January 5, 2010

Once released from the hospital’s RIO unit, my wife drove me home. I was set up in a spare bedroom, with a lower mattress than my usual, to make it easier to get in and out of bed.
 
Luckily, the local anesthesia was in full force, so I remained comfortable and pain-free. I checked out the dressing, but it was clean and dry, with no sign of bleeding. So far, so good. Then, I got a cold seltzer to drink. Remember, I had been NPO (nothing by mouth) since 10PM the night before surgery, and only had ice chips in recovery, so I was pretty thirsty. Hungry, too. 
 
Then, I noticed I was tired. No surprise there. Surgery is a trauma to your body, so it induces a lot of stress. After drifting in and out of sleep, I had to go to the bathroom. That’s when things started to get interesting.
 
Turns out that when you try to get out of bed, especially without any leverage, you put a lot of stress on those new sutures, just placed in the surgical repair. YEOW! Only a momentary thing, but despite the local anesthetic, I felt that! I had to figure out how I was going to do this.
 
So, I decided to try using a cane, which I had handy, left over from my last surgery, an arthroscopy of my left knee in 2005. I discovered that of I pressed down with the cane in my left hand, I was able to get up with only minimal discomfort. How about that?

Further experimentation revealed that if the came was used in my left hand while walking, it relaxed my right abdominal muscles, by reflex. Now, I’ve known for years that the use of a cane reduces the joint reaction forces across the opposite hip and knee. In fact, I make a great point of that technique, as a way to minimize joint pain, in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN  http://www.drbillsclinic.com/eliminate_knee_pain.html
 
But I never heard that it also relaxes the abdominal muscles on the opposite side from the cane. I don’t believe my surgeon even knows about this (but you can be sure that I’ll let him know, for his future patients). Keep this trick in mind, if you ever need to get abdominal surgery–it makes quite a difference.
 
The other thing that made a big difference in my comfort was the use of a rectangular cooler pack, stored in our freezer against emergencies, instead of a simple ice pack. The surgeon had recommended intermittent use of ice to reduce swelling, but this solid, cold cooler pack not only chilled the tissues, reducing local pain and swelling, but also acted as a buttress against any intra-abdominal pressure. When I pressed it against my surgical site, it kept the repair under pressure, so it reduced any tension on the internal sutures.
 
Between the cane and the cooler pack, I managed very well, indeed. I was completely comfortable, when at rest in bed. I only had some momentary pain, when attempting to get in and out of bed. Even walking was not bad, so long as I went slowly, using the cane in my left hand and holding the cooler pack against my lower abdomen, on my right.
 
In bed, I found by trial and error that a slightly bent fetal position, on my left side, with a pillow between my legs, made me very comfortable. Virtually no pain, at all. I still had taken no pain medication. In that position, I slipped off to sleep and slept all night long.
 
Next day, I found the same thing. Using the cane and the ice pack, I was comfortable enough that I was not in need of any analgesics, even though the local had surely worn off by then. I just took it easy, watched TV, read a bit and periodically took a nap.
 
Long and short of it is that, despite having filled a prescription for Percocet, just in case, I have not needed a single pill. Not one, to date. Just took off the dressing and the incision is healing fine. Of course, the real issue is the internal healing. And that’s the reason that I can’t take my twice daily dose of POWERHOUSE OMEGA FORMULA   http://www.favoriteformulas.com 
 
A hernia is a defect in the tough fibrous sheath across the groin, which is pierced by the spermatic cord, on its way to the testes. The descent of the testes leaves a potential weakness there, which in some people, under some conditions, leads to a tear, or rupture in that sheath. This tear allows loops of bowel (small intestines) to protrude, causing a bulge under the skin. In some cases, that loop of bowel can twist, cutting off circulation and literally dying. This is called strangulation and it’s a surgical emergency. That’s why I wanted this fixed, pronto.
 
