Archive for the ‘Dr. Bill’s Blog’ Category
Wednesday, September 8th, 2010
September 9, 2010
One of the most common questions I’m asked is whether or not it’s “too late” to use my knee pain exercises, once a person has undergone knee surgery. It’s actually a pretty reasonable question. The answer, however, is good news.
They’re just as effective and even more important after you’ve had necessary knee surgery, whether that’s arthroscopic, or a full open surgery, like partial or total joint replacement. In fact, these very exercises were derived from those I prescribed for my own pre and postop patients, while I was in active private practice. And, of course, I used them myself after my own knee surgery.
If you’re new here at Dr. Bill’s Clinic, you may not know it, but I had arthroscopic surgery of my left knee on Tax Day, 2005 (thought it best to get all the unpleasantness out of the way on the same day).
My knees were injured in the same fall in which I broke my back, in 2001. Or so I assumed. In all probability, I had some degenerative changes prior to that, especially since I had prior pain behind my kneecap, where I had known chondromalacia patellae (a degenerative softening of the retropatellar articular cartilage) for years, based on my symptoms.
In fact, I had written previously about my inner “teenager” being responsible for a momentary lapse in judgment that resulted in me injuring myself on the leg press machine. But though I had some pain on deep squatting, or steep stair climbing, due to that condition, what we in the trade call “evocative activities,” I did NOT have spontaneous pain, just on walking.
That emerged only after the fall and suggested that I had done some inner damage with that injury, not present before. And I had tried my best to exercise the knee, specifically to avoid surgery. Last thing I wanted was a knee surgery. After all, I KNOW, as few do, after a couple of decades doing just that, exactly what is done. And no one wants that done, unless it’s really necessary. So I did my best to avoid it.
Which is what I have always recommended to others, with the same problem, then and now.
But sometimes, your best just isn’t good enough. Sometimes, you have an injury that can’t be healed, without help.
That was the case with my own knee: persistent pain was beginning to limit my walking, which in turn made it harder and harder to stay in shape and keep my weight down. I finally decided that I’d better find out what’s going on in there, before I do irreparable harm by neglect.
That’s when I got an MRI scan-of BOTH knees. Might as well get all the bad news at once. And it’s always a good idea to have the other side for comparison. Helps to make an accurate diagnosis.
I reviewed my scan images with the radiologist, who’s an old friend of mine (one of the very best on Long Island-Dr. Steve Kuchta, of Suffolk MRI in Smithtown). We both agreed that I had a probable tear of the posterior horn of the medial (inner side) meniscus. The other knee was suspicious, but not definitive. That side could be just degeneration of the substance of the meniscus.
Bad news is that once you have any physical disruption of cartilage, like a tear, it simply won’t heal. Doesn’t have a blood supply (except for the outer 25% periphery, which is less than 10% of tears and almost never degenerative tears) and without blood in the tissues, nothing can heal.
So, my choices were, live with the pain and accept the consequences (ie., progressive degeneration, meaning arthritis), or have arthroscopic surgery and get it fixed. Which is what I opted to do.
I had a good friend do the surgery (almost as good as me, as I loved to tell him-HA!). And as expected, he did a great job: partial removal of the meniscus, removing the tear and sculpting the remainder, so it approximated the ring-like shape of the normal structure, débridement (shaving of the shredded, arthritic surfaces, to make them smoother) and synovectomy (shaving away redundant and inflamed lining membrane of the joint).
But I turned out to have some areas of arthritis, much worse and much deeper than I would have thought. One area of the tibial surface was right down to bare bone, beneath the remaining meniscus rim in the back. That’s not good. Fortunately, however, the area was relatively small, less than a centimeter (smaller than a half inch). And it was covered by the meniscus rim.
Well, postop, I started right away on my quad exercises and gentle active range of motion stretches. I actually did my own physical therapy. After all, I had been prescribing this regimen for years. I knew what to do. It was just a matter of DOING it. Which I did.
I got my functional motion back under a week, though it took a few months to achieve those last few degrees of flexion. I needed crutches and pain pills for the first few days, as my surgeon did a lot of work in there. But after that, it was daily progress with the exercises.
So when I tell you how good these exercises are and how well they work, I’m telling you based not only on my clinical experience with my own patients, but I’m telling you what I personally experienced, with my own knee.
In addition, I used the same exercises on my right knee, too. As a result, as my muscles strengthened, any residual pain gradually disappeared and I have not needed to have surgery on that knee, to date.
So, if you, or someone you know, has a similar story, or similar knee pain, you now know what will work: my popular and effective PAIN-FREE PROGRAM & DVD. No reason to suffer needlessly, any more. Take charge and get started on these great knee pain exercises and stretches NOW-Just click the link:
http://www.drbillsclinic.com/exercise_eliminate.html
Whether you’ve already had knee surgery, or you hope to avoid it, these specially modified exercises are the long term solution to knee pain. And the answer to the original question is that, before or after surgery, it’s never too late to start.
Til next time, my friend, be well.
Yours for a pain-free tomorrow and your optimal health,
Dr. Bill
“The Wellness Warrior” TM
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phone: 813-650-8252
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Dr. Bill’s Clinic, Inc. | 816 Turtle River Court | Plant City | FL | 33567
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Wednesday, September 8th, 2010
September 8, 2010
Yesterday, at dusk, I was going through my many stacks of stuff in the “rat’s nest” (my wife’s affectionate nickname for my little study). The piles had gotten so high that they were becoming unwieldy, threatening to bury any of the cats that might have been just a little too inquisitive and upset their precarious balance. Whenever they get like that, I have to break down and get rid of some stuff.
