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

This morning, I was going through some old boxes stored in my garage (no basements in Orlando–the water table is so high that you can strike water eighteen inches into the ground). I’m trying to get rid of some stuff that has been lying around for far too long and to do that, I have to go through it all. I’m trying to be ruthless, but it’s hard.
 
I’m a “pack rat” by nature. I save books, old notebooks from school, articles, pages cut from magazines, illustrations that took my fancy, paintings, posters, art prints, sculpture, electronics, tools, guns, coins, items of clothing, weights, exercise equipment, office and tax records, you name it. Then, there’s the stuff my wife likes, like multiple sets of china, clothes, pocketbooks, and enough shoes to give Imelda Marcos a run for her money. And on top of all of that is furniture and more furniture. You name it, I’ve saved it. Never know when it might come in handy….
 
In digging through this stuff, it’s like being an archeologist, or treasure hunting. Every new box I open is filled with stuff. Everything I touch evokes a memory. Which is why it’s hard to part with this stuff–it’s like throwing away a part of my life, in a way. But it’s got to be done.
 
The trouble with stuff is that after a while, you don’t own your possessions–they own YOU. We’re now married for over 34 years and I still have stuff from Grammar School, Junior High, High School, College and Medical School for God’s sake! Little by little, like barnacles on the hull of a ship, the stuff accumulates. This, of course, makes every move a nightmare. So the stuff has to go.
 
But, as it’s contrary to my nature, I can’t simply pitch everything. No, I have to go through it, to be sure I’m not throwing away some long buried treasure from my past. It’s sick, I admit it. In my own defense, I don’t smoke, I don’t drink and I don’t fool around on the bride–hey, you’ve gotta do SOMETHING, right? Could be worse.
 
So, while I’m digging through the boxes, I came across my old bones collection, from the office: near perfect skull, probably a young woman, a femur, tibia, a vertebral body, a bag of foot bones. Thing is, these are REAL human bones. Can’t get these any more. The countries that used to produce them, chiefly India, under Indira Ghandi, outlawed the practice many years ago. 
 
Today, plastic models are the best a young medical student can do. Not the same thing, though–they can’t capture the subtle details, especially in the delicate internal bones of the skull. So I’m thinking, good thing I didn’t just throw these out. Can you imagine these bones coming to light in the garbage dump? I can see the cops knocking on my door now….
 
Then, I came across my old knee model. This IS plastic and shows the menisci and all the ligaments. I used to use this to explain why someone was having pain, to demonstrate which part of the joint was damaged. Then, under these items, I came across my teaching handouts. I used to give these to the patients as “take aways” so they’d remember some of what I told them during their office visits. Even though I could tell what was wrong with someone and formulate a treatment plan in under a minute, I would often spend the next hour or so explaining everything to the patient and family. But as studies done at the University of Florida showed years ago, people just don’t remember what they were told. They retain less than 27%, especially stuff like complications of surgery, after only 24
hours. 

So, my handouts were my way of reminding them. Each one was a single page, with all the pertinent information we had just discussed. One for each of the most common clinical problems I treated. And then, there was my physical therapy prescription. The therapist loved my Rx, because I gave them the diagnosis, the surgery (if any), with exactly what was done, and specified exercises and modalities to be done. This was the prototype of the exercises I teach in my PAIN-FREE PROGRAM, which you can get at
 http://drbillsclinic.com/exercise_eliminate.html
 
The therapists liked this because most docs sent them a prescription that said “P.T.” They left pretty much everything up to the therapist, who of course had NO clinical information about the patient. Incredible. How could they help, if they didn’t know what they were treating? Made no sense to me. So they generally gave the patients knee extensions, or leg presses with resistance, to strengthen the quads, followed by ice and later, hot packs and electrical stimulation. Hard to go too wrong with those.
 
