Well, the Holiday Season is upon us, recession and all. I just now got back in from Costco (though I still like to call it Price Club–much more euphonious, don’t you think?). I had to stock up on some essential things, prior to taking the flight back to New York, tomorrow night.

Then, the very next day, I get to drive back to Central Florida with the bride, and a bunch of cat carriers, so we can take the last of the brood to New York. The plan is to see Christmas in, here in Florida, then drive the last batch of kitties to the Northern Command.

You see, it’s cold up there, will soon be freezing so naturally, the bride (who LIKES the cold) wants to winter there (while most sane people are COMING to Florida, for the relative warmth and sunshine). Don’t ask me–I just live here (and there, whatever), but I digress….

But before we drive back up north with the cats, we get to festoon the house with Christmas decorations, and that means cleaning the whole place, top to bottom, in preparation for entertaining (though admittedly, it’s a whole lot easier with fewer cats in the house).

And that’s on top of getting in some late Christmas shopping. I always start early (I think I got my wife’s first present in July), but it’s finishing that’s the problem. I’m getting more exhausted, just thinking about all I have to do.

So, with every spare minute accounted for already, naturally I have requests for articles and product reviews and other projects coming up, out of the blue.

This situation reminds me of a handwritten sign we used to see in the O.R. every so often: “The difficult we do immediately. The impossible takes a little longer!” Words to live by. I think the sign was put up by one of the male nurses, a guy who used to work in the Psychiatry Ward, but transferred to the Operating Room. As you might expect, this gave him a rather unique perspective.

His name was Tim, and he was the resident wit and cartoonist of the place. His droll and dry sense of the absurd saw us through many rough times. No one was exempt from his pen–when I was injured (falling through a high ceiling and fracturing my spine, if you’re a newby), he posted a cartoon of me falling behind a couch, with a line of cats all holding up signs with scores (8.9, 9.6, 9.2, 9.8…) just like an olympic event. I saw this my first day back. It WAS pretty funny. Certainly pointed out, in a humorous way, the idiocy of my predicament. But anyway, I think he posted that sign.

Together with the other members of my team, I took that motto to heart. We did some of the most truly outrageous surgical reconstructions ever seen in our region. Stuff that really did border on the impossible. I remember one little wizened lady, deep into her seventies, with horrible rheumatoid arthritis, that had BOTH knees so contactured, she couldn’t even stand.

A contracture is where the joints, in this case both knees, are literally scarred into a fixed, bent position, in her case, well beyond 90 degrees. And no amount of stretching, or force, can straighten them. In this lady, her bones would have shattered before the scar tissue gave way.

Because of ignorance and neglect, very gradually over time, her knees became more and more bent. No one thought to have her evaluated by a doctor; no one had started her on stretches and exercises, like those in my PAIN-FREE PROGRAM http://drbillsclinic.com/exercise_eliminate.html or got her braces, or splints to keep her knees straight. So eventually, the poor thing was stuck in a Nursing Home bed, in a fetal position.

I don’t remember how I came to care for her, but I remember that the older, wiser heads in the Department all gravely assured me that she was beyond hope, that it was impossible. Luckily for her, I was still in that early phase when I believed in my heart I could do anything–and so, I did.

If there was ever a case that exemplified the necessary surgery, this was the one. I had to release virtually every ligament and muscle around her knee, and cut away a significant amount of bone to allow the knee to both straighten and accept total knee implants. At one point, her leg was literally hanging in the breeze, connected only by the posterior nerve and blood vessels. I should have been scared out of my wits…but you see, it never occurred to me that this could fail. So it didn’t. The ligaments, once released, found their own correct levels and went on to heal at those spots. When we were done, the leg was straight and the knee was stable.

Ideally, she should have had both done the same day, so she could walk. But she couldn’t tolerate that much anesthesia at one time–”The impossible takes a little longer.” So initially she was left with one leg bent up and one leg down and straight (kind of like Superman, when he flies up, up, and away). Next week, we took her back for the other side. This went faster, with the lessons learned from the first go round.