The problem is that I’m a bit of a pack rat (hence, the “rat’s nest”). I have stuff that dates back to my childhood lying around. It’s a kind of controlled chaos that drives my wife nuts. But like others with this disease, I’m perfectly content and know where to find most anything I need, when I need it (well… more or less).
The truth is, my artistic nature made me one helluva surgeon and much more personable and approachable than the typical “surgical personality.” I believe it made me a much better doctor-a healer, not just an ace technician. But it also thrives in chaos.
I completely lacked organization and discipline in nearly every area of my life…except the operating room. In there, I was like a precision anal retentive machine. 180 degrees from my “normal” M.O. Kind of like Jekyll and Hyde, you know? Of course, if you have to pick one place to be anal, the O.R. is the place.
In fact, if not for the wonderful girls in my office and my wife at home, I never would have gotten anything done. They made me a schedule, pointed me in the right direction and gave me a push.
Of course, I had the good sense to know my weak spots and I made sure to hire (and marry) the best. But I must say, I do miss them (well, my girls. I still have my wife, but for some odd reason, she’s less inclined to try to organize my “area”). Left to my own devices, my study is a study in bedlam.
So, there I was, sun going down through the plantation shuttered windows to my left, looking through some of my old stuff. I was trying to see what I could get rid of and live without. As I considered each item, and relived the memories it conjured, I came across my old medical school yearbook, Fleur-O-Scope.
(Lame name, I know, but I didn’t name it. I was just Co-Editor-in-Chief and Art Editor, in my year. Some nameless senior in decades past has to take the rap for that name.)
Anyway, I spent a few minutes, that somehow became a couple of hours, looking through it. I saw a number of my old friends, fellow students, some already gone now, and relived the adventures we shared, learning the art of Medicine.
One guy I remember with fondness, was the class orthopod. That is, he always wanted to become an orthopaedic surgeon. As luck would have it, I constantly made fun of him for his wanting to go into orthopeadics. “Don’t you want to be a REAL surgeon, Vic?”
At that time, I was all set to become a cardiovascular/thoracic surgeon. And, at that time, like many people who know no better, I thought orthopaedics was all crude, like carpentry. I learned differently, in time.
Fate seems to richly enjoy irony. My pal Vic did indeed become an orthopod, but then… so did I. You see? You just never know.
Unfortunately, after a number of years in practice, on the South Shore of Long island, while I was on the North Shore, he succumbed to lymphoma. All too many of those young faces in that yearbook have already cashed in their chips.
But that set me to thinking about the rest of my training, my time as a resident in St. Luke’s in New York, my fellowship in Boston, learning to deal with end stage arthritis and hone my natural gifts to a scalpel’s edge.
I remembered how Dr. Potter taught me to do a total knee replacement, totally freehand, by eye, well before the modern instruments and techniques were invented and popularized.
I remembered how Dr. Bierbaum taught me to do a hip surgery, by watching him. I just didn’t understand when he told me I could learn more by watching him than by trying to do it myself, with his guidance. He was right, as it turned out, but I didn’t get it, at the time.
I remembered how I really appreciated the genius of Dr. Turner when it “hit the fan” during surgery. Nobody better when you had to be right, the first time, when it was all on the line.
And I remembered my personal talk with the legendary Dr. Otto Aufranc (after whom my fellowship was named), at the end of my fellowship. He had been the teacher of my teachers. And one of his greatest principles was that the soft tissues around the joint had to be treated with gentleness and respect, an unusual approach to orthopaedics, to say the least.
He emphasized physical therapy and exercise, before and after surgery, far beyond any other surgeon I ever saw, or heard of (except for those he taught). He didn’t rush to do surgery, but tried to enhance functional motion and relieve joint pain, with conservative measures, including exercises designed to strengthen and mobilize the hip and knee.
His idea was to “get the tissues ready,” and avoid surgery until the tissues (and the afflicted joint) were ready for surgery, if that was what was needed. Hip and knee pain nostalgia….
And as I ended my reveries with a gentle smile, remembering with fondness and gratitude all those who taught me and helped to forge me into the physician and surgeon I became, I realized that I had stayed true to Dr. Aufranc’s ideals, for my entire career…and even now that my surgical career is over, I still do, with the special exercises in my PAIN-FREE PROGRAM & DVD.
http://www.drbillsclinic.com/exercise_eliminate.html
They relieve pain; they restore function. In many cases, they help to avoid knee surgery. Somehow, I think that Dr. Aufranc and my other teachers would approve.
But don’t take my word for it. If you have knee pain and want to be rid of it, or just want to prevent it, then click the link above and see 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
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phone: 813-650-8252
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Dr. Bill’s Clinic, Inc. | 816 Turtle River Court | Plant City | FL | 33567
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Tuesday, August 31st, 2010
September 1, 2010
Last night, after dinner, I repaired to my study with CoCo, my antisocial cat (she loves me, but wants me all to herself–she’s hostile to all the other cats). I was reading my subscribers’ emails, as I usually do, and answering questions, as they came up.
One question that I’ve been asked pretty frequently is from people who have already had some type of knee surgery. But they still have pain. So, they wonder, not unreasonably, if there’s anything they can do to get rid of the pain.
They are usually afraid that they’ve burned all bridges, because they’ve had the surgery, whether it be an arthroscopic procedure, or a full total knee replacement. Since the ideas behind having a surgery is that it fix the problem, whether that be just pain, or functional stability of the joint, if problems remain, they naturally fear that there’s nothing else to be done.
Fortunately, that’s NOT the case.
Back in the day, when I was the regional expert in these procedures on Long Island, New York, patients came from far and wide to see me for such situations. I was sort of “the Court of Last Resort.” There was me, or there was New York City.
