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

Eeeeeeeeeeeeeeee! The electronic tone went off as our front door opened this morning at 8 AM, and Joe, our contractor, came in to continue the renovation job in our basement. Woke me up instantly, though the bride remained asleep. Hey, after lots of years of having to get up at the very crack of dawn, I like to sleep in, now that I’m retired. Just before awakening, I had been dreaming about Jonathan Swift’s iconic character Gulliver, standing in the sea, on a shore, bound with a host of Lilliputian lines. 
 
“Why in the world was I dreaming about that?” I wondered. 
 
Then it dawned on me, that an article in the Oct. 14th Wall Street Journal by Bret Stephens, “America Will Remain The Superpower,” referenced that character, as a metaphor for the international ramifications and implications of the recent market meltdown: “When the tide laps at Gulliver’s waistline, it usually means the Lilliputians are already ten feet under.”
 
The author’s point was that the decline in value of our stock market by 25% in three months (before the surge back of yesterday)meant that the Dow had “outperformed nearly every single major foreign stock exchange (which all had losses substantially in excess of our own)” and that “America’s financial woes are nobody elses gain.” Or put another way, the news of America’s demise as a superpower is greatly exaggerated. And whatever affects us is that much worse for pretty much everyone else.
 
It was only a single line in a long article, but I guess that image made an impression on my subconscious, that showed up in the dream.

Well, as you may or may not recall, Jonathan Swift was a satirist, responsible for some pretty biting criticisms of his society at that time (my favorite was “A Modest Proposal,” which suggested that a way to deal with famine was cannibalism). And Gulliver met people both much smaller (Lilliputians) and much larger (Brobdingnagians) than himself. But I think my subconscious took the image more literally, perhaps portraying various problems and concerns I might be thinking about as those pesky lines, binding my “big self.” And in taking this form, the dream itself suggested the solutions. 
 
What’s interesting about this metaphor is that in order to break free of those entangling lines, ACTION is required. Passive acceptance of his situation will only result in further loss of freedom. It’s only Gulliver’s travails that will ultimately set him free.
 
In the same way, if you have any problem, physical, mental or spiritual, the worst thing you can do is nothing. Passive acceptance guarantees no change. You have to analyze your situation, determine what’s necssary to change it, and then you must take the necessary action to effect that change.
 
For example, if you’re crippled with arthritis, or suffering from knee pain of any cause, just sitting around won’t change your condition. You have to TAKE ACTION, like the simple, non-surgical treatments and the specialized modified exercises I teach in my newest healing program, HOW TO AVOID KNEE SURGERY, which you can see at this link:  http://drbillsclinic.com/avoid_knee_surgery.html
 
If you want to relieve your knee pain, FAST, and restore your joint stability and full function, then you need this program! Click on the link and see how:  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

This email comes much later than most because we just got in from a Hampton Jitney Tour into New York City. We got up at the crack of dawn this morning, around 5:45AM, so we could get to Riverhead, where we were to meet the Jitney. I know the proverbial early bird catches the worm, but this WAS pretty early…especially for me. I need my “beauty sleep!”

My wife had arranged this little excursion because her father and a friend of ours have been staying with us all this week. This was a particularly nice trip and I’d been looking forward to it all week. I have to tell you, this was a really nice way to get into The City. I’d never done this before, but I got to rest, even nap a little, in comfort and with no stress. 

Normally, just driving into New York, especially in the morning rush hour, leaves me tense and often with a tension headache, just from dealing with the traffic and trying to stay alive on the road. There’s a reason they say “The LIE (Long Island Expressway) is LOL.” We got in about an hour and a half early at Chelsea Piers, on the West Side of Manhattan, right on the Hudson River. 

The plan was to have lunch aboard one of the harbor cruises in New York Harbor, then see a play at Lincoln Center’s Vivian Beaumont Theatre. The weather was supposed to be lousy–rain was expected from Tuesday night through Wednesday morning. Luckily, the rain held off all day. We only saw some rain tonight, on the way back home. So, despite the dire predictions, we had just great conditions–not too hot, not too cold, mostly sunny with a nice breeze. All in all, couldn’t have been better. 

The food was pretty good, too. I had the wild salmon with dill sauce that was REALLY good. Spent most of the time above decks, taking photos of the skyline, just like the rest of the tourists.Then, we all got back on the bus and were dropped off at the Vivian Beaumont. 

The play was “SOUTH PACIFIC,” the first revival since the original musical production in 1949. It’s based on the novel by James Michner, “TALES OF THE SOUTH PACIFIC.” As sheer entertainment, it was terrific! Many of the musical numbers and songs from this Rogers & Hammerstein production have entered the cultural lexicon: “Some Enchanted Evening,” “I’m Gonna Wash That Man Right Outa My Hair,” “Bali Hai,”and a number of others were dimly remembered from my youth (I saw the movie, not the original play). It was well done and I enjoyed myself thoroughly. 

One of the funny things was that my father-in-law, Charlie, who actually WAS in the South Pacific Theatre during World War II, said, “Bill, I don’t remember the South Pacific being like THAT. It was hot and sticky and the enlisted men were NOT allowed to fraternize with the natives.” Well, that’s show business for you!

The thing about the theatre is that the rows of seats are so jammed together that your knees are bent, with virtually NO leg room. And I’m not a tall guy. Really tall people must feel like they’re folded up and boxed in! And for three hours, too! It was a loooong play. 
 
So my knees and those of all my party were aching by the time the play was finished. But at the intermission, I was able to knock out a few quadriceps setting isometrics, like those I teach in my new program, HOW TO AVOID KNEE SURGERY http://drbillsclinic.com/avoid_knee_surgery.html
I swear, it was like magic! The aches disappeared–just like that. 
 