The miracle was that many people got better, anyway. That’s a tribute to the power of exercise to relieve pain, even if done in a very general way. Better, by far, if exercise is done strategically, to alter the dynamics of the knee, according to the pathology causing the problem. That’s what the PAIN-FREE PROGRAM does. See it at http://drbillsclinic.com/exercise_eliminate.html 
 
Well, back to the junk heap. I’m sure I can get rid of a lot of this stuff. Just have to keep digging…. 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

It’s hard to believe how fast time is flying. Here it is October 2nd, and the last quarter of 2008 has already begun. You know, it was a year ago yesterday that I sent my very first email to a small group of friends–my first subscribers. Well, everyone has to start somewhere, right? Things have changed quite a bit during this last year, too. I started with my LITTLE GREEN BOOK   http://drbillsclinic.com/eliminate_knee_pain.html
 
I have a number of products, including CD’s for the LGB and for my newest healing program, HOW TO AVOID KNEE SURGERY, which you can see at http://drbillsclinic.com/avoid_knee_surgery.html And, there’s also my magnum opus, HOW TO ELIMINATEKNEE PAIN–ONCE AND FOR ALL! THE ADVANCED MASTERS’ COURSE http://drbillsclinic.com/advanced_masters.html  for the last word in the entire spectrum of methods of treatment for knee pain of all kinds. This can be obtained in a single, BIG volume, or in 12 monthly installments, or Lessons–your choice. Or, if you’re just interested in the specially modified exercises that I used myself after my own knee surgery, and those I prescribed for my patients during my nearly quarter century of private practice in orthopaedic surgery, you could benefit from my PAIN-FREE PROGRAM  http://drbillsclinic.com/exercise_eliminate.html

These exercises can help get rid of knee pain, FAST, but can also PREVENT knee pain, when done as instructed. And, I’ve made some other great products available to you as well, like the human growth hormone releasing hormone analog, that when rubbed on the skin, helps to reduce inflammation, speed healing, and has anti-aging properties, as well. You can get it here: http://drbillsclinic.com/trans_d_tropin.html 

I’m grateful for all the subscribers who have joined our ranks and for the support of all those who have purchased one or more of my programs. I’ve gotten some great feedback from those who have followed my advice–none better than those who have come back to buy again. All in all, it’s been an exciting and pretty gratifying time. Just think–even though I can’t operate any more, I can still help people all over the world, through my programs, CD’s, tips and general advice. 

Let’s face it. The internet is a gusher of information: some good, some bad, some irrelevant. So much, in fact, that the average person is just swamped–people have NO frame of reference, no filter to determine what information is correct and what isn’t. What you really need is ADVICE, from someone who KNOWS. And that’s what I’ve tried to provide. 
 
So, what’s next for Dr. Bill’s Clinic? Well, I’m now working on a program for ARTHRITIS–what it is, and more important, what you can do about it: how to slow its effects, relieve pain and prevent joint damage, with my usual approach of giving you the latest measures from across the entire medical spectrum, conventional, alternative and complimentary. 

I’m also going to produce some DVD’s and digital videos, and I may provide some teleseminars, as well. So, it should be fun. I’m looking forward to it. And it starts right now….Talk to you soon, my friend. Til then, 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

For the past week or so, I’ve been trying to relieve your fears about surgery. Hey, you never know. One day you might NEED one of these procedures, and it would be a shame if you were terrified, due to misperceptions, misinformation, distortions and urban myths. It’s also a good idea to know just what your options are, so you can make an informed decision, should that day ever come.
 
So, I’ve attempted to give you the straight dope, tell you exactly what’s done, in each of the most common surgical procedures for the knee. As I’ve said before, when you KNOW the finite dimensions and the finite duration of an experience you fear, it helps a lot to put it in perspective, help you face it and help you handle it. 

Today, to round this all out, is the ultimate option: ARTHROPLASTY, more commonly called joint replacement. Though the term actually means “creation of a joint,” it’s come to be identified with joint replacment, and is now virtually synonymous. This was initially TOTAL knee replacement, but today, through many technical advancements, it encompasses PARTIAL or UNICOMPARTMENTAL joint replacement, as well. These options are explained in great detail, though in layman’s language, in my LITTLE GREEN BOOK at http://drbillsclinic.com/eliminate_knee_pain.html
 
This is really a misnomer, though. Unlike a total hip replacement, a total knee DOES NOT replace the entire joint, nor does it remove the bony segments of the joint. Instead, only the SURFACES are replaced with man-made shells of polished metal, articulating on very tough plastic. Technically, the operation is a joint resurfacing arthroplasty. If there’s severe arthritis on only one side of the joint, then only that side has its surfaces replaced. The so-called UNI (unicondylar knee replacement) can be done through a very small incision, sometimes even on an outpatient basis. The trick is for the surgeon to balance the ligaments and align the knee properly, so the kneecap tracks properly.
 