Now, of course, there are quite a few fellowship trained joint experts on the Island. But back then, other than the Chairman and Professor at Stony Brook, I was pretty much it (and the only one in private practice).
Thanks to my training at the New England Baptist Hospital, in Boston, where I did my fellowship in joint reconstruction, I had been taught to utilize extensive physical therapy (read, exercise) to get the most from my surgical patients. And I carried that into my own practice, on my own patients, too.
My approach was simple. I had my patients work every single day for a week after any procedure, to get a rapid return of motion of the postsurgical joint, especially the knees. Only after they had obtained a superior range of motion did I cut back a bit to three times a week for resistance exercises.
That’s because resistance training builds muscle, but it needs recovery time to do that. So I always gave them at least a day off in between training sessions.
But I discovered that if they got their motion back quickly, they healed better, with less swelling, much less pain and a much better result. That’s why I had them work every day, for the first week.
It was so striking a difference that physical therapists always knew, before asking, whether the new patient was from me, or one of my colleagues. First, the wound was always a hairline (I did a lot of Plastic Surgical training and used it on my wounds) and second, they always came with a detailed physical therapy plan, that specified their diagnosis, the surgery they had and which specific exercises they were to have.
By contrast, most of my colleagues, even those in the City, would either send their patients home with a Xeroxed few pages of exercises to do on their own, or a therapy prescription that simply said: “P.T.” They actually left what exercises the patient needed up to the therapist! Unbelievable. I never understood that.
Surgery creates potential. But to realize that potential, you need to do the specific exercises, for motion and strength, that are now in my new, fully illustrated PAIN-FREE PROGRAM & DVD
http://www.drbillsclinic.com/exercise_eliminate.html
Not only did this approach make more sense, but it WORKED. And it produced better results-every time.
So, yes, there ARE things that can be done, if you still have pain after knee surgery. And sometimes, they can avoid additional surgery, depending on the cause of the pain.
But there is more.
If these exercises are done prior to a surgical procedure, there is a good chance that you may be able to avoid (or at least delay) the surgery. Even people with advanced arthritis can benefit from strengthening the muscles around the affected joint.
When muscles are strengthened, they share in bearing the load of weight bearing. They also help to stabilize the joint. And the exercises themselves bring healing blood into the joint and surrounding tissues, so they reduce swelling of the joint itself and the soft tissues and reduce inflammation.
Used in conjunction with various anti-inflammatory measures, exercise can give painful, worn joints a new lease on life. In fact, it is the best treatment for long term control of knee pain that exists.
I’m a perfect example. After my own arthroscopic knee surgery in 2005, I did my own physical therapy. I worked hard to get my knee to bend, as soon as I could, just as I had prescribed for my patients for so many years. I worked hard to get it to fully straighten (often more difficult and more painful to achieve than bending).
And, just as in my patients, I worked after the first week with resistance exercises, like straight leg raising, quad setting and various squats, to strengthen my thigh and calf muscles. The end result was so good that the exercises helped me avoid surgery on the opposite knee, too, which had similar symptoms. And I haven’t needed any additional knee surgery since. At present, my knees no longer spontaneously hurt, at all.
So, when I say I KNOW that these knee pain exercises work, I’m saying that on the basis of personal, first hand experience. So, if you have knee pain, try this proven effective program. Exercise is the perfect prescription for knee pain. Can’t hurt and it might very well help. Click this link NOW, for yours:
http://www.drbillsclinic.com/exercise_eliminate.html
That’s it for today, my friend. Til next time, be well.
Yours for a pain-free tomorrow and your optimal health,
Dr. Bill
“The Wellness Warrior” TM
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phone: 813-650-8252
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Dr. Bill’s Clinic, Inc. | 816 Turtle River Court | Plant City | FL | 33567
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Monday, August 30th, 2010
August 31, 2010
You know, periodically I get requests from people all over the world for advice on knee pain, hip and back pain, arthritis and other orthopaedic problems, or just general health topics. There is a definite hunger out there. People want to know. They are willing and able to assume responsibility for themselves. And that’s a good thing, as Martha would say.
It’s frustrating at times to have to tell people what they don’t want to hear. Many people read my blog and those of others, trying to stay “natural.” By “natural,” they mean no drugs, no surgery. And that’s a good goal, for the most part.
But you have to temper that reasonable goal with some rational thought. Their desire to stay “natural” rests on a belief that the human body is fully capable of healing itself, given the chance. And there’s a lot of truth in that-to a point. But only to a point.
You could say that it’s “natural” to just let someone who is sick die. After all, Nature’s plan (or “God’s will,” take your pick) seems to call for individuals to reproduce, to perpetuate the species, and after that, it pretty much doesn’t matter what happens to you. In fact, it’s better if you die, so that there’s more room for yet another generation.
You could even say that a doctor and Medicine in general are counter-evolutionary forces, keeping alive the lame and the sick, far beyond what was originally intended, when Nature, unassisted, would have them dead. In the Middle Ages, for example, odds are good that I would have been dead for over 20 years by now.
Personally, I believe in the individual. I believe in the worth and in preserving the life and well-being of the individual. And I believe in the improvement and extension of life for the individual, the attempt, however unachievable, of perfecting the individual. For me, the virtue is in the trying.
But there are times when medications and even surgery are not only the options of last resort, but are the best options available, or just the right things to do.
Contrary to a very large body of alternative thought out there, conventional Medicine and the Pharmaceutical Industry do not exist solely to foist poisons and unnecessary surgeries on you and your family, in an effort to enrich themselves, at your expense. There is much good there, as well.
The trick is to find and apply the truth, regardless of the discipline, for the betterment of mankind.
