Well, the Holiday Season is upon us, recession and all. I just now got back in from Costco (though I still like to call it Price Club–much more euphonious, don’t you think?). I had to stock up on some essential things, prior to taking the flight back to New York, tomorrow night.

Then, the very next day, I get to drive back to Central Florida with the bride, and a bunch of cat carriers, so we can take the last of the brood to New York. The plan is to see Christmas in, here in Florida, then drive the last batch of kitties to the Northern Command.

You see, it’s cold up there, will soon be freezing so naturally, the bride (who LIKES the cold) wants to winter there (while most sane people are COMING to Florida, for the relative warmth and sunshine). Don’t ask me–I just live here (and there, whatever), but I digress….

But before we drive back up north with the cats, we get to festoon the house with Christmas decorations, and that means cleaning the whole place, top to bottom, in preparation for entertaining (though admittedly, it’s a whole lot easier with fewer cats in the house).

And that’s on top of getting in some late Christmas shopping. I always start early (I think I got my wife’s first present in July), but it’s finishing that’s the problem. I’m getting more exhausted, just thinking about all I have to do.

So, with every spare minute accounted for already, naturally I have requests for articles and product reviews and other projects coming up, out of the blue.

This situation reminds me of a handwritten sign we used to see in the O.R. every so often: “The difficult we do immediately. The impossible takes a little longer!” Words to live by. I think the sign was put up by one of the male nurses, a guy who used to work in the Psychiatry Ward, but transferred to the Operating Room. As you might expect, this gave him a rather unique perspective.

His name was Tim, and he was the resident wit and cartoonist of the place. His droll and dry sense of the absurd saw us through many rough times. No one was exempt from his pen–when I was injured (falling through a high ceiling and fracturing my spine, if you’re a newby), he posted a cartoon of me falling behind a couch, with a line of cats all holding up signs with scores (8.9, 9.6, 9.2, 9.8…) just like an olympic event. I saw this my first day back. It WAS pretty funny. Certainly pointed out, in a humorous way, the idiocy of my predicament. But anyway, I think he posted that sign.

Together with the other members of my team, I took that motto to heart. We did some of the most truly outrageous surgical reconstructions ever seen in our region. Stuff that really did border on the impossible. I remember one little wizened lady, deep into her seventies, with horrible rheumatoid arthritis, that had BOTH knees so contactured, she couldn’t even stand.

A contracture is where the joints, in this case both knees, are literally scarred into a fixed, bent position, in her case, well beyond 90 degrees. And no amount of stretching, or force, can straighten them. In this lady, her bones would have shattered before the scar tissue gave way.

Because of ignorance and neglect, very gradually over time, her knees became more and more bent. No one thought to have her evaluated by a doctor; no one had started her on stretches and exercises, like those in my PAIN-FREE PROGRAM http://drbillsclinic.com/exercise_eliminate.html or got her braces, or splints to keep her knees straight. So eventually, the poor thing was stuck in a Nursing Home bed, in a fetal position.

I don’t remember how I came to care for her, but I remember that the older, wiser heads in the Department all gravely assured me that she was beyond hope, that it was impossible. Luckily for her, I was still in that early phase when I believed in my heart I could do anything–and so, I did.

If there was ever a case that exemplified the necessary surgery, this was the one. I had to release virtually every ligament and muscle around her knee, and cut away a significant amount of bone to allow the knee to both straighten and accept total knee implants. At one point, her leg was literally hanging in the breeze, connected only by the posterior nerve and blood vessels. I should have been scared out of my wits…but you see, it never occurred to me that this could fail. So it didn’t. The ligaments, once released, found their own correct levels and went on to heal at those spots. When we were done, the leg was straight and the knee was stable.

Ideally, she should have had both done the same day, so she could walk. But she couldn’t tolerate that much anesthesia at one time–”The impossible takes a little longer.” So initially she was left with one leg bent up and one leg down and straight (kind of like Superman, when he flies up, up, and away). Next week, we took her back for the other side. This went faster, with the lessons learned from the first go round.

