Autumn is here. In Orlando, the brutal heat and humidity of the Summer has already begun to ease. Occasional cool breezes are beginning to waft through the air. And the quality of the sunlight is changing to the rich autumnal tones.

We’re entering the time of year in which the weather is absolutely sublime in Florida. So, naturally, the bride chooses this particular time to take a road trip away from here, to visit the cooler climes of the Northern Command.

She’s chosen six of our feline brood to keep us company. The rest will hold the fort in Orlando, cared for by Mickie, the Pet Nanny of Lake Mary (no, not that Mickey), until we return.  

So, I’ve spent the last few days packing, cleaning and choosing what stuff to take with me. It never fails, but I always discover a need for something I’ve left behind. Obviously I can’t take everything, so I try to choose what’s most likely to be needed while I’m gone. Combined with trying to pick the right clothes for a different climate (which usually results in taking about 50% more than I end up using), I’ve been busy.

So, we finally took off yesterday, packed to the gills with cats and our stuff, and headed north on our way to Southampton.

Now, it’s a pretty long trip by car, especially if you mind all the speed limits (well, no one really does, but you do run the risk of being pulled over, some states worse than others). It’s roughly 1,200 miles, door to door, by the time we make our way out to the East End of Long Island. And that’s a long time to be sitting on your butt.

Don’t get me wrong. I actually do enjoy road trips. They’re a nice break in routine and a series of changes in venue that are always refreshing.

But the cats can’t take more than eight hours at a time in the car, stuck in their crates as they are. They need to eat and make pit stops, too. So it generally takes us about three days. I can make it in two, if it’s just the bride and me-but she will have her cats for company, so what am I gonna do?

After many hours at the wheel, I begin to notice an ache in my lower back, as well as my knees, which reminds me I’m not getting any younger. Stuck in a bent position for long periods, any knees with some degenerative softening of the cartilage (chondromalacia patellae), or frank arthritis (like mine), begin to complain.

So here are a couple of road trip tricks to help you ease the pain and make a long trip more bearable.

First, kick the driver’s seat waaaay back, to its limit. This allows your knees to nearly straighten, depending on how long your legs are, of course. And that markedly reduces the compression forces across the patellofemoral compartments (ie. your kneecaps).

For even greater relief, you can put the car on cruise control and place your feet down into the well, below the pedals for brief periods. This usually allows you to fully straighten them out, especially if you tense your quadriceps in six second intervals, in isometric exercises. When done in normal circumstances, these are called quad sets.

In fact, these are one of the simple foundational exercises in my popular healing DVD, my PAIN-FREE PROGRAM:

http://www.drbillsclinic.com/exercise_eliminate.html

Obviously, DO NOT DO THIS ON CITY STREETS. This is strictly for long open stretches of highway, with nary another car on the road. Because you can’t get to the brake, very quickly. So it’s potentially dangerous.

But these quad sets can be done safely, if you use common sense. They not only help to relieve knee pain, from holding the joints in a flexed position for extended periods, while driving, but they also help pump the stagnant blood through the legs and thighs.

This helps to prevent deep vein thrombosis (used to be called DVT, but today, it’s often called VTE for venous thrombembolic disease, which is more inclusive-same thing). It also returns more blood to the heart, which, together with deep breathing can help keep you awake, if you begin to drowse.

After you kick the seat back, place a folded pillow or other soft object behind the small of your back, in the lumbar area. You would be amazed at how much extra support this gives you. This alone will relieve any back pain almost immediately.

Now, if you’re prone to neck pain, from the tension of a long drive, I’ve found that using one of those microbead neck pillows, that you often see in airport shops, helps to ease that quite a bit. If you don’t have one of those handy, you can roll up a face towel (or even a light jacket) for the same purpose. Just be sure that it’s placed low enough around your neck that it doesn’t impede your peripheral vision.

So, there you go-a few tips to make road trips more comfortable that I’ve found to be very helpful.

Naturally, if you’re in pretty good shape to start with, you’re less likely to have aches and pains in your knees and otherwise while on a trip. So do your exercises daily. If you DO have any knee pain, or want to avoid getting it, I suggest you get my program and do something from it, daily. Why continue to suffer? Click the link and get relief. Do it NOW.

http://www.drbillsclinic.com/exercise_eliminate.html

Til next time, my friend, be well.

Yours for a pain-free tomorrow and your optimal health,

Dr. Bill

“The Wellness Warrior”^TM

The email I wrote earlier in the week suggested that, like the proverbial free lunch, there ain’t no such thing as “The Best” doctor for whatever ails you. Instead, I suggested that there was a “top shelf,” on which top quality doctors could be found. And from there, it’s just a matter of taste-do you like the doc’s style, the bedside manner, do you feel confidence in the advice given? And so on….

One subscriber asked me if I knew of any “top shelf” doc in her neck of the woods. As it happened, I don’t know anyone where she lives, much less the best docs. However, I do know HOW one goes about that.

But rather than just tell her how to find the best doc on her own, I thought it made more sense for me to teach how it’s done for all my subscribers, at once.

This is how I find the best guys for my own family, if I’m in a new town, where I don’t already know everyone.

First, decide if you’re looking for a primary care physician, which can be a Family Practitioner, or an Internist (a specialist in Internal Medicine), or a specialist for a particular problem.

If the former, recognize that Family Practitioners are the modern equivalent of the old GP (General Practitioner). Although they may be well educated and well meaning, they cover the entire medical field for the entire family. They are not trained to the same depth and extent as is an Internist. They’re more like a screening practitioner who monitors your overall care and an orchestrator of other doctors, for more specialized care. However, they often have more time to be personal with you and many people prefer this approach.

