January 21, 2010

The other day, I got another email from one of my subscribers, who had an interesting, but not uncommon story. Seems he had knee pain located right on his inner (medial joint line). He saw his doctor, and was sent for an MRI.
 
Sure enough, he had a torn medial meniscus. He also had some degenerative changes (read that as “early arthritis”), not uncommon in a middle aged guy. His question for me was, do I REALLY need to have an arthroscopic surgery? 
 
He was understandably reluctant to go “under the knife,” and was hoping that I could give him some less aggressive treatments that would relieve his pain, but help him avoid surgery. He also didn’t understand why these structures simply didn’t heal.
 
So, I tried to explain. I used to have to do this a dozen times a week, in my practice–meniscal injuries were the second most common cause of knee pain that I saw, after kneecap problems. So here’s the short story.
 
In each knee, there are two crescent shaped fibrocartilage structures that guide and cushion the knee in motion. They help to spread out the stresses of weightbearing over a larger surface area, kind of the way snowshoes work to keep you from sinking into a snow bank.
 
I have a great illustration of this principle in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN http://www.drbillsclinic.com/eliminate_knee_pain.html  which I drew myself. (I used to work for the comics as an artist, back in the 70′s.) 
 
Here’s the thing he didn’t understand, though, that makes all the difference: These structures are mostly avascular. That means that they mostly lack a blood supply. There is virtually no circulation within these cartilage cushions, at least in the inner 2/3 to 3/4. There IS a marginal circulation at the periphery, where the medial (but NOT the lateral) meniscus attaches to the fibrous capsule of the knee joint.
 
If a tear occurs within this so-called “red zone,” it does have the potential to heal. But only 10% of tears occur there. The remainder occur in the avascular part, and therefore CANNOT heal (at least not without fairly sophisticated surgical help), because nothing heals without blood. 
 
This anatomical fact governs the behavior of meniscal tears AND determines what constitutes effective treatment.
 
Given that he has a positive MRI, he probably SHOULD have an arthroscopic examination. If pathology is confirmed at surgery, it can be fixed on the spot. This is a prime example of what I like to call a NECESSARY surgery. And, it’s a simple, outpatient procedure, with a fairly rapid recovery. I know. I’ve not only done thousands of them, but I’ve had the surgery myself, too.
 
Had he presented with the same pain pattern, but NOT had an MRI, I probably would have urged him to try the non-surgical treatments I teach in my healing program, HOW TO AVOID KNEE SURGERY, which you can get here:
 http://www.drbillsclinic.com/avoid_knee_surgery.html
 
With methods from across the entire medical spectrum, including many effective alternative treatments, it can provide relief of pain and help you avoid surgery, in many cases. 
 
In this way, if pain is relieved, you’ve avoided an UNNECESSARY surgery. If not, you’ve “burned no bridges” and can still get an MRI and if that is positive, arthroscopy, if needed. But it gives your knee a chance to heal itself.
 
Except in case of a completely locked knee, which is a surgical emergency, it can buy you time, perhaps heal you, and you lose nothing. 
 
For other causes of knee pain, like chondromalacia patellae, or arthritis of the knee, it may be definitive treatment. I teach you how to relieve pain fast, but also how to stay pain-free for the long term, with special, modified exercises and the anti-inflammatory properties of my pharmaceutical grade fish oil, DR. BILL’S POWERHOUSE OMEGA FORMULA:   http://www.favoriteformulas.com 
an ultra pure, highly concentrated omega 3 formulation, with a special enteric coating that prevents virtually all the fishy aftertaste and fish burps that plague other, lesser brands. 
 
But in this man’s case, he already had a demonstrated, through and through tear in the avascular zone. The probablity of healing was poor to none. And further delay would accomplish nothing good, but might result in degenerative damage to the articular cartilage, which is permanent damage. This must be avoided. 
 
THAT’S why I recommended that he proceed with surgery. And now, you can understand the thought processes that led me to that conclusion, too.
 
