Hope you had a nice weekend. I know I did. But when I woke up this morning, I had a problem I haven’t had for a long time–a wry neck. Why? Well, I was doing a bit of unaccustomed activity, namely vacuuming the house. And with a bunch of cats flinging litter over the side of their boxes all the time, that’s a necessary evil more frequently than I would like.
 
Felt fine at the time. No soreness, no stiffness, no problems apparent. But this morning, as I tried to roll over and get out of bed–OUCH! Stabbing pain and spasm in my upper back, just at the base of the neck. If this were to follow the old pattern, it would gradually tighten, all throughout the day, and suddenly spasm in certain positions, like when I would try to rapidly turn my head.
 
This was a chronic recurrent problem during my surgical career. You may not think that surgery is stressful to your muscles, but you’d be wrong. Orthopaedic surgery, which often requires the surgeon to lug around some pretty large and heavy legs, is extremely physical. And the surgeon is required to get into some pretty awkward positions, to get at the parts of the joint that’s being fixed. You don’t think of that, because when you see a photo of surgery, it’s sanitized and usually features actors or models. I assure you, the reality is very physical indeed.
 
In addition to the actual physical labor involved, and this was the biggest factor for me, the near constant tension of personal responsibility for the patient. Whatever goes on, your fault or not, is your responsibility. It’s the “Captain of the Ship” concept. And it’s that subtle tension that permeates every waking moment, always in the background, always there, that makes the vulnerable neck prone to spasm.
 
I remember during my first rotation as an intern, my chief resident, Fred, asked me about some adverse effect that affected one of my assigned patients. I don’t even remember what it was, after all this time, but I protested, “It wasn’t my fault.” He replied, and this burned its way into my brain and lasted for the rest of my surgical career, “Stillwell, it ain’t your fault, but its YOOORE responsibility” (delivered in a real Southern drawl).  Indeed. From that time onward, I took that to heart. So that subtle tension was ALWAYS there.
 
In fact, when I saw some of my friends in the OR, after my retirement, almost to a person, they remarked on how relaxed I looked. First time they’d ever seen me when I wasn’t carrying that burden.
 
In addition, it seems I had a couple of bulging discs in my neck, which I’m sure played a role as well. In fact, if you ever experience stabbing pain along the upper back, just along the border of your shoulder blade (ie., medial border of the scapula) that’s a classic pattern for a C5-6 radiculopathy (pain caused by pressure on the C5-6 nerve root, as it emerges from the spine, usually a bulging or herniated disc). I can vouch for that, personally. It’s true.
 
So, what happened this time? Well, besides the vacuuming, I think I slept in an awkward position, giving those chronic discs in my neck a chance to get pinched, get inflamed and cause mischief. Given that it rarely happens these days, I should be grateful. But, hell, it HURTS. So here’s what I did, and what you can do if it happens to you.
 
First, I mobilized both my shoulders, rolling them forward and backward. Most wry neck cases (also called torticollis, in medical lingo) involve spasm of the trapezius, the large muscle that attaches to the base of the skull, both shoulder blades, and then sweeps down to the middle of the spine. So this movement helps to loosen up that muscle.
 
Then, I rolled my head slowly in each direction, again to break up spasm and loosen up the trapezius. You can actually feel the muscle stretch as you do this.
 
Then, I used a powerful vibrator to massage the site of maximal spasm. Now, to do this, you need one of the long wand-like electric vibrators, with a club-like head. The idea is to increase local blood flow to the spastic areas and relax the spastic muscles. Hand massage, by a significant other or a professional, is also very effective.
 
Local heat, local applications of magnets (yes, this DOES work) and medications and diet to reduce inflammation and relax muscular spasm are also helpful. Oddly enough, even though this regimen is for your neck, it’s effective for local inflammation and spasm anywhere, and in any joint.  This is how a sore neck is like a painful knee.

This regimen is reviewed in great detail in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN http://drbillsclinic.com/eliminate_knee_pain.html  
 
And it works. If it didn’t, I wouldn’t be able to sit and write this email. So, whether you have a wry neck or a painful knee, the principles are the same and this combination of methods will work for you. You can see for yourself and try it at http://drbillsclinic.com/eliminate_knee_pain.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

A good friend of mine emailed me today for advice.  He’s a doctor of chiropractic who’s developed severe pain in his hip joint. He saw an orthopaedist, who got an MRI, but it was inconclusive–could be edema, or it could be a more serious disease that could result in surgery. 
 