Next, decide of you want a strictly mainstream medical guy, or one who is mainstream, but open to alternative, or complementary methods. Personally, I prefer the latter, which is how I always classified myself and still do.

For example, even though I was a top orthopaedic surgeon, I always promoted the importance of exercise, before and after surgery. And now, I’ve taken the very best and most effective exercises and put them in my PAIN-FREE PROGRAM & DVD

http://www.drbillsclinic.com/exercise_eliminate.html

Now, I do not recommend you see an alternative practitioner as your only healthcare provider, no matter how well recommended. Many alternative options are offered based on tradition, or questionable theories, and some are antithetical to conventional medicine.

Understand that although many alternative methods DO work and ARE helpful, that is no reason to cut yourself off from the proven treatments available from mainstream Medicine and Surgery. To do so is simply foolish and may, in some circumstances, cost you your life. Why not use both, as needed? It just makes sense.

OK, next step. Depending on what town you are in, a local town magazine may have a “best doctors” issue. Go to the library and check the last couple of years. Doctors are listed by specialty and location. Year after year, the same names will keep coming up. These are usually doctors, chosen by other doctors, to care for their own families, so any of them is a good place to start.

Another alternative, available at the bookstore or library, is Castle Connolly’s America’s Top Doctors. These listings are broken down by location, across the USA. Same idea as the magazine list, just broader nationwide coverage.

Be aware of limitations to this method, though. Sometimes, the very best doctors are NOT listed, because they’re SO good, they can afford to practice without accepting or participating in any insurance plans, which limits patient access, one of Castle Connolly’s criteria. Same idea in the yellow pages-the very best docs are often simply NOT listed…they don’t have to be.

Here’s another good method. Call the local hospital Emergency Room. Ask to speak to the charge nurse, or, if it’s a teaching hospital, the Chief resident in whatever specialty you’re searching. Ask what doctor they use for their own family.

That phrasing is very important, because it’s considered unethical for them to recommend any specific practitioner. So don’t ask for a recommendation-you’ll get a list of the next three guys on the ER roster and that’s all.

But it’s not unethical to answer you, if you ask them who THEY use. Repeat this with a few nurses, or doctors, and again, the same names will keep coming up.

You can also call the local Medical Society and do the same thing, with whomever answers the phone.

If you’re lucky enough to have found a great doctor, in any specialty, ask for a recommendation. You know that old saying, “Birds of a feather flock together?”  It’s really true. The best hang out with the best. And the closer you get to the top of the pyramid, the smaller the area-so everyone at the top knows everyone else there.

Bear in mind though, that this only works of the doc you’re asking is a real ace. Otherwise, a lesser doc may refer you to his buddy, with whom he has a business relationship, where they inter-refer to each other.

I experienced this, first hand. Many docs would refer to their buddies, with whom they enjoyed this kind of relationship. But when it was a really challenging case, or a member of their own family, why then, they called me.

Anyway, once you’ve got a few names, call one and go see him, or her. Interview the doctor, as you would anyone else. Ask questions. Listen to your feelings; follow your gut. You already now know that the doc knows his stuff. But this part is the personal connection that is so important to a good doctor-patient relationship.

You have to feel comfortable and secure-you are, after all, putting your life in these hands, so you MUST feel comfortable giving this person that level of trust. I use to tell my patients, “Look, if you don’t believe in me 100%, I’m the wrong guy for you.”  

When you meet the right doctor for you, you will know it.

So, there you have it. If you follow these guidelines, you have an excellent chance of finding a great doctor. And once you find the one, he or she will introduce you to others of like quality, as needed.

This is a big part of being proactive and taking responsibility for your own health. Another is staying in good shape and avoiding problems. So eat right, get a good night’s sleep and exercise….

http://www.drbillsclinic.com/exercise_eliminate.html  

Til next time, my friend, be well.

Yours for a pain-free tomorrow and your optimal health,

Dr. Bill

“The Wellness Warrior” ^TM

Now, I know I don’t look it, but when I was much younger, I was a pretty fair basketball player. True, I was never one of the tallest guys around (even before I lost 1 ½ inches in height in that fall that broke my back). But I was pretty fast, very strong and could dart in and feint with the best of ‘em. Made a lot of shots with good hand-eye coordination, too, but that’s not surprising in a future surgeon, right?

Oddly enough, these days, I don’t follow professional or college basketball, at all. The few live games I’ve been to have been fun, but I’m just not a sports nut. If I’m not doing it, it just doesn’t hold my interest to watch other people doing it. This is lucky for the bride, who was unhappy enough being a “medical widow,” when I was in practice, much less a “sports widow.”

But I have treated a number of basketball players in my time, mostly high school and college level, with the occasional aspirant to professional glory. Other than jammed fingers, knee injuries were, by far, the most common complaint.

Makes sense when you think about it. Mostly these are big, tall guys, with long lower limbs and the game requires lots of jumping and landing, as well as sudden cuts and pivots. All of these kinds of stresses take their toll on the human knee.

When any player would show up in my office, complaining of knee pain, one of the first things I would try to find out was whether it was injured on the way up, or on the way down after a jump, upon landing. The reason is that the answer provides a clue as to what the injury is.

 You see, if the pain was of sudden onset as the player was leaping upward, then it’s a classic case of “jumper’s knee.” This means that the muscular action of the quadriceps has avulsed (think, torn out) some of the microscopic Sharpey’s Fibers from their attachment, deep in the bony surface on either end of the patella tendon (sometimes called the patellar ligament).