Some months after she was discharged from the hospital, I was giving a talk on knee replacement in a public forum and this same lady WALKED up and thanked me. And damn! Those knees were straight! What a transformation. She was now very talkative and lively, where before she had sunk into a torpor and would surely have died from lack of stimulation and despair. And I knew that THIS was why I did what I did.

Those older wiser heads still shook their heads: “just lucky,” they said. Well, yeah, but better lucky than smart, eh?

The lesson here is that she need not have ever reached that point. Today, we know that there are many ways to prevent knee surgery, or at least delay it. You can combine effective conventional and alternative treatments from across the entire medical spectrum to relieve your pain and restore your function, like those I teach in HOW TO AVOID KNEE SURGERY  http://drbillsclinic.com/avoid_knee_surgery.html

If that patient had only had worn a simple extension brace at night, she might have avoided the magnitude of that complex surgery. In like manner, if you ever have a knee injury or a knee surgery, get your full range of motion back as soon as you can. And KEEP it, even if you need bracing to do it.

Til next time, my friend, be well.

Yours for a pain-free tomorrow,

Dr. Bill

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

A few days ago, one of the members of an exclusive fitness group, for whom I serve as a medical advisor, emailed me with a knee injury. He had been participating in his jiujitsu class and was close to the end of his class, when he experienced a “pop” within the inner aspect of his left knee. He didn’t feel pain when it happened, but he was smart enough to stop what he was doing and not finish the class. He was also able to
bear weight without difficulty.
 
But by the next day, the knee was aching and swelling.  He iced his knee through the night, took just a couple of Aleve caplets and wondered whether he should visit a doctor. Then, he asked for my advice.

Since I had no way of seeing him or examining his knee, I had to base my differential diagnoses (ie., educated guesses of the likely source of his pain) on his history alone. Now, even in a clinical setting, history is THE most important factor in determining a diagnosis. But the physical examination adds important mechanical information that leads the examiner toward one possible diagnosis and away from another.
 
In this instance, the leading contenders were a snapping synovial plica (a thickened band of lining membrane of the joint, that is plucked like a banjo string over the end of the femur), or a torn medial meniscus (the inner cartilage cushion, between the femoral condyle and the tibial plateau). Both of these can cause popping and be initially painless. And both can result in a delayed inflammation, manifested by stiffness, pain and swelling.
 
This man was smart–he stopped doing the class immediately after his incident, suspicious that he had sustained some injury. He iced his knee a number of times over the next couple of days, took it easy and took just two Aleve caplets. Then, he decided to ask for my advice.
 
I advised him to follow the usual conservative measures, as I have described in detail in my LITTLE GREEN  BOOK  (http://drbillsclinic.com/eliminate_knee_pain.html)   These included switching to local heat, increasing his use of Aleve to 2 caplets twice a day (with FOOD or MILK, to protect your stomach from the side effects of NSAID’s), and selected exercises to preserve his quad strength, while avoiding motion, like those at   http://drbillsclinic.com/exercise_eliminate.html
I also advised him to consider going to see an orthopaedist, if his symptoms don’t improve pretty soon.

Then, he asked a very good question: “What about bracing?” 

As it happens, bracing is a very good idea. But you  don’t need an expensive, custom brace. No, just an elastic or neoprene sleeve, to provide some extra support and a gentle, generalized compression of the knee joint. Compression is important as a counter-pressure to the swelling and fluid generation of the inflamed knee. The external squeeze tends to minimize the production of excess joint fluid. 

Unless you have a specific ligament problem (which, based on his presentation, he does not), you don’t need hinges on the sides of the brace, either. A central hole, a patella cutout, is warranted if you have pain in the kneecap, but is otherwise not necessary. But this simple and inexpensive addition to the usual anti-inflammatory regimen is a great help in relieving pain and restoring function after a knee injury. And
I heard today that, sure enough, he’s getting better already.  Hopefully, he’ll be back in action again, real soon.

Well, that’s it for today, my friend. Have a great weekend and, 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