Trouble is, the picture doesn’t look like what you’d expect if he had the more serious disease. Typical of the problems one sees in clinical practice–cases often don’t follow the textbook presentation. So it makes it tough to know exactly what to do.
 
Seems the guy has asthma and he’s been taking steroids (prednisone) for some time to try to control the symptoms. But one of the potential and most dreaded side effects of longer term systemic steroid use, typically seen in asthmatics, rheumatics, or people with chronic allergies or skin diseases, is a bone disease called avascular necrosis.
 
Avascular necrosis is a kind of weird disease that no one’s ever heard of, until they get it, or know someone who did. It refers to the death of bone cells inside a bone. It’s variously called aseptic necrosis (meaning it is NOT caused by an infection), ischemic (meaning it’s due to oxygen deprivation) necrosis, or avascular (lack of blood supply) necrosis, or just plain old osteonecrosis (or “dead bone”) where “necrosis” means cell death. It commonly affects the hip, knee, shoulder, or ankle, in roughly that order.
 
For any number of reasons, this happens because there is a blockage of the blood supply to the bone of the affected joint. Think of it like a dam in a river. So everything “downstream” that is normally fed by the blood supply is suddenly cut off. The cells, deprived of oxygen, begin to die. The surrounding bone then begins to deteriorate. In the case of the hip, this area is recognized as “dead” by the body and special cells go to the site and begin eating away the dead bone area, so that new healing bone can be laid down.
 
The problem is that as that dead bone is removed, support for the overlying joint surface is is removed, too. The pressure across the joint surface causes the joint surface to collapse under the pressure. Think of a house that has its foundation eroded by an underground river, or a sink hole. What happens to the roof? Caves in, right? 
 
Same thing.
 
When the “roof” caves in, that segment collapses, the hip suddenly hurts like Hell and the resulting irregularity rapidly chews up the rest of the joint, causing rapid onset of arthritis. Very bad news, indeed.  Once that happens, nothing short of a hip replacement can relieve pain and restore function.
 
If you recognize the disease early enough, you can do a small surgery that can often save the joint from collapse. Through a tiny stab wound incision and under fluoroscopic control, a surgeon can drill a hole from the side of the hip bone into the femoral head, just like coring an apple. This relieves pressure inside the femoral head, which is believed to be responsible for cutting off the blood supply to the femoral head. Not as big a deal as total hip replacement, but, hey, it’s still surgery, right? You want to avoid it, if you can.
 
So the doctor’s dilemma is to get an accurate diagnosis quickly enough to do a lesser surgery and head off joint collapse, but not to do an unnecessary surgery, if it isn’t needed. And he has to try to relieve the hip pain, while all this is going on. Not always an easy thing to do. And made much more difficult when the picture isn’t typical. Tough to know what the right thing is to do…
 
Same thing occurs in the knee, but there, because the knee is a larger joint (in fact, the largest joint), it’s a lot more forgiving and less likely to collapse than the hip. So there, conservative non-surgical treatments make the most sense, like those I teach in my newest healing program, HOW TO AVOID KNEE SURGERY, which you can get at  http://drbillsclinic.com/avoid_knee_surgery.html
 
Meanwhile, I recommended my friend reduce the forces across his hip joint by using a cane. Same thing for a painful knee. Sometimes, the simplest things are the most effective. That, combined with a number of the alternative and conventional non-surgical treatments  to relieve pain, that I describe in detail at http://drbillsclinic.com/avoid_knee_surgery.html  may be very helpful to him. Even though the program was written for the knee, the methods I use are systemic, that is, they work for the whole body, hip included. And that program comes with a FREE Special Report on HOW TO RELIEVE HIP PAIN, too.
 
So, I wished him luck. Hopefully, he’ll recover soon, and avoid all those problems. We’ll just have to wait and see…
 
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

Soon after touching down in the Orlando International Airport last week, I realized that my local comics shop (ACME Superstore, Longwood, FL) was holding two weeks’ worth of my comics. The books come in on Wednesdays, and we had left town early on a Wednesday, returned late on the following Thursday, so they had two weeks’ worth of comics in my file. 
 
The problem with that, is that I often pick up additional titles, when I pick up the books I subscribe to. And if I let it go for more than a week, it’s hard to keep track of these. So I end up missing some items I would have liked to have. Also, they sometimes sell out of an issue I want. The point is, I like to keep current and visit the shop weekly, if I can. 