If the injury occurs upon landing after a jump, then the injury is likely something inside the joint, like a torn meniscus, or a coronary ligament sprain, or a capsular, or collateral ligament sprain.

For today, let’s just look at the “jumper’s knee” injury.

On physical examination, this results in tenderness, at either the lower pole of the patella (kneecap), or alternatively, the bump on the front of the upper tibia, the tibial tubercle. Sometimes, an x-ray will show a few bits of bone that have been pulled out by the injury, but most often, the x-rays show nothing, except maybe some soft tissue swelling.

Whether the injury is actually on the patellar side, or the tibial side, of the patellar tendon is largely academic-treatment is the same, regardless of where the tendon is pulled. It involves rest in extension (with the leg straight), anti-inflammatory measures, local and systemic, and lots of patience.

These injuries take a good while to heal, sometimes as long as 8-12 weeks. The reason is because tendons and their attachments have a lousy blood supply. Less blood equals longer healing time. And this is made worse by the fact that young athletes are always less than patient, so re-injury is very common.

But eventually, they DO heal. And then, the knee needs lots of exercise to regain lost strength that occurs after any injury form disuse atrophy (ie., if you don’t use it, you lose it).

Better, by far, to prevent these injuries, by strengthening the tendon attachments around the knee. Very few exercise systems concentrate on this common sense approach. But, in fact, that’s one of the fundamental principles in my PAIN-FREE PROGRAM

http://www.drbillsclinic.com/exercise_eliminate.html

Static, isometric exercises, in various positions, are recognized as an excellent way to improve the tensile strength of the muscle-tendon and the tendon-bone attachments. And this is one of the fundamental series of exercises that I recommend and demonstrate, as part of this great program, which is not only a great healing program for those with knee injuries, but a great prophylactic method to prevent knee pain, as well.

Treating jumper’s knee is easy, when you know how. Preventing it is even easier and a whole lot less painful, too. So, especially if you’re an aging weekend warrior, a little effort before the fact and a little prudence during the game will go a long way to helping you avoid this painful and debilitating injury.

Click the link and see what I mean. No need to suffer. Help is here. Now. Get your own copy, today.

Til next time, my friend, be well.

Yours for a pain-free tomorrow and your optimal health,

Dr. Bill

“The Wellness Warrior”^TM

The other day, I was chatting with a lady who had a medical problem. She wanted to know what I thought about what she should do. During the discussion, she mentioned that she was going to see a “Big Doctor” in that field. I had to smile.

During my years in practice, I often heard that particular phrase during the process of obtaining a history, the first step in the evaluation of a new patient. When I’d ask the patient about other practitioners who were treating them, I’d often hear that they were scheduled to see, or were seeing, a “Big Doctor.”

My usual wise guy rejoinder was, “Well exactly how big IS he? Is he THIS big?” as I held my hand up to a certain height. “How about this big?” as I moved it a little higher. Delivered with a smile and a twinkle, after the second it took them to realize I was kidding, they would invariably laugh. Always good for a tension breaker. Which, of course, was the purpose.

What they actually meant was that the doctor they were going to see had a great reputation and was known as a “big man” in his field. By intentionally taking them at their word, in concrete terms, I gently made fun of the idea of a single guy being “The Best.”

This was especially important, because that label was often applied to me, as well, as a top specialist in my own field. But the very idea of one doctor being “The Best” is absurd on its face.

When it’s you they’re talking about, sure it’s a great ego boost. But once you grow up and realize that no one can possibly be “The Best” for all people, all the time, you start to see the down side of that kind of praise-it raises expectations.

When expectations are unrealistically high, meeting them can be a problem, maybe impossible, no matter how good you are.

Some years ago, plastic surgeons were being sued left and right, for unrealized expectations. If a doc fixed a nose and she was still homely, it was always the doc’s fault. Gynecologists were driven out of obstetrics, so very few wanted to continue to assume the almost unlimited liability of delivering babies (which lasted until the child was 21!). If a baby developed cerebral palsy, Hell, if the baby wasn’t the next Mozart, it was because some incompetent doc applied too much pressure with the forceps, at birth.

Mighty high price to pay for the temporary ego boost of being perceived as “the best.”

No doubt about it-excessive expectations are not something you want to encourage, as a doctor and especially as a surgeon.

Now, if a nervous patient needed to see confidence in me, well, I could do that. I could look them straight in the eye and say: ” I’m the best there is at what I do.” And I meant it. You gotta have supreme confidence in yourself to be a good surgeon.

But if you’re smart, you don’t really believe your own press.

Now, here is a tip that will serve you well in dealing with doctors in the future.

You see, the truth is, there’s no such thing as “The Best Doctor,” any more than there’s a single bottle that’s the “best wine.”

What there is, is the “Top Shelf,” and the bottles (or docs) sitting on that shelf are of proven superior quality. From there, whether or not you happen to be “the best” for a given person depends strictly on taste, with regard to wine, or doctors. In the end, it’s an emotional, rather than a rational decision.

If the doc has the requisite levels of credentials and skills, you, as a patient, have to have real confidence in him, or her. Otherwise, they’re the wrong choice for you, no matter how exalted those credentials are.

I believed that then. I believe that now.

As a doctor, you really can’t be the best for all people, or even the best for some people, all the time. But you can aspire to be worthy of that top shelf.

And that’s what I always tried to do.

