January 19, 2010

Last week, while I was perusing my emails for Dr. Bill’s Clinic, I came across a request from one of my older subscribers. By older, I mean (quite naturally) older than ME. Ever notice how when anyone talk about “old guys,” they always mean older than THEM. Right?
 
Anyway, this man is, shall we say, in late middle age, has stayed in good shape and has been a runner for years. Problem is that he recently had a sudden onset of severe knee pain, after running to catch a bus, or something.
 
He was seen by an orthopaedist, who after examining him, decided that he may well have a torn meniscus. 
 
As you may know, there are two crescent shaped fibrocartilages, called menisci, which lie between the end of the femur (thigh bone) and the upper tibia (shin bone), inside the knee. 
 
They act as cushions and guides for motion of the joint, especially in twisting, or cutting movements. For more about these and other causes of painful knee pathology, please refer to my LITTLE GREEN BOOK:  http://www.drbillsclinic.com/eliminate_knee_pain.html
 
Because these cartilage structures are invisible on standard x-rays, the doctor ordered an MRI scan of the offending knee. This scan is terrific, because it can show the structures and can predict if they are torn, with an accuracy of about 90-95%, on the medial (inside) compartment of the knee.
 
Sure enough, he had a torn medial meniscus. But he also had a surprise–he had almost completely bare bone exposed on the end of his femur, in the medial compartment. The guy was understandably shocked. How could he have such bad arthritis and not have felt it before this injury?
 
The answer is, this is not an uncommon picture. Sometimes, the articular cartilage becomes degenerative and gradually erodes away, exposing the bone. Though most people will feel this as significant pain, as it happens, a few will compensate (high pain threshhold, endorphins, etc.) and will feel nothing, at all. Until something happens, as did here, to DE-compensate his defenses against pain. THEN, he felt it.
 
Naturally, as a believer in natural healing, he was leery of knee surgery. And studies have demonstrated that arthroscopic surgery added nothing to just medicine, physical therapy and exercises, like those I teach in my newly updated and expanded PAIN-FREE PROGRAM & DVD:  http://www.drbillsclinic.com/exercise_eliminate.html 
 
HOWEVER…in this case, I DID recommend that he go ahead with surgery. Here’s why.
 
This man is very active and wants to remain so. He has exposed bare bone and therefore, will need at least a partial knee replacement, perhaps a total knee replacement, when his symptoms warrant it. But then, he will NOT be able to run or do any exercises involving impact, which could damage, or loosen the artificial implants.
 
He also has a significant tear, easily fixed, in addition to his arthritis. It seems reasonable to conclude that if the tear were “fixed,” he might well “buy time” and return to his asymptomatic state, at least for a while.
 
The studies that recommended against knee surgery for arthritis were talking about a general “clean out,” or debridement, NOT addressing a specific torn meniscus, with very specific mechanical symptoms, directly attributed to that damaged structure. When dealing with arthritis and knee pain, it IS best to be conservative, in most cases, where there is diffuse disease and no specific mechanical symptoms, as seen here.
 
That’s why I wrote my newest healing program, HOW TO AVOID KNEE SURGERY, which you can get here: http://www.drbillsclinic.com/avoid_knee_surgery.html 
 
The many treatments from both conventional and alternative medicine are designed to help you avoid the UNNECESSARY procedure. but if the surgery IS necssary, as it was here, then it should be done.
 
Well, he DID have the arthroscopy, he did, in fact have the tear that the MRI predicted, and he DID do very well. He’s now glad he did it, as he has returned to his preoperative state of virtually no pain. And the procedure has bought him time, which he can continue to enjoy, until further progress of his disease makes a total knee unavoidable.
 
I love being right. 
 
And the only other recommendation I gave him that I would give you, too, is to get on my Powerhouse Omega Formula, an ultra pure, highly concentrated, pharmaceutical grade fish oil, with a special enteric coating that prevents any fishy aftertaste and the dreaded “fish burps.”
 
http://www.favoriteformulas.com  
 
Omega 3′s have potent, long term anti-inflammatory properties that help to control the pain of arthritis, a as well as many heart and brain healthy effects, as well.
 
I also advised him to consider giving up the running, in favor of power walking, or hill sprints, which avoid the damaging shocks to the weight bearing joints, seen with running. If he listens to me, these measures may buy him even more time….
 
Til next time, my friend, be well.
 
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

I was notified by my email account that my account was in danger of becoming completely filled and was advised to purge some of the emails that I had let accumulate. In the process of winnowing those that I still wanted to save from those that could be safely eliminated, I came across a few that I thought might be instructive for you.
 