If you’re a long time subscriber, you know that I’ve been reading and collecting comics since the early sixties. In fact, as a professional artist, I actually worked in the comics industry, back in the early seventies. If you’re not a long time subscriber, you know it NOW. If you’re at all interested in seeing some of my non-medical drawings (heroic fantasy and horror) and a glimpse of “what might have been,” go get back issues of CREEPY #35  and CREEPY #37 (Warren Publications) in your local comic shop’s back issue files, or a fanzine called HOT STUF’ circa 1973.

My wife, who was mortified at my extracurricular interest, as being somehow beneath my station, would often exclaim, “A man in your position! What if your patients knew what you read in your spare time?!” 
 
With characteristic modesty, I would always reply, ”Honey, when you’re as smart as I am, you really don’t give a damn WHAT they, or anyone else, thinks!” C’mon! It’s not as if I was doing anything that was illegal or immoral (I keep those activities strictly hidden
 
Anyway, it was an off day, Friday, when I finally made it there. The owners and most of the staff were away, and only Penny, one of their sales associates (a very pretty blond and, as it happens, one of my listed testimonials on the website) was there. She got my comics from my file, and, sure enough, there were some other books I wanted, as well.
 
As I took the books to the register, to pay for them, I noticed that Penny didn’t look too happy–not like her, at all. “What’s the matter?” I asked. “Oh, my knee’s been bothering me lately. It’s feeling kind of numb,” she replied. 
 
From many long years of clinical experience, I knew to ask her what she meant by “numb.” See, my father-in-law would always say he felt “numbish,” by which HE meant a dull aching pain. To me and any other physician, “numb” means something entirely different: a decrease in sensation, usually soft touch. But had I not learned that some folks SAY that, when they really mean a deep, dull pain, we could’ve been there all day, not understanding each other.
 
Then, she said that the pain was behind her kneecap, but indicated with her hand that it was really behind the entire knee, in back of the leg. Again, a potential failure to communicate, had I not seen her point. 
 
But the kicker was that she also had pain in her buttock, right in the middle, just behind her “hip bone” (greater trochanter), above the “painful knee.” And it would radiate down the outer, posterior thigh into the knee and the upper calf. Well. Even though Penny had previously had arthroscopic knee surgery, to treat real pathology (I saw her intraoperative photographs), her problem was really one of sciatica– pinching or pressure on the sciatic nerve, probably as it emerged from the sciatic notch in the pelvis, on its way down the lower extremity.
 
Sometimes, “knee pain” isn’t from the knee at all. Other problems, in the spine, the hip joint, the pelvis, the sacroiliac joint, the abductor muscles, the trochanteric bursa, the piriformis muscle (which I suspect in Penny’s case) can give a false impression of knee pathology, even though the true cause is from a distant site. You can learn more about all the root causes of knee pain in my LITTLE GREEN BOOK; see it at  http://drbillsclinic.com/eliminate_knee_pain.html
 
By this time, we had a few of the other customers watching us, as I conducted a cursory exam and ran my makeshift “comic shop clinic.” I gave her some advice, like the alternative measures I reveal in my new healing program, HOW TO AVOID KNEE SURGERY at   http://drbillsclinic.com/avoid_knee_surgery.html   My tips included ways to rapidly reduce any local inflammation, relieve pain and stretch the offending tendon, which is placing the sciatic nerve under pressure. If she does what I told her to do, she’s  likely to be better in just a few days, without even a doctor’s visit (unless you count mine .
 
If you, or someone you know has knee pain, there are a number of effective methods to relieve it, and do it without expensive drugs or surgery. See how at:  http://drbillsclinic.com/eliminate_knee_pain.html   And if you think you need knee surgery, first try: 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

 There I was over this past weekend, talking with some of the paticipants of Matt Furey’s GET TOUGH! Fitness Seminar this past Winter. I wasn’t there myself, built as I am for comfort rather than speed . But a near universal remark among those of my vintage, or even a bit younger, was the deep and persistent muscular aching they all experienced. Even those who are very fit and are habitual exercisers felt it. 