Some months after she was discharged from the hospital, I was giving a talk on knee replacement in a public forum and this same lady WALKED up and thanked me. And damn! Those knees were straight! What a transformation. She was now very talkative and lively, where before she had sunk into a torpor and would surely have died from lack of stimulation and despair. And I knew that THIS was why I did what I did.

Those older wiser heads still shook their heads: “just lucky,” they said. Well, yeah, but better lucky than smart, eh?

The lesson here is that she need not have ever reached that point. Today, we know that there are many ways to prevent knee surgery, or at least delay it. You can combine effective conventional and alternative treatments from across the entire medical spectrum to relieve your pain and restore your function, like those I teach in HOW TO AVOID KNEE SURGERY  http://drbillsclinic.com/avoid_knee_surgery.html

If that patient had only had worn a simple extension brace at night, she might have avoided the magnitude of that complex surgery. In like manner, if you ever have a knee injury or a knee surgery, get your full range of motion back as soon as you can. And KEEP it, even if you need bracing to do it.

Til next time, my friend, be well.

Yours for a pain-free tomorrow,

Dr. Bill

So here I am, sitting in the study of the Southern Command Post, reviewing emails. And I came across one from a nice lady who is very concerned because she has knee pain, she is very heavy, given her size and worst of all, she has noises inside her joints that can actually be heard by people around her.
 
She was quite properly concerned because she’d like to get rid of her knee pain, and she wanted to get a copy of my newest healing program, HOW TO AVOID KNEE SURGERY (which you can get here at this link:  http://drbillsclinic.com/avoid_knee_surgery.html ), but she was afraid that it was already far too late for her–that the noise in her knees meant that all the cartilage had worn away completely, and that she had a “bone-on-bone” condition. This is what we in the trade call an “end stage knee.”
 
When articular cartilage, that normally coats the joint surfaces, is so diseased that it has eroded away and exposed the underlying bone, the naked bony surfaces grind upon each other with a deep, hard grinding sound and sensation that, once experienced or heard, is difficult to mistake for anything else.
 
It really is like rubbing two big rocks together, with grinding, rubbing and at times a mechanical ratcheting sensation. And, since the bone is where all the nerves reside, it hurts like hell! And that doesn’t count the extra pain from the inflamed lining membrane (synovium) that adds its own component to the pain.
 
So whether it’s osteoarthritis or rheumatoid arthritis, it’s at this end stage of disease, with exposed, bare bone, when major surgery IS truly indicated. Because at this state of the art, at this time, we cannot yet regrow new, healthy articular cartilage in a totally arthritic joint. The best we can offer is total knee replacements. And when they are indicated, they can be wonderful: pain relief, restoration of function and correction of deformity, with good to excellent results in over 95% of cases.
 
BUT…it’s major league surgery, with lots of risks and potential complications. So you don’t do it if you don’t HAVE to. 
 
However, all noise from within the joint doesn’t necessarily mean that your joints are finished and you need major surgery. Other conditions can cause noise, as well. When the lining of the joint becomes inflamed and swollen, its folds become thickened and enlarged. They rub upon each other, making a finer, more delicate crunching that we call crepitus or crepitation. 
 
If the membrane is restored to normal, the inflammation resolved, the swollen folds stop rubbing together and the noise stops. But if the condition persists for a long time, the membranous folds may become replaced with fibrous tissue (they become bands of scar tissue) and they then must be cut away surgically, to eliminate the sensation and the sound.
 
Then, there is degeneration of the articular cartilage surfaces, which may break apart into shredded beds of cartilage fronds, appearing like areas of “crab meat.” When these fragmented or fibrillated regions rub, one upon another, they too produce a crunching sensation, like walking in a gravel pit. 
 