In the end, judgment has to be based on the anatomical and pathological facts. And that’s another good reason to get your doctor involved early in the course of your knee problem. Til next time, my friend, be well.
 
Yours for a pain-free tomorrow and 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

The last time, we discussed what’s really involved in arthroscopic knee surgery. My thesis is that you’re far less likley to be afraid of necessary, needed surgical procedures, if you understand what’s actually done. Otherwise, your imagination creates a lot of nightmares that are much more intimidating than the real thing–by far!
 
Although the procedure I described was for treating a painful, degenerative kneecap, the same basic techniques are utilized when dealing with torn menisci, loose bodies, inflamed synovium and even ACL ruptures and tibial plateau fractures. The specifics are different for each type of pathology, but the basic approach is the same.
 
Let’s look at torn menisci first, for today. As I point out in the section on menisci in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN    http://drbillsclinic.com/eliminate_knee_pain.html   these cushions have no blood supply, except for the peripheral 25-30%. So many tears on the inside of the knee simply won’t heal. Therefore, treatment is basically removing the loose, torn fragment. 

After inserting the arthroscope into the joint, as we discussed yesterday, and identifying the loose torn piece of the meniscus, the surgeon uses small nippers, called “basket forceps” to nibble away the offending fragment. The little pieces of the meniscus float around inside the joint, until they’re sucked out by a power shaver (basically a tube with a rotating blade, attached to suction).  This shaver is also used to cut away overgrown and/or inflamed synovium (joint lining membrane), or shredded, fragmented articular cartilage (a process called debridement, or “house cleaning”).
 
Loose bodies, usually fragments of bone coated with cartilage, which have “fallen out” of the articular surface by disease, have been grown inside the synovial membrane, or have been “knocked out” of the joint surfaces by trauma, are removed by long grasping forceps. These are basically “grabbers” that the surgeon uses to capture the loose body and extract it. If it’s too big to pass through the arthroscopic portal (the little incision used to introduce the scope into the knee), either the incision can be enlarged, or the loose body can be broken up into smaller pieces and remove them, one by one.
 
Anyway, as you can see, you can do lots of different things through the arthroscope, but since nearly all the stuff inside the knee is devoid of nerves (or blood), the minimal disability is about the same, no matter WHAT you do inside. And THAT’S what the arthroscopic revolution is all about. And that’s why the pain is so minimal and recovery so rapid after this type of surgery. Pain and disability are functions of the size of the incisions and the amount of internal bleeding.  Minimal incisons, minimal disability. Simple, no? Pretty cool, too. It’s really transformed surgery!
 
Now, you know the worst of it. Not so scarey, is it? But that doesn’t mean you want to have surgery if it isn’t really necessary. That’s the key: you don’t want to be irrationally afraid of surgery, because there ARE times it’s needed. But you DO want to AVOID the UNNECESSARY surgery. This is a common sense, rational approach and the same one I used for lo those many years in practice, which resulted in my treating over 90% of my patients, WITHOUT SURGERY.
 
If you want to give your body the chance to heal naturally, if you want to stay OUT of the operating room, if you want to improve the odds of conservative treatment working, or use alternative methods to relieve your pain, then you need my newest healing program, HOW TO AVOID KNEE SURGERY, which you can see at   http://drbillsclinic.com/avoid_knee_surgery.html
 
Now, I had planned to continue with a description of joint replacement — what it is and what it isn’t–with the same idea: you will be less afraid if you understand what it really is. But I have a special treat for you instead. My friend, Fred Nicklaus, a veteran of 30 years in the martial arts and a guy who has HAD a hip replacement himself, is going to have a special offer on his Combat Endurance course, a proven method to give you a core of steel. But more about that tomorrow…
 
Meanwhile, if you have knee pain and you’re keen to stay out of the O.R., try HOW TO AVOID KNEE SURGERY at
http://drbillsclinic.com/avoid_knee_surgery.html  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

Just today, I was driving along in my car, listening, as I usually do, to a talk show on AM radio. The traffic was miserable, the weather was lousy, but the kitties need food, so there I was. Anyway, one caller came on and said, quite emphatically, to the host of the show, “Healthcare is a RIGHT! It’s a disgrace that there are people who are uninsured in this country…We’re the only major industrialized country in the world that doesn’t provide care for everyone…Yada, yada, yada…(with apologies to Seinfeld)”.
 