One of the ways that you know you’re getting older is this delayed muscular aching after vigorous exercise, that seems to be more intense, and seems to last much longer than when you were younger. The technical term for this is Delayed Onset Muscular Soreness, or DOMS.  As a mnemonic, just remember the old DRAGNET theme: “DOM…DA DOM-DOMS…” 

This is a product of inflammation, provoked by microtears and other microtrauma, induced by exercise. This is the stimulus for muscular hypertrophy–in other words, this is how exercise causes muscle fibers to grow larger and stronger. With age, this process takes longer, and the discomfort is prolonged. Since muscular hypertrophy results from this process,
it follows that it isn’t the exercise, but rather the REST after the exercise that allows the muscles to grow and strengthen. This has practical implications. If you’re trying to get stronger, REST, for proper recuperation, is just as important as the exercise you do.

This is especially important when you’re doing exercises to treat joint pain, such as the specially modified exercises I teach in HOW TO AVOID KNEE SURGERY, at  http://drbillsclinic.com/avoid_knee_surgery.html
 
It’s sometimes difficult to differentiate between the joint pain itself and the muscular soreness that results from the exercises, when it’s excessive. The rule of thumb that I was always taught and that I have found to be true throughout my career is that mild muscular soreness that follows exercise, but fades by the following day indicates just the right level of exercise intensity. If soreness persists beyond the following day, it’s too much.

To treat this condition, first, REST. Don’t add to the problem by exercising before the soreness and stiffness have resolved. Next, apply local moist heat.  You’ll find it feels soothing, which helps to bring healing blood into the area and speed the resolution of inflammation. Anti-inflammatory measures are also helpful, including OTC medications. But be sure to take any of these meds with FOOD, to protect your stomach. 

It’s also worth noting that in the GET TOUGH! Seminar, the exercises were ALL bodyweight techniques–no free weights. And still, many participants had significant persistent soreness, in some cases for many days. That should put to rest the idea that bodyweight exercises are not adequate to really stimulate muscular strength. If you want a full body workout that is challenging, functional and SAFE, try Combat Conditioning, at  http://drbillsclinic.com/combat_conditioning.html
 
And if you want to treat a painful knee with non-surgical methods, including many of my specially modified exercises, see HOW TO AVOID KNEE SURGERY at   http://drbillsclinic.com/avoid_knee_surgery.html  It’s the only program like it out there…and it works. 

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

Well, here we are in Orlando, where it’s cloudy but not even raining yet. And the press has worked itself into a lather over the approach of Fay, a tropical storm with hurricane potential. Now, it is true that Fay has spawned some tornados, apparently killed ten people and should be taken seriously. But so far, virtually nothing that has been predicted has happened.
 
I’m well aware that meteorology is an inexact science. That’s rather like saying King Kong is a large monkey. I mean, these guys are wrong so often that they could probably do better if they flipped a coin. They know it’s raining when they look out the window. For all the sophisticated computer models, specialized radars and scientific analysis, they are clueless about what’s going on in the real world.
 
See, the problem is the computer models. The models are accurate ONLY if the premises on which they’re based are valid. Wrong assumptions, wrong results. Since the facts on the ground (or rather, in the air) are always changing, it makes it tough to accurately predict what’s actually going to happen. You see, I understand their limitations, but talk about your overpaid guys!  They get paid whether they’re right or wrong! In fact, most people expect them to be wrong. Meanwhile I was supposed to be perfect–any deviation from perfect is assumed to be defacto evidence of malpractice. Feh! Makes me sick!
 
Don’t get me wrong. I’m glad we don’t have to deal with a major hurricane. It’s just annoying that every prediction these guys make is presented with a certitude that keeps us all in a state of fear. That was the premise of a very good book by Michael Crichton, he of Jurassic Park fame, of the same name (State of Fear). His theme was the constant “state of fear” that the media tries to keep the public in, with one dire prediction after the next. And it’s absolutely true.
 
And here’s something else to think about: this is the same “science” that supports those who buy into the whole apocalyptic “global warming” business. Almost all of it is based on computer models, just like the day to day weather, apparently with the same degree of accuracy. 

This would explain the phenomenon of melting polar ice caps, rising seas (which, given Al Gore’s time line, should have swallowed several coastal cities by now) et al, which are a product of extrapolated computer models. Same problem: if the assumptions on which the models are based are faulty (ie. warming, such as it is, is the product of man made activity, greenhouse gases and the like), the results are, too. This is why the polar ice caps of Mars are also observed to be receding, absent ANY man-made activity (so far as we know). And it explains why our polar ice is now INCREASING, contrary to the predicted findings of the models.
 