It’s the same thing with exercise programs. I’m well aware that there are a zillion products out there and they all work, if you do them. What I like to think I bring to our relationship is a proven track record of clinical experience and a series of proven exercises and stretches that WORK, to prevent, or eliminate knee pain.

That was and is my specialty, so I really do know what I’m talking about. My PAIN-FREE PROGRAM & DVD

http://www.drbillsclinic.com/exercise_eliminate.html

is based on decades of clinical experience, plus my own personal experience with them. And they’re designed to be used strategically, which is unique among all those others out there, so that they alter the dynamic forces across the joint, which is what helps to end the pain.

I like to think it’s the best of its kind. And it’s certainly “top shelf” quality. But don’t just take my word for it. If you have knee pain, from arthritis or an injury, or you want to avoid having pain in the future, see for yourself. Don’t suffer needlessly with knee pain. Click that link NOW and get your own copy.

Til next time, my friend, be well.

Yours for a pain-free tomorrow and your optimal health,

Dr. Bill

“The Wellness Warrior” ^TM

It was back in 1986, in Bay Shore, on the South Shore of Long Island, New York, that I passed my certification examination for scuba diving. I was the oldest guy in the class to pass. There was one man older than me, but he couldn’t get used to the idea of breathing through a regulator, so he washed out.

No, I was the “old dog” amongst all the young Turks in the SCUBA (Self Contained Underwater Breathing Apparatus) class. And like them, when I graduated, I received my “C-card,” proof of certification as a trained diver, qualified to dive and to purchase compressed air, around the world.

The physiology they taught was easy for me-calculating partial pressures of gases, like nitrogen and oxygen, is a routine part of Medicine, after all. Likewise, the physics of atmospheric pressures was merely a review, for someone with my level of education.

The physical trials… now, that was a different matter.

The one thing you have to do, that I dreaded, was swimming a mile (or approximating that by twenty laps in the pool). I was already overweight at that time (though not nearly as bad as I got, much later) and I’ve always been built more for comfort than speed and more for power than endurance.

But, I psyched myself up, refused to quit and kept plugging away, until, exhausted and shriveled, but triumphant, I finally finished. For me, it was a big success not to have drowned in the attempt!

But the most important skills the class taught were those that could save your life in the event of an emergency. They taught us to remove our masks under water, completely flooding them, then reapply them and purging them of water, using the exhalation of pressurized air.

You had to jump into the deep end of the pool, remove your regulator (mouthpiece), cast it away, then retrieve it, purge it and breathe. You learned to take off everything, your tank, BC (buoyancy compensator, basically an inflatable vest), mask, all of it. Then, one piece at a time, put it all back on, calmly and methodically.

Finally, you had to learn to give and receive “buddy breathing,” where you and another diver alternately breathing by sharing the same regulator, against the day that an emergency causes a diver to lose his scuba gear, or he runs out of air, while submerged.

The commonality to all these scenarios is psychological, not physical. But running through the physical steps helps you to control the impulse to panic, which is “the kiss of death.”

I was always amazed that these techniques actually worked, but they did, indeed. And on more than one occasion, I was very glad that I had been trained so well.

My brother-in-law John (who was a master diver, far more advanced than I) and I were diving on a ship wreck in the Caribbean one time, when I became caught by some debris. I was in effect, trapped. Thanks to that training, it never even dawned on me that I was in any danger. I was just annoyed that I was caught in the debris, instead of enjoying the view.

Once I realized that I couldn’t go forward, or backward, I simply popped the release tab on my BC, and slipped out of it, just like in the pool at Diver’s Way in Bay Shore. Once out of my gear, I could see where and how it was caught and I easily extricated the gear from the debris. Then, I calmly slipped back into the BC, refastened my straps and went on my way. No sweat.

John, who had been gliding ahead of me, hadn’t even realized that I had been in any trouble. I enjoyed the rest of the dive, exploring the wreck and all the fish that inhabited it.

It wasn’t until later that I realized that this was just the kind of incident that takes the life of divers who panic, many times, every year. Thing is, because I had been trained what to expect, what to do and had done it in practice, many times, there was no fear. Not even a little. I felt calm and completely safe, at all times, through the entire event.

That’s the value of training. It can prepare you to deal with adverse events, by helping you maintain self control and giving you the tools you need to survive, regardless of circumstances.

That’s why I encourage people, who don’t yet have any overt knee pain, to do the specially modified knee pain exercises and stretches that I demonstrate in my PAIN-FREE PROGRAM:

http://www.drbillsclinic.com/exercise_eliminate.html

Because none of us is getting any younger and knee pain is one of the most common afflictions I saw in my years in practice. After back pain, knee pain is one of the most common disabling  conditions.

If you’re middle aged or beyond, it’s just common sense: avoid kneeling on hard surfaces, like concrete or tile, consider low impact activities like swimming, walking, or bicycling, rather than running, which can aggravate any pre-existing degenerative changes in the weight bearing joints and back. Burn off some of that excess fat, so your poor, overworked joints can catch a break.

And train the muscles around the knee in a strategic way, as my program instructs, so the dynamics of the joint are altered in a favorable way and pain is avoided, or eliminated.

http://www.drbillsclinic.com/exercise_eliminate.html

By following these tips, you will be preparing for the future possibility of knee pain, even if you don’t suffer from it, now. And these are some of the best ways to avoid it.

So don’t defer, until you already have the problem. Preempt it. Be proactive. Click the link and get it NOW. Til next time, my friend, be well.