And that’s what YOU can expect, with this and other tips I reveal in this new healing program.If you have knee pain, sore kneecaps, or knee injury,and want FAST pain relief , with conservative, non-surgical treatments and selected, specially modified exercises, then try my program today: http://drbillsclicic.com/avoid_knee_surgery.html

So, all-in-all, a really pleasant day…and you might even say, an “enchanted evening,” too. We had a great time. 
 
Well, it’s back to Florida tomorrow, for a while at least. Talk to you soon, my friend. Meanwhile, be well. Til next time,
 
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

As you know, before the last few days, I’d been giving you the “Readers’s Digest” version of a number of different types of knee surgery. The purpose is to alleviate your fears, based as they are on misinformation, exaggeration, outright distortion and your own imagination, by telling you exactly what’s done. This gives the fears limits, as reality limits imagination, and helps you to cope, if you actually DO need one of these procedures at some time.
 
We’ve already covered basic arthroscopy, as well as patella debridement and realignment, partial meniscectomy for a torn meniscus, and, most recently, arthroscopically assisted ACL reconstruction. Today, I will finish up the description of other miscellaneous arthroscopic procedures, that are often done simultaneously. 

Bear in mind that once you’ve entered the joint through those tiny arthroscopic portals (mini-incisions), there’s almost no limit to what you can do in there. And the postop morbidity (pain, swelling, stiffness, disablity, etc.) is pretty much the same, regardless of how much you do inside the knee, UNLESS you cut, drill, abrade, puncture, or otherwise violate the bones. 
 
If you DO get into the bones, you automatically increase postop bleeding, pain and swelling–which makes sense, right? Otherwise, however much you do, the postop limitations are a function of those tiny portal incisions. That’s the great advantage of arthroscopy and why it’s been a transformative concept in modern surgery, that’s made outpatient surgery possible.
 
All these procedures are described in much greater detail, including the conditions that require them, in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN,  available now as a book and an audio CD, too, at  http://drbillsclinic.com/eliminate_knee_pain.html
But for now, let’s look at a few other conditions for which arthroscopic surgery is often recommended, how they are treated surgically and whether other options and NON-surgical treatments are available.
 
First up is SYNOVITIS, an inflammation of the lining of the joint (any joint that has freely moving parts, not just the knee). I alluded to this with a brief remark, last Wednesday. When the lining of the joint gets irritated, it gets bigger, actually grows, often in an irregular way, resulting in flaps, shelves, clumps and masses, that can flop around inside the joint, occasionally getting trapped between the moving parts. This entrapment causes pain, and further swelling and inflammation. The irritated membrane produces lots of joint fluid, resulting in “water on the knee,” as well as pain.
 
The arthrocopic removal, or resection, of this diseased membrane is executed with an electronic motorized shaver. This is a stainless steel tube, with a small window at its end. The window encloses a rotating (or reciprocating) blade, that nips off small morsels of synovium, which are then sucked out by a vacuum pump and collected in a trap, for pathological study. Using this technique, you can systematically resect almost ALL the lining, as in cases of Rheumatoid Arthritis, or Bacterial Infection, where you want to rapidly “debulk” the mass of diseased membrane. But guess what? A new membrane grows back very rapidly, hopefully in an uninflamed, relatively normal state.
 
DEBRIDEMENT is a French term, meaning “house cleaning,” and it’s pronounced “De-BREED-mont,” not de-BRIDE-mont. I had an Australian professor once, who use to say “Da BRIDE is whut walk down de aisle wit’ de groom. Gentlemen, it’s deBREEDmont.” This refers to shaving off loose shreds of degenerative cartilage from the articular surfaces, to smooth them out. It’s important to remember that you can only REMOVE tissue; you can’t put anything back. 
 
Normally, the shaver is used to do this and it’s combined with synovectomy and LAVAGE, essentially washing out the joint with irrigation fluid. This is controversial in the treatment of arthritis, but if you’re there for other reasons, you might as well “clean house.” Today, you can also do this with radiofrequency probes and lasers, too.
 
And, as I also mentioned last Wednesday, LOOSE BODIES and FOREIGN BODIES can be grasped by forceps and extracted through the arthroscopic portals.
 
Areas of bare bone, if they’re small enough, can be treated through the scope to restore some kind of cartilage covering, but as I mentioned above, the morbidity and pain is greater once you penetrate the bone surface. Arthroscopic awls are sharp, pointed steel spikes that are used to put multiple shallow punctures into the bone, a procedure called MICROFRACTURE. Another way to do the same thing is to use a high speed burr to “sand” the surface and stimulate bleeding. This is called ABRASION CHONDROPLASTY. Both these techniques result in blood clot, which is changed into fibrocartilage over the bare area.
 
An alternative is to restore actual hyaline cartilage, in one of two ways: CHONDROCYTE TRANSPLANTATION, in
which cells initially harvested from non-articular parts of the knee are cultured, then reimplanted to grow new cartilage; and OATS (Osteochonral Articular Transplanation ) which transposes plugs of bone, with its articular cartilage attached, into drill holes in the bare area. Pretty cool stuff, no?
 
And, really, NOT so scarey, now that you KNOW what’s involved, right? Whatever it is in your life, if you KNOW what you have to deal with, you can DO it, if you have to.
 
But, there are many times that you DON’T need any of these techniques. Those are the times that surgery ISN’T warranted, because conservative methods will work to relieve your pain and restore your function just fine, thank you very much. If you want to AVOID An
UNNECESSARY SURGERY, then you need my newest healing program, HOW TO AVOID KNEE SURGERY. Get it here, at
 http://drbillsclinic.com/avoid_knee_surgery.html
 
Next up, osteotomies and realignment surgeries. Talk to you tomorrow, my friend. Meanwhile, 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