Here I am back in Southampton, having delivered another batch of cats to their new digs. They were remarkably good for the entire trip–they cry a little bit at the start of each day, but then they settle down and go to sleep. All except the smallest one, who can see right out the front window, through her cage door, situated as it is between my wife and me–she looks and looks, with wide eyes. I wonder what she’s thinking, seeing all that world out there, just flashing by….
 
Anyway, for a trip of over a thousand miles, they really did do very well. Unlike my last trip down to Florida, the weather was clear and bright the entire way. But COLD! You live in Florida for a while, your blood gets “thinner.” Well, not really, but you do get much more sensitive to the cold when you’re living in a warmer clime. And of course, I didn’t realize that I had forgotten our coats until I was well on the way here, and went to look for them.
 
24 degrees it was, last night in Maryland, and I was freezing my butt off, ferrying cats into the motel room, two at a time, in their carriers. And
for about the 800th time, I said to my loving wife, “Are you friggin’ CRAZY?! THIS is what you’re dragging me back to? Are you out if your mind?”  Then I strangled her. No. Not really. But I’m confident that no jury would convict me….:)
 
I DID however, point out to her that if ever she doubted my love for her, THIS should quell any doubts. Brrrrrrrrrr!
 
On a positive note, she didn’t get any mosquito bites.
 
Well, we finally got them all packed into the car for the last leg of their fantastic voyage. And we’re driving along at more or less the speed limit  (honest) when two cars pass me at warp speed, like I was standing still, one on either side. And both were trying to occupy the same space at the same time, right in front of me.
 
Now, you don’t have to be a genius at math or physics to realize that that won’t work in the real world. I instinctively did what good sense dictated: I stepped on the brake to allow young Newton and the new Einstein to battle it out just ahead of me. Ah, the excitement and drama, when idiots (almost) collide. 
 
You see, perhaps thirty years ago, I would have stepped on the ACCELERATOR. But, hopefully, with a bit of age, testosterone levels decline a little and acetylcholine rises, so brain triumphs over hormomal urges to a pointless (and dangerous) battle. As it happens, they nearly did run right into each other. Missed disaster by a whisker.
 
Unutterably stupid. 
 
But, I’m more charitable these days. After all, if it wasn’t for clowns like these, those of us with more than two neurons firing couldn’t feel special.
 
Meanwhile, I discovered a new way to deal with aching knees while driving on long distance trips. This is especially good for cars (like mine) that don’t permit the driver’s seat to slide back far enough to allow the knee to fully extend. 
 
In these cars, you’re forced to keep your driving knee bent for hours. And if, like me, you have chondromalacia (degenerative softening of the cartilage behind the kneecap–see the full description of this, and many other knee problems, in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN, at  http://drbillsclinic.com/eliminate_knee_pain.html ), this forced flexion results in a really annoying ache, that builds with time.
 
So, here’s what I learned. Most cars today have a cruise control. When you’re on cruise control, you can control your speed with your fingers, while steering.  And while you’re on a long straightaway (obviously, you DON’T use this method when on a series of turns, or when you’re surrounded by other cars), I found that you can straighten your driving leg, do quad isometrics, just like those I teach in my PAIN-FREE PROGRAM, at  http://drbillsclinic.com/exercise_eliminate.html/.
 
Again, obviously, DO NOT DO THIS IF THERE IS ANY CHANCE THAT YOU MIGHT NEED TO BRAKE SUDDENLY–because you CAN’T. So use this judiciously.
 
By tensing my quads (like any other isometric exercise), for multiple reps, then switching legs and repeating, I made a trip of over a thousand miles, without any knee pain. Simple, but effective.
 
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

So here I am, sitting in the study of the Southern Command Post, reviewing emails. And I came across one from a nice lady who is very concerned because she has knee pain, she is very heavy, given her size and worst of all, she has noises inside her joints that can actually be heard by people around her.
 
She was quite properly concerned because she’d like to get rid of her knee pain, and she wanted to get a copy of my newest healing program, HOW TO AVOID KNEE SURGERY (which you can get here at this link:  http://drbillsclinic.com/avoid_knee_surgery.html ), but she was afraid that it was already far too late for her–that the noise in her knees meant that all the cartilage had worn away completely, and that she had a “bone-on-bone” condition. This is what we in the trade call an “end stage knee.”
 
When articular cartilage, that normally coats the joint surfaces, is so diseased that it has eroded away and exposed the underlying bone, the naked bony surfaces grind upon each other with a deep, hard grinding sound and sensation that, once experienced or heard, is difficult to mistake for anything else.
 
