If you’ve been a reader for a while, you know that I’m a long time comic book collector. I used to work as a professional artist for the comics, back in the 70′s for a brief stint and I’ve always maintained a serious interest in the art form, collected original art and kept up friendships with some of the best pros in the business.
 
This, of course, has always been a source of great embarrassment to my wife, who shares the opinion of many, who know no better, that comics are for kids, geeks and retards. I would patiently point out that there is an entire wing in the Louvre dedicated to graphic arts (ie., comic art)and many very highly creative, very wealthy and intelligent men, like George Lucas, Steven Spielberg and Clint Eastwood, to name but a few, have collected original paintings and drawings of some of the best modern illustrators, painters and comics artists. So I feel I’m in good company.
 
Anyway, as soon as I arrived back in town, in Orlando, I went straight over to my local comic shop, ACME SUPERSTORE in Longwood, to pick up the latest issues which had come out during my recent absence. While I was in there, seeing what else had come out that I might want to read, I overheard a middle aged guy talking to Penny, one of the store employees.
 
Penny had had arthroscopic surgery for her own knee in the past, after a number of conservative measures failed to relieve her very significant and disabling knee pain. I had reviewed her preop studies and her intraoperative photographs, and there’s no question she had a defined pathology that needed surgery to fix.
 
This guy knew about her experience and was asking her for advice. So, since she had come to me for advice herself and since I was there, she called me over to meet this man. Sure enough, he had episodes of pain and swelling that would come and go, after what he called a “blowout,” that is, a traumatic injury that ruptured his ACL (Anterior Cruciate Ligament) and gave him a torn meniscus.
 
Despite this, though, what bothered him the most was what he described as a sudden “shift” inside his knee and the insecure feeling this gave him. What he was actually feeling was the typical instability that results from a ruptured ACL. Naturally, he was concerned because he didn’t want ACL surgery, if he could avoid it.
 
I pointed out to him that there ARE ways to treat this condition nonsurgically, BUT there is a price to be paid–namely, if he doesn’t have arthritis yet, he soon will. The articular cartilage is damaged every time he experiences that “shift,” which is really a slippage of one bone on the other, that is usually prevented by an intact ACL.
 
However, if he is willing to accept that fact, and if his daily activities are not affected, then a number of conservative conventional treatments, combined with alternative methods, that help to relieve knee pain and resolve inflammation, appropriate bracing and vigorous specialized exercises, especially for the hamstring muscles, may be all he needs. 
 
He was amazed at this information, which was all new to him, and which is revealed in detail in my new healing program, HOW TO AVOID KNEE SURGERY (see here at http://drbillsclinic.com/avoid_knee_surgery.html )
 
He didn’t even realize that CRUCIATE means “crossed” in Latin, or that the cruciate or crossed ligaments, ACL and PCL, hold the interior of the knee together and prevent excessive, abnormal motions, front to back and back to front, between the femur and the tibia.
 
The anatomy and basic functions of these ligaments are presented in my LITTLE GREEN BOOK, together with lots of inside information on the many root causes of knee pain and disability. See what I mean at   http://drbillsclinic.com/eliminate_knee_pain.html
 
So, at the end of my “comic shop consult,” this man realized that he has options he didn’t know he had. I gave him my card and suggested he visit my website  http://drbillsclinic.com/avoid_knee_surgery.html  for more detailed information and advice. Hopefully, he’ll take my advice and get knee pain relief and joint stability back in his life.
 
At that point, I said, “My work here is done!”  Then I grabbed my comics and leaped out into the night…up, up and away……Heh.
 
Have a great weekend, my friend. I’ll be spending mine shooting the DVD version of my PAIN-FREE PROGRAM
 http://drbillsclinic.com/exercise_eliminate.html   Til next time, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill

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

As many of you may recall, my dog Kelly had a serious problem a few months back. She suddenly was unable to get up easily or walk without falling down, and when she did walk, her hind legs were all wobbly and uncoordinated (what we in the Medical Profession call ataxia). Naturally, I was concerned that she had a stroke, or some other life-threatening problem of older dogs. But the veterinary specialist I took her to told me that she had a disease not seen in humans (luckily).
 