In the old days (when I was an intern), the only repairs sutured the edges of the tear back together and to the big oblique inguinal ligament, that runs between the “point” of the hip (anterior superior iliac spine) to the pubic bone. But that repair is under a lot of tension and ruptures can recur at a rate of around 30-40%. With a new, tension-free technique, the surgeon covers the defect with a fine mesh of polypropylene and sews that to the edges and the ligament. 
 
Eventually, fibrous tissues grow into that mesh, which acts like a scaffold, and upon maturity reconstitutes the abdominal wall, obliterating the defect and restoring integrity to the wall. The recurrence rate for this technique is only 1%. The downside is that it needs inflammation to provoke the ingrowth of the fibrous tissues. So, since fish oil is so effective at reducing inflammation, I can’t use it yet. And the rest of my joints KNOW it, too.
 
Anyway, that’s what happened next. So far, so good. I walked a bit more today and went out for the first time. So, little by little, day by day…it’s getting better. Til next time, my friend, be well. 
 
Yours for a pain-free tomorrow and your optimal health,
 
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 4, 2010

Finally, the Holidays are over. The confetti and tinsel are over for another year. And here we are in the beginning of a new year, of a new decade. Here’s hoping it’s a good one….
 
As for me, I’m recovering from my recent herniorrhaphy (inguinal hernia repair), which I had done last Thursday morning, New Year’s Eve Day. The idea was to get this problem fixed, while in the old year, so I could begin the New Year with the surgery behind me and start a new chapter of my life, with healing. 
 
Now, my wife has a dim view of all things Floridian and would have preferred that I have my surgery in New York, with one of my old compadres. But my attitude was that, if I’m living down here, I’d better learn who’s good, on an elective basis, before any emergency occurs.
 
I was referred to Dr. Possada, a general surgeon recommended by my cardiologist, of whom I think very highly. I asked the correct question of him: “Who would YOU use, for this procedure, for YOU or YOUR FAMILY?” 
 
Very important point and the best teaching, with which to start the New Year: Never just ask for a referral. Depending on the doctor (or nurse) and the relationship they have with the specialist, you may get lucky, or you may get referred because of business reasons. I saw this many times in my years in private practice.
 
I got many a back-handed compliment: these guys would send all their referrals to other docs, for business reasons, but when it was someone from their own family, why then, they wanted them to come to me.
 
It’s considered “unethical” for nurses or docs in the ER, for example, to refer to the docs who they KNOW are the best. Instead, if asked for a referral, they are required to refer to the person on the ER call roster, who may or may NOT be the best choice for you.
 
The case for this is that they can otherwise “steer” referrals to their favorites and away from those not so favored. However, what they are NOT doing is looking out for YOU. They don’t know you. They have to live with all these guys, long after you’re gone and forgotten.
 
So, be smart. Ask instead who THEY use, personally. Different question. And not unethical to answer. Repeat this a few times, with different health professionals and the same two or three names are going to keep coming up. THAT’S who you pick from.
 
In Medicine, as in Life, “birds of a feather DO flock together.” The best hang around with the best. Always did. Always will.
 
Anyway, I met this guy and was immediately impressed with his manner, his confidence, his over 20 years of experience in doing this procedure. I trust my gut. And I like and trust my cardiologist. So that’s how I made my choice. I didn’t look up his credentials, or whether he had any malpractice suits, or any of that other crap that people think matters. It doesn’t. I know a good man when I meet him.
 
So we scheduled the surgery, in accordance with my wishes that it be done in 2009. And he accomodated me, despite a solidly booked schedule (another indicator that he has a good reputation and a busy practice–which he wouldn’t, if he was leaving dead bodies all over).
 
So, Tuesday, I went to the Florida Hospital, Orlando, for presurgical testing–simple blood work, interviews and collection of my medical history. Early…and I mean EARLY…Thursday morning, I got up at a little after 4AM, showered, dressed and drove with my wife to the FLORIDA HOSPITAL outpatient surgery unit, what they call their RIO, an acronym for Rapid In and Out. 
 
When you think about it, that’s a sort of unfortunate name they’ve chosen, with echoes of “A Clockwork Orange.”
 