Let me give you one example, from my residency days in orthopaedics. I was on duty in our Pediatric Clinic in the Crown Heights section of Brooklyn, at the House of St. Giles the Cripple. A mother and father brought in their child with tremendously curved shin bones-they almost looked like two “C’s,” facing each other.
They were vegans, that is, very strict vegetarians, allowing the child no milk from any animal, in favor of soy “milk.” So this child had a disease, virtually wiped out in the civilized world, at the end of the 20th century: Ricketts. This comes from a calcium and Vitamin D deficiency. We’d all read about it, but never expected to actually see a case.
This is an extreme example of a too strict “natural” approach. This child was healed by giving him vitamin D supplements (from a pharmaceutical company) and lots of almonds (which have an enormous amount of calcium in them, far more than milk).
This approach, which I worked out, as their doctor, used medical science to identify his problem, combined with compassion and respect for their desire for a “natural solution,” compatible with their beliefs, to solve his problem. And it worked.
My point is, sometimes the solution to a problem can have multiple options. It doesn’t make sense to cut yourself off from a potential answer, because of a mistaken assumption, such as that all drugs and surgery are “bad.”
So it’s not a question of conventional vs alternative treatments. I believe in using whatever works: without drugs or surgery, when possible, but using them wisely, when they represent the best option for a successful resolution to a clinical problem.
That’s the premise upon which I base all my products, advice and recommendations: to use whatever works.
For example, if you have persistent knee pain, along the joint line, you might have a torn meniscus. And if you do and if it becomes disabling and painful and causes persistent mechanical symptoms, you might eventually come to arthroscopic surgery. But, doesn’t it make sense to try the proven, effective exercises in my PAIN-FREE PROGRAM & DVD, first?
http://www.drbillsclinic.com/exercise_eliminate.html
They burn no bridges, they may solve the problem and get rid of the knee pain, for good, and they may help you to avoid that surgery. And if not, you’re no worse off. There’s virtually no down side. If you win, you win big.
And besides, having used these very exercises myself and on my own patients, for well over two decades, I know they WORK. So, if you have knee pain, click the link NOW:
http://www.drbillsclinic.com/exercise_eliminate.html
and take the first step on your road to pain-free recovery.
Til next time, my friend, be well.
Yours for a pain-free tomorrow and your optimal health,
Dr. Bill
“The Wellness Warrior” TM
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| Quick Links…
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| Contact Information
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phone: 813-650-8252
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Dr. Bill’s Clinic, Inc. | 816 Turtle River Court | Plant City | FL | 33567
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Posted in Dr. Bill's Blog | No Comments »
Sunday, August 29th, 2010
August 30, 2010
Late last week, in my study, while reading over my emails for Dr. Bill’s Clinic, I got an all too common question that I thought I’d share with you. It’s unfortunately all too common, because young people tend to think they’re immortal and invulnerable and older people find out, the hard way, that they’re not. In either case, someone ends up hurt.
One guy wanted to know how he could continue to play soccer, if he had sprained his knee. From his question, I already know he shouldn’t be playing, because his injury was a few weeks ago. Naturally, he had no treatment, hoping it would just “go away.” (Well, it ALL goes away eventually, doesn’t it?) And here we are, some few weeks later, still no treatment, and he wonders why he still hurts.
A “weekend warrior” tends to be his own victim and his own worst enemy. It’s that inner teenager that lives in the heart of every man. Women, in my experience, are much too smart for this. Please understand, I’m not being smugly judgmental-I’ve been subject to this same syndrome-and I KNOW better.
Some years ago (in the mid to late 80′s), after office hours, I was working out in the Physical Therapy Department of the office building I shared with my pals and partners, the rheumatologists. I was on the leg press machine, using a very heavy weight for very short arcs, to strengthen my knees. This is, in fact, one of the classic exercises to strengthen knees, to prevent pain. I still have this classic in my PAIN-FREE PROGRAM & DVD
http://www.drbillsclinic.com/exercise_eliminate.html
In any event, I was doing it as it should be done, a very short arc of motion, to protect the knee. And I was using in excess of about 400 pounds, for these short arcs. Chris, a senior physical therapist, who was there after hours, cleaning some of the equipment, was watching me from across the room.
As I was focused on pressing out the last few reps, he shouted encouragement, “C’mon Bill! Bend Deeper! Dig deeper! You can do it!” With that, my dopey inner teenager woke up and responded to that challenge, right past my conscious brain.
Yeah, I could DO it! I bent down deeper, twice as deep as I intended and…PING!
I felt, rather than heard, a little sharp sting of pain, behind my right kneecap, that almost made me drop the weight. But I held on and lowered it, with some control, even though it HURT like the devil.
Crap!
I knew instantly what I had done. Stupid. STUPID. STUPID! I had overloaded my retropatellar cartilage and split it open. And once articular cartilage is split, it will never be normal again-it simply can’t heal. Great.
I couldn’t blame the therapist. He was trying to encourage me. I should have known better. I DID know better. But that damn inner 18 year old was in there, alive and well… and stupid. From that day onward, I had trouble with that knee, soon followed by the other one.
That was the beginning of my knee pain, from chondromalacia patellae, a degenerative softening of the cartilage behind (or rather underneath) the kneecap. Now, in all fairness, I probably would have developed this trouble sooner or later, anyway. But I might have delayed it for years, but for this one attack of idiocy.
So, believe me, I sympathize with this guy who wrote me. I’ve been there and done that.
Anyway, he apparently got himself a sprain of his knee. But, since he isn’t a real teenager, rather a middle aged guy, his body doesn’t forgive, the way a kid’s might. He didn’t heal. And his constant activity level was preventing his recovery.