This condition is called chondromalacia (“soft cartilage” grade III) and once this point has been reached, where there is physical disruption of the cartilage surface, it can never again return to a pristine, smooth surface. I discuss this disease and the various types of arthritis in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN (manual and CD). Get it here at: http://drbillsclinic.com/eliminate_knee_pain.html  However, even though the knee is noisy, it doesn’t mean that it will immediately go on to full end stage arthritis. The knee can stabilize in this state for a long time, sometimes pain-free (if a little noisy), if treated with the exercises I teach in my PAIN-FREE PROGRAM. See what I mean at this link:   http://drbillsclinic.com/exercise_eliminate.html
 
The point is, this lady has nothing to lose and everything to gain by at least trying all the conservative measures that are available, to relieve knee pain. One of them, or some combination of them, may give her the knee pain relief she seeks, and buy time, until she can lose weight and make an eventual surgery safer and more likely successful. 
 
So the next time someone, maybe you, says, “Hey, what’s that horrible crunching noise in my knee?” now you know what some of the reasons might be. And some may well be treatable by non-surgical measures, like those in HOW TO AVOID KNEE SURGERY: http://drbillsclinic.com/avoid_knee_surgery.html   Noise doesn’t necessarily mean it’s the end of the line, or that a total knee is the only option.
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill 
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

This past weekend, I was at a business/marketing meeting in Tampa. One of the attendees was a fellow I had advised in the past, and one who had used the recommended exercises in my PAIN-FREE PROGRAM  http://drbillsclinic.com/exercise_eliminate.html/.  He’s  a few years older than me, but in otherwise good shape.
 
Up to now, he had done pretty well. So well in fact, that he has written a testimonial for me, which I will post, once he sends me a photo of himself to run with it. But, like many of us (me too) he got a little bit complacent and slacked off the exercises. 
 
Sure enough, he started to develop recurrent symptoms. ”Hey, what’s that vague ill-defined knee pain?” he wanted to know. I shouldn’t wonder. 
 
Knee pain, especially low grade, achey pain, is often diffuse and ill-defined. That is, unless there’s a specific injury that causes a sharp, acute pain, associated with damage to specific structures. These would be things like a fall, twist or sprain of ligaments, or strain of muscles, a tear of the meniscal cartilage, a rupture of the ACL, degenerative diseases (like chondromalacia or it’s cousin, osteoarthritis), or inflammatory conditions, including rheumatoid arthritis (and its relatives, psoriatic arthritis, lupus, spondylitis, etc.)infectious arthritis (Lyme Disease, staph or strep infection).
 
Why do these conditions cause this low grade ache? In a word, SYNOVITIS. This is an inflammation of the lining membrane of the joint. Now, synovitis is a very non-specific response to ANY stimulation, regardless of what it is–IT HURTS. The membrane also becomes thicker and more swollen, actually grows in volume, becomes red (from dilated blood vessels) and produces an excessive amount of joint fluid (which it normally makes in very small amounts, to lubricate the articular cartilage and nourish the cartilage surfaces). Lay people call this “water on the knee.” 
 
Since I was there with him, I examined my friend’s knee, right there in the conference room. Very few findings, though. Some loss of the last few degrees of motion at the extremes of flexion and extension, maybe five degrees at each end, consistent with the thickening of the synovial membrane. And he had a little bit of pain under the kneecap, when pressure was applied. Pretty much, that was it. Of course, I had no x-rays or MRI images to examine.
 
My impression was that he had developed a recurrent case of chondromalacia patellae–softening of the cartilage of the patella. Either that,or it’s first cousin, osteoarthritis. So, what to do?
 
First, he needs to resume the exercises I teach at http://drbillsclinic.com/exercise_eliminate.html  Exercise is the overall best method for long term pain relief of the knee.
 
Next, he needs to get on the anti-inflammatory regimen I present in detail in my newest healing program, HOW TO AVOID KNEE SURGERY, at  http://drbillsclinic.com/avoid_knee_surgery.html
 
With luck and some work, he should get fast pain relief in as little as one week. If he does the work…
 
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, I’m back in my study this morning, after being at a business/marketing meeting this weekend in Tampa. Since I live in the Orlando area, it’s a straight shot for me, driving along I-4 West. Takes about an hour and forty minutes to two hours, depending on traffic, especially through the city of Tampa. Compared to my recent drive to Southampton, New York, this is a snap! 
 