It really is like rubbing two big rocks together, with grinding, rubbing and at times a mechanical ratcheting sensation. And, since the bone is where all the nerves reside, it hurts like hell! And that doesn’t count the extra pain from the inflamed lining membrane (synovium) that adds its own component to the pain.
 
So whether it’s osteoarthritis or rheumatoid arthritis, it’s at this end stage of disease, with exposed, bare bone, when major surgery IS truly indicated. Because at this state of the art, at this time, we cannot yet regrow new, healthy articular cartilage in a totally arthritic joint. The best we can offer is total knee replacements. And when they are indicated, they can be wonderful: pain relief, restoration of function and correction of deformity, with good to excellent results in over 95% of cases.
 
BUT…it’s major league surgery, with lots of risks and potential complications. So you don’t do it if you don’t HAVE to. 
 
However, all noise from within the joint doesn’t necessarily mean that your joints are finished and you need major surgery. Other conditions can cause noise, as well. When the lining of the joint becomes inflamed and swollen, its folds become thickened and enlarged. They rub upon each other, making a finer, more delicate crunching that we call crepitus or crepitation. 
 
If the membrane is restored to normal, the inflammation resolved, the swollen folds stop rubbing together and the noise stops. But if the condition persists for a long time, the membranous folds may become replaced with fibrous tissue (they become bands of scar tissue) and they then must be cut away surgically, to eliminate the sensation and the sound.
 
Then, there is degeneration of the articular cartilage surfaces, which may break apart into shredded beds of cartilage fronds, appearing like areas of “crab meat.” When these fragmented or fibrillated regions rub, one upon another, they too produce a crunching sensation, like walking in a gravel pit. 
 
This condition is called chondromalacia (“soft cartilage” grade III) and once this point has been reached, where there is physical disruption of the cartilage surface, it can never again return to a pristine, smooth surface. I discuss this disease and the various types of arthritis in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN (manual and CD). Get it here at: http://drbillsclinic.com/eliminate_knee_pain.html  However, even though the knee is noisy, it doesn’t mean that it will immediately go on to full end stage arthritis. The knee can stabilize in this state for a long time, sometimes pain-free (if a little noisy), if treated with the exercises I teach in my PAIN-FREE PROGRAM. See what I mean at this link:   http://drbillsclinic.com/exercise_eliminate.html
 
The point is, this lady has nothing to lose and everything to gain by at least trying all the conservative measures that are available, to relieve knee pain. One of them, or some combination of them, may give her the knee pain relief she seeks, and buy time, until she can lose weight and make an eventual surgery safer and more likely successful. 
 
So the next time someone, maybe you, says, “Hey, what’s that horrible crunching noise in my knee?” now you know what some of the reasons might be. And some may well be treatable by non-surgical measures, like those in HOW TO AVOID KNEE SURGERY: http://drbillsclinic.com/avoid_knee_surgery.html   Noise doesn’t necessarily mean it’s the end of the line, or that a total knee is the only option.
 
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

You may have noticed that yesterday’s email was a bit late–like, it wasn’t broadcast until after midnight, which pissed me off to no end. Fortunately, that was just after midnight EDT, and many of my subscribers reside all over the world, in other time zones. So only the east coast people were affected. But it was still mega annoying.
 
Thing was, I had it written and ready to go much earlier in the day, but my terrific merchant service, 1shoppingcart was on the fritz. “Error” kept coming up, every time that I clicked on the appropriate button and tried to send the email. Very frustrating, to say the least. So I saved my work, by clicking on “save draft.” And then, clicked off, hoping that whatever the problem was would be resolved with a little time.
 
Later, about 11PM my time, I logged back in, clicked on the “saved drafts” button, so I could retrieve the email and send it off, and guess what? The damn thing had ERASED 80% of my email! AAAAARRRRGGHHH!  I HATE when that happens! Must have been gremlins in the shopping cart….
 
Anyway, I had to rewrite nearly the whole damn thing again, from memory. Luckily, my memory isn’t shot just yet I was retyping frantically, with my rudimentary hunt and peck skills, re-saving every paragraph or so, just to be on the safe side. And I finished before midnight. YEAAA! Only, the line-up of others ahead of me pushed its transmission to after the witching hour. C’est la guerre….
 
Well, I guess I should be thankful that this doesn’t happen ALL the time. Anyway, when I was so rudely interrupted by the gremlins, I was telling you about my friend, who had recurrent knee pain. He initially had a very good response to the specially modified knee exercises I teach in my PAIN-FREE PROGRAM, at http://drbillsclinic.com/exercise_eliminate.html
 
But, like many people, he felt so good, he became lax and gradually stopped doing them. After all, he felt good, no pain, so the knee must be OK, right?
 
