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

Back in the Dark Ages of 1969, I started Medical School like many generations of young doctors-to-be before me, with Gross Anatomy. I understand that the powers that be have demoted the importance of Anatomy in the training of medical students, teaching only that fragment of the whole necessary to have a basic understanding of whatever topic is being discussed at that time. 
 
Like much in education today, all change is not progress…but I digress. 
 
At that time, having a sense of the whole mechanism of the human body was still considered a necessary fundamental. So Anatomy was where everything began for us.

Now, in all the Pre-Med training in High School and in College, Anatomy was always a staple subject, as a part of Biology, together with Chemistry, both Inorganic and Organic, and Mathematics (though why they thought you needed higher Math to be a physician was and is beyond my comprehension–especially Calculus). 
 
But the Anatomy studied was always that of the lower orders: frogs and earthworms in High School, dogfish (tiny sharks) in Introductory college Biology, and progression up the taxonomic scale with each succeeding course through The Fetal Pig and finally, The Cat in Mammalian Anatomy. And with each textbook, filled with anatomical minutia we were expected to memorize, there was an actual animal, preserved in formaldehyde, we were expected to dissect.
 
Sure, there were discussions and pictures and textbooks color slides and even movies (pre-video–these were 16mm films. I TOLD you these were the Dark Ages:) of human anatomy, boiled down to its essentials. But mainly, the study of animals was used to acquaint the student with the various physiological systems, which were then related to human beings.
 
But in Medical School, this was finally the real thing: the gross dissection of the human body. The cadavers were bodies from a variety of sources, from homeless people, who had died on the street, to physicians and scientists, who had willed their bodies to Medical Science, for the education of the next generation of physicians. Regardless, each was a precious gift, a key to unlocking the secrets of the human body, as a foundation to understanding its workings. And we all honored their gift and treated their remains with the utmost respect.
 
Each cadaver was preserved in formadehyde and the pungent odor permeated every square inch of the huge and brightly lit room of the lab, with dozens of stainless steel tables, each holding a body draped entirely in a long white sheet. 
 
As we trudged into the Anatomy Lab that first day, we all had on our new long white lab coats and carried our dissection manuals. We were assigned in groups to a table and a cadaver, which we would be expected to dissect, as instructed.
 
Naturally, we were nervous–anticipation was high, but for most of us, this was the first time we had seen a dead body, up close and personal. But, this was our introduction to the mysteries of the human body that we were all determined to master, our first step into the unknown, but knowable.
 
Each group had to choose two dissectors, that is, those students who would actually do the cutting, while the others watched. I naturally volunteered. I figured since I wanted to be a surgeon, I might as well get started. So, my partner and I carefully peeled back the layers, one section at a time, according to the guide and our instructors, exposing the secrets beneath. 
 
It’s harder than you think–cadavers are stiff and leather-like, and the parts are NOT color-coded like they are in the books. Everything is of a similar pale bleached tan, so unlike the color and texture of living tissues. And you have plenty of time to think about the nature of life. 
 
This inanimate body was once a living, breathing person, had a mother and a father, perhaps a family, had hopes and dreams, joys and sorrows, even as we. And yet, now, he lay here, inert, like a meat machine that someone turned off. Even as, one day, we too will lie somewhere, just like this. Can this be all that there is to us? Makes you think….
 
These anatomical fundamentals provide the necessary foundation for the understanding that emerges when you eventually experience the dissection of living flesh. It was an extraordinary experience.
 
Those students who drew back and were mostly grossed out by the whole thing, well, you just knew they were going to be the internists of the group. Some spent most of the time in the library, learning from books, instead of the cadaver. But I always learned better when I could SEE and FEEL and TOUCH, in three dimensions, with my own hands. To experience is to KNOW. 
 
For example, the first time I dissected the human knee, I SAW the fibers of the vastus medialis obliquus (VMO) muscle, inserting into the upper, inner margin of the patella, while I noticed that the other three muscles of the quadriceps were all attached to the tendon ABOVE the kneecap. So, based on this arrangement of the muscles, the VMO pulled inward on the kneecap, while the other muscles pulled outward.
 
It was only years later that I came to understand the physiological consequences of that anatomical fact, and its clinical significance. In fact, that’s the very reason that the exercises taught in my PAIN-FREE PROGAM, which you can see for yourself here at http://drbillsclinic.com/exercise_eliminate.html  concentrate so strongly on developing the VMO, in order to balance the kneecap and relieve anterior knee pain.
 
It’s also the reason that you can often relieve your knee pain if you do modified Hindu Squats, or even Straight Leg Raising. These exercises take advantage of that anatomical arrangement to relieve your pain. See how at http://drbillsclinic.com/exercie_eliminate.html
 
But this was the beginning. Years later, when I was being taught the arts of surgery, there were many times that I reflected on the lessons learned in Gross Anatomy Lab, and thought with gratitude upon that unnamed person who had granted me the gift of his body, that I might become a healer of my fellow man.  “Greater love hath no man…”
 
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

 I’m back in Southampton, having flown in yesterday. So this past morning, we drove to the airport to pick up my father-in-law and his wife. We thought it might be nice to gather at the new house for Thanksgiving and to see in the new Christmas Season. 
 
And to be honest, there’s something bizarre about having Thanksgiving and the Christmas Holidays in 70-80 degree temperatures in Florida, when you’ve grown up associating them with the cooler weather of Fall in the Temperate Zone. You know, the whole “chestnuts roasting on an open fire” thing rings truer when “Jack Frost is nipping at your nose.” When it’s perrenial summer, not so much.