Given my personal history of knee pain and arthroscopic surgery, this would be a real trial causing nagging aching and swelling of the knees.  But I actually practice what I preach– I use all the tips I’ve passed along to you to reduce your knee pain, while driving. You can see all of these in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN, and you can get your own copy at
 http://drbillsclinic.com/eliminate_knee_pain.html   These tips were a life saver during the long haul to New York, but they’re pretty useful for shorter drives, too. Try them yourself and see.
 
Anyway, I was catching up on my email and other correspondance when I came across an advertisement that promised to END ARTHRITIS PAIN FOREVER. Hmmmm… It sounds like they’re promising a CURE. But what do they really mean?
 
Here’s the thing: I spent a quarter century treating people with various forms of arthritis. And as a surgeon, I’ve actually SEEN the damage that arthritis does, first hand. That’s intimate knowledge of the destruction that these diseases (note, it’s NOT just one disease, but MANY) can wreak on joints. This is direct experience of seeing and feeling those destroyed joint surfaces, with my own hands, that even rheumatologists don’t have, unless they’ve personally scrubbed in on open joint surgeries.
 
Based on that experience, I can tell you this–there is NO CURE for the most serious forms of arthritis, osteoarthritis and rheumatoid arthritis (and other inflammatory forms), at this time.
 
But the ad says they cured “rheumatoid arthritis SYMPTOMS.” That implies that they cured rheumatoid arthritis, doesn’t it? But, I assure you, no one to date has done so.
 
So again, what do they REALLY mean? Is is just false advertising? No, not really. But it IS deliberately misleading. 
 
You see, when most people think of arthritis, they think of the “wear and tear” arthritis you get as you get older, in other words, osteoarthritis. When you talk about rheumatoid arthritis symptoms, you suggest (without quite saying so) that you are talking about rheumatoid arthritis. But when you read the ad copy, you find out that what they’re really describing is the arthritis of LYME DISEASE, which is due to a bacterium and therefore CAN be cured. 
 
Are the SYMPTOMS the same as rheumatoid arthritis? In the short term, yup. But will the same treatment, antibiotics, actually cure rheumatoid arthritis or osteoarthritis? Nope.
 
This is just a classic case of advertising leading you to draw inaccurate conclusions, based on false assumptions. They are NOT lying. But they ARE trying to fool you. And if you don’t know any better, you’re going to fall for it. These guys are GOOD at this.
 
To help you sift the truth from all the B.S. out there, you need someone who KNOWS on your side. If you had read my newest healing program, HOW TO AVOID KNEE SURGERY, which you CAN, if you go to  http://drbillsclinic.com/avoid_knee_surgery.html you would know better. 
 
With treatments drawn from across the entire medical spectrum, conventional, alternative and complimentary, you can finally understand WHAT TO DO, and HOW TO DO IT to relieve your pain and restore your function. And WHY, as well. So don’t be fooled. Arm yourself with the best health resource you can get to get rid of your knee pain, FAST, with easy, proven methods that WORK. Go to  http://drbillsclinic.com/eliminate_knee_pain.html
 
That’s all for today, my friend. I’m going out for a walk in this beautiful weather. There ARE advantages to being in Florida, at least at this time of year   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

Red, burning, swollen and so stiff you don’t want to move…that’s what those who suffer from arthritis experience on a daily basis. If you know this all to well, you are probably one of the 46 million Americans (that’s 1 out of every 5 people) that are living with arthritis every day. To better understand how to get relief from this debilitating disease we need to dive deeper into its root cause.

Some of the types of arthritis, and other related conditions, which are associated with inflammation 

    * rheumatoid arthritis                                                                              

    * gout
    * tendinitis
    * bursitis
    * polymyalgia rheumatica

What is Arthritis?

