January 12, 2010

One of the most frequent questions I get is whether or not surgery is indicated for knee pain. Usually this applies to chronic, aching, long term knee pain, typically seen with osteoarthritis. But once in a while, it applies to a sudden onset, or an acute exacerbation of low grade, pre-existing knee pain.
 
Especially among those who lean toward the natural, often holistic treatments available in the realm of Alternative Medicine, the very idea of knee surgery is anathema. Even when they’ve been seen by a qualified orthopaedist, or other licensed health care practitioner, and been told that they do need surgery, suspicion remains.
 
Part of this is due to the Medical Profession itself, those practitioners who are overly aggressive in their promotion of the surgical approach. But part of it is unwarranted, based on a knee-jerk (sorry) assumption that a surgeon will always want to operate. That’s simply not true. 
 
The best surgeons DON’T operate on anyone who comes in the door. They only offer surgery when it’s appropriate, as the only, or the best alternative treatment, from the available options. I don’t even ask you to rely on the altruism of the surgeon. No. You can always depend on self-interest.
 
Just think about it. Were that NOT the case, if surgery was done frequently, without just cause, there would be a very high number of complications from unindicated procedures, poor results, very dissatisfied patients, and very, very unhappy referring physicians (because that would reflect badly on THEM). 
 
Result? The referrals would simply dry up and the surgeon would have no practice, in very short order. 
 
Surgeons survive and prosper by referrals from primary care physicians and other (HAPPY) patients. And the best way to enjoy an excellent reputation is to do the right thing, for the right patient, at the right time, consistently. That means to do surgery ONLY when it’s necessary and avoid unnecessary procedures.
 
Ironically enough, this approach is not only more honest and more in the interests of all concerned, patient, surgeon and referring doctor, but it results in the surgeon doing MORE surgery, that’s really needed.
 
Still, there is that suspicion, that little voice of doubt….
 
Let me give you a current example. One of my subscribers sent me the following email to ask for my opinion.
 
“Dear Dr. Bill,
 
I have arthroscopic surgery scheduled for tomorrow for a “potential” meniscus tear in my left knee (interior). I just stumbled onto your website and am having second thoughts about having surgery. I am 39 and in good health. 
 
The pain in my knee started after overindulging in three days of soccer, running and biking. It started about four months ago. It initially swelled and was painful to walk on, but is now just occasionally sore (mainly before storm events and after heavy use). 
 
My knee is tender on the inside, lower area. I have full range of motion and do not want to risk losing this due to surgery complications. Your insight would be greatly appreciated.”
 
I advised him to proceed with the surgery, which was arthroscopic, after all, and likely to cause little disability. He just sent me copies of his intraoperative photographs, taken by his surgeon as documentation of pathology, a standard practice today. He did indeed have a degenerative tear of his posterior horn of the medial meniscus. And the surfaces of his knee were otherwise in good shape. All this was consistent with his symptoms and his diagnosis of a torn medial meniscus.
 
That means that if surgery were NOT done, he would certainly have developed irreparable cartilage changes and ultimately, arthritis. In other words, this was a NECESSARY surgery. However, the same tear in someone who already had severe arthritis may, or may NOT be necessary, depending on his symptoms.
 
So, in this instance I was right. His surgeon was right. And, ultimately, the patient himself chose correctly.
 
So what can you do to choose correctly for your own knee pain? First, and I’ve said this over and over, get a real evaluation by an orthopaedist, or at the very least, a licensed health care practitioner. 
 
It’s what you DON’T know that can hurt you. No one can make you have surgery. But you need information to make a rational decision. And this is the best way to get complete information, so you can explore your options, based on what your problem actually IS.
 
By all means TRY conservative, non-operative measures, from the entire spectrum of treatments, alternative as well as conventional, like those I teach in my newest healing program, HOW TO AVOID KNEE SURGERY
 
  http://www.drbillsclinic.com/avoid_knee_surgery.html 
 
For example, inflammation is usually part of the reason for pain. Reducing inflammation will almost certainly reduce pain. One natural way to do that is to take a pharmaceutical grade fish oil, like my ultra pure, enteric coated, POWERHOUSE OMEGA FORMULA    http://www.favoriteformulas.com 
 
Local heat and strategic exercise also play a role, as do braces and ambulatory aids, at times. In many cases, pain can be resolved and function restored, using these nonsurgical therapies. 
 
But at other times, an operation IS the conservative thing to do. So don’t suffer needlessly, wondering should I, or shouldn’t I?
 
It’s a matter of judgment, based on the facts. So get your doctor involved early. And though you SHOULD be sure you are kept informed and fully understand ALL your options, don’t automatically assume that the doctor is there to screw you, or give you a surgery you didn’t really need. Most of us are pretty decent guys, if you give us a fair chance.
 
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
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