I told him he needed to rest for a couple of weeks. And that means, getting a hinge brace for his knee, to splint the sprained collateral ligament, while still allowing the knee to bend and extend. Once he’s no longer tender, he can start to train his knee muscles, to bring blood to the area for faster healing and to increase his strength. Stronger muscles will help share the load and stabilize the joint, with the healing ligament. And the best and fastest way to accomplish that is with my PAIN-FREE PROGRAM & DVD.
http://www.drbillsclinic.com/exercise_eliminate.html
So if you, too, get an attack of “the stupids” and discover that you’re paying the price in pain, get started NOW with my program. You’ll get fast pain relief and get back in the game quicker. And if you continue with those exercises and stretches after the injury heals, you’ll be a whole lot less likely to get another injury, too.
Til next time, my friend, be well.
Yours for a pain-free tomorrow and your optimal health,
Dr. Bill
“The Wellness Warrior” TM
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| Quick Links…
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| Contact Information
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
phone: 813-650-8252
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Dr. Bill’s Clinic, Inc. | 816 Turtle River Court | Plant City | FL | 33567
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Posted in Dr. Bill's Blog | No Comments »
Friday, August 27th, 2010
August 27, 2010
While it isn’t widely known, in 2005, I had an arthroscopic surgery of my left knee. You may recall that I had fallen through a ceiling in 2001, breaking my mid back, but also injuring my knees and right ankle.
Take it from me, even if you have air conditioner trouble…stay OUT of the attic.
It’s actually not as stupid as it sounds-I did call the service guys, but they refused to come. And we did have a major water leak, through the ceiling light fixtures…putting the whole house in danger from a possible short-caused fire. It seemed like a good idea at the time….
Though the back was my major limiting factor, the knees continued to give me trouble, even after the ankle sprain had healed, without any residual effects. We had moved to Florida, thinking that the heat might make my back feel better (it did) and I spent hours, walking daily to drop any excess weight.
I also tried everything I could to strengthen the left knee, as that was the worse of the two. That included quarter squats and other quadriceps exercises, in an effort to reduce the persistent medial (inner side) joint line pain. But despite my best efforts, the pain was getting worse, even using fish oil and anti-inflammatory drugs, as needed.
So I got an MRI scan and lo and behold, there it was-a torn medial meniscus. After weighing my options and exhausting all the alternative and conventional conservative treatments, I finally decided to get it fixed.
So I went to one of my colleagues, a great guy (whose technical skills were as good as my own. Well…almost J). And on Tax Day, 2005, I had the procedure done, under conscious sedation (ie., with I.V. Versed and local anesthesia). He took lots of photos of the inside of my knee during the surgery and of course, he trimmed the damaged cartilage away, leaving me with a nice, rounded rim of meniscus.
Turns out that I had quite a bit more arthritis in there than I would have thought. He was surprised, too. There was, in fact, one area of chondromalacia grade 4, which means all the way down to the bare bone. This is indistinguishable from osteoarthritis.
Unbelievable! Who would have guessed that? There were other areas of shredded cartilage as well. And all this, with no other injury than that one fall.
Post op, I had a whole new appreciation for what my own surgical patients had been going through for many years. Of course, I probably gave them more local anesthesia in their knees than my surgeon gave me. Let me tell you, when you lower your leg to hobble to the bathroom on crutches, it hurts.
But I healed rapidly and started range of motion exercises, as soon as the pain permitted me to do it. This was followed by progressive strengthening exercises, like those in my recently updated PAIN-FREE PROGRAM & DVD
http://www.drbillsclinic.com/exercise_eliminate.html /.
In short, I did my own rehabilitation and physical therapy.
It took a couple of months before I was healed enough to walk for exercise, again. And some mild aching continued for over six months. You just can’t get away from it: youth is wasted on the young. Us older guys have to get by, just doin’ the best we can.
Now, if all this is familiar to you, in some respect or another, I just wanted you to know that I understand what you’re going through, first hand. For all my clinical experience, through decades of performing surgery and nearly a quarter century of private practice in orthopaedics, there’s nothing quite like being the patient yourself, to teach you what you really need to know.
And I learned a lot. Even though I did well with the surgery, I learned enough to treat my right knee even more aggressively, with those same knee pain exercises
http://www.drbillsclinic.com/exercise_eliminate.html
and other treatments, so that I’ve been able to avoid surgery on that knee, to this very day. And the odds are good that you can, too. Just click the link and learn what I can teach you about preventing, or getting rid of your knee pain, for good!
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
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Dr. Bill’s Clinic, Inc. | 816 Turtle River Court | Plant City | FL | 33567
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Friday, August 27th, 2010
August 26, 2010
I was sitting in my home office last evening (which my wife affectionately calls my “rat hole”), as the sun set and darkness crept over the room. I was answering the comments and questions that my recent emails about knee pain engendered.
I got a few from some pretty far flung places around the world, mostly saying “Thanks,” in so many words, for the advice and encouragement they had received from my email tips. No crank mail, this time. That’s always a plus.
Every so often I get some folks who think that I work for them, or who think they know better than I do about my own field. No way I can ever reach those types-they’ve already made up their minds and there’s no more room in there for any new ideas.
I generally suggest that they’d probably be happier elsewhere. (I was known for occasionally doing that, even when I was in practice-I decided early on that I couldn’t make 100% of the people happy, no matter what I did, so why put up with vexation?)
None of that this time, though, which was a blessing.
Then, I came across an email from one of my old patients, who is now a subscriber. He told me that the total hip replacement I did on him over 22 years ago had needed to be revised, but the total knee I had done was still doing well at 21 years… and counting.