Small power saws are used, with special saw guides and alignment tools, to cut thin slivers off the ends of the bones, the femur and the tibia. This removes the arthritic surfaces and “opens up” the spongy (cancellous) bone, for acrylic cement intrusion, which holds the implants in place on the respective bones. The properly sized implants are then selected and implanted. 
 
A total knee replacement, like the name implies, resurfaces all three compartments, medial lateral and patellofemoral. It’s done for more extensive, or end stage disease, in two or all three compartments. It needs a larger incision, generally involves somewhat more pain, swelling and potential bleeding. It has a greater potential to develop adhesions, and limited motion, after surgery.
 
In both cases, weight bearing is initially limited by pain, and the use of crutches or a walker. Motion is started right away. Pain is controlled with medications, and physical therapy and rehabilitation are essential. Many of the exercises used are those I teach in my PAIN-FREE PROGRAM, at   http://drbillsclinic.com/exercise_eliminate.html
 
But here’s the thing. Although the success rate, in the right hands, is very good with joint replacement, you NEVER do this without the right indications. The truth is, nothing made by man is as good as what God gave you. Man-made parts can wear out, can get loose, even get infected…and there’s always the chance of a technical problem or human error, even in the best of hands. 
 
So you need to be SURE that if TKR or a UNI is recommended, it’s NECESSARY. And if you can get relief from ANY more conservative methods, conventional, alternative, or complementary, provided you don’t have a lot of bone loss in the joint or severe deformity, then it’s an UNNECESSARY SURGERY and should be delayed, or avoided. And it was to help you do just that, that I wrote my new healing program, HOW TO AVOID KNEE SURGERY   http://drbillsclinic.com/avoid_knee_surgery.html
 
Well, I hope that this series on knee surgeries has been informative for you and that I accomplished my goal: to tell you exactly what goes on in the O.R., give you some perspective and relieve your anxiety and fears about surgery. If you NEED surgery, by all means, accept the risks and get the benefits.  Odds are, you’ll do great. But if you’re not sure, or if all non-surgical measures have NOT been exhausted, then there’s at least the possibility that you may be headed for an UNNECESSARY SURGERY.
 
In that case, get my program and be prepared. Don’t guess, when you can KNOW. Click on the link and get HOW TO AVOID KNEE SURGERY today, right NOW, at   http://drbillsclinic.com/avoid_knee_surgery.html   to relieve 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

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

Just the other day, I got an email from one of my subscribers, who also happens to be one of my friends from the “old days,” back when I was living in New York and practicing orthopaedics. It seems she was looking for some helpful advice for a friend of hers who apparently has arthritis of her knee. 

The woman had apparently developed gradual onset pain of her knee over the last several years. She had seen a physician and apparently had x-rays. The x-rays reportedly showed “bone-on-bone” in the inner aspect of her knee (the medial compartment). She was told that she needed a total knee replacement. But she clearly didn’t want to have surgery. So she asked my friend to ask me what she should do.
 
Well, I wrote back that once you have an x-ray that demonstrates “bone-on-bone,” you are pretty much committed to having a joint replacement, eventually. However, that procedure can be DELAYED, or postponed.

You see, “bone-on-bone” means that the bones of the knee joint, that you see on the x-ray, are touching each other. And that means that their protective cartilage layer has worn away. Since cartilage is invisible on an x-ray, the normal appearance of an x-ray is one of the bones appearing to “float” apart. In other words, there is a  joint “space” between them. Once the cartilage is gone, there’s nothing to hold them apart anymore–hence, the bones touch, ie., “bone-on-bone.” 