She had developed showers of emboli (small bits of something that are released into the blood stream) of fibrous and cartilaginous tissue from her hip joints. These fibrocartilaginous emboli had lodged in the tiny blood vessels that feed her spinal cord, blocking the blood supply to the cord and causing neurological damage.  This nerve damage was the cause of her wobbly walking.
 
The good news was that the condition was supposedly self-limited. Given time and the proper support, she should improve. And so she did, initially. But recently, she seemed to get worse again. I can only assume that same phenomenon had happened again. It was so bad that we were discussing whether it would be kinder to put her down.
 
Then, our pet sitter (yes, we have a pet sitter–no kids, but lots of animals) suggested the use of our vet’s new “COLD LASER,” claiming she had seen it work wonders with some of her clients’ dogs. So, the next time she was looking after Kelly, she took her up to the vet and  started her on cold laser treatments.
 
Now, the cold laser has been around for a while. There have been a few studies in humans that yielded conflicting results: some showed improvement in wound healing, pain relief, decreased inflammation, and so on, others showed no benefit. I honestly attributed much of what was reported to a placebo effect, rather than a true beneficial modality.
 
But, there are no placebo effects in animals.
 
And when I came home, I couldn’t believe the results I saw in Kelly, after only three treatments: she was walking almost normally! She was definitely improved.  She was stronger, walked with a spring in her step I hadn’t seen in quite a while and even her tail was held higher, while she walked. Unbelievable. No matter what the reason, it is clear that the cold laser was working, because it was the only variable that had been introduced.
 
A “cold” laser is so called because it is a relatively low power laser, that does not appreciably elevate the temperature of the tissues on which it is applied. It seems to exert an effect by stimulating endorphins (internal morphine-like substances, produced by the body) and reducing inflammation. 

The process is called “biomodulation.” In other words, the low power laser light stimulates biochemical changes within the body, which appear to have a beneficial, regenerative effect. 

Now, a few of my subscribers have asked me about this modality. Some people swear by it. Not a whole lot of valid scientific studies, but lots of anecdotal positive reports. I’ve had a few of my patients use it during the years I was in clinical practice, and those that tried it swore it helped them. And, as I mentioned, there’s no such thing as a placebo effect in animals. If it can objectively help my dog, Kelly, maybe it can help you, too.
 
My attitude has always been that if it can’t hurt and it might help, why not try it?
 
Cold Laser is just one of the many non-surgical, alternative methods for relieving knee pain that I review in my newest program, HOW TO AVOID KNEE SURGERY. See what I mean for yourself at my website, at http://drbillsclinic.com/avoid_knee_surgery.html
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 

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

May 30, 2008

As I promised yesterday, today I’m going to tll you how my love affair with knees began. Once again, it was during my formative years in the St. Luke’s residency program, in the mid-seventies. One of our favorite professors, smartest diagnosticians and all around good guys was Dr. Robert E. Zickel, or “Zick,” as pretty much everyone called him. He was a completely self-made world authority in trauma, having invented a unique nail for fixing subtrochanteric hip fractures (a particularly nasty and difficult-to-fix broken hip), while still in his own residency. This device was so good that most surgeons around the world adopted its use.
 
By the time I met him, he was a Full Professor of Orthopaedic Surgery at Columbia, which was the academic affiliate of St. Luke’s Hospital and Deputy Director of the Department of Orthopaedics at St. Luke’s, under Bill Fielding. His was always the voice of reason, keeping Fielding (who was a bit of a wild man) under some kind of control. More than that, he had common sense, an all too rare commodity in academic circles. He was one of two professors who really taught me how to think about what I was doing.
 
Despite his fame for and his contributions to hip surgery, he was the first one to bring arthroscopy to St. Luke’s. Up to that time, we only had indirect means of diagnosis, like x-rays, arthrograms (a kind of x-ray taken after iodine-containing dye is injected, to make normally invisible structures, visible) or CT scans. All these studies require interpretation–meaning someone has to look at them and decide what those shadows mean. These are all great, but what arthroscopy did was allow us to see directly into the joint for the very first time.
 