People who are fully invested in the whole global warming enterprise are aware of these disturbing variations in the real world from the computer models. That’s why you now hear more about “climate change,” than global warming these days. Here’s a clue: the climate is ALWAYS changing–that’s what it does. And all climate is a function of the activity level of the SUN, the source of all energy on earth. The amazing thing is not that climate varies now and again, but that the narrow range necessary to preserve life on our little planet is remarkably constant.
 
So while the meteorologists and weathermen appear to be fey on Fay, I’m going to look out my window, onto the real world, and see what the weather’s doing. Still cloudy, still no rain, mildly breezy here in Orlando. But the radio says twisters were noted in Southern Florida. Which way will it go? They have NO IDEA, though they have plenty of predictions. Ah well, let’s hope it misses us. We’ll soon know…
 
Speaking of the crappy weather of the Hurricane Season, ever notice that your joints ache when it’s about to rain? Or that you feel sleepy when it’s cloudy and damp? Well, that’s a function of specialized nerve endings in the tissues around your joints that respond to a fall in barometric pressure (baroreceptors). Any inflammation, as from synovitis, arthritis, a chronic sprain or strain, a recent fracture (even if healed) aches with damp weather.
 
You can ease those aches and pains with some local heat applications and the various anti-inflammatory measures I teach in my newest program, HOW TO AVOID KNEE SURGERY    http://drbillsclinic.com/avoid_knee_surgery.html
Using measures from across the medical spectrum, you can relieve pain, reduce inflammation and restore function in your painful knee–without surgery. 

Til next time, my friend, stay dry, stay safe, and 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

Besides the fact that I am a hip & knee specialist, albeit retired from active practice, the reason that I decided to focus on knee productsfor the start of my “second career” on this web site is that knee pain seems to be a very common, nearly universal problem, especially in people of my age group, The Boomers.  It happens almost every day–someone will mention that they have a painful knee, or they have arthritis, or they have a knee that “gives out,” or some other problem. It doesn’t get the “press” that back pain does, but everybody seems to have it, in one form or another.
 
Hell, I’ve had it myself–as many of you know. There’s nothing quite like having the same problem as your patients to give you a whole new appreciation of what they’re going through. They call that empathy. When I had my arthroscopic surgery on April 15, 2000 (Tax Day–might as well get all the agony over with at one time), believe me, I had a brand new understanding of what all my patients over the years had been experiencing. 

The need for the surgery, as you might expect, was well documented by physical exam, and a positive MRI, that demonstrated a torn medial meniscus. It had been interfering with my walking and exercising and I had just had enough. I called two of my best buds in the Department; one was busy and didn’t return my call, but the other saw me right away. Hey, rank has its privileges, right? Well, he agreed that I needed the ’scope. So we booked it for the local Surgi-Center, which specializes in outpatient surgeries.
 
So on the big day, they rolled me into the OR, smiles all around. They started an IV and slipped me a little IV Versed (a short acting relaxant that has the side effect of short term amnesia). Very relaxing, almost pleasurable. I remember just a tiny stab of sharp pain in my left knee, where I needed a little more local anesthetic, otherwise, nothing. Woke up gradually in recovery, feeling fine. If you ever need to have surgery, this is called “conscious sedation” and it’s definitely the way to go.
 
As soon as I woke up sufficiently, they let me go and I went home. Set myself up in bed with my leg well elevated, with a big bag of crushed ice on it, to reduce swelling. At first, I was quite comfortable…then, the local anesthetic, injected into the knee at surgery, wore off. Oh boy! That was sore and even worse when I had to put it down to limp to the bathroom on crutches. So THAT’S what they were all complaining about. I suspected that MY surgeon had given me less anesthetic than I gave my patients. Took at least 2-3 days, before I could put some pressure on it.
 
Turns out I had a whole lot more pathology in that knee than I initially thought. That’s the thing about MRI’s and other interpretive examinations: the real thing is always worse than the scan indicates. In my case, a small area of bare bone under the residual meniscal rim, in other words, some arthritis. Now, with time, and me doing my own therapy, with the same exercises I teach at http://drbillsclinic.com/exercise_eliminate.html   I gradually improved, more and more.
 