The problem is that once the cartilage has worn away, and the underlying bone is exposed, the cartilage isn’t going to grow back. That’s one of the key factors about cartilage: it lacks a blood supply. And without a blood supply, healing, or regrowth of the tissue CANNOT take place. 

Yes, yes. I know there are methods out there being promoted that CLAIM to regrow cartilage. They even show x-rays, reportedly “un-retouched,” that seem to show a new “joint space” re-formed. I saw one just recently in an in-flight airline magazine and I’ve seen them before on various web sites, which market to the credulous. 

Unfortunately, that is absolute crap! No known non-surgical method can regrow cartilage, once it’s been destroyed. 

What these magazines and websites show is actually a “before” weight bearing x-ray, in which the bones are touching, followed by a NON-weight bearing x-ray,  in which the bones APPEAR to be separated, because there’s no weight on them to press them together. 

So their claim is technically true: the x-rays ARE un-retouched. But the new “space” is  NOT from new growth of cartilage. And they’re even cleverer than that–they never actually SAY that they grow new cartilage. They show the pictures and let YOU make the inference.

Now, mind you, there ARE non-surgical methods that can help relieve pain, and forstall the need for surgery. But actually re-grow cartilage? No. ‘Fraid not. Maybe some day, with stem cells or some such, but not now.
 
So the best advice I can give this lady is to follow the many measures, from across the entire medical spectrum, that I teach in my newest healing program,  HOW TO AVOID KNEE SURGERY, which you, too, can see at http://drbillsclinic.com/avoid_knee_surgery.html
 
These methods, conventional and alternative alike, when used together, create a SYNERGY, where the combination is far more effective than any single component alone. And these methods are proven and safe. They won’t grow new cartilage. Nothing short of a very sophisticated, two-stage surgical technique can, at this time. But they CAN give you relief of pain, buy you time, and delay a joint replacement. See how at  http://drbillsclinic.com/avoid_knee_surgery.html
 
That’s all for today, my friend. Talk to you soon. 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

The phone rang the other night and I almost missed it.  It’s a big house, so if I’m not right next to the phone I have to run to the nearest one, without running the cats underfoot. But, I got it just as the answering machine picked up. Then, I had to wait for the recorded message to finish before I could hear and be heard.
 
It was one of our good friends, who is a female cop. She’s a sweet girl, but she’s one of those people I don’t hear from, until she’s got some medical problem.  I have more than my share of those. But, hey, it’s good to hear from them, regardless of the reason they decided to call.
 
It seems she was playing racket ball and suddenly felt this lancing pain in one of her calves. Because it was this sudden, hot poker sensation, she was a bit scared.  Who could blame her? She had heard of painful clots in the calves that could be dangerous (deep vein thrombosis), so she was pretty anxious.
 
Well, I asked her a few questions, so I could try to figure out what had happened to her. You may not realize this, but it’s tough to diagnose anything, sight unseen, over the phone. Lay folk simply don’t share the same vocabulary with medical people, so it’s hard for them to accurately describe what they feel, or what actually happened, or even what something looks like.  So, pity the poor doc who’s trying to make sense of what he’s being told and trying to make an intelligent diagnosis, based solely on this questionable information.
 
I’ll give you a great example of what I mean. My father-in-law used to tell me that the outer part of his hips (the trochanteric region) felt “numbish.” Now, to a physician, “numbish” indicates a decrease in sensation; that’s what “numb” means to us–a possible neurological problem. What he actually meant was “dull pain,” which indicated a bursitis, but he didn’t know how to accurately describe it to me. Took me a while, and a physical examination, to figure out what he really meant. The point is, I had to interpret what he said into what he really meant. So, when you’re trying to do this over the phone, it just adds another layer of difficulty to a tough situation. 

Anyway, this sharp, hot pain at the back of her calf was familiar to me. I asked her if she felt a “pop” when she felt the pain. “Oh, yeah,” she said, “now that I think about it, I DID kind of feel a “pop,” when it happened.” I also found out that she was able to walk on it, even though it hurt, and that her calf swelled up and was tender. I should mention that she’s in her forties, now, too. 