So, to prepare for the Season, my wife got us tickets to Winter Wonderland in New York for later this afternoon. True, the Rockerfeller Center Christmas Tree won’t be lit yet; the official Christmas Tree Lighting Ceremony won’t be for a couple of weeks– I think it’s December 4th. But all the other Lights and Christmas Decorations will be up and well worth seeing. 
 
So, I was prepared for cooler weather and looking forward to it. But last night, my wife and I went out shopping, and man, it was COLD! Late last night, it was down into the twenties. I guess I’ve been in Florida too long. I was looking forward to the cooler weather but here I am, freezing in Southampton!
 
Well, hopefully, it will warm up a little later. Brrrrrrrrrrr! This part of New York I didn’t miss.
 
Funny thing about cold weather is that, like damp weather, it can make your joints ache when you have any degenerative joint disease. Among the things that can make you feel better and provide a little relief are supplements and joint wraps.
 
I’ve mentioned before that if you improve the balance of Omega 3 Fatty Acids in your diet, by avoiding red meat, saturated fats and other sources of Omega 6 Fatty Acids and then taking fish oil and other sources of Omega 3′s, you can reduce inflammation and therefore, relieve joint pain.
 
You can also keep your joints warm, too. Ways to do this range from simple elastic or neoprene knee sleeves, to far infrared capturing KENKO wraps and magnetic knee wraps that generate  internal heat within the joint tissues (both are available from your nearest NIKKEN distributor). 

These and a number of other methods for relieving knee pain are described in greater detail in my newest healing program, HOW TO AVOID KNEE SURGERY. See it at http://drbillsclinic.com/avoid_knee_surgery.html 
 
In addition, I list a number of other methods, from across the entire health care spectrum, to relieve knee pain and restore knee function–conventional, alternative and complimentary. And I include a Baker’s dozen of the most effective exercises to prevent and eliminate knee pain, for long term relief. See them at   http://drbillsclinic.com/avoid_knee_surgery.html
 
Gotta go! Til next time, my friend, be well. And stay warm….
 
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

You may have noticed that yesterday’s email was a bit late–like, it wasn’t broadcast until after midnight, which pissed me off to no end. Fortunately, that was just after midnight EDT, and many of my subscribers reside all over the world, in other time zones. So only the east coast people were affected. But it was still mega annoying.
 
Thing was, I had it written and ready to go much earlier in the day, but my terrific merchant service, 1shoppingcart was on the fritz. “Error” kept coming up, every time that I clicked on the appropriate button and tried to send the email. Very frustrating, to say the least. So I saved my work, by clicking on “save draft.” And then, clicked off, hoping that whatever the problem was would be resolved with a little time.
 
Later, about 11PM my time, I logged back in, clicked on the “saved drafts” button, so I could retrieve the email and send it off, and guess what? The damn thing had ERASED 80% of my email! AAAAARRRRGGHHH!  I HATE when that happens! Must have been gremlins in the shopping cart….
 
Anyway, I had to rewrite nearly the whole damn thing again, from memory. Luckily, my memory isn’t shot just yet I was retyping frantically, with my rudimentary hunt and peck skills, re-saving every paragraph or so, just to be on the safe side. And I finished before midnight. YEAAA! Only, the line-up of others ahead of me pushed its transmission to after the witching hour. C’est la guerre….
 
Well, I guess I should be thankful that this doesn’t happen ALL the time. Anyway, when I was so rudely interrupted by the gremlins, I was telling you about my friend, who had recurrent knee pain. He initially had a very good response to the specially modified knee exercises I teach in my PAIN-FREE PROGRAM, at http://drbillsclinic.com/exercise_eliminate.html
 
But, like many people, he felt so good, he became lax and gradually stopped doing them. After all, he felt good, no pain, so the knee must be OK, right?
 
Err….no, sorry. The problem he had was a chronic degenerative condition. And that doesn’t disappear, just because you’ve compensated for it and relieved the resultant pain. So, absent the beneficial effects of exercise, the kneecap gradually fell back into the  abnormal tracking pattern that caused his problem to start with. Whether his actual disease was chondromalacia, or osteoarthritis of the patellofemoral compartment, the final result was recurrent anterior knee pain. 
 
As I mentioned, there are two fundamental components to treating this condition: 1.exercise and 2.measures to reduce inflammation. And they must be addressed simultaneously. 
 
Fortunately, there are many ways to combat inflammation. Conventional conservative treatments, home remedies, over the counter medications (with proper precautions), as well as a number of proven alternative treatments, which work by different mechanisms, can have a  synergistic effect to relieve knee pain. I cover a number of these, with specific instructions how to use and combine them, in my newest healing program,  HOW TO AVOID KNEE SURGERY, which you can get at http://drbillsclinic.com/avoid_knee_surgery.html
 
Long term, there is no better treatment than exercise.  That’s why I include a Baker’s Dozen of the most effective, proven knee exercises and stretches in this new program, as well. Or you can get the full range of exercises and stretches in the PAIN-FREE PROGRAM, at   http://drbillsclinic.com/exercise_eliminate.html  But either way, exercise is key in getting and maintaining complete pain relief and restoration of full knee function. 
 
If he follows my advice, my friend should get relief of his recurrent knee pain in short order, probably less than seven days. But to keep it, he’s got to do the work…and keep doing it.
 
You can get away with a lot and slack off when you’re young. Young tissues are forgiving. But as you age, more conscientious efforts are required. If you don’t do the necessary work, you will pay the price. It’s as simple as that.
 
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

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