Contrary to my usual tardiness, we were precisely on time, at 5:30AM. A nurse picked me up and took me, with my wife, to a patient station in the preop staging area. I undressed, put on thigh-high TED (thromboembolic disease) stockings, a prophylactic measure to minimize the risk of blood clots, during the immobility of surgery, a pair of socks with rubber treads, to provide non-slip surfaces, and a johnnie (those ridiculous patient gowns that tie up in the back, leaving your naked butt exposed).
 
Then, I was visited in turn by the preop nurse, who started an IV, gave me some preop antibiotics and worked through her checklist, then the OR circulator nurse, the nurse anesthetist and the anesthesiologist. The plan was for LMA anesthesia–laryngeal mask airway.  This is used for light general anesthesia, which my surgeon prefers, as it provides maximal muscle relaxation, a must for a good hernia repair.
 
I advised the anesthesiologist to forget that I was a surgeon, myself, treat me like any other guy off the street and do whatever he thought was necessary, at any time, even if that meant full intubation, with an endotracheal tube. That’s always the best way to survive. It’s when they think they’re doing you a “favor” and treat you different from the standard of care that you get into trouble.
 
Then, they slipped a little Versed (a very short acting hypnotic agent and relaxant, that causes retrograde amnesia, as one of its little benefits) into my IV, started wheeling me out to the OR and….
 
When they roused me, a little later, I thought I had just dozed off and was now in the OR, ready to begin. But the procedure had already been done. I felt no pain, at all. My surgeon had infiltrated the repair and all the tissues with a long acting local anesthetic, with epinephrine (adrenaline, which constricts blood vessels, minimizing bleeding and allowing the local anesthetic to stay much longer in the tissues, keeping them stone numb).
 
Thanks to the short acting anesthetic agents, like Propofol (Deprivan, the same stuff that killed Michael Jackson, used incorrectly, but a great drug, when used by pros and monitored correctly), I was wide awake in a very short time. Very chatty, according to my wife, but hopefully, not too obnoxious to the nurses, who I’m sure are used to this. 
 
Hey, it’s like the old movie title–”Blame it on RIO.”  The residual anesthesia inhibits your inhibitions, like you were a little high. Well, that was my “drink” for the night….
 
A few hours later, once I was able to walk, urinate on my own and appeared to be stable, I was ready to leave. And so we did. All in all, everyone involved, start to finish, in the RIO did a simply an exemplary job. I was very favorably impressed. And comfortable, the entire time.
 
And that’s how I spent my New Year’s Eve, this year.
 
Tomorrow, I’ll tell you about the early recovery process and the new things I learned from this experience, that I didn’t know before. I still can’t start my fish oil, which I really do miss,   http://www.favoriteformulas.com   but for reasons I’ll explain, I can’t suppress my inflammatory response, just yet. Neither can I start my isometric exercises, as yet, for fear of stirring up bleeding. But soon, I’ll begin with these fundamentals from my newly expanded, completely redone PAIN-FREE PROGRAM & brand new DVD:
 http://www.drbillsclinic.com/execise_eliminate.html 
 
2010: This will be a different year, a new chance to get healthy, get fit and leave your bad habits and health care problems behind. And despite the wretched economy and the forces arrayed against us, from ignorant & arrogant fools in our own government, who would dare to use your life, your health and that of your family, as a political means to power, to Big Pharma plots to make statin drugs “preventive care” for everyone, to internationalist efforts to interfere in our personal rights, to use supplements as we see fit (Codex Alimentarius), against all these and more, we will join together and fight back, with the truth and with actions. 
 
This year, we will explore, together, the best ways to relieve pain, restore function, prevent disease and disability, lose weight; to be better, stronger, leaner, fitter, happier, healthier; to live as we ought to live, in optimal health, for as long as we may….plus many new surprises, new products, new features and more emails, to educate, entertain and amuse you.
 
And if you will stick with me, this year, continue to be part of our extended family of friends, one of “Dr. Bill’s Wellness Warriors,”TM and DO what I teach you to do, together we can all enjoy a brighter, happier, healthier future. So stick around and I’ll promise to do my very best to make you glad you did. Til next time, my friend, be well….
 