Every so often, I get emails from some poor souls who are suffering with persistent, or progressive knee pain. They ask for help in relieving their pain and in many instances, are fearful of knee surgery. This is one such exchange, which I pass on for the lessons it entails. I have deleted any reference to the author’s origin or identity, for reasons of privacy, and some products this person was using, but otherwise the emails are as they were written. 
 
I’ll have a few comments after you read this:
 
“Dear Dr Bill
 
I came across your website and am writing to ask your advice on which of your books would help me the most (I have spent $$$$$ on lots of so-called self-help measures, like anti-inflammatories, painkillers, etc).
 
I have what surgeons call very “mobile” knee caps. It stems from being very slightly knock-kneed. About 15 years ago (when I was in my twenties), my right knee was operated on,­ after it started to track incorrectly as a result of a fall. 
 
I had a “lateral release” arthroscopy. I was advised to have another on the left knee (I never did). Today, both my knees are extremely sore and painful. I used to do yoga, but stopped two months ago, as it was too painful for my knees.
 
The last month or so, both my knees have buckled and collapsed at the same time on two separate occasions, leaving me to collapse in a heap and barely able to walk. My right knee (the one operated on) is by far the worst. It is sore, inflamed and very painful. My left knee is not so inflamed, but is also very sore and painful.
 
I swim about once a week and exercise on steps in the pool to try to build the strength up in my legs. My knee surgeon once told me we generate four times our body weight to get up the stairs! The pain in my knees prevents me from exercising more, ­even walking. When my knees collapse, I am forced to use a cane to get around for a few weeks.
 
More recently, a GP suggested getting the meniscuses in my knees trimmed so that I can walk better. Given the experiences of my last knee operation, naturally I am not inclined to have more surgery!
 
I would welcome your advice and especially advice on which of your books may help me the most.
 
And I am a vegetarian, so fish oil is out of the question.
 
Thanks for your help and I look forward to hearing from you.
 
Kind regards…”
 
Here was my response:
 
“Sorry to hear of your problems. Your story is a common one, though. Your pain is coming from chondromalacia patellae, a degenerative softening of the cartilage in back of the kneecap. This is caused by the loose (hypermobile) patellae, which in turn is due to lax ligaments and weak muscles.
 
The best value book of mine that will help you is the newest one: HOW TO AVOID KNEE SURGERY http://drbillsclinic.com/avoid_knee_surgery.html
 
That includes herbs, alternative measures, and a selection of exercises that should improve your condition, by strengthening the VMO muscle.
 
Instead of fish oil (given that you’re a vegan), try FLAX SEED OIL, as a source of omega 3 fatty acids. Other herbal anti-inflammatory measures are in the book as well. 
 
Good luck. Hope this helps.
 
Best wishes,
 
Dr. Bill”
 
Well, she took my advice and this was her follow-up email:
 
“Thank you so much for getting back to me so quickly (and in the middle of the night??) with useful information and advice.
 
I’ll definitely order the book – although I’m inclined to order the Little Green Book, as well
 (http://drbillsclinic.com/eliminate_knee_pain.html ).
 
I don’t know much about your background, but from what I’ve read so far, you truly appear to be an ethical doctor with the highest level of integrity and one that is willing to readily share his knowledge: that in itself is remarkable as well as highly reassuring.
 
This morning, I tried the leg raises you suggested in one of your articles (with one knee bent) and immediately felt the legs were stronger. 
 
Everyone else who has told me to do leg raises in the past has suggested raising both legs at the same time (which I would do for a while, but then give up because of the strain on my back). One physician suggested raising the legs with the head held up (which then puts a strain on the neck!) You are the only one who recommends bending one knee, while raising the other leg.
 
For the first time in a long time, I have confidence that – thanks to you – I can beat this problem, without knee surgery.
 
I will keep you posted of my progress and hope you won’t mind if I contact you again should I have any questions. And of course, I’d be more than happy to provide a testimonial in due course!
 
Thanks again for your help and advice.”
 
And if you have knee pain ruining your life or the life of a loved one, don’t suffer. Help me to help you. Get my new program. Click here, NOW:   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

Last Friday about nine AM, I was sitting in the Grand Ballroom of a hotel, listening with rapt attention to the speakers at an internet marketing seminar, with a number of high profile entrepreneurs. To my surprise, a number of the particpants were martial artists, and pretty well-known champions, at that. One guy, from Canada, actually did two pushups ON TWO FINGERS, just to demonstrate that it could be done. That’s TWO FINGERS of just ONE HAND, by the way. And he did it not two feet from my seat, so I can tell you, it was no trick. Wow! I couldn’t do that on my best day…and I have very strong fingers, from years of crushing bones in the OR .  This young man and his father are among the most successful martial artists in their country.
 