The idea was developed by a Japanese surgeon, Dr. Watanabe. He had the idea to take the cystoscope, a thin telescope used to look inside the bladder, and stick it into a knee. It’s one of those ideas that after the fact, everyone says, “Oh, how obvious!” But no one did it before him. After his initial success peering into the knee joint, to see all the structures in real life, he had the cystoscope modified to better serve his purpose. Thus, the arthroscope (an endoscope specifically for joints) was born.
 
Anyway, Zick had read about this great new instrument, seen its potential and decided to get on board this great new idea. I remember when he first brought his brand new arthroscope into the St. Luke’s OR. All the residents crowded around to see this shiny little steel tube, with a black plastic eye piece. It was about 8 or 9 inches long and 5 mm thick. We all watched in fascination, as he showed us how it worked on his patient. 

Wow! You could see everything inside! Just like a movie, but live. In those days, that meant you had to stick your capped (but still non-sterile) head down into the surgical field, to look through the eyepiece, which turned, so you could fine tune the focus. The scope was inserted through a little 1/4 inch stab wound, and another little stab wound was made on the other side of the knee, to allow the insertion of a steel probe, so you could touch those structures and examine them for pathology.
 
I still remember Zick saying proudly “Best orthopaedic surgery in North America,” as he taught us how to use the scope. Sure enough, it confirmed that the patient had torn his meniscus, just like the arthrogram said. But this was LIVE–you could actually move the torn fragment around. Well, at that time, the scope was considered just a diagnostic tool, so after we had confirmed the diagnosis, we re-prepped and re-draped the patient for a standard open surgery to fix the problem. I loved it! I was hooked on scopes from that time on.
 
But, it never occurred to us that the probe could be replaced with special cutting instruments and the entire business could be done with only those tiny little stab wounds, instead of a real knee incision. And if it had, we wouldn’t have believed it possible. That’s the real
difference between those that are true visionaries and the rest of us.
 
That same Dr. Watanabe DID make that intuitive leap, that seems so obvious to us, now. He and his colleagues developed the concepts, the instruments and the techniques that eventually became arthroscopic surgery. It took until the early 1980′s before the techniques became more and more accepted by orthopaedists. Old dogs don’t like new tricks, and many feel intimidated by new technology,
especially when the old methods worked just fine for them. This was especially true for arthroscopy, which involves an entirely different set of skills from those of normal surgery.
 
When I first started my practice, years later, even I was skeptical at first, when tales were told of same day surgery. “Just a gimmick,” I thought. Then, Dr. Turner, one of my other profesors from my fellowship, asked if I had gotten into arthroscopy yet. When I told him my
reservations, he laughed at me. “Bill, this is the greatest thing since sliced bread. You oughtta look into it.”
 
So, I did. Initially borrowing long thin instruments from the neurosurgeons, I started to remove loose bodies through the scope. Then, I went to Salt Lake City for a hands-on course to learn the latest techniques and see what equipment was needed. When I came back, I spent my own personal funds to purchase the first camera, recorder, arthroscope and instruments at my hospital. And that was the beginning….
 
Despite my original claim to fame as a fellowship-trained expert in joint reconstruction, my love for arthroscopy expanded over the years. By the time of my forced retirement, fully half my practice was arthroscopic surgery. It’s funny how life works out. Originally trained to do some of the biggest, most invasive open surgeries, arthroscopy led me further and further away from open procedures, and now, here I am, doing no surgery at all and teaching all the many methods I know for healing knees without surgery (see what I mean at
http://drbillsclinic.com/eliminate_knee_pain.html ).
 
So, my love affair with knees continues to this day, just in a different form. From the latest in cutting edge surgical techniques to the best conservative, conventional treatments, to the alternative methods that work, I teach it all at Dr. Bill’s Clinic. And I’m grateful that you’re along for the ride, my friend. Til next time, have a great weekend, and be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION

Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved