February 1, 2010

Worked my butt off this past weekend, cleaning the house for an anticipated visit by my father-in-law’s wife’s brother and his wife, from Italy. Seems the guy is reported to be allergic to cats. Heh. That would make ours the wrong house to visit, as a general rule (we’re down to 24 now, having just lost Misty, our oldest, on this past Christmas Eve Day).
 
But, as these nice folks have never been in the States before, in the interests of international diplomacy, we decided to go the extra mile and super clean the place to make it “safe” for an allergy sufferer.
 
But first, we had to trap the cats and confine them. Otherwise, you’re just spinning your wheels. Fortunately, like me and most of our friends, they’re “food sluts.” Nothing they wouldn’t do, no place they wouldn’t go, for a tasty meal. So, my wife and I cracked open a few cans of wet cat food and played “Pied Piper” with them.
 
It’s quite a sight to see them all following the aroma of the food, right into the bedrooms, where we locked them in for the day. Then, we could work in peace.
 
So, we finished the house and then set about making some food. One thing about Italians is that they know good food. So we pulled out all the stops.  Turned out pretty well, too. They seemed to like everything and had seconds….
 
Nice couple they were: Mario and Tina. Live near Naples (the real one, not the one in Florida), have four kids, the oldest of whom is now in his forties. And they speak no English. Fortunately, Anna, Charlie’s wife and Mario’s sister, is bilingual, so we had our own built-in interpreter. Very lovely people. And we had a good time.
 
During the meal, Mario mentioned to my father-in-law that his son was supposed to have surgery on his knee. Between Anna’s interpretations and sign lingo, I was made to understand that he was having arthroscopic surgery on his lateral mensicus, which according to an MRI scan, was torn. And, since he found out that I was an orthopaedic surgeon, he naturally wanted to know if I thought that surgery was necessary.
 
Pretty good question, really. I pointed out to him that if he had read my book on treating knee pain, DR. BILL’S LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN  http://www.drbillsclinic.com/eliminate_knee_pain.html  he would know the answer. And a lot has to do with the nature of the tear, where in the meniscus it is, and how active he intends to be after surgery. And all that is assuming that the tear actually exists.
 
The MRI scan is a great tool for diagnosis. On the medial side of the joint (inner side), its accuracy is about 90-95%. But, because of the screwy anatomy of the lateral compartment of the knee joint, MRI findings of the lateral meniscus are only about 60% accurate. So, actual pathology has to confirmed at arthroscopy, before you can begin to decide on appropriate treatment.
 
Apparently, he got the injury playing football. Not our idea of football, as in the Superbowl, but European football, or soccer. The rapid twisting, cutting movements in that game result in lots of meniscal tears. And, despite his age, he’d like to continue playing, after the proposed procedure. That being the case, he SHOULD have the surgery. 
 
If he was a low demand user, ie., a couch potato, then the same injury need not be treated so aggressively. In fact, the pain could then be treated with a number of the non-surgical options that I recommend, from across the entire medical spectrum, including the best alternative treatments, in my newest healing program, HOW TO AVOID KNEE SURGERY: http://www.drbillsclinic.com/avoid_knee_surgery.html  
 
The exercises I show you, plus one, or several, of the other simple, easy to apply solutions for knee pain, including the anti- inflammatory properties of my POWERHOUSE OMEGA FORMULA,  http://www.favoriteformulas.com    an ultra pure, pharmaceutical grade fish oil, can often get rid of your knee pain fast and keep it gone, for good. Two capsules, twice a day, for a couple of months should do the trick, by reducing inflammation.
 
He felt very reassured that his son was making the right decision. And he was relieved that he had every reason to believe that his recovery would be fast and uneventful. Especially after I told him that I’d had such surgery myself and obviously, did well.
 
Then, it was time for them to make the run to the Orlando International Airport. Another of his sons was flying in to visit and they were going to pick him up. Naturally, they all want to go to Disney World.
 
So, having done our bit for U.S. international relations, and made two new friends, we all said “Ciao!” and bid them farewell. After a few well-earned moments of peace, for ourselves, the bride and I released the feline hordes, who descended on the kitchen, looking for more food!  There’s no end to it!
 
And, you know, that guy, Mario, never sneezed once! Guess we did a pretty good job. Well, that’s it for today, my friend. 
 
Remember that very soon, now, I will be asking you to sign up again, if you’d like to continue getting my daily emails and commentary, when I switch to a new server to improve email reliability and delivery. I know it’s a pain in the butt, but it’s necessary. 
 
On the other hand, if you’d like to bail, but were afraid of hurting my feelings, just don’t do anything and that will be done for you–you’ll just stop getting these daily ramblings and musings. To continue, you will have to take action, when the time comes.
 
Anyway, be well. Talk to you soon. 

Yours for a pain-free tomorrow,
 
Dr. Bill
 
“The Wellness warrior”         TM

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 conventional and alternative treatments and exercises to relieve knee pain without surgery click on http://drbillsclinic.com/avoid_knee_surgery.html 
 
P.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, 2010 by William Thomas Stillwell, MD, FACS
All rights reserved

January 26, 2010

I got an email from a friend of mine, about someone with a peculiar hip pain. Seems this guy had a sudden onset of a popping over the outer aspect of his hip, when he twisted. This was accompanied by pain down the back of his thigh. Naturally, he was concerned. So my friend asked me what I thought.
 
Well, y’know, there are always a number of conditions that can cause a similar pattern of symptoms. But it’s an old, but true saying popular in medical circles: “When you hear hoofbeats, don’t think of zebras.” Meaning, of course, that the most common cause is usually the answer.
 
In this case, the guy probably had an acute onset of ITB (iliotibial band) tendinitis. The ITB is a thick, wide fibrous band that runs down the side of the leg, like a wide tuxedo stripe, from the pelvis and the abductor muscles at the side of the hip, overlying that lump of bone that you probably call your “hip bone,” and I call the greater trochanter.
 
If this band was injured, or irritated, perhaps by a minor bump, now forgotten, that minor injury might have been sufficient to provoke the cell-mediated, delayed inflammation I spoke about yesterday. Then, the tissues can become swollen and thicker than normal, causing the band to impinge on the underlying lump of bone (which is all “trochanter” really means). Any twisting or torsional movement would then cause the band to snap or pop over the trochanter, like plucking a banjo string.
 
The resultant pain would follow the path of the anatomy, down the side of the leg. Not uncommonly, its back edge is the most tender, hence the pain “down the back of the leg.” This can sometimes mimic sciatica, though that is usually NOT accompanied by sound effects, nor is it provoked by twisting motions at the hip. And true sciatica is often a severe, burning pain, often accompanied by numbness, or muscular weakness, or even reduced or absent reflexes in the distribution of specific nerve root(s). From the description, this man had something quite diffferent.
 
And this particular condition (ITB Tendinitis) can be double trouble, as well. Wherever the pain starts, it can also cause pain at its other end, where it crosses the outer aspect of the knee joint, to insert on the small bump of bone at the outer, upper tibia (shin bone), called Gerde’s Tubercle. 
 
So it’s not uncommon to see hip AND knee pain from this entity. That’s the probem with a long structure that crosses two joints–it can cause pain anywhere along its entire length and at both ends, as well.  

So, what to do?
 
Fortunately, the same measures are effective whatever part of the ITB is inflamed. So treatments intended for the knee ARE effective for symptoms from the hip and vice versa. Here are a few helpful things you can do for relief:
 
First, you need to avoid any activities that aggravate the structure and cause the popping. 
 
Second, relieve stress and tension on the band, by using a cane in the hand opposite the affected side. 
 
Third, rest with your hips apart (abducted). A good way to do this is to put a couple of pillows between your knees. 
 
If you must sit, do so on a pillow, or gel pad, as the greater trochanters roll backwards when you sit and if you sit on a hard chair, that can actually cause pain and just make things worse. 
 
If symptoms have just started, ice the tender area a few times a day. 
 
After the first 48 hours, switch to moist heat. 
 
Reduce inflammation short term, by using Advil or Aleve. BUT, you must take these NSAID drugs with food, to protect your stomach from side effects, which include gastritis, reflux, ulcers and bleeding. 
 
Long term, I’d recommend a high quality pharmaceutical grade fish oil, like my POWERHOUSE OMEGA FORMULA, http://www.favoriteformulas.com   which lacks any significant side effects, but has potent, proven anti-inflammatory properties. Once the “fire” is out, you can then begin gentle stretching and strengthening exercises for the ITB, like those I teach in my PAIN-FREE PROGRAM, available here at:  http://www.drbillsclinic.com/exrrcise_eliminate.html
 
As with any tendon problem, healing is slow, because the iliotibioal band is mainly fibrous tissue, which has a very poor blood supply. So slow and steady progress, without repetitive aggravation of symptoms, is the way to go. I’ve had this particular condition myself, so I know these measures work. You just need patience and “tincture of time.” Til next time, my friend, be well.  Talk to you soon.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 
“The Wellness Warrior”        TM
 