Another one of the speakers was a champion karateka in Tae Kwon Do and is now the President of NAPMA, National Association of Professional Martial Artists and a successful informational marketer. Man, how things have changed from the old days, when I studied Goju-Ryu karate in New York.
 
I remember entering the rickety elevator in the five story commercial building on 17th Street, just North of Union Square, in the summer of1967. The dojo was a large loft, with a polished wooden floor, on the third floor. On the fifth floor were the offices of Al Goldstein’s Screw magazine (but, of course, I never went up there). The sensei was a medium tall, very broad shouldered Hispanic guy (though no one had thought up that term, at that time) named Joe Lopez, a fourth dan (4th degree black belt) in Goju. 
 
With all the 7th, 8th, and 9th dans floating around today, 4th dan doesn’t sound like much, but I can tell you, Goju was a Japanese style, and pretty conservative about promoting people. Joe had come out of the old Peter Urban dojo in New york and he was widely respected by all the martial artists, of all schools, for his unbelievable strength and tremendous punching power. Even the Chinese respected him and actually taught him Gung Fu. Today, that’s no big deal, but in those days, they wouldn’t teach “white guys.” So he was the real deal. Solid and traditional–Nothing inflated, or puffed up about him.
 
Goju only had four belt ranks, too: white, green, brown and black. None of the multicolor constellation you often see with the Korean styles. Pretty conservative, all around. And our sensei absolutely idolized the Grand Master of the style, Gogan “The Cat” Yamaguchi.
 
“Cat” Yamaguchi was a really impressive guy, too: Short man, with long flowing black hair past his shoulders, who wore traditional black Japanese robes all the time. By the time I got involved in Goju, he had become a Shinto priest, with great emphasis on the “internal” or meditative aspects of the art. But when he was young, by all accounts, he was a real street fighter. He was one of the original students of Chojun Miyagi, the Okinawan founder of Goju, and he represented a direct lineage to the roots of modern karate. So everyone in the dojo, from the sensei on down, was greatly honored to follow in the footsteps of the “Cat.”
 
One of the things I admired most about the style was its Chinese influence and its emphasis on flowing, circular motions, very unlike the linear forms seen in Shotokan style, another Japanese form. But, some of these circular movements, especially round house kicks, if not done correctly, would result in knee pain, and occasionally, torn menisci, or injured ligaments, that could result in knee surgery–and they didn’t have arthroscopy in those days.
 
Of course at that time, I didn’t know what I know today. I knew barely enough anatomy to be dangerous. And as for exercises, I was into weights, like everyone else and the basic exercises taught at the dojo, some of which could actually cause knee injuries. But who knew? Had I known then what I know now, I could have helped a number of my fellow students avoid pain and disability, with the exercises I teach today in my new healing program, HOW TO AVOID KNEE SURGERY, which you can see at  http://drbillsclinic.com/avoid_knee_surgery.html
 
Whether you’re a fledgling karate student like I was in 1967, or a champion mixed martial arts fighter, an aging Boomer, or an aspiring young athlete, if you have knee pain, or would like to be sure you avoid it, try the measures I reveal in HOW TO AVOID KNEE SURGERY http://drbillsclinic.com/avoid_knee_surgery.html   I thnk you’ll be glad you did. 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

April 7, 2008 

During the mid-to late 1970′s, in my orthopaedic residency at St. Luke’s Hospital in New york City, we had a number of instructors from the world of private practice, who had clinical, as opposed to academic appointments. Even Dr. Fielding, who was the Department Chairman, had a private practice, with patients from all over the world. This gave a very down-to-earth, very practical flavor to our training, what is often called “bread ‘n’ butter orthopaedics.” This was in addition to the really exotic cases that were referred for the special, world-class expertise of several of our professors. 

Years before my time, St. Lukes was considered the hospital for the “carriage trade,” the affluent and the frankly rich in New York City. In fact, the hopsital was composed of a number of separate buildings, each built by the donation of a prominent benefactor, who was rewarded by naming that building after him. These buildings were physically strung together, but were constructed all at different times. So, each
building was actually on a different level, with floor three on one building becoming floor four, as you passed from that one to the next. This made finding your way around in there a real adventure for the first couple of weeks. You really needed a compass!
 
St. Luke’s was situated right on Amsterdam Avenue, its Emergency Room across the street and next door to the beautiful and immense Cathedral of St. John the Devine, an Episcopalian cathedral and the largest gothic cathedral in the world, on which work still continues, 
using the original stone cutting techniques, used in medieval times. The local artisans were taught these techniques on the job, so the methods of the stone masons would not be lost, but be perpetuated, and work on the building would be authentic. 