Now, this man was very young when I did his surgery, which is normally not done. But he has a particularly nasty form of inflammatory arthritis, which destroyed his hip joint in under six months, from the diagnosis. We had no choice.
But the fact that the hip lasted over 22 years in such a young active man was a major achievement. And his total knee is still surviving and going strong.
That news alone was enough to give me a sense of satisfaction that my skills were proving to be as good as I always believed them to be (Hey, you’ve gotta have mega self confidence, if you’re going to be a surgeon-can’t be tentative or timid and expect excellent results. You have to believe in yourself and your ability!).
But what really made my day was that he told me that he wished he was still my patient, not just my subscriber. He said that he knows he needs to get another orthopaedist, but he doesn’t feel as comfortable with anyone, as he did with me.
Well. That made me feel pretty good, indeed. Made my whole day, in fact. I was really touched and very grateful that he would take the time from his busy day to email me that message.
For me, that’s what it was always all about-helping my patients to get rid of their pain, changing their lives for the better.
I try to do the same thing today.
Nothing makes me happier than to have someone write me that they have “no more knee pains,”as a result of following my advice, or my specially modified knee pain exercises.
http://www.drbillsclinic.com/exercise_eliminate.html
You know, when I broke my back, it ended my surgical career. But I chose to be grateful that I hadn’t been paralyzed, or killed outright (which I certainly could have been). I not only screwed up my back, but my knees, as well.
That’s how I know that these exercises work. They’re the same ones that I’ve used myself, for my own arthritic knees, and the very same ones that I prescribed for my patients, for lo those many moons.
And now, they’ve been completely renovated and updated, with new photographs and a completely new DVD, to show you exactly how to do them, for best results. No need to guess, anymore.
Quadriceps exercises, hamstring exercises, calf exercises and complimentary stretches for the quads, ITB, hamstrings and so on. All modified, so you eliminate pain, not aggravate it, by actually changing the dynamics of the knee joint.
Every exercise is demonstrated for you, so you can get rid of that nagging knee pain, for good!
If you are one of those rare people, like my former patient, who have aggressive, rapidly advancing, end stage joint disease, you might need joint replacement surgery, as he did.
But if you’re one of the great majority who have garden variety arthritis, or an old sports, or work injury, odds are good that you can eliminate that persistent knee pain, on your own, without surgery, with my PAIN-FREE PROGRAM & DVD:
http://www.drbillsclinic.com/exercise_eliminate.html
So if you have knee pain, why continue to suffer?
For only a fraction of the cost of a consultation with a doctor, you can have your own copy of this proven program of effective, pain-relieving knee exercises and stretches. Don’t wait another minute. Click the link and eliminate your pain, NOW! And feel better, FAST.
Til next time, my friend, be well. Talk to you again, soon.
Yours for a pain-free tomorrow and your optimal health,
Dr. Bill
“The Wellness Warrior” TM
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Dr. Bill’s Clinic, Inc. | 816 Turtle River Court | Plant City | FL | 33567
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Friday, August 27th, 2010
August 25, 2010
While reading some of my email in my study this morning, I came across an article on a disease that can cause diffuse joint pain, resembling arthritis. Now, it is true that a number of diseases can do that. Even some episodes of flu can cause diffuse joint pain, as part of the complex of symptoms.
Some new cases of rheumatoid arthritis can first present as a swelling of one single joint. I saw this personally happen to my wife’s niece, who developed swelling of her ankle, after a sprain. But the swelling continued long after a simple sprain should have disappeared.
Sure enough, once she was tested, she was found to have a form of inflammatory arthritis called JRA (Juvenile Rheumatoid Arthritis). Fortunately, it’s not too common. But I have seen some cases that are so rapidly destructive that you have the situation of a young girl with multiple joint replacements, before she’s out of her teens.
Obviously, this is not good, as man made parts have a finite life span-they don’t last forever. And their revision is a much more challenging surgery than the initial replacement. It’s a heart breaking condition, no question about it.
However, the condition I’m talking about is endemic to the Northeast of the USA, specifically around New England and parts of Long Island, New York, though it has since spread far and wide.
I’m talking of course about Lyme Disease, a form of arthritis that results from an infection by a spirochete bacterium, related to syphilis, called Borrelia burgdorferi, which is responsible for most of the cases in the US, while Borrelia afzelii and Borrelia garinii (different species of the same genus, Borrelia) cause the disease in Europe. The disease got its name from Lyme, Connecticut, where it was identified in 1975. However, it has since spread all over.
The bacteria are carried by deer ticks, very tiny arachnids, which are about the size of the period at the end of this sentence. They are so small that the victim often does not even feel the bite and is unaware that he’s been exposed. The bacteria are passed on to the host (that would be you), when the host is bitten by the tick. They then migrate all over the body and set up shop in your joints, where they cause the pain and swelling.
A single deer can harbor hundreds of ticks and a single female tick can lay a couple of thousands eggs, that become the next generation of ticks.
In the classic case, you may develop a characteristic “bulls-eye” rash at the site of the tick bite, but usually a while after the tiny bite has disappeared, if you ever knew it was there. But sometimes, that diagnostic sign just doesn’t develop, or is unnoticed by the patient.
That makes the disease difficult to identify, so again, the doctor must think of this disease whenever he sees an atypical case of knee pain and swelling, without another obvious cause.
This is just one of the less common causes of knee pain and swelling that I discuss for you in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN:
http://www.drbillsclinic.com/eliminate_knee_pain.html
Now, Lyme Disease can be treated and cured, in most cases, by an aggressive and prolonged course of antibiotics. But you have to know that this is the cause of the pain, so you know to treat for it. And that means having a very high index of suspicion, if you’re the examining physician.