Like many people who hold this viewpoint, the man who called into the show was long on passion, but short on facts and true knowledge of the problem. Which is to say, he was clueless about the real situation, but he gets points for compassion for his fellow human beings.
 
Here are a few things to consider. First, yes, there are a large number of people who do not have insurance coverage. BUT, and this is a big “but,” for many, this is a CHOICE. I know this seems like heresy, but in this country, people still have the freedom to make some choices. 

A young guy with no dependents, in the full flower of his life and strength, often thinks he’s near invulnerable and feels like he’s immortal. He may choose not to spend his money on an insurance policy (health OR life), because the need for it seems very far away and he’d much rather spend it on something else. 

Now, there are people who need coverage and can’t afford it, or maybe they can afford it but they’re disqualified by a “pre-existing condition.” That last is a real problem in anyone who is younger than Medicare-eligible age. Finally, there are a horde of ILLEGAL ALIENS included in that number of the uninsured–not only can they not afford it, or qualify for it, but they’re NOT supposed to be here, at all! And yet, their every emergency is treated FREE, if necessary, in the local ER, by law. WE pay for that, BTW.
 
Now, I’m not going to say that there aren’t problems with the current system–there are. But politicians are attempting to use this situation to seize control of yet MORE of our freedom and our money by attempting the government takeover of the healthcare industry. 

And underlying all of it is the idea, popular on the left, that health care is a RIGHT. Sorry, but it’s NOT a right. A need, obviously; desirable, certainly; but not a right. Why? Well, any other right guaranteed by our system and our constitution can be freely expressed by an individual and IT DOESN”T IMPOSE A COST ON ANYONE ELSE. That is, if I want to speak my mind and express an opinion, my “right” of free speech, it doesn’t cost anyone else a dime for me to do that. 

It’s true that in at least some of these cases, there is a true need. And that should be addressed. There are ways to deal with that. But NOT by putting the ponderous federal government in charge. These people can’t do anything right! Do you really want to trust your health to a bureaucrat? Think about it–it’s better for their budget if you die.
 
And do you want to stifle the innovation, investment and effciency of the private model? I mean, already a whole lot of physicians are from elsewhere–because our best and brightest, right out of college, have already figured out that they don’t want to be under a government thumb. They’ve gone into other fields, where they can prosper to the limts of their own talents and drive, free from government regulation. And the old dogs (like me), who have decided to retire, rather than put up with ever more regulation, litigation, and decreasing revenues, further decrease the physician pool. 
 
Then there’s convenience. Tear your meniscus? Today, you can see a doc, get an MRI that afternoon, and if needed, get surgery done a day or two later. So you can be back at work or play in a few days to a week or so. Done. Want to give that up, so some government fool can tell you that you have to wait a few months to get the MRI and then, another 6-12 months to get the surgery? I don’t.

Then just think about this: now you have cancer. And some drone tells you, sorry, you’ll have to WAIT to get that CT scan and then WAIT again to get the surgery. And all the while, the cancer is eating you alive, spreading through your system with unseen virulence…while you WAIT. That’s what the future holds if we let this happen.
 
And then, there’s the financial argument. Create a “right” to care and you create an endless demand–which YOU will pay for. Take a look at Europe and Canada. Anywhere this idea has been tried, it has all but bankrupted the country. We can’t afford this. The American taxpayer is not a bottomless well.

There are problems that need to be solved in healthcare. But the government is NOT the solution. It’s part of the problem.
 
So next time you hear someone tell you how healthcare for all is a “right,” you now should know better. Your best bet for your future healthcare is to STAY HEALTHY.
 
This rant has been brought to you by HOW TO AVOID KNEE SURGERY, where you can avail yourself of the latest cutting edge techniques, from across the entire treatment spectrum for eliminating knee pain, without surgery, at
 http://drbillsclinic.com/avoid_knee_surgery.html
Thank you.
 