(Be sure to sign up for my Podcasts at iTunes, or http://thewellnesswarrior.mypodcastworld.com)
 
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 conventional and alternative treatments and exercises to relieve knee pain without surgery click on http://drbillsclinic.com/avoid_knee_surgery.html 
 
P.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, 2010 by William Thomas Stillwell, MD, FACS
All rights reserved

The early Christmas party went well, last night. Everyone ate their fill (and that’s one real advantage to an early celebration–if you run out if anything, the stores are still open, so you can just go out and buy whatever you want). We did our presents (except for the bride and myself–we like to do our own gift exchanges in private… we always did). And everyone seemed to have a really good time.
 
Slept in late today. That last minute push before an event at the house always knocks me out, so I indulged myself with lying abed this morning and allowed myself to recharge.
 
Not sure if I mentioned this before, but I recently discovered that I have developed an inguinal hernia–just came out of the blue. Don’t recall any trauma, or any sensation of straining, or tearing. But a few days after Thanksgiving, I noticed it for the first time–it just WAS. The surgeon says that’s how these things normally present in us middle aged guys. Another step on the road to decreptitude.
 
This is one of those “mechanical problems” I’m always talking about, as a differentiation between “necessary” and “unnecessary” surgeries, a point I make repeatedly in my newest healing program, HOW TO AVOID KNEE SURGERY: http://www.drbillsclinic.com/avoid_knee_surgery.html  
 
Anyway, it seems I need some surgery soon, to fix it, so I have to stop all dietary items that could cause excessive bleeding, during the procedure.
 
That would include any low dose aspirin, or garlic, or fish oil, that are normally taken precisely because they “thin the blood” and reduce the incidence of abnormal clotting. The problem is that they all have additional effects, like the proven, potent anti-inflammatory properties of omega-3 fatty acids, found in pharmaceutical grade fish oil, like my POWERHOUSE OMEGA FORMULA   http://www.favoriteformulas.com 
 
That means that if I stop the fish oil and the other items for any single reason, I give up ALL their benefits. And having done so now, for a few days, I can TELL it’s missing, when my back and joints start aching again.
 
There’s no question that those anti-inflammatory properties really exist. Same thing can be said for its anti-platelet aggregation properties, that make the blood platelets less “sticky” and therefore, less likely to form clots. 
 
That’s why the doctors tell you to quit them a week, or ten days, before surgery. That’s tacit admission from the medical establishment that omega-3′s WORK.
 
Then, earlier today, my oldest cat, Misty, started falling around. Poor thing is over 18 1/2, which makes her over 80, in human years. We were very upset, fearing that she had had a stroke. We’ve lost a few of our older cats to sudden strokes. And there’s no coming back from that, if it’s a big one.
 
So, I was moping around all day, until I could get her to the vet. My wife was convinced she’d come to the end of the road and that we’d have to put her down. Some timing! I hate that. And I was dreading hearing that I would have to do that, today. 
 
I know she’s old, but she’s really sweet and I tend to fight for my pets, every step of the way, whatever is needed, so they get every minute of quality life that’s coming to them. Funny, but I apply the “Medical Ethic” to my cats, while Congress is getting ready to apply the “Veterinary Ethic” to us (ie., those who pay the bill determine the level of care), with their Christmas Eve vote on their alleged Health Care bill. November can’t come soon enough, for me….
 
But when the vet finally looked at her, blood work was great, x-rays were OK and he only found some high blood pressure, ie., a treatable condition. Thank God! You know, I can handle anything involving my health, or that of my family, but I still get all choked up about our cats.
 
So Misty got a reprieve–she came home and promptly went to sleep, none the worse for wear. And you know what? As far as I was concerned, it was the best gift of all!
 
Well, nothing left now, but some last minute shopping for my bride and then, the peaceful interlude of Christmas Day. I wish you every joy for this Holiday Season, and hope you enjoy a very Merry Christmas, you and your loved ones, and a Happy, Healthy New Year! Til the next time we speak, enjoy the peace and the hope of this special time of year…and be well, my friend.
 
With seasonal greetings and my warmest wishes for your optimal health,
 
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 conventional and alternative treatments and exercises to relieve knee pain without surgery click on http://drbillsclinic.com/avoid_knee_surgery.html 
 
P.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, 2009 by William Thomas Stillwell, MD, FACS
All rights reserved