But after my left knee recovered, the right started acting up. I thought about going through the same process that I had just finished on my left knee, and decided that the odds were good that I had a “mirror image” lesion (in other words, the very same pathology) in my right knee. THIS time, I opted to AVOID SURGERY and treated myself with all the various options I knew about from across the entire treatment spectrum: the best of conventional therapy, alternative measures, dietary changes, nutriceuticals, the works.

And it’s worked–so far, I haven’t had to have surgery on my right knee. And these same measures are those that I used for the over 90% of my patients, who I was able to treat without surgery. Now, I’ve put all these strategies and a number of healing programs into my newest product: HOW TO AVOID KNEE SURGERY. Go see it at    http://drbillsclinic.com/avoid_knee_surgery.html
Get rid of your pain, restore your function, and do it WITHOUT SURGERY. 

Til next time, my friend, be well. And have a great weekend.
 
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

June 2, 2008

Over the weekend, I came across an article published in the Washington Post by Dr. Jeremy Brown, Associate Professor of Emergency Medicine at George Washington University Hospital. He described a woman in her mid-forties who came into the ER with knee pain, but
no history if trauma or other obvious reason, except that she was “close to 300 pounds.” Besides evaluation, she reportedly wanted an    x-ray of her knee.

Dr. Brown pointed out many of the reasons one would want to get an x-ray, and the fact that everyone would be happier if he did just that. But he then used this as a springboard to point out that obesity is one of the last “forbidden” topics to bring up with patients. He noted that besides past history and immunizations, allergies and HIV status can be discussed, but no one mentions the topic of obesity and its role in many diseases, including knee pain. 

While I get his point, he made kind of an either/or situation out of his example. And I really don’t think that’s entirely appropriate. In point of fact, although it’s just fine to approach the topic of obesity with a heavy patient, if a doctor actually refused to order an x-ray in such a case, I promise you, an attorney would be knocking on his/her door with a subpoena, in short order! And, for a change, the attorney would be right. 

Just because a patient is heavy is no reason to assume that obesity is the only reason for his/her pain. You know what they say about assume, right? I mean, heavy folks get intra-articular pathology too. And if you don’t look for it with x-rays, and where appropriate,
MRI, etc., you won’t even know it’s there. And the weight makes the pathology that much worse; in some cases, it actually causes, or at least contributes to the pathology. 

I’ve told you before about the extra forces that above average body weight imposes on the knee joint, especially when attempting to run, jump, or climb stairs. And, of course, there’s the whole list of attendant health problems from coronary artery disease and strokes to
pulmonary problems, higher incidence of cancer and degenerative spinal and joint changes. So it’s well accepted that being considerably overweight isn’t good for you. But, if it also prejudices an ER doc to attribute your pain to an overloaded joint, without further investigation, then that’s an additional risk of compromising your care.
 
When I was in training at Metropolitan Hospital in New York City, back in the early 70′s, I remember that one of the key points that was drilled into us was to NEVER ASSUME. That drunk with the slurred speech and the bump on his head might just be drunk, but he also
might have a subdural hematoma from a hairline skull fracture, which will kill him, if you don’t work him up, just like everyone else, and discover it in time.
 
In the same way, you can’t just assume that an obese patient with knee or other joint pain is suffering because of the obesity. There might well be a torn cartilage (meniscus), or arthritis, that will usually respond to treatments, like those I teach at
 http://drbillsclinic.com/eliminate_knee_pain.html      The point is, if you don’t look, you can’t know.
 
So, according to Dr. Brown, when a doctor is evaluating the obese patient with a painful knee, but no obvious history to explain it, the physician has a choice between counselling the patient about weight control measures, versus conventional workup and x-ray. For the reasons I’ve outlined above, I don’t think they’re mutually exclusive. In fact, I have a modest proposal–Why not do both?
 
In practice, that’s what’s done anyway. Too much chance of missing something pertinent if you don’t, and like I said, you just can’t assume. So, if you’re ever in an ER and some guy tries to blow you off, counselling you about your weight (especially if it IS a problem), you INSIST on an x-ray and any other appropriate tests. Once you KNOW there’s no other pathology causing your pain, THEN  try dieting and knee exercises, like those I teach at    http://drbillsclinic.com/exercise_eliminate.html
Just remember, pain from overloading, like pain from overuse, is what we call a DIAGNOSIS OF EXCLUSION. And that means, you have to PROVE there’s not another reason.  Don’t settle for less! 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