis, heard my friend and me talking about running and quite naturally, she wondered whether the running led to the arthritis. This is very common question. And even after they get the answer, ie., no, it doesn’t, they don’t completely buy it.
 
I can understand that, though. It IS kind of counter-intuitive, isn’t it? Most lay people believe that running does result in arthritis. It’s like the way people used to say that if you eat too many sweets, you’ll get “sugar diabetes.” The fact is, in both cases, the disease comes about as a result of a genetic predisposition. I mean, if you’re a  normal person, you can eat all the sugar in the world and without that genetic predispostition, you won’t get diabetes. With it, you do. The running (or the sugar) just stresses an already compromised system, which results in the emergence of symptoms of the disease. The stressor doesn’t CAUSE the problem; it just brings it out into the open.
 
In this case, since her friend had severe arthritis and was, in fact, a candidate for a total knee  replacement, which he’d rather avoid, she wondered if there is anything else that might help him. As it happens, there is: a special treatment that owes its effects to a common barnyard bird–and no, it isn’t chicken cartilage! But it can stave off the need for surgery, even in end stage disease, for
many months, if not a year. And, more good news, it can be redone again and again…. You can read all about the full details in my LITTLE GREEN BOOK  http://drbillsclinic.com/eliminate_knee_pain.html   The secretary is going to speak to her friend about this treatment. Maybe it can help him relieve his pain and restore his function. He doesn’t seem to want surgery…and who can blame him?
 
So, my friend’s knees are doing well. He’s in training again, for the next marathon event. I dunno.
Running holds no fascination for me–I was built for comfort, not speed I get tired going around the block! But he likes it. Well, to each his own, as they say. 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

May 14, 2008

You may recall from several months ago that my female German Shepherd, Kelly, had been pretty sick. She’s over 13 years old now and a sweet old girl. Well, several months ago, she suddenly developed severe weakness of her hindquarters. One day, she just started falling around, and couldn’t even stand up to urinate. I had to try to hold her up, poor thing, with a Jerry-rigged sling under her belly. This was completely out of the blue. I thought she was done for.
 
I had seen something like this in one of our cats, years ago, that turned out to be mesenteric thrombosis (ie., sudden blood clotting in the vessels in the stomach, including those feeding the spinal cord. We had to put the poor cat down. So, I thought this was much the same thing. I took her into the vet with a heavy heart. I thought I would have to put her down. I wasn’t about to torture her, at her age, with overly aggressive surgery. So I steeled myself for the worst.
 
Luckily, I was wrong, and pleasantly surprised.
 
Turns out she had a species-specific disease, affecting dogs, which is why I didn’t know about it. Like I always say, better lucky than smart…. 

This is a disease in which microspcopic fragments of fibrous tissue and cartilage from the hip joints
break off and travel into the tiny blood vessels (ie., embolize) that feed the spinal cord and nerves that go to the muscles of the hind legs, causing weakness and instability (ataxia).  And the best part was that the disease is self-limited. That meant that she was likely to get better, given time. Not perfect, but better.
 
And so she has. We treated her with oral steroids–high dose first, then a tapering dose, and finally
a maintenance dose. And she’s done just great! Oh sure, she can’t run like a puppy anymore (Hell,
neither can I), but she can walk almost normally, I haven’t had to use her sling for many months now, and she hasn’t fallen, anymore. She can go up and down a few stairs like a champ, too. Overall, she seems happy and with the steroids, even a low dose, she’s cheerfully eating me out of house and home.
 
While I was writing my new book, she would come in to my office every few minutes, to nudge my arm (naturally, while I was trying to type), just to let me know she was still there. If I put her on
a lead and leave her for more than two or three minutes, she whines–she wants company. So things are largely back to normal, for now. Just now, as I was answering email from a subscriber who was asking what to do for knee pain (and I replied that that was why I wrote my LITTLE GREEN BOOK  http://drbillsclinic.com/eliminate_knee_pain.html   and my PAIN-FREE PROGRAM EXERCISES   http://drbillsclinic.com/exercise_eliminate.html), she was doing the same thing. 

But tonight, she has a surprise and a special treat. I’m taking a week off and she’s going to “summer camp.”  We have a pet sitter, to care for all our critters, while we’re away. As it happens, the lady’s taken a shine to Kelly, so she takes her back to her farm, where she can romp and play with a number of other dogs and eat boiled chicken breasts (Yum!) to her heart’s content.  Just like doggie heaven! So it’s off to camp for her, for lots of fun! And a little respite for me, 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

May 13, 2008 

So I busted my butt for the last month or so, doing research, writing, drawing, editing and pretty much doing everything I could to finish my newest book, HOW TO AVOID KNEE SURGERY by the weekend before last. Why?, you might ask.
 
Well, I wanted to have it done in time for a quarterly meeting I attend, with a number of other writers and informational marketers. What better way to get good, objective and critical feedback than to have your peers take a look at what you’ve been up to. So, I really pushed to get it done.
And I succeeded, too.

I even had time to do a cover layout, using an old photo of my hands, doing surgery, that was originally featured in my first professional book, THE ART OF TOTAL HIP ARTHROPLASTY (1987, Orlando, FL, Grune & Stratton, publishers). Now that was a major undertaking. Took me two years to get it done, and see it in print. 

Not only did I write well over half the book myself, but I edited the other submissions, as well, as I had some 42 orthopaedic expert authors from around the English speaking world contribute chapters on their special areas of expertise. You would be amazed at some of the submissions–here these guys were the best in their fields, been through college, medical school, years of postgraduate training and years more of practice–and they STILL couldn’t write a decent sentence. So I did a lot of “ghost writing,” rather than editing, on some of them. But what can you say? They’re contributing their work for free; the least I could do was make them look good (or read well… you get the idea). So it was a mammoth undertaking.
 
And, I illustrated the book, too, with over 171 B & W, halftone (gray) and color illustrations and several paintings, including both front and back covers. I even worked with the publishers and printers on the typeface used, the size, the layout, the type and weight of paper and the endplates used–stuff an author is normally never involved with, because of my art background. They really did indulge me, but we turned in a helluva finished product!
 
If you look it up in the Library of Congress, I’m listed as the author, rather than the editor of the book. Their criterion is whether or not you personally wrote more than half the book. If you did, they consider you an author, with contributors. If you didn’t, then you’re an editor, compiling and editing the work of others. It’s a fine distinction, but it indicates how much of a personal investment
the book represents.
 
Anyway, I’m sitting there in there in the meeting, feeling pleased with myself, and enjoying a warm
glow of accomplishment…when I realize that I didn’t include something I had meant to put in. Then, as I relaxed further, I remembered another omission…and another. Then, the guy next to me, who I had asked to review it, offered a suggestion. “Hey, Bill, why not do this….” And I was forced to ask myself the same question.
 
All of a sudden, what I thought was finished, really wasn’t. And here, I thought I was done…. Well, it’s just as well. Most people thought I  set a pretty high standard with DR. BILL’S LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN    http://drbillsclinic.com/eliminate_knee_pain.html
And even more have sent me emails praising DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN
 http://drbillsclinic.com/exercise_eliminate.html    After all, I sure don’t want to disappoint anyone by turning in a half-baked product, or one that falls short of expectations. So I’ve spent the last ten days, adding an additional 20 pages of solid information and advice. Turns out, as I worked on it, I remembered even more that I wanted to include. NOW, it’s finished. And, looking back, I’m glad I asked for reviews.  NOW, it’s my best work.

And, as of today, it’s in the hands of the printers. I hope you’ll like it as much as I enjoyed writing it, and I hope you’ll find it helpful. 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