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

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

 There I was over this past weekend, talking with some of the paticipants of Matt Furey’s GET TOUGH! Fitness Seminar this past Winter. I wasn’t there myself, built as I am for comfort rather than speed . But a near universal remark among those of my vintage, or even a bit younger, was the deep and persistent muscular aching they all experienced. Even those who are very fit and are habitual exercisers felt it. 

One of the ways that you know you’re getting older is this delayed muscular aching after vigorous exercise, that seems to be more intense, and seems to last much longer than when you were younger. The technical term for this is Delayed Onset Muscular Soreness, or DOMS.  As a mnemonic, just remember the old DRAGNET theme: “DOM…DA DOM-DOMS…” 

This is a product of inflammation, provoked by microtears and other microtrauma, induced by exercise. This is the stimulus for muscular hypertrophy–in other words, this is how exercise causes muscle fibers to grow larger and stronger. With age, this process takes longer, and the discomfort is prolonged. Since muscular hypertrophy results from this process,
it follows that it isn’t the exercise, but rather the REST after the exercise that allows the muscles to grow and strengthen. This has practical implications. If you’re trying to get stronger, REST, for proper recuperation, is just as important as the exercise you do.

This is especially important when you’re doing exercises to treat joint pain, such as the specially modified exercises I teach in HOW TO AVOID KNEE SURGERY, at  http://drbillsclinic.com/avoid_knee_surgery.html
 
It’s sometimes difficult to differentiate between the joint pain itself and the muscular soreness that results from the exercises, when it’s excessive. The rule of thumb that I was always taught and that I have found to be true throughout my career is that mild muscular soreness that follows exercise, but fades by the following day indicates just the right level of exercise intensity. If soreness persists beyond the following day, it’s too much.

To treat this condition, first, REST. Don’t add to the problem by exercising before the soreness and stiffness have resolved. Next, apply local moist heat.  You’ll find it feels soothing, which helps to bring healing blood into the area and speed the resolution of inflammation. Anti-inflammatory measures are also helpful, including OTC medications. But be sure to take any of these meds with FOOD, to protect your stomach. 

It’s also worth noting that in the GET TOUGH! Seminar, the exercises were ALL bodyweight techniques–no free weights. And still, many participants had significant persistent soreness, in some cases for many days. That should put to rest the idea that bodyweight exercises are not adequate to really stimulate muscular strength. If you want a full body workout that is challenging, functional and SAFE, try Combat Conditioning, at  http://drbillsclinic.com/combat_conditioning.html
 
And if you want to treat a painful knee with non-surgical methods, including many of my specially modified exercises, see HOW TO AVOID KNEE SURGERY at   http://drbillsclinic.com/avoid_knee_surgery.html  It’s the only program like it out there…and it works. 

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