Arthritis actually means joint (arthr) inflammation (itis). Arthritis can be used to define a group of more than 100 rheumatic diseases and other conditions that can cause pain, stiffness and swelling in the joints or any part of your body. Additionally, it can damage the joint cartilage which can lead to joint weakness, instability and visible deformities that can interfere and, in severe cases, limit a person’s ability to perform most basic daily tasks such as walking, climbing stairs, using a computer keyboard, washing dishes or brushing your teeth. Arthritis can affect anyone regardless of age and most commonly affects joints in the knees, hips, hands and spine. If left undiagnosed and not treated properly, arthritis can cause irreversible damage to the joints, bones, organs, and skin, not to mention dramatically impair your quality of life.

Arthritis-related conditions primarily affect the muscles and the bones but are also considered to be systemic, affecting the whole body. Arthritis can cause damage to any bodily organ or system, including the lungs, kidneys, blood vessels, skin and even the heart. The Arthritis Foundation cites two independent studies (Brigham and Women’s Hospital in Boston and at the Mayo Clinic in Rochester, Minnesota) both of which prove that the widespread inflammation in rheumatoid arthritis is linked to heart disease and an increased risk of early death.

No one really knows the exact cause of arthritis but there are certain risk factors to keep in mind:

    * Genetics – likely to contribute to risk but no one knows how much.
    * Age – the older you are the more at risk you become.
    * Weight – maintaining a healthy weight will ease the load on the joints.
    * Previous Injury – major injuries are likely to contribute to risk.
    * Occupational Hazards – repetitive, high demand jobs increase risk.
    * Certain Sports – high level, high demand sports can contribute to arthritis (however, general exercise is always a plus)
    * Illness or infection – an infection in the joint or gout can lead to arthritis.

What we do know is that when you have arthritis your immune system goes into over-drive and causes the joints to swell and become inflamed. Therefore, treating the inflammation becomes key in managing the pain and discomfort associated with this condition.

Sadly enough, the Arthritis Foundation reports that half of those Americans with arthritis don’t believe anything can be done to help ease their pain. You may be in that situation yourself, having thrown your hands up in frustration and simply decided to live with your pain. The good news is that by reducing the inflammation you can significantly ease the painful symptoms associated with arthritis.

Here are a few ways to reduce your inflammation:

    * Exercise – less weight equals less stress on joints
    * Diet – Eat plenty of vegetables, fruits and whole-grain products; limit sugar, salt and fat (especially saturated fat found in animal products)
    * Rest – a good balance between rest and activity is the key to joint health
    * Over-the-counter and prescription medications – while these may provide temporary relief by masking the pain they do not always get to  the root of the problem – inflammation. They can also have serious side effects, especially with long-term use.
    * Natural anti-inflammatory supplements – probably the most promising natural approach to reducing inflammation in a long while. We recommend looking for supplements containing systemic enzymes and all-natural herbal ingredients.

By taking these simple steps to reducing inflammation you will be well on your way to managing your arthritis pain and it devastating effects on your mind and body. Everyone should strive to achieve a healthy and active lifestyle for optimal health and wellbeing.