Assembling all the pieces, I felt pretty confident that she had experienced a rupture of the plantaris tendon. Given her symptoms, her age, the activity she was engaged in and my past experience with these same symptoms, it was most likely that she had popped her plantaris tendon. So, I first reassured her that she most likely didn’t have anything really bad, and she probably wasn’t going to need any surgery (for a discussion of this and other posterior knee conditions that can be treated without an operation, please see my newest healing program         HOW TO AVOID KNEE SURGERY    http://drbillsclinic.com/avoid_knee_surgery.html )

Then, I explained what had happened to her and why.  And then, what to do about it. First, she needed to get over the acute inflammation, and I gave her a host of the conservative mainstream and alternative methods to reduce inflammation and relieve pain, all the most effective treatments from my new program at  http://drbillsclinic.com/avoid_knee_surgery.html
 
Once the tenderness and swelling were gone, then she could begin the stretching and strengthening exercises taught in my PAIN-FREE PROGRAM, which you can see at   http://drbillsclinic.com?exercise_eliminate.html   The good news is that she’ll be back in action in a few more weeks with no disablity. And she won’t have any residual weakness. 

Of course, she could still rupture the OTHER one…. But with the proper warm-up before any exercises, and the recommended stretching and strengthening, hopefully, she’ll avoid it.

Well, that’s it for today. 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

I just got off of the phone with my printer to OK the last few corrections and fine tunings of my newest program, HOW TO AVOID KNEE SURGERY, and the good news is, the first print run will be available for shipping in only 3-5 days. The website page for this new product should be up in just a few days. I just have to keep nudging my ace webmaster and get him to do it.
 
Now, I’m really excited about this product, and you should be, too. This was the topic that YOU asked for. And based on my nearly quarter century of experience in the Operating Room, as well as my personal experience as a knee surgery patient, it will reveal all the secrets to staying OUT of the OR. Having undergone surgery myself, I can tell you that there are times when it’s really necessary. But there are times when it isn’t, and times when it’s only one option of many.
 
My goal in writing this is to give you the best, most up to date methods for avoiding that unnecessary surgical procedure, from across the entire medical spectrum–mainstream, conventional, alternative, nutritional, nutriceutical, pharmaceutical, orthotic, therapeutic and a variety of healing programs that will relieve your pain, without surgery. 

I know these methods work, because I use them myself to keep my opposite knee from progressing to surgery.

In the years before my back injury, a good friend of ours, a very busy guy who is the founder and CEO of his own nationwide security company was told by many surgeons that he needed a knee replacement. And, based on his x-rays, he DID. The only problem was, he was very busy, travelling from office to office around the country, the business depended on him to keep new business flowing in. And, more important, he was a very nervous guy, who absolutely dreaded the very idea of surgery. He’d heard all the horror stories, and saw himself in every one. But he was also in constant pain, made worse by the fact that he was on his feet every day for long hours.
 
So, understanding his feelings and his desire to delay the inevitable as long as possible, I started him on the very measures and healing programs that I knew would help him. I taught him what to eat and what NOT to eat, what nutrients to take and how much, what muscles to develop and how, how to modify his activities to minimize pain and joint damage. 

Did they work? Well, he just recently had a total knee replacement, but this was TEN YEARS after I started him on these methods. That’s right–over a DECADE of relief, in a guy with known, end stage, surgical disease. How much better would they work for you, if your condition is not so dire?
 
Now, my other products have all revealed a number of complementary treatments to relieve knee pain, but this time, I’ve pulled out all the stops to help you AVOID KNEE SURGERY. As many of you have reason to know, I often proffer advice to those subscribers who email me with their orthopaedic problems. I can’t answer every question personally, there are just too many of you. But I try to help, when I can. And this was one of the most frequent questions and comments that I’ve seen: “I don’t want surgery–How can I avoid it?” 

Then, some few months ago, I polled a number of fitness buffs, martial artists, gymnasts, yogins, physical therapists and trainers, athletic and personal, with an age spread from the early 20′s to 74. I wanted to know what THEY wanted to know, about my field of expertise. If they could pick my brain, sample my accumulated experience, and ask me just one question about their problem knees, what would it be? 
 