Unfortunately many times, no one thinks of it and the symptoms continue, on and on, tick…tick…tock…and the patient develops a progressive arthritis, often of the knee. Luckily, the old rule in Medicine remains true: “when you hear hoof beats, don’t think of zebras.”
Standard treatments should be tried first, including rest, local heat, anti-inflammatory medication and/or omega-3 fatty acids, which have a natural anti-inflammatory effect, like those in my premium, enteric coated, deep arctic water, pharmaceutical grade fish oil, POWERHOUSE OMEGA FORMULA and my JOINT HEALTH FORMULA, with its unique Green Lipped Mussel extract.
http://www.favoriteformulas.com
http://www.favoriteformulas.com/jointhealth
They work in conjunction with NSAID medications, but without the adverse side effects. But they are so potent that in Europe, fish oil is a first line treatment for RA. So they are ideal for the treatment of standard knee joint inflammation.
When the pain and swelling recede, it’s time to begin rehabilitation, with strategic knee pain exercises like those in my newly revised PAIN-FREE PROGRAM: DVD & Manual.
http://www.drbillsclinic.com/exercise_eliminate.html
If it’s a garden variety joint inflammation, from injury, or degeneration, it should respond to these conservative measures.
But if it should persist, despite faithful adherence to this proven regimen, then other diagnoses must be entertained: more severe osteoarthritis, inflammatory arthritis (like rheumatoid, or lupus), gout, pseudogout, or a low grade infectious arthritis. (High grade arthritis makes the patient sick as a dog, with a high temperature and the knee is so glowing red, it looks incandescent; so there’s no mistaking that.)
Blood tests will usually tell the story, but sometimes, aspiration (sticking a needle into the joint to draw out fluid, for microscopic examination) is necessary. However, even with the absence of the usual history of a tick bite, or that diagnostic bulls-eye rash, the doctor must think of Lyme Disease, or the diagnosis will often be missed.
If you ever find yourself in this situation, don’t be bashful-ask your doctor if Lyme is a possibility. The doc is only human and it’s YOUR knee, so don’t hesitate to remind him. Something to think about, the next time you see those cute deer munching on your shrubs.
Til next time, my friend, be well.
Yours for a pain-free tomorrow and your optimal health,
Dr. Bill
“The Wellness Warrior” TM
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phone: 813-650-8252
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Dr. Bill’s Clinic, Inc. | 816 Turtle River Court | Plant City | FL | 33567
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Posted in Dr. Bill's Blog | No Comments »
Friday, August 27th, 2010
August 24, 2010
After a busy weekend with long road trips back and forth to Clearwater this past weekend, I needed a day to recuperate. So naturally, the bride decided yesterday was the day to take a road trip to visit her father in Palm Coast. So it goes….
We were fortunate that it was a nice day, with only a few sprinkles, coming and going, to mar the drives. Otherwise, it was smooth going the whole way.
We arrived in the early afternoon and everyone was hungry. So we went to a local family restaurant to have dinner. The clientele was older, without many kids in evidence, as you might expect in a retirement community.
There was one couple with so many facial piercings and confluent tattoos that I speculated about how much trouble they must have if they ever travel by air, what with all the metal detectors and all. (Not to mention their various pins, rings and posts locking together when they kiss…but I digress.)
But in looking around at our fellow feasters, there were an inordinate number of extremely heavy people, mostly women. One thing they shared in common was that they all sported excessively tight clothes that did nothing to conceal the various rolls and bulges that overflowed the constraints of their clothes. It was “muffin top madness,” wherever I looked.
As I looked around, I idly took a look at what was on their plates. And it suddenly dawned on me that what I was seeing was the cumulative result of their own daily choices. Without exception, their plates were piled high with carbohydrate laden fare, covered with flour fortified sauces and lots of batter covered fried foods, like Southern Fried Chicken, when clean, moist rotisserie chicken was available right next to the fried fare. Lots of cokes were in evidence and “sweet teas,” too. Very few were drinking plain ice water, or even diluted lemonade.
While I was sitting there, I remembered one such girl in my practice. She was young, just in her twenties, and worked in New York City. She was talented, smart, personable and would have been quite pretty, if her features hadn’t been smothered in too much flesh. She came to see me because of severe persistent knee pain that was literally ruining her life.
Unfortunately, every conservative measure had already been tried and had failed to give her any relief. Though she claimed that she tried, she just couldn’t lose weight and that excess weight applied tremendous forces across her kneecaps whenever she attempted to climb stairs.
This was exacerbated by a tendency for her kneecaps to “jump the track” and slip out of position, sideways. She was born wit very wide hips which made her knees relatively “knocked.” This, in turn, tended to pull her kneecaps laterally (toward the outside of her knees). Combined with all this was profound weakness of her thigh muscles.
This was one of the times when surgery was clearly warranted. But to be sure, I sent her to another knee expert for another opinion. He concurred with my analysis, so, with her permission, we went ahead.
You see, she was so big that nothing bit a dramatic shift in the forces across her knee would help her. And that can only be done by physically moving the tendons that attach the kneecap, to keep it in the midline and restore stability.
Had she not been so heavy, it’s very likely that surgery might have been avoided. There are many non-operative treatments, alternative and conventional, that might have been successful. I present many of them in HOW TO AVOID KNEE SURGERY
http://www.drbillsclinic.com/avoid_knee_surgery.html
But every pound above the norm is multiplied by a factor of 3-4 times, just when walking. That jumps to 7 times, climbing stairs and as high as 10 times, when running (though she clearly could not run).
So massive obesity was this girl’s worst enemy. And that doesn’t even take into account the metabolic problems and the increased risks for diabetes, heart disease, cancer, stroke, arthritis, lung diseases and so on that are a result of excess body weight.