Yours for a pain-free tomorrow and your optimal health,

Dr. Bill

“The Wellness Warrior” ^TM

One of the more difficult dilemmas I am asked to deal with is the person who is both massively overweight and who also has knee pain. It would always mystify me when such people would come to my office with complaints of severe knee pain, sometimes mechanical findings or frank arthritis, yet be completely oblivious to the fact that their very weight was the main cause of their pain.

I had a friend who was a cardiologist, when I was in practice. Helluva nice man, very pleasant, non-threatening, great bedside manner and a very smart guy. Patients all loved him. Only problem was that he was massively obese. I mean, I was heavy, but this guy was two and a half of me (or maybe it just seemed that way to me).

Anyway, this guy would tell his patients, who had just had or were about to have a heart attack, that they needed to lose weight. He would look them straight in the eye, with a completely straight face and make this pronouncement. Most patients were so taken aback, being given this advice in all sincerity, by a guy who was clinically, morbidly obese himself, that they said nothing. Probably were just shocked into silence.

Now, I had the same experience in my own practice, with heavy patients, who also had joint pain. But I’m not oblivious, so I was well aware of the, shall we say, “cognitive dissonance” of the situation. So I would turn it into a joke.

After telling them they needed to lose weight, I’d see them giving me the “fish eye,” looking at my own gut. So I’d smile and say, “Yeah, I know what you’re thinking. But MY knees don’t hurt!” And we’d both laugh. But my message was delivered in a way that didn’t offend.

My pal Izhar, who comes from Pakistan, had a different mind set, having come from  a foreign culture. His approach was more like, “stick it in and break it off.” Big, enormous lady would come to see him, complaining of knee or foot pain. He’d look her right in the eye and say, “Of course it hurts-you’re fat as a pig!”

Yes, I know it’s a bit…direct. Brutally honest, really. But we’re all a product of our cultures, are we not?

Amazingly, they loved him. Tough love, I guess. Some people need that. Some people like that.

And he was and is a great orthopaedist, highly skilled, very knowledgeable and full of compassion (though I admit it doesn’t sound like it). He really cared about his patients.

From his point of view, he was being honest with them. He just didn’t believe in sugar coating his pronouncements. Tact was not his strong suit. Takes all kinds, I guess.

BTW, there’s another factor. Unlike myself and my portly cardiologist comrade, he was and is very slender with no extra fat anywhere. Maybe that’s why they accepted that from him-he was walking the walk.

The point is, there’s a better chance of a patient following good advice, if the purveyor of that advice is an example of it.

The overweight patient with the painful knee, hip, back, or feet is a commonly seen combination. The more weight the joint is carrying, the more pain it’s likely to produce. But the weight prevents the exercise that could help the person lose the weight, which in turn would reduce, or eliminate the pain.

That’s the paradox of knee pain and pain in all the weight bearing joints: Pain prevents the actions that would ultimately relieve the pain.

Fortunately, there are ways to solve this conundrum.

First, use a cane, crutches, or a walker, anything to get the extra pressure off the ailing limb, while upright. That is something you can do that provides immediate relief. Or, you can lie down; get off your feet.

Next, start on any diet you can tolerate to begin to burn off the extra pounds. You should do this under a physician’s supervision and only after you have had a medical evaluation. For every pound you lose, you remove 3-4 times that much pressure on the joints, because of the muscles pulling on and surrounding the joints.

Next, you must boost your metabolic rate, stoke the “furnace,” so you burn more fat, faster. The best way to do this is to exercise.

Initially, walking is good. If you are so obese you can’t walk very far, try walking in a pool or other body of water, which will buoy your body. This will boost your metabolic rate.

In addition, start doing some specific strengthening exercises for the muscles and tendons around the knee, like the specially modified exercises and stretches in my PAIN-FREE PROGRAM

http://www.drbillsclinic.com/exercise_eliminate.html

There are even isometric postures that can be very effective in building strength and joint support. So even if you’re very heavy, you CAN do these and by so doing, build a foundation for further future gains.

Now, if you’re NOT especially fat, so much the better. You can benefit from the more advanced moves even more quickly and rid yourself of knee pain in 30 days or less, in many, if not most cases. So click the link and see for yourself. Why suffer any longer? Do it NOW.

Til next time, my friend, be well and have a great weekend.

Yours for a pain-free tomorrow and your optimal health,

Dr. Bill

“The Wellness Warrior” ^TM

Well, here we are-another autumnal equinox at hand: equal periods of day and night. The days get shorter and the nights longer from here on in. And time begins to accelerate, subjectively, as we approach the Holiday Season, according to  Stillwell’s Special Theory of Relativity. As Jackie Gleason used to say, “Awaaay we go….”

Last night, a friend of mine, who has had a long history of knee pain, sent me scans of his x-rays by email. Overall, they looked pretty normal.  I mean, there was a tiny little bit of degenerative change at the inner aspect of his knee, but nothing major that would be responsible for his symptoms.

Naturally, he wanted to know if I thought he could get away without surgery. Well, first of all, it would be irresponsible for me to proclaim, “Of course you can!” when I haven’t even seen him as a patient, or laid hands on his knee. Physical findings, not just x-rays, make quite a contribution to a diagnosis. And that, of course, is what’s missing from any digital consultation.

Fact is, there are a number of clinical entities that can cause joint line pain. Meniscus tears are high on the list, but other things can cause identical symptoms. Without a physical examination (and many times, even with it) you simply cannot determine what is really causing the pain.

And without knowing that, you can’t know what to do, in order to get pain relief.

A few years ago, when I was dealing with my own knee pain, I found that out, first hand. I had had some medial aching in my knees for years. Never had a specific knee injury (well, until I fell through that ceiling in 2001), but still had aching that was related to twisting, especially under load.

