So here I am, sitting in the study of the Southern Command Post, reviewing emails. And I came across one from a nice lady who is very concerned because she has knee pain, she is very heavy, given her size and worst of all, she has noises inside her joints that can actually be heard by people around her.
 
She was quite properly concerned because she’d like to get rid of her knee pain, and she wanted to get a copy of my newest healing program, HOW TO AVOID KNEE SURGERY (which you can get here at this link:  http://drbillsclinic.com/avoid_knee_surgery.html ), but she was afraid that it was already far too late for her–that the noise in her knees meant that all the cartilage had worn away completely, and that she had a “bone-on-bone” condition. This is what we in the trade call an “end stage knee.”
 
When articular cartilage, that normally coats the joint surfaces, is so diseased that it has eroded away and exposed the underlying bone, the naked bony surfaces grind upon each other with a deep, hard grinding sound and sensation that, once experienced or heard, is difficult to mistake for anything else.
 
It really is like rubbing two big rocks together, with grinding, rubbing and at times a mechanical ratcheting sensation. And, since the bone is where all the nerves reside, it hurts like hell! And that doesn’t count the extra pain from the inflamed lining membrane (synovium) that adds its own component to the pain.
 
So whether it’s osteoarthritis or rheumatoid arthritis, it’s at this end stage of disease, with exposed, bare bone, when major surgery IS truly indicated. Because at this state of the art, at this time, we cannot yet regrow new, healthy articular cartilage in a totally arthritic joint. The best we can offer is total knee replacements. And when they are indicated, they can be wonderful: pain relief, restoration of function and correction of deformity, with good to excellent results in over 95% of cases.
 
BUT…it’s major league surgery, with lots of risks and potential complications. So you don’t do it if you don’t HAVE to. 
 
However, all noise from within the joint doesn’t necessarily mean that your joints are finished and you need major surgery. Other conditions can cause noise, as well. When the lining of the joint becomes inflamed and swollen, its folds become thickened and enlarged. They rub upon each other, making a finer, more delicate crunching that we call crepitus or crepitation. 
 
If the membrane is restored to normal, the inflammation resolved, the swollen folds stop rubbing together and the noise stops. But if the condition persists for a long time, the membranous folds may become replaced with fibrous tissue (they become bands of scar tissue) and they then must be cut away surgically, to eliminate the sensation and the sound.
 
Then, there is degeneration of the articular cartilage surfaces, which may break apart into shredded beds of cartilage fronds, appearing like areas of “crab meat.” When these fragmented or fibrillated regions rub, one upon another, they too produce a crunching sensation, like walking in a gravel pit. 
 
This condition is called chondromalacia (“soft cartilage” grade III) and once this point has been reached, where there is physical disruption of the cartilage surface, it can never again return to a pristine, smooth surface. I discuss this disease and the various types of arthritis in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN (manual and CD). Get it here at: http://drbillsclinic.com/eliminate_knee_pain.html  However, even though the knee is noisy, it doesn’t mean that it will immediately go on to full end stage arthritis. The knee can stabilize in this state for a long time, sometimes pain-free (if a little noisy), if treated with the exercises I teach in my PAIN-FREE PROGRAM. See what I mean at this link:   http://drbillsclinic.com/exercise_eliminate.html
 
The point is, this lady has nothing to lose and everything to gain by at least trying all the conservative measures that are available, to relieve knee pain. One of them, or some combination of them, may give her the knee pain relief she seeks, and buy time, until she can lose weight and make an eventual surgery safer and more likely successful. 
 
So the next time someone, maybe you, says, “Hey, what’s that horrible crunching noise in my knee?” now you know what some of the reasons might be. And some may well be treatable by non-surgical measures, like those in HOW TO AVOID KNEE SURGERY: http://drbillsclinic.com/avoid_knee_surgery.html   Noise doesn’t necessarily mean it’s the end of the line, or that a total knee is the only option.
 
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 many of you may recall, my dog Kelly had a serious problem a few months back. She suddenly was unable to get up easily or walk without falling down, and when she did walk, her hind legs were all wobbly and uncoordinated (what we in the Medical Profession call ataxia). Naturally, I was concerned that she had a stroke, or some other life-threatening problem of older dogs. But the veterinary specialist I took her to told me that she had a disease not seen in humans (luckily).
 
She had developed showers of emboli (small bits of something that are released into the blood stream) of fibrous and cartilaginous tissue from her hip joints. These fibrocartilaginous emboli had lodged in the tiny blood vessels that feed her spinal cord, blocking the blood supply to the cord and causing neurological damage.  This nerve damage was the cause of her wobbly walking.
 
The good news was that the condition was supposedly self-limited. Given time and the proper support, she should improve. And so she did, initially. But recently, she seemed to get worse again. I can only assume that same phenomenon had happened again. It was so bad that we were discussing whether it would be kinder to put her down.
 
Then, our pet sitter (yes, we have a pet sitter–no kids, but lots of animals) suggested the use of our vet’s new “COLD LASER,” claiming she had seen it work wonders with some of her clients’ dogs. So, the next time she was looking after Kelly, she took her up to the vet and  started her on cold laser treatments.
 
Now, the cold laser has been around for a while. There have been a few studies in humans that yielded conflicting results: some showed improvement in wound healing, pain relief, decreased inflammation, and so on, others showed no benefit. I honestly attributed much of what was reported to a placebo effect, rather than a true beneficial modality.
 
But, there are no placebo effects in animals.
 
And when I came home, I couldn’t believe the results I saw in Kelly, after only three treatments: she was walking almost normally! She was definitely improved.  She was stronger, walked with a spring in her step I hadn’t seen in quite a while and even her tail was held higher, while she walked. Unbelievable. No matter what the reason, it is clear that the cold laser was working, because it was the only variable that had been introduced.
 
A “cold” laser is so called because it is a relatively low power laser, that does not appreciably elevate the temperature of the tissues on which it is applied. It seems to exert an effect by stimulating endorphins (internal morphine-like substances, produced by the body) and reducing inflammation. 

The process is called “biomodulation.” In other words, the low power laser light stimulates biochemical changes within the body, which appear to have a beneficial, regenerative effect. 

Now, a few of my subscribers have asked me about this modality. Some people swear by it. Not a whole lot of valid scientific studies, but lots of anecdotal positive reports. I’ve had a few of my patients use it during the years I was in clinical practice, and those that tried it swore it helped them. And, as I mentioned, there’s no such thing as a placebo effect in animals. If it can objectively help my dog, Kelly, maybe it can help you, too.
 
My attitude has always been that if it can’t hurt and it might help, why not try it?
 
Cold Laser is just one of the many non-surgical, alternative methods for relieving knee pain that I review in my newest program, HOW TO AVOID KNEE SURGERY. See what I mean for yourself at my website, 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