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