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

This morning, I was going through some old boxes stored in my garage (no basements in Orlando–the water table is so high that you can strike water eighteen inches into the ground). I’m trying to get rid of some stuff that has been lying around for far too long and to do that, I have to go through it all. I’m trying to be ruthless, but it’s hard.
 
I’m a “pack rat” by nature. I save books, old notebooks from school, articles, pages cut from magazines, illustrations that took my fancy, paintings, posters, art prints, sculpture, electronics, tools, guns, coins, items of clothing, weights, exercise equipment, office and tax records, you name it. Then, there’s the stuff my wife likes, like multiple sets of china, clothes, pocketbooks, and enough shoes to give Imelda Marcos a run for her money. And on top of all of that is furniture and more furniture. You name it, I’ve saved it. Never know when it might come in handy….
 
In digging through this stuff, it’s like being an archeologist, or treasure hunting. Every new box I open is filled with stuff. Everything I touch evokes a memory. Which is why it’s hard to part with this stuff–it’s like throwing away a part of my life, in a way. But it’s got to be done.
 
The trouble with stuff is that after a while, you don’t own your possessions–they own YOU. We’re now married for over 34 years and I still have stuff from Grammar School, Junior High, High School, College and Medical School for God’s sake! Little by little, like barnacles on the hull of a ship, the stuff accumulates. This, of course, makes every move a nightmare. So the stuff has to go.
 
But, as it’s contrary to my nature, I can’t simply pitch everything. No, I have to go through it, to be sure I’m not throwing away some long buried treasure from my past. It’s sick, I admit it. In my own defense, I don’t smoke, I don’t drink and I don’t fool around on the bride–hey, you’ve gotta do SOMETHING, right? Could be worse.
 
So, while I’m digging through the boxes, I came across my old bones collection, from the office: near perfect skull, probably a young woman, a femur, tibia, a vertebral body, a bag of foot bones. Thing is, these are REAL human bones. Can’t get these any more. The countries that used to produce them, chiefly India, under Indira Ghandi, outlawed the practice many years ago. 
 
Today, plastic models are the best a young medical student can do. Not the same thing, though–they can’t capture the subtle details, especially in the delicate internal bones of the skull. So I’m thinking, good thing I didn’t just throw these out. Can you imagine these bones coming to light in the garbage dump? I can see the cops knocking on my door now….
 
Then, I came across my old knee model. This IS plastic and shows the menisci and all the ligaments. I used to use this to explain why someone was having pain, to demonstrate which part of the joint was damaged. Then, under these items, I came across my teaching handouts. I used to give these to the patients as “take aways” so they’d remember some of what I told them during their office visits. Even though I could tell what was wrong with someone and formulate a treatment plan in under a minute, I would often spend the next hour or so explaining everything to the patient and family. But as studies done at the University of Florida showed years ago, people just don’t remember what they were told. They retain less than 27%, especially stuff like complications of surgery, after only 24
hours. 

So, my handouts were my way of reminding them. Each one was a single page, with all the pertinent information we had just discussed. One for each of the most common clinical problems I treated. And then, there was my physical therapy prescription. The therapist loved my Rx, because I gave them the diagnosis, the surgery (if any), with exactly what was done, and specified exercises and modalities to be done. This was the prototype of the exercises I teach in my PAIN-FREE PROGRAM, which you can get at
 http://drbillsclinic.com/exercise_eliminate.html
 
The therapists liked this because most docs sent them a prescription that said “P.T.” They left pretty much everything up to the therapist, who of course had NO clinical information about the patient. Incredible. How could they help, if they didn’t know what they were treating? Made no sense to me. So they generally gave the patients knee extensions, or leg presses with resistance, to strengthen the quads, followed by ice and later, hot packs and electrical stimulation. Hard to go too wrong with those.
 
The miracle was that many people got better, anyway. That’s a tribute to the power of exercise to relieve pain, even if done in a very general way. Better, by far, if exercise is done strategically, to alter the dynamics of the knee, according to the pathology causing the problem. That’s what the PAIN-FREE PROGRAM does. See it at http://drbillsclinic.com/exercise_eliminate.html 
 
Well, back to the junk heap. I’m sure I can get rid of a lot of this stuff. Just have to keep digging…. 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