The best example of this was the deep aching, in both knees, that I experienced when I was scuba diving. If you’ve never done this yourself, you may not fully appreciate this, but the resistance of the water against your knees is tremendous, when you’re trying to kick and propel yourself along, with fins. The fins magnified the twisting forces that applied torque to my knees, with every kick. That always bothered me, more than any other activity.

I never did get the mechanical signs, like buckling or giving way, or worst of all, locking of the joint. But that deep boring ache was always present and was really annoying. It just never went away and got worse with any more strenuous activity. I tried everything I knew how to do, including all the alternative tricks I had picked up over the years. (These are all presented for you in my newest healing program, HOW TO AVOID KNEE SURGERY

http://www.drbillsclinic.com/avoid_knee_surgery.html )

But I still had pain.

Finally, I got fed up with my knees aching, after just walking (which I was doing to try to keep my weight down). As a physician, I suspected that I had a torn medial meniscus and I had already done all the conservative, non-operative measures, to no avail.

Despite trying everything, I still had pain. At that point, I got myself an MRI scan of both knees (for comparison and because they both hurt; it’s just that the left hurt more). Sure enough, seems I had a small tear of the medial meniscus and a small effusion (water on the knee).

By this time, I had now demonstrated that conservative treatments didn’t work and that I had objective findings, on the MRI, consistent with a torn meniscus.

So, I went to see a friend of mine, a great guy and a terrific orthopod (I loved to tweak him, by telling him he was almost as good as I was) for evaluation and for surgery, if it turned out that he agreed that it was necessary, as I suspected it was. Yep, he did. So I got my knee fixed, by arthroscopic surgery on Tax Day, 2005.

Postop, I used the exercises, which are a big part of my non-surgical recommendations in HOW TO AVOID KNEE SURGERY

http://www.drbillsclinic.com/avoid_knee_surgery.html

not only on my postop knee, but the right knee, as well. And as time went by, the pain subsided in BOTH my knees. Once the mechanical problem in my left knee was fixed, those measures could now work. And they did.

But the point is, there are a specific series of steps to an accurate diagnosis and exhaustion of all non-operative , conservative treatments is in order, BEFORE proceeding with surgery, in many, if not most cases.

The idea is, try these measures FIRST and see of the pain is relieved. If it is, you’re WAAAY ahead of the game. If not, you’re no worse off. You burn no bridges, either way. In this way, you’ll never have a surgery that isn’t proven to be necessary.

That’s what I recommended to my friend, who sent me the x-rays, and it’s what I recommend to you. If you have knee pain, click the link above and get my program.

Odds are good you will rid yourself of knee pain in 30 days, or less. If not, THEN you know what doesn’t work and it justifies a trip to see the doctor, for a hands-on evaluation. Doesn’t that make sense? Of course it does. So click the link and get help, NOW.

Til next time, my friend, be well.

Yours for a pain-free tomorrow and your optimal health,

Dr. Bill

“The Wellness Warrior” ^TM

Just sitting around blue-skying in the study (while I should have been working) yesterday, when I happened to recall my first run-in with a local doc, shortly after I had started my first real job. I had been brought in with a group of great orthopaedists, as the new wunderkind on the block, the only fellowship-trained joint surgeon on Long Island, at that time.

I had assumed (incorrectly, as it turned out) that everyone, that is, the other docs in town, all related to each other with friendly camaraderie and good humor-all for one and one for all, just like it was in all the residency and fellowship programs I had ever  been in.

No such luck.

My first few days on the hospital floors, the reception among the other orthopods was definitely chilly. I couldn’t understand it. I’d never met any of them before, so I couldn’t have offended anyone. I hadn’t had the chance, yet.

Now, I’m a pretty informal, friendly guy. Despite my credentials, I have never been one to “play the role.” I smile a lot, I make friends easily, I’m hard to offend and I’m very slow to anger. And I always listened… to patients, nurses, other docs, aides, pretty much anyone who wanted to talk to me. I’m certainly not aloof, arrogant, or unapproachable.

So my “welcome” to the realities of private practice was a rude awakening, to say the least. I just didn’t get it.

You never saw such a bunch of narrow, jealous, venal, back-biting, petty creatures in your life. You see, I wasn’t a just a new young guy, a possible resource for the medical community. Nope. I was a threat to their incomes! Not everyone, of course. But enough of them to make me feel I was intruding, somehow.

I was shocked! This was not how I saw the noble profession of Medicine, in my then naïve view of the world.

I had been taught that if I took good care of my patients, they would take care of me. And the words of the Hippocratic Oath required me to care for others in my profession as if they were my own family. So all this did not compute.

Nor was it only the orthopaedists. Let me give you an example of what I mean.

One day, I was making rounds on a post surgical patient, who complained of symptoms suggesting a urinary tract infection. Not an uncommon problem among women. So I asked her who she would like me to call in consultation.

You see, this is how it’s done in private practice. If a patient has seen a specialist before, you usually call that doctor when there’s a need for them, in the hospital. It’s just courteous and it’s how a specialist maintains a practice.

This lady told me she had seen a certain doctor in the past for a similar problem, but she didn’t want to see him. In fact, she told me to call anyone other than him. The basis for her disdain turned out to be a personality conflict, nothing bad medically, but hey-she’s the patient. She can ask for whomever she wants.

So I called a different urologist, who came to see her, prescribed appropriate treatment and that was that. Or so I thought.