Given her many problems, we simply couldn’t overcome all the adverse forces against her. I finally did formal patella realignments, to stabilize her painful kneecaps, one knee at a time. Postoperatively, she did very well. We used a number of the knee strengthening exercises and stretches that are now demonstrated in my PAIN-FREE PROGRAM DVD & MANUAL
http://www.drbillsclinic.com/exercise_eliminate.html
And as her strength improved, her pain receded and finally disappeared. As her pain resolved, her energy soared and her body weight finally began to drop. Even her appearance improved, as the attractive young woman, that had been buried within, began to emerge and her confidence soared. This was the kind of result that made me proud to be a surgeon.
But the fact remains that had she not gotten so heavy to start with, she probably would not have had to suffer all that pain and all that surgery.
I remembered all that, as I watched another rather large woman, who sat next to me in the restaurant, pile yet another piece of pie onto her plate. In the end, we all are a product of our choices.
Bearing that in mind, I popped another couple of capsules of my POWERHOUSE OMEGA FORMULA into my mouth.
http://www.favoriteformulas.com
This premium, enteric coated, pharmaceutical grade fish oil is my foundation for a healthy lifestyle. It keeps my heart and my brain in peak form and keeps my arthritic back and knees pain-free. Knowing that we ARE a product of our choices, I choose to stay pain-free, well and healthy. How about you?
Til next time, my friend, be well. Talk to you again, soon.
Yours for a pain-free tomorrow and your optimal health,
Dr. Bill
“The Wellness Warrior” TM
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phone: 813-650-8252
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Dr. Bill’s Clinic, Inc. | 816 Turtle River Court | Plant City | FL | 33567
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Posted in Dr. Bill's Blog | No Comments »
Friday, August 27th, 2010
August 23, 2010
Just this past weekend, I was in Clearwater, Florida with a group of friends and fellow internet marketers. A number of us were up early each morning to do sprints on the beach, in an effort to hike up our metabolisms and burn off a little extra fat. Yesterday morning, around 7 AM, we were all out there, but the dark thunderclouds were heavy on the western Gulf horizon and appeared to be heading right for us, as the sun rose behind us.
Amazingly, as threatening as the sky appeared, it didn’t rain for all the time we ran the beach. Truth to tell, this was the first time in nine years that I have been able to run on flat ground, without mid back pain, which has been the case, ever since I fractured my spine in that bad fall, in May of 2001.
After the morning run, a few of us went to breakfast, before our group meeting. As luck would have it, a couple of guys had knee pain-not surprising, since most of us are middle aged and have more than our share of joint aches and pains. One of my friends and business partners, however, is a very fit young man, but he had some knee pain, too.
More than likely, this was the result of this sudden burst of unaccustomed activity. More often than not, that’s the reason these things happen. In any case, while we were at breakfast, he asked me to check his knee. He was understandably concerned and wanted to know what was the source of knee pain. It had come upon him suddenly, during that last run, when he had the knee go so wobbly on him, he nearly fell.
Well, it doesn’t take much for me to check out someone’s knee. If I didn’t want to help people, I never would have become a doctor. So an opportunity like this is a good way for me to keep my hand in, so to speak, and besides, the man is a good friend. If you can’t take care of your friends in need, what good are you?
So, I examined him, right there in the restaurant. I felt around in his knee in the systematic way I have always done, through all those years of private practice in orthopaedics. Luckily, he had no swelling, nor was his kneecap injured. But once I got to the back of his knee, he let me know I was getting “warmer.”
At that point, I felt around more gingerly, for fear of hurting him. Sure enough, he had maximal tenderness in his medial (inner side of the knee) hamstring tendons. But nothing was disrupted. The ligaments were all pretty stable, thank goodness, and there was no real pain in the joint itself. So, it seems my friend has a classic pulled hamstring, or more accurately, a hamstring tenosynovitis.
Now, luckily, he’s already on a good daily dose of my POWERHOUSE OMEGA FORMULA
http://www.favoriteformulas.com
Although he takes it as a measure for good health, to minimize his chances of future heart disease or stroke, the omega-3 fatty acids in this premium, enteric coated, pharmaceutical grade fish oil have powerful anti-inflammatory properties. I recommended that he take an extra dose a day. This will work to help him heal. He should also rest with his leg in the healing position I recommend in my Little Green Book for Eliminating Knee Pain.
http://www.drbillsclinic.com/eliminate_knee_pain.html
Once the tendon stops hurting, he can start on the strategic exercises and stretches that I recommend in my newly illustrated PAIN-FREE PROGRAM DVD
http://www.drbillsclinic.com/exercise_eliminate.html
This DVD and the accompanying manual were designed to be companions to the Little Green Book. With these proven knee pain exercises and the great advantage of youth on his side, he should be feeling much better, in almost no time at all.
As one of the older guys in the group, I thought I did OK: Nothing broken, nothing pulled, or bruised and I did manage to keep up with the younger guys and, most important, finish the course. So I had a pretty good feeling of self satisfaction.
And, at least the rain held off until my drive back home to Orlando, last evening. But then, the skies finally opened, in a deluge so heavily that I could barely see the highway. Luckily, no mishaps on the road and I made it home in pretty good time, despite the weather. Better lucky than smart, right? Well that’s it for today. Til next time, my friend, be well.
Yours for a pain-free tomorrow and your optimal health,
Dr. Bill
“The Wellness Warrior” TM
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| Contact Information
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phone: 813-650-8252
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Dr. Bill’s Clinic, Inc. | 816 Turtle River Court | Plant City | FL | 33567
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Posted in Dr. Bill's Blog | No Comments »
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