I was sitting in my study this afternoon, fielding calls, writing emails and other correspondance and perusing the Google Alerts I have in place for interesting topics. I came across an interesting article from The New York Times Health Section, dated 12/09/08 (you see, there are some uses for the NYT other than lining bird cages and wrapping fish) that reminded me of the many times I faced similar diagnostic dilemmas in my years of practice. 
 
The gist of the article was that, in the quest for better and ever more sensitive noninvasive methods of diagnosis, like MRI Scans, more and more pathology is being revealed. But, the pathology observed may have nothing to do with the patient’s symptoms. 
 
This leads to a number of unnecessary surgical procedures, as doctors try to treat the pathology revealed by the scan, even if that was not the actual cause of the patient’s pain. This is the paradox of the nonsurgical study–it may result in MORE surgery, not less.
 
A good example is the common finding of a torn meniscus, inside the knee, revealed by an MRI Scan. It’s now well known that many middle aged and elderly people are walking around with torn menisci, without any resulting pain or other symptoms. So they really don’t need surgery, just because they have a torn meniscus, UNLESS they also have very specific mechanical findings or very specific pain, localized to the area where there is an identified torn meniscus. And yet, that is exactly what was happening, until recently.
 
I always got an MRI if my patient had persistent pain that failed to respond to conservative treatments, like those I describe in my newest healing program, HOW TO AVOID KNEE SURGERY, which you can see at  http://drbillsclinic.com/avoid_knee_surgery.html
But they only came to arthroscopic surgery if they had identified pathology AND specific symptoms and signs, consistent with the observed pathology.
 
I remember once, when I was much younger, I had a young man who had very specific joint line pain. He failed to get better with all the conservative treatments I prescribed–medications, local heat, physical therapy, the works. So, we got an MRI Scan. WOW! He apparently had an enormous tear of the posterior horn of his medial meniscus. Lit up like a Christmas tree! So obvious, even a lay person could see it from across the room.

Now, in a young person, job #1 is to preserve the articular cartilage at all costs: in other words, prevent arthritis, which is what happens if an untreated, unstable torn meniscus is allowed to remain, without treatment. So, with this as our goal, the patient, his parents and I were all of one mind: this kid needed surgery, pronto!
 
With all best intentions, I scoped the kid, expecting to see and repair or remove this enormous tear. Only…there WASN’T ANY TEAR. I looked and probed everywhere.  Nope.  Nada.  Well, I wasn’t about to fix what wasn’t broken, so I shaved away some inflamed synovium at the medial (inner) joint line, and got out.
 
He had what we call a “false positive” MRI Scan, a diagnostic image that appears for all the world to be a bona fide meniscus tear, only the tear doesn’t really exist. Imagine my embarrassment when I had to tell the family that I didn’t find the expected pathology, other than the inflamed synovitis (swollen, reddened lining membrane of the joint, which can get caught between the moving bones, just like a torn meniscus).  

The family was very grateful that he didn’t have a tear and all turned out well, because the patient’s preop pain was relieved, probably because I cut away that inflamed membranous tissue. But you could very easily argue that this was a completely unnecessary surgery–I was chasing the chimera of a false finding on a scan. It taught me a lesson, that’s for sure.
 
The fact is, MRI Scans are, at best, only 90-95% accurate on the medial (inner) compartment of the knee joint. This drops to only 60-70% accuracy on the outer or lateral compartment of the knee, because of the more complex anatomy of the lateral meniscus. Bottom line: MRI Scans and other diagnostic tests are NOT 100% accurate. They are just one part of the puzzle and have to be interpreted, based on the physical findings and a patient’s response to treatment. 
 
There are lots of reasons for knee pain. You can learn more about them, in layman’s English, in my best selling LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN (see here at http://drbillsclinic.com/eliminate_knee_pain.html )
 
Many, if not most of them, can be treated with effective nonsurgical treatments, including alternative and complementary methods. The trick is knowing when surgery is really warranted–and when it’s NOT. That’s why I wrote HOW TO AVOID KNEE SURGERY, which you can see here http://drbillsclinic.com/avoid_knee_surgery.html
 
Remember, the very best surgery is the one you avoid. 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

It’s hard to believe how fast time is flying. Here it is October 2nd, and the last quarter of 2008 has already begun. You know, it was a year ago yesterday that I sent my very first email to a small group of friends–my first subscribers. Well, everyone has to start somewhere, right? Things have changed quite a bit during this last year, too. I started with my LITTLE GREEN BOOK   http://drbillsclinic.com/eliminate_knee_pain.html
 
I have a number of products, including CD’s for the LGB and for my newest healing program, HOW TO AVOID KNEE SURGERY, which you can see at http://drbillsclinic.com/avoid_knee_surgery.html And, there’s also my magnum opus, HOW TO ELIMINATEKNEE PAIN–ONCE AND FOR ALL! THE ADVANCED MASTERS’ COURSE http://drbillsclinic.com/advanced_masters.html  for the last word in the entire spectrum of methods of treatment for knee pain of all kinds. This can be obtained in a single, BIG volume, or in 12 monthly installments, or Lessons–your choice. Or, if you’re just interested in the specially modified exercises that I used myself after my own knee surgery, and those I prescribed for my patients during my nearly quarter century of private practice in orthopaedic surgery, you could benefit from my PAIN-FREE PROGRAM  http://drbillsclinic.com/exercise_eliminate.html

These exercises can help get rid of knee pain, FAST, but can also PREVENT knee pain, when done as instructed. And, I’ve made some other great products available to you as well, like the human growth hormone releasing hormone analog, that when rubbed on the skin, helps to reduce inflammation, speed healing, and has anti-aging properties, as well. You can get it here: http://drbillsclinic.com/trans_d_tropin.html 

I’m grateful for all the subscribers who have joined our ranks and for the support of all those who have purchased one or more of my programs. I’ve gotten some great feedback from those who have followed my advice–none better than those who have come back to buy again. All in all, it’s been an exciting and pretty gratifying time. Just think–even though I can’t operate any more, I can still help people all over the world, through my programs, CD’s, tips and general advice. 

Let’s face it. The internet is a gusher of information: some good, some bad, some irrelevant. So much, in fact, that the average person is just swamped–people have NO frame of reference, no filter to determine what information is correct and what isn’t. What you really need is ADVICE, from someone who KNOWS. And that’s what I’ve tried to provide. 
 
So, what’s next for Dr. Bill’s Clinic? Well, I’m now working on a program for ARTHRITIS–what it is, and more important, what you can do about it: how to slow its effects, relieve pain and prevent joint damage, with my usual approach of giving you the latest measures from across the entire medical spectrum, conventional, alternative and complimentary. 

I’m also going to produce some DVD’s and digital videos, and I may provide some teleseminars, as well. So, it should be fun. I’m looking forward to it. And it starts right now….Talk to you soon, my friend. Til then, 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

Here in Southampton, it’s just about 11 PM and I’m sitting here, writing my daily subscriber email. That’s the really nice thing about being an internet information marketer these days–I can do what I want, when I want, with no one to make any demands on my time (well, except for my wife). Far cry from what my life used to be….

On surgery days, I had to be IN the OR at 7:30AM, so I could say “HI!” to the patient. If I wasn’t there, Anesthesia would not bring the patient into the room. That, of course, would back up the entire OR schedule, and piss off all the other surgeons. So, I made it my business to be on time, all the time. 

After saying hello to the patient (and often the family) in the preoperative waiting area, I would go to the doctors’ locker room, and suit up in my scrub clothes and a long white clinical coat. Then, I’d take the elevator to the fourth Med/Surg floor, The Joint Implant Unit (Long Island’s FIRST such dedicated orthopaedic Unit–despite the specious claims of LIJH), where I would make rounds, visit my postop patients, confer with the nurses, write notes, do consults, give orders and so on…until the OR called me. In this way, I wasted NO time and I was maximally efficient. 

I then went down to OR #5, often referred to as “my” OR. Operating Room 5 was the largest of all the eight OR’s in St. Catherine of Siena Medical Center. It was also the only room that had a full bank of windows across the back wall, overlooking the forest outside. And it had a special “Laminar Flow” air filtration and conditioning unit, to hyperclean the air flow into the operative field, to prevent any contamination, or infection. It was ideal for doing the big joint replacement surgeries and revision procedures I was known for.

The windows were there specifically because I asked for them, during their renovation. Of course the other surgeons ridiculed the concept and called me a prima donna and worse, for asking for them. But oddly enough, when the room was finished, they ALL wanted to get that room. “Hey! How come Stillwell rates that room all the time?”they’d say. And I would reply sweetly, “Say, didn’t you think this was a stupid idea? And it WAS my idea, wasn’t it?” HA! 

Today, there’s a bronze plaque outside OR#5, “The William T. Stillwell, MD Operating Room”–an honor which, though pretty cool, is usually reserved for the dead.

Anyway, after doffing my coat, putting on a mask and coming into the room, I had to position the patient. Most often, I did this myself, with help from the OR staff, the assistant and Anesthesia, who always was in charge of the patient’s airway and head. Before my back injury, I was a strong little sucker, so I liked to turn the patients on their sides and position them just so, in preparation for the surgery. 

It’s hard to overemphasize the importance of this positioning. In joint reconstruction at that time, my judgment and assessment of the proper angles for implanting the artificial parts were all that resulted in a stable joint, and avoided dislocation. So when the patient was so positioned that a true vertical and a true horizontal were established, it made my determination of the correct angles for implantation much more accurate and more likely to be successful.