Err….no, sorry. The problem he had was a chronic degenerative condition. And that doesn’t disappear, just because you’ve compensated for it and relieved the resultant pain. So, absent the beneficial effects of exercise, the kneecap gradually fell back into the  abnormal tracking pattern that caused his problem to start with. Whether his actual disease was chondromalacia, or osteoarthritis of the patellofemoral compartment, the final result was recurrent anterior knee pain. 
 
As I mentioned, there are two fundamental components to treating this condition: 1.exercise and 2.measures to reduce inflammation. And they must be addressed simultaneously. 
 
Fortunately, there are many ways to combat inflammation. Conventional conservative treatments, home remedies, over the counter medications (with proper precautions), as well as a number of proven alternative treatments, which work by different mechanisms, can have a  synergistic effect to relieve knee pain. I cover a number of these, with specific instructions how to use and combine them, in my newest healing program,  HOW TO AVOID KNEE SURGERY, which you can get at http://drbillsclinic.com/avoid_knee_surgery.html
 
Long term, there is no better treatment than exercise.  That’s why I include a Baker’s Dozen of the most effective, proven knee exercises and stretches in this new program, as well. Or you can get the full range of exercises and stretches in the PAIN-FREE PROGRAM, at   http://drbillsclinic.com/exercise_eliminate.html  But either way, exercise is key in getting and maintaining complete pain relief and restoration of full knee function. 
 
If he follows my advice, my friend should get relief of his recurrent knee pain in short order, probably less than seven days. But to keep it, he’s got to do the work…and keep doing it.
 
You can get away with a lot and slack off when you’re young. Young tissues are forgiving. But as you age, more conscientious efforts are required. If you don’t do the necessary work, you will pay the price. It’s as simple as 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

This past weekend, I was at a business/marketing meeting in Tampa. One of the attendees was a fellow I had advised in the past, and one who had used the recommended exercises in my PAIN-FREE PROGRAM  http://drbillsclinic.com/exercise_eliminate.html/.  He’s  a few years older than me, but in otherwise good shape.
 
Up to now, he had done pretty well. So well in fact, that he has written a testimonial for me, which I will post, once he sends me a photo of himself to run with it. But, like many of us (me too) he got a little bit complacent and slacked off the exercises. 
 
Sure enough, he started to develop recurrent symptoms. ”Hey, what’s that vague ill-defined knee pain?” he wanted to know. I shouldn’t wonder. 
 
Knee pain, especially low grade, achey pain, is often diffuse and ill-defined. That is, unless there’s a specific injury that causes a sharp, acute pain, associated with damage to specific structures. These would be things like a fall, twist or sprain of ligaments, or strain of muscles, a tear of the meniscal cartilage, a rupture of the ACL, degenerative diseases (like chondromalacia or it’s cousin, osteoarthritis), or inflammatory conditions, including rheumatoid arthritis (and its relatives, psoriatic arthritis, lupus, spondylitis, etc.)infectious arthritis (Lyme Disease, staph or strep infection).
 
Why do these conditions cause this low grade ache? In a word, SYNOVITIS. This is an inflammation of the lining membrane of the joint. Now, synovitis is a very non-specific response to ANY stimulation, regardless of what it is–IT HURTS. The membrane also becomes thicker and more swollen, actually grows in volume, becomes red (from dilated blood vessels) and produces an excessive amount of joint fluid (which it normally makes in very small amounts, to lubricate the articular cartilage and nourish the cartilage surfaces). Lay people call this “water on the knee.” 
 
Since I was there with him, I examined my friend’s knee, right there in the conference room. Very few findings, though. Some loss of the last few degrees of motion at the extremes of flexion and extension, maybe five degrees at each end, consistent with the thickening of the synovial membrane. And he had a little bit of pain under the kneecap, when pressure was applied. Pretty much, that was it. Of course, I had no x-rays or MRI images to examine.
 
My impression was that he had developed a recurrent case of chondromalacia patellae–softening of the cartilage of the patella. Either that,or it’s first cousin, osteoarthritis. So, what to do?
 
First, he needs to resume the exercises I teach at http://drbillsclinic.com/exercise_eliminate.html  Exercise is the overall best method for long term pain relief of the knee.
 
Next, he needs to get on the anti-inflammatory regimen I present in detail in my newest healing program, HOW TO AVOID KNEE SURGERY, at  http://drbillsclinic.com/avoid_knee_surgery.html
 
With luck and some work, he should get fast pain relief in as little as one week. If he does the work…
 
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