A few weeks later, the urologist she didn’t like cornered me in the O.R. locker room and berated me for not calling him for “his patient.” He castigated me for not knowing how to behave. Didn’t my senior partners teach me what proper protocol was? And so on….

I was just flummoxed. I didn’t want to hurt his feelings, but it was “his patient” who had ordered me NOT to call him. I just took the arrows and was properly deferential. My senior partners all laughed at this.

Turns out, it was kind of like “hazing the new guy.”

Later on, when I got to know this doc, he was really an OK guy: smart, funny, creative and outspoken. His misunderstanding with the patient was, in fact, just a personality conflict. It happens. In fact, some years later, we had become friends and he asked me to operate on his own mother, despite the fact that all his pals were part of a clique that was the primary rival to my own orthopaedic group.

They gave him a hard time, that’s for sure. But he just told them that I was the best, everybody knew it and that’s what he wanted for his mother. End of story.

And all those guys (especially the other orthopods) who had given me a hard time, when I first came to town, were suddenly very pleasant indeed, when I was appointed Chief of the Section of Orthopaedics, within only five years from arriving in town. I later found out that they were all quaking in their boots, fearing that I would treat them in kind. But they didn’t understand that I would never have abused the power of my office for petty, self-serving purposes. And I didn’t.

So years later, when Orthopaedics became a full Department and the Director & Chairman was to be elected, my colleagues elected me unanimously. By that time, I had demonstrated that I really meant what I said. They had seen, many times, that I could be trusted to do the right thing.

It’s the same thing a patient has to decide whenever he or she sees any doctor. “Do I trust this doctor?” is the most important question they need answered. The doctor can be the most brilliant guy in the world. But if the patient doesn’t trust him (or her), that advice, however good it may be, will NOT be followed.

That’s why when I tell you, at the risk of repeating myself, that I’ve personally used the specially modified knee pain exercises and stretches in my PAIN-FREE PROGRAM & DVD

http://www.drbillsclinic.com/exercise_eliminate.html

I do so, so you’ll know you can trust what I tell you. Because it’s the truth. This program was created to include all the exercises proven to be effective over the course of my career.

So if you have knee pain and you’d like to be rid of it, click that link. Now. And say goodbye to that pain, for good. Til next time, my friend, be well.

Yours for a pain-free tomorrow and your optimal health,

Dr. Bill

“The Wellness Warrior”^TM

The papers last week had a number of small articles, in the back pages, that may have significant positive impact on the practice of Medicine in the future. The articles were all about a new phenomenon in U.S. Medical Schools, “the white coat ceremony.”

In this ceremony, each student, holding a folded white lab coat, is called up by name to the front of an auditorium, filled with proud family and friends. There, they shake hands with and are greeted by the officers of the Medical School, the President, Provost and Chancellor, as a member of the healing arts. Each student is then vested with the white coats they carried, which act symbolizes their initiation into the Discipline of Medicine with this, “the cloak of compassion.”

This seems to be a conscious effort to counteract the sometimes cold and aloof air of the high technology that has taken over much of Medicine.

The symbolism in this ceremony is a reminder of the real mission-to bring help, hope and compassion to the sick and the suffering. And they are introducing this very human message very early in the long and arduous process that forges and refines the steel of the physician from the base metal of his or her prior existence.

It’s a timely reminder that it is not just a job. It’s a calling. One that relatively few are qualified, or privileged, to follow.  

Given the pressures and impossible demands on doctors in recent years, it’s easy to become cynical and even bitter, as politicians and attorneys, who are hardly morally fit to judge our worth, or our competence, have systematically chipped away at our station, our autonomy, our authority and our reimbursements. It’s easy to lose sight of the idealism that made all of us choose an arduous path of sacrifice and continual learning, to be able to serve our fellow human beings.

So the idea of “the cloak of compassion” is a great symbol of the true meaning of the practice of Medicine, for the new doctors of tomorrow.

Speaking as one of the older docs of yesteryear, it was a bit different on my first day in Medical School. We were all excited, but a little bit scared, as well. Every one of us was used to being the top of the heap in each of our respective colleges. This was the big leagues, though…the great leveler. It was a new experience for everybody.

In those days, Medical School was divided into two separate courses of study: the pre-clinical didactic years and the clinical years. The former was all the basic sciences: anatomy, physiology, biochemistry, clinical pathology (lab tests), bacteriology and microbiology, pathology, pharmacology, internal medicine, and so on. That was just the first year. No need for white coats there, except to protect our own clothes in the anatomy dissection labs and in biochemistry.

The second year, we had more didactic study of each of the specialties in Medicine: internal medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry. You get the idea. Still no need for white coats. There was virtually NO patient contact. It was so dry and so different from what I had imagined, I nearly left school.

But a nurse I was dating at the time arranged an externship for me at N.Y.U., at the Rusk Institute for Rehabilitation, where she worked at that time. Now an externship is like an internship, except it’s pre-graduate and you have absolutely NO authority, whatsoever. You’re there strictly to learn and observe (good thing, as you don’t know anything!). This was working with paraplegics and quadriplegics, people who had strokes, that sort of thing. You would think it would be depressing, but you’d be wrong.

The doctors, nurses and aides were all so upbeat, so positive and obviously loved what they were doing so much, that it was inspiring. For an instant, I even thought how great it would be to be a patient there, just to be part of it.

That’s nuts, of course, given what their afflictions were, but I mention it just to impart how positive an environment they created there.

Well, I loved it all: the patient contact, going on rounds with the doctors, residents, nurses and fellows, making a real difference.