After all of that, finally, the surgical team: myself, and my assistant, preceded by the Scrub Technician, would then go to the sinks just outside the room and scrub, while the nurses were scrubbing the hip or knee with antibacterial soap. We would then re-enter, gown and glove. The patient was then prepped and draped, and at long last, surgery could begin. This mini-opera was re-enacted before every surgical procedure. 

As you can see, there was a heck of a lot of activity before anything actually happened. Just thinking about all of that makes me tired! It’s amazing what you get used to, through training and repetition. 

These days, life is much more civilized. And I spend all my time trying to teach you how you can AVOID surgery, with the best alternative and conventional treatments and strategies. Ironically, I can potentially affect far more people now–many thousands more–than I ever could as a surgeon. Which reminds me…

Hard to believe though it is, this Wednesday will be ONE YEAR since Dr. Bill’s Clinic Website went live and I presented my first product, the popular LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN, which you can see at http://drbillsclinic.com/eliminate_knee_pain.html 
But after one full year, my “special introductory rate” has run its course. After all, it’s not “introductory” anymore, is it? So here’s fair warning: as of midnight, October 1st, the price for the LGB will revert to its originally intended price, roughly double the current price. 

If you have been “on the fence” about getting this book til now, further delay WILL cost you. So don’t delay any longer. Click here and buy NOW: http://drbillsclinic.com/eliminate_knee_pain.html

Don’t say I didn’t warn you….
 
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

Just the other day, I got an email from one of my subscribers, who also happens to be one of my friends from the “old days,” back when I was living in New York and practicing orthopaedics. It seems she was looking for some helpful advice for a friend of hers who apparently has arthritis of her knee. 

The woman had apparently developed gradual onset pain of her knee over the last several years. She had seen a physician and apparently had x-rays. The x-rays reportedly showed “bone-on-bone” in the inner aspect of her knee (the medial compartment). She was told that she needed a total knee replacement. But she clearly didn’t want to have surgery. So she asked my friend to ask me what she should do.
 
Well, I wrote back that once you have an x-ray that demonstrates “bone-on-bone,” you are pretty much committed to having a joint replacement, eventually. However, that procedure can be DELAYED, or postponed.

You see, “bone-on-bone” means that the bones of the knee joint, that you see on the x-ray, are touching each other. And that means that their protective cartilage layer has worn away. Since cartilage is invisible on an x-ray, the normal appearance of an x-ray is one of the bones appearing to “float” apart. In other words, there is a  joint “space” between them. Once the cartilage is gone, there’s nothing to hold them apart anymore–hence, the bones touch, ie., “bone-on-bone.” 

The problem is that once the cartilage has worn away, and the underlying bone is exposed, the cartilage isn’t going to grow back. That’s one of the key factors about cartilage: it lacks a blood supply. And without a blood supply, healing, or regrowth of the tissue CANNOT take place. 

Yes, yes. I know there are methods out there being promoted that CLAIM to regrow cartilage. They even show x-rays, reportedly “un-retouched,” that seem to show a new “joint space” re-formed. I saw one just recently in an in-flight airline magazine and I’ve seen them before on various web sites, which market to the credulous. 

Unfortunately, that is absolute crap! No known non-surgical method can regrow cartilage, once it’s been destroyed. 

What these magazines and websites show is actually a “before” weight bearing x-ray, in which the bones are touching, followed by a NON-weight bearing x-ray,  in which the bones APPEAR to be separated, because there’s no weight on them to press them together. 

So their claim is technically true: the x-rays ARE un-retouched. But the new “space” is  NOT from new growth of cartilage. And they’re even cleverer than that–they never actually SAY that they grow new cartilage. They show the pictures and let YOU make the inference.

Now, mind you, there ARE non-surgical methods that can help relieve pain, and forstall the need for surgery. But actually re-grow cartilage? No. ‘Fraid not. Maybe some day, with stem cells or some such, but not now.
 
So the best advice I can give this lady is to follow the many measures, from across the entire medical spectrum, that I teach in my newest healing program,  HOW TO AVOID KNEE SURGERY, which you, too, can see at http://drbillsclinic.com/avoid_knee_surgery.html
 
These methods, conventional and alternative alike, when used together, create a SYNERGY, where the combination is far more effective than any single component alone. And these methods are proven and safe. They won’t grow new cartilage. Nothing short of a very sophisticated, two-stage surgical technique can, at this time. But they CAN give you relief of pain, buy you time, and delay a joint replacement. See how at  http://drbillsclinic.com/avoid_knee_surgery.html
 
That’s all for today, my friend. Talk to you soon. Meanwhile, 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