Try some today! 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

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

May 8, 2008For all the many years that I served my community as The Hip & Knee Specialist of Long Island, the majority of my patients were women. Not that I didn’t see a good number of men as well, but they were outnumbered by a significant number of females. Now, I would have liked to think that this was because of my killer looks, my expertise, reputation and technical skill, or maybe my overwhelming personal charm . Yeah, I would have liked to imagine any of that. But the truth is, there were more women patients simply because, due to anatomical and physiological  factors, they have more joint problems than men do. I mean, they have a higher incidence of patellofemoral problems, like painful kneecaps, a higher incidence of idiopathic adolescent scoliosis (spinal curvature), more arthritis, both degenerative (osteoarthritis) and inflammatory (rheumatoid arthritis) and more osteoporosis. And that doesn’t even take into account the increasing numbers of young women who get involved in contact and running sports, like soccer, with itsattendant injuries. Who said, “I enjoy being a girl?” So, why is that? You would think that as the bearers of offspring, females would be better protected. Actually, a lot of knee pain is a direct result of the structural variations in female anatomy that differ from the male. Because women must deliver children, their pelvises are, in general, proportionally broader than those of men. This means their hips are wider and that results in a greater valgus (knock-kneed) angle at the knee, as the thigh bones sweep inward from the wider hips. So the knees of women tend to be more”knocked” than those of men. Since the thigh muscles follow the path of the bones, this tends to make the quadriceps pull the kneecaps more toward the outside of the knee, resulting in kneecap pain and a greater tendency to maltracking (slipping out of position). Then, there’s the tendency to get arthritic changes, both degenerative (osteoarthritis) and inflammatory (rheumatoid arthritis, lupus) that’s considerably higher in women. And, like the rest of us, women these days are getting heavier, too, which adds more stress to the knee joints. All these factors are additive, too.  I discuss all of these elements in greater detail at    http:drbillsclinic.com/eliminate_knee_pain.htmlWhen you add up all of these influences and predispositions, it’s not really too surprising that I ended up seeing more women than men in the office. Fortunately, I was able to get most of them better by conservative measures, that allowed them to heal and get pain relief, without surgery. Weight loss, activity modification, bracing and very specific, specially modified exercises, like those I teach at http://drbillsclinic.com/exercise_eliminate.html   worked most of the time, to get rid of their pain and get them back in action again.And, you know what?  They still work… really, really well. You can even apply the same principles to the rest of the body. If you are a lady, or if you know a lady, that needs a terrific overall dedicated exercise program for the fair sex, try Bodysculpting for Women    http://drbillsclinic.com/body_sculpting.html      Eddie Baran’s program is great for toning, strengthening and, yes, sculpting the female form. I’ve personally spoken to women who’ve tried it and they love it! So, whether you need your knee pain relieved, or you need an overall program for improved health, exercise is not only a great cure for a lot of what ails you,  but the closest thing we’ve found yet to the “Fountain of Youth.”  Til next time, my friend, be well. Yours for a pain-free tomorrow, Dr. BillP.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, MDAll rights reserved

April 11, 2008

One of the most striking things I noticed early on in my practice was that most of the knee problems were in women. When you think about it, that’s kind of counterintuitive. I mean, you would think that guys playing weekend warrior would be the most frequent visitors to my office, but no. Women, hands down. That’s not to say that I didn’t see a good number of men, too. Just that they were outnumbered by the ladies.
 
Turns out, there are a few good, scientific reasons for that observation. First, anatomically, you may have noticed that most women have broader pelvises than men. Not all men, just most men. And that makes sense, because they need a wider pelvis to permit childbirth. Because of that anatomical fact, their hips are also wider. So the thigh bones have to sweep inward to the knee at a more pronounced angle.
And therefore, their knees tend to have a more knock-kneed angle than men, too.

This is the source of most of the trouble. This increased knock-kneed angle (genu valgum) means that the thigh muscles that pull on the kneecap are also more angled outward. So the kneecap (patella) is more likely to be pulled outward and track laterally. This makes the possibility of the kneecap slipping out of joint more likely and also puts abnormal pressure on the kneecap, often resulting in painful
degenerative softening of the cartilage (chondromalacia patellae). You can read more about the influence of gender on knee pain in my LITTLE GREEN BOOK   http://drbillsclinic.com/eliminate_knee_pain.html

Now, in addition to the anatomical influences, women also tend to get osteoporosis, especially in middle age, after having children, or after a total  hysterectomy. And they have a greater tendency to develop osteoarthritis, and rheumatoid arthritis–no one knows why. Finally, in general, most women have less muscle mass and are not as strong as most men: their legs are simply weaker. They lack the joint stabilizing and shock absorbing effects of more muscle. This is why they can benefit from my PAIN-FREE PROGRAM of selected knee exercises
http://drbillsclinic.com/exercise_eliminate.html
 