As part of our training, we learned to diagnose and treat the various diseases and injuries in all comers, from the gunshot wounds, injuries, and neglect, so commonly seen in the ER visitations from Spanish Harlem and Morningside Heights, to the upper crust of Manhattan’s rich and famous, and the occasional Hollywood star. We were expected to treat everyone the same, regardless of their station. It was remarkably
egalitarian, though admittedly the consequences could conceivably be a bit more severe if we screwed up on one of the hot-shots. 

Because of Bill Fielding’s world wide reputation as a spine surgeon, especially of the cervical spine (neck) and Dr. Bob Zickel’s reputation as an expert on hip fractures, we saw unbelievable cases, referred for their care, and we therefore saw things we’d have never seen anywhere else. As a mere resident, I actually DID 13 atlantoaxial (C1-2) fusions, with Dr. Fielding’s supervision, more than many fellows did, or even saw,
in advanced training. Dr. Zickel, or “Zick,” as he was affectionately known by everyone, actually invented a special nail, which bore his name, to fix a special kind of hip fracture (subtrochanteric fractures) and devised a method of classification for them that was once used all over the world.
 
It was Zick who became enthused with a new technology called “arthroscopy” and taught us to do it. This was 1974-1975. We still did the knee surgeries open, but this was the foundation of what became the standard treatment for torn menisci, loose bodies, and the other techniques that have been perfected today. In addition, he had great judgment and taught me the value of good conservative care. Whenever I teach you the nonoperative methods for relieving or preventing knee pain that I teach today at
 http://drbillsclinic.com/eliminate_knee_pain.html ,  I am passing on to you much of what Zick taught to me.
 
In addition to these “superstars,” we had a diverse bunch of other attendings and other practicing orthopods, from the community, who were affiliated with the teaching program, and agreed to bring their patients to St. Luke’s, that we might learn from them. They were a really colorful cast of characters!
 
Leon was a short, stocky, and gruff old Russian, who liked his vodka. He had a nice private practice on Park Avenue, and was an expert on joint replacement. It was Leon who showed me how to do a total hip and who, for all his gruffness, was patient in teaching me. 

Clarence was a constantly frazzled, perpetually tired man who had a bread “n” butter, emergency room practice. Not an academician, he nevertheless had a lot of tricks of the trade to teach that made our lives easier in the decades to come. He could always be counted on to come in at any hour, to scrub with the residents. He also taught us not to guild the lilly, with the time worn phrase he said, at least once a case, “Better is the enemy of good.”  And every time I violated that tenet, going that one little millimeter more, to perfect what was already
very good, and immediately had cause to regret it, I remembered his advice, and wished I’d followed it.

“Ax” was the blueblood of the group, an Ivy League socialite, who loved his martinis, hobnobbed with the upper crust (of which he was a card carrying member) and carried “heat,” everywhere he went. There was an apocryphal story of his sticking the barrel of his gun out his car window to discourage a squeegee man to ”move on, buddy,” but I can’t confirm this. It was not uncommon for him to scrub in with us and rest his .357 magnum on a stool next to the operating table, so he could keep an eye on it. He was a fine hand surgeon, who taught me a great deal about the delicate techniques involved. I actually considered being a Hand Surgeon for a while, due to his influence.
 
Then, there was Maggie, also called Henry, who was a solid member of the attending staff. He was a resident in the St. Luke’s program himself, years before. He was the doc for the actor Roy Scheider, of Jaws fame, and did a back operation on him. He was known for his caution and was famous for responding to questions for specific advice, on how much to tighten a wire or screw, with the admonition,          “Not too much–just enough!”
 
Among the attendings, was George, a really nice man, who was a fine general orthopaedist in his own right. He, himself, was a product of the training program at St. Luke’s. He always had a sanguine approach to life and was great at pouring oil on the water in case of conflict between the sometimes colliding egos of our teaching staff. He helped to keep our heads straight and was often the social lubricant that kept situations from escalating. And yet, he was always “Broadway” Bill Fielding’s choice as assistant whenever he had an especially difficult case or when the
patient was a VIP. He was everyone’s “rock” of stability.  He took a liking to me and my friend, Ben and looked out for us throughout our training. Today, he’s the Director of the Program, himself. Just a great guy.
 
They were quite a crew. And I haven’t even gotten to the other residents. A number of my teachers are gone now.  But the legacy of their teaching lives on, in me and in all my fellow trainees, and those we taught, in turn and in the many thousands of lives we touched and made
better. When you think about it, what’s a better legacy than that? 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