That three week experience, over the summer, changed my life. I was determined to go on to the clinical years. THAT was what I had been waiting for. It was what I believed I was born to do.

After the first two didactic years, we started our last two clinical years, rotating through the various medical services, for a month or two at a time. We were still in street clothes, though, maybe with a white short coat, to make us look “clinical.”

It wasn’t until I was an intern that, finally, we were entitled to wear white uniforms. We got our “whites,” ironed and starched, from the hospital laundry. No ceremony there. You were lucky if they came close to fitting. But again, no long white coats.

That was for Attending physicians, only. Though technically we had our degrees, we weren’t even real physicians, yet. The internship is where they’re made.

During our years of training, we worked hard, learned all we could and did what we were told. We were immersed to our necks in the “real thing,” with limited, but real, responsibility. But that was how I learned that I was really meant to be a doctor, a healer.

And the core of that desire to heal, so necessary in the physician, is compassion for the plight of the afflicted.

That’s why that “cloak of compassion” ceremony is a good thing. Instill that value early and you will make a better, more humane doctor…you will make a healer.

You see, if you’re truly a healer, you have that innate, undeniable desire to help and to healothers.

I did then. I do now. That’s why I put all the best healing knee pain exercises I know into my PAIN-FREE PROGRAM & DVD

http://www.drbillsclinic.com/exercise_eliminate.html

They’ll rid you of knee pain inside of 30 days, assuming no irreparable harm. I know. I use them myself and my pain is gone….

And while I can’t physically operate anymore, I still want to help and heal. It’s what I was born to do. So let me help you. Click the link and I’ll help you make it all better…Til next time, my friend, be well.

Yours for a pain-free tomorrow and your optimal health,

Dr. Bill

“The Wellness Warrior” ^TM

I was sitting in my study, with the sun setting over my right shoulder, while I went through my inbox on Saturday. The weekend’s emails brought an article to my attention about the use of physical therapy after knee surgery.

And that, of course, led me to think of all those who came to see me, expecting knee or hip surgery, but who were pleasantly surprised to discover that they could delay, if not entirely avoid the major procedures for which they had been referred to me.

If they knew me better, they would not have been surprised.

When I was in my fellowship in adult joint reconstruction at the New England Baptist Hospital in Boston, the pater familias of the entire program was Dr. Otto E. Aufranc, he for whom my fellowship is named. He was still living then and enjoyed a true reverence, as the teacher of my teachers.

Dr. Aufranc was a world renowned hip surgeon, as few other surgeons ever have been, not only for his depth of knowledge, experience and peerless surgical technique, but also for his extreme gentleness with the soft tissues, that is to say, muscles, nerves, blood vessels, ligaments, tendons and skin.

What differentiated his teachings (and his teaching program) from all others was his insistence that we treat the tissues very gently during surgery and his emphasis on pre and postop physical therapy, which is to say, exercise. This was quite different from other centers, where a postop patient was usually only given a mimeographed sheet of paper, with a dozen exercises on it, for the patient to do at home.

And it showed in his results-and ours.

When knee surgery was added to the repertoire at the Baptist, the same deference for soft tissues and exercise was incorporated. It was literally a part of the culture, there. So, it should be no surprise that I carried that philosophy into practice with me, made it my own and extended its benefits to my own patients.

What I learned in my years of practice was that in many cases, hip and knee surgery could be avoided and if not, at least delayed, by the use of exercises and lifestyle changes. When someone did come to surgery, it was because nothing else had worked and the patient had proven that by exhausting all the conservative options.

In that way, only those who truly needed a procedure ever saw the inside of an operating room. I thought that was the only right way to proceed in those days. I still do.

Today, with my surgical days behind me, I still recommend strategic knee exercises, like those in my PAIN-FREE PROGRAM

http://www.drbillsclinic.com/exercise_eliminate.html

The idea is to alter the dynamics of the joint, to more evenly distribute the forces across the knee joint, especially those behind the kneecap. In this way, the forces are spread over a larger surface area and the pressure that finds its way into the nerves of the knee bones is reduced to below the critical level that results in pain.

In addition, general strengthening helps to support the stresses of weight bearing by the other parts of the knee joint, including the bones themselves, the cartilage covering them and the stabilizing structures, the tendons and ligaments. And it helps prevent giving way, which can lead to additional injuries.

In fact, exercise is the best all around method of long term knee pain relief available. It works even for cases of moderate to severe arthritis, where the essential problem is the erosion of the cartilage surfaces. That extra support from increased muscular and tendinous strength makes all the difference.

Thing is, this isn’t just theory. I’ve literally used these same exercises on countless thousands of patients throughout the years…and on my own knee, too. So when I tell you they work, I KNOW what I’m talking about, from first hand experience. That’s why I collected them in my PAIN-FREE PROGRAM & DVD

http://www.drbillsclinic.com/exercise_eliminate.html

Now, if you have knee pain yourself, or if you know someone who does, there’s no need to suffer needlessly, any more. Click the link and get the program.

Of course you DO have to do the work. It’s effective and rapid, but not magic. But if you do invest the effort and the time, there’s no more effective program for pain relief out there.

Exercise is the key knee difference, the difference between persistent, aching pain and endless medications (with all their side effects) and a method of treatment that gets rid of the pain, for good, while improving your motion and function. Whether you’re trying to avoid surgery, or you’re trying to regain function after knee surgery, this simply can’t be beat.

Get it now and see the difference for yourself. Til next time, my friend, be well.

Yours for a pain-free tomorrow and your optimal health,

Dr. Bill

“The Wellness Warrior” ^TM