But this is true of the rest of their bodies, as well, especially in the older women. My friend Ed Baran, “The Baron of Body Sculpting” has developed a terrific bodyweight exercise program, especially designed for women. I can’t recommend this highly enough. You don’t
need any equipment, just the desire to improve your function and your appearance. See what I mean at
http://drbillsclinic.com/body_sculpting.html
 
Whether it’s osteoporosis, knee or back pain, high blood pressure, diabetes, high cholesterol, or frank heart disease, exercise is often the very best medicine for what ails you. Try it. You’ll like it. That’s all for today my friend. Have a great weekend and, as always, 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

Remember Christopher Lee as the Count in the early Hammer Films production of The Horror of Dracula? That was always my favorite version. Newer films, notably Frank Langella’s interpretation of his run on Broadway (which was far better than the film), and Francis Ford Copolla’s newest take on the story were great, but for sheer horror, no one beats Chris Lee as the quintessential vampire. Why do I bring this up?
 
Well, it’s time to go get my blood chemistries checked to find out how badly my misspent youth has damaged me. Actually, it’s my wife who needs the blood work, now, but it’s as good a time as any for me, too. We actually met as a result of lab work, back in the dim past.
 
I was a young intern, brand new to the job, at the Medical College of Virginia, “The Harvard of the South.”  I was physically exhausted, working those first few months for an average of–get this–120 hours a week!  That’s no misprint. I averaged only two hours of sleep
a night, at that time. No kidding. They’ve since outlawed this practice of near slave labor and inhuman conditions, but at that time it was believed to “build character.” 

I actually had an instructor tell me, “Hey Stillwell, you ain’t even HUMAN til July,” meaning NEXT July. The attitude of the attending physicians & surgeons was “I did it; now YOU do it.” And the surgeons were, by far, the worst. 
 
Quite insane, actually, but the feeling was that if they could train you to automatically do the right things, in the right order, without thought (you were much too tired for rational thought), then you would learn “reflexes” that were always correct. That actually was correct, but it’s still NUTS! To this day, I still do things by rote that were “burned” into me during those formative years of training.
 
Anyway, there I was, in a zombie-like state, terrified that I would kill someone, by action or inaction, in a state of constant anxiety. I was literally afraid to go to the bathroom, for fear I’d miss a page. I had to have all my patients seen and examined, notes written, bloods
drawn, x-rays collected and be IN the O.R. by 7:30 AM, so surgery could begin at 8:00 sharp. I was a mess. 

Then, one day, I noticed that my bloods (patients’ lab work) were being drawn for me. I was a little puzzled by this, but I “never looked a gift horse in the mouth,” as the saying goes. And, truth be told, I was so burned out from exhaustion that I accepted this, without really caring why. This went on for a couple of weeks, until one day on the ward, a beautiful little girl, with butt-length, reddish chestnut hair asked for
my help in drawing the blood of a quadruple amputee.
 
Now, when no limbs are available from which you can draw a blood sample, your main option is what we call a “femoral stick” — a puncture of the femoral vein in the groin. Technicians were supposed to ask a physician to do this, because there is a certain amount of danger in doing this technique, where you could hit the artery, by mistake. Sure, get the zombified intern to do a delicate procedure–brilliant!
 
Well anyway, the patient, a very cheerful older black man, who had been injured in the war, was up for it. He looked back and forth between this young lady and me and finally laughed and laughed. “Hey doc, that vampire gonna GET you,” he said, laughing at me.
“What are you talking about?” I replied. He laughed even harder. “YOU’LL find out…heh-heh-heh,” he said. With that, I got the sample, gave it to the young woman, who I found out later was FAR better at femoral sticks than I was (rules be damned). 

And the rest, as they say, is history. The young woman became my wife. I never saw it coming. I never had a chance. That guy sure knew what he was talking about. And that’s why I have a soft spot in my heart for vampires, to this day, which I always think of whenever blood work is needed.
 
Getting periodic blood work on yourself is a good idea, at least yearly. And some special tests, like the CRP (C-reactive protein test) can be helpful in diagnosing inflammation, while Rhematoid Factor can be diagnostic in Rheumatoid Arthritis. I teach