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

Tiger Woods has done it again! Only a couple of months after arthroscopic surgery on his left knee, for “cartilage damage,” he came from behind to win the U.S. OPEN. Wincing in obvious pain throughout the tournament at Torrey Pines, San Diego, Tiger fell behind earlier in the game, with a couple of bogeys, but then went on to pull even, with a couple of simply spectacular shots, that apparently defied the laws of physics, and resulted in eagles. After 90 gruelling holes of golf, Tiger finally clinched the title from opponent Rocco Mediate in sudden death on the 91st hole. This is one for the ages!
 
So Tiger pulls it off again, against a great player, with a real physical and mental handicap. He’s now won his 3rd U.S. Open and his 14th Major Title, hot on the heels of Golfing Great Jack Nicklaus’ Lifetime 18 Major Titles. And Tiger is only 32 years old (though I bet his left knee is a lot “older”). 

I’m not a big golfer, personally (tough to do when you have a fractured spine and crushed discs), but I fiercely admire excellence and achievement, especially when wrested from adversity. This was the third time that Tiger had this same knee operated on. He had a benign tumor removed in the late nineties, and arthroscopy in 2002.
 
If you were watching him walking in the Masters, he was wincing and in obvious pain from that left knee. It’s very possible that the distraction lost that tournament for him, but even there, he almost pulled it off and finished second. This guy is unbelievable! No matter
how you cut it, he is a true champion.
 
The “cartilage damage” referred to could refer to degenerative or traumatic damage to the articular cartilage, manifested as shredding, crevasses or flaps. If widespread, this could be consistent with arthritic changes, despite the fact that Tiger is only 32 years old. On the other hand, it could refer to a tear or degenerative shredding of the meniscal cartilage. No real details have been made available, so it’s anyone’s guess. But his pathology was likely one of these, or both.
 
What happens when the cartilage is damaged? Well, in brief, whether from direct impact, or from slow, progressive degeneration, the ice smooth resilient articular cartilage coating of the bearing surfaces of the knee joint become softer than normal and eventually begin to fragment and shred. Once the cartilage is physically disrupted, this unravelling of the protein fibers of collagen (that normally give support) speeds up and progresses. This is discussed and illustrated in detail in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN (see it at   http://drbillsclinic.com/eliminate_knee_pain.html)
 
If the damage is to the crescent-shaped meniscus, it’s usually a tear. Thing is, any cartilage damage is a problem because cartilage, once physically broken or torn, cannot heal without very sophisticated surgical techniques (at least with current technology).  But there are a number of supplements, herbs, OTC medicines, and even food choices that can have a positive or negative influence on inflammation and
pain.
 
When Tiger was walking the links in pain, something within his knee was catching in that joint, causing traction on the capsule of the joint and/or the lining membrane. Problem is, if the thigh muscles are weakened by the persistent pain, they can’t stabilize the joint and help absorb the shock of walking (especially up and down the rolling hills of a golf course).
 
The solution, both before and after knee surgery, is to strengthen the thigh muscles, the quadriceps, so they will be able to absorb shock and supplement the ligaments to priovide optimal stability. To do that, a number of exercises designed to increase muscle tone, strength and power, and stretches for the antagonists on the opposite side of the thigh, are necessary. But not any old squatting motions will do. No, you need to strengthen your thighs strategically, based on the type of pathology you have. 

As an orthopaedic surgeon and, more important, as a knee surgery patient myself, I’ve collected the best and most effective exercises, specially modified to prevent or eliminate knee pain, in my PAIN-FREE PROGRAM  http://drbillsclinic.com/exercise_eliminate.html
 
Using a combination of the movements described in my PROGRAM, anyone can improve the stability of their knee and relieve their pain. Of course, as I mentioned yesterday, you actually have to DO the exercises. Nothing happens without effort. But if you do them, your thighs will grow strong and your knee pain will get better and better. Try it and see for yourself.
 
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