Yours for a pain-free tomorrow, with optimal health & wellness,
 
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, 2009 by William Thomas Stillwell, MD, FACS
All rights reserved

December 30, 2009

Today I’m in the final countdown before my surgery tomorrow morning. I’m trying to anticipate all the things that will need doing prior to my recovery period, when I expect to be incapacitated by abdominal postop pain. 
 
Though a number of people think I’m crazy getting surgery on New Year’s Eve Day, my wife among them, my attitude is that if you recognize a problem, it’s best taken care of ASAP. Were I to wait, the damn hernia would likely just get bigger and more painful. And there’s always the chance of strangulating a loop of bowel, entrapped in the abdominal wall defect. Now, that would be a problem.
 
No, better to get it behind me, face the issue head-on and fix the damn thing. Compared to what I used to do, this is pretty straightforward stuff. But of course, no surgery is minor surgery when you’re the patient. All in all, I like being the operator better than being the operatee, if you know what I mean.
 
However, this episode gives me a chance to teach you something that I normally wouldn’t think about much. And that is ISOMETRIC EXERCISES.
 
Now, after a surgery like this, any contraction of my core muscles is going to hurt like Hell, at least for the first few days. So after the immediate period of rest, to allow postop bleeding to stop and postop swelling to recede, I have to be able to maintain and then rebuild my leg strength. 
 
This is especially true since I’m not going to be able to restart my fish oil for a while. And I feel it in every joint. There are a couple of reasons for this.
 
First, fish oil’s omega 3 fatty acids act to reduce platelet adhesiveness, or stickiness. That’s great when you want to reduce your risk of heart attack or stroke, by reducing clot formation. Not so great, when you WANT clot formation during and after surgery.
 
Then, there are the known anti-inflammatory properties of fish oil. Well, normally that’s exactly what you want. But in this surgery, inflammation is a part of the initial healing process. So, if I want a good repair, I have to suffer the lack of my POWERHOUSE OMEGA FORMULA  http://www.favoriteformulas.com  for a few weeks. But the other parts of my body, like my back and my joints can definitely feel the difference when I don’t take it. And that’s why YOU should.
 
The kind of hernia repair I’m getting is called a “tension-free” (Lichtenstein) repair, which uses a polypropylene mesh, to cover the abdominal wall defect. This mesh acts like a scaffold, to allow fibroblasts (fiber producing cells) to infiltrate it and rebuild a fibrous layer over the defect. Inflammation plays a role in initiating this process. So, I just have to grin ‘n’ bear it.
 
In the aftermath, when the abdominal wall is sore, active exercise for my knees simply wouldn’t be possible. Nor would it be wise, as it might compromise the repair, before it was strong enough to bear extra tension or intrabdominal pressure. So, what I plan to do is to use the isometric exercises that I teach in my newest edition of my PAIN-FREE PROGRAM & DVD http://www.drbillsclinic.com/exercise_eliminate.html 
 
Isometric exercise generate muscular contraction, without shortening of the muscle. That’s how they’re defined. The advantage is that I can strengthen my knee with these static postures, without putting any pressure on my sure to be sore belly and groin. 
 
The Wall Chair and the Horse Stance, derived from the martial arts, like karate and kung fu, are ideal for this purpose. And they’re safe. They’re ideal for the person just starting out, or the morbidly obese, who want to eliminate their knee pain, but lack any strength, at present. These are a great way to build a foundation of strength, for more aggressive exercises, later on. Just strike the position, and hold it for time. It’s as simple as that. 
 
So that’s what I’ll be doing, after surgery. And what YOU should be doing, if you’d like to start on the road to pain-free knees, safely and effectively. Well, my friend, that’s about it for today. This was my last lesson on eliminating knee pain for 2009. 
 
My wish for you, as we enter a new year and a new decade, is one of peace, happiness, health and prosperity. Have a Happy and Healthy New Year, my friend. All the best, as always. Talk to you again in 2010.
 
Yours for a pain-free tomorrow and 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