Well, as devoted to natural methods as this group is, what most of them feared the most was “going under the knife.” Many people volunteered this spontaneously, before I could even ask them. And then, of course, as in every group, were those people who had HAD surgery, with less than hoped-for, optimal results. So in response to this, I wrote this program. 

This is a program about SOLUTIONS. The causes of knee pain and the anatomy of the joint are briefly touched on, just enough to orient you. But mainly, this course will TEACH YOU WHAT TO DO, in every aspect of your life, EASY methods to relieve your pain and restore optimal function, and do it WITHOUT SURGERY. It’s a menu of effective alternatives, from which you can choose. 

And, you can also get the program on an audio CD, if you’d like to hear the dulcet tones of my own voice, narrating the program. Of course, you can’t see the illustrations, then, but you can listen to the concepts while you’re stuck in traffic. It’s a great complement to and a reinforcement of the written course. It’s EASY and a great way to really learn this stuff, so it becomes a part of you, for when you really need it.
 
So, forgive me for going on about this, but I think it’s the best thing I’ve done so far, and I think you’re going to LOVE it! So keep a look out for it–it’s coming soon, maybe next week. 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 few days ago, one of the members of an exclusive fitness group, for whom I serve as a medical advisor, emailed me with a knee injury. He had been participating in his jiujitsu class and was close to the end of his class, when he experienced a “pop” within the inner aspect of his left knee. He didn’t feel pain when it happened, but he was smart enough to stop what he was doing and not finish the class. He was also able to
bear weight without difficulty.
 
But by the next day, the knee was aching and swelling.  He iced his knee through the night, took just a couple of Aleve caplets and wondered whether he should visit a doctor. Then, he asked for my advice.

Since I had no way of seeing him or examining his knee, I had to base my differential diagnoses (ie., educated guesses of the likely source of his pain) on his history alone. Now, even in a clinical setting, history is THE most important factor in determining a diagnosis. But the physical examination adds important mechanical information that leads the examiner toward one possible diagnosis and away from another.
 
In this instance, the leading contenders were a snapping synovial plica (a thickened band of lining membrane of the joint, that is plucked like a banjo string over the end of the femur), or a torn medial meniscus (the inner cartilage cushion, between the femoral condyle and the tibial plateau). Both of these can cause popping and be initially painless. And both can result in a delayed inflammation, manifested by stiffness, pain and swelling.
 
This man was smart–he stopped doing the class immediately after his incident, suspicious that he had sustained some injury. He iced his knee a number of times over the next couple of days, took it easy and took just two Aleve caplets. Then, he decided to ask for my advice.
 
I advised him to follow the usual conservative measures, as I have described in detail in my LITTLE GREEN  BOOK  (http://drbillsclinic.com/eliminate_knee_pain.html)   These included switching to local heat, increasing his use of Aleve to 2 caplets twice a day (with FOOD or MILK, to protect your stomach from the side effects of NSAID’s), and selected exercises to preserve his quad strength, while avoiding motion, like those at   http://drbillsclinic.com/exercise_eliminate.html
I also advised him to consider going to see an orthopaedist, if his symptoms don’t improve pretty soon.

Then, he asked a very good question: “What about bracing?” 

As it happens, bracing is a very good idea. But you  don’t need an expensive, custom brace. No, just an elastic or neoprene sleeve, to provide some extra support and a gentle, generalized compression of the knee joint. Compression is important as a counter-pressure to the swelling and fluid generation of the inflamed knee. The external squeeze tends to minimize the production of excess joint fluid. 

Unless you have a specific ligament problem (which, based on his presentation, he does not), you don’t need hinges on the sides of the brace, either. A central hole, a patella cutout, is warranted if you have pain in the kneecap, but is otherwise not necessary. But this simple and inexpensive addition to the usual anti-inflammatory regimen is a great help in relieving pain and restoring function after a knee injury. And
I heard today that, sure enough, he’s getting better already.  Hopefully, he’ll be back in action again, real soon.

Well, that’s it for today, my friend. Have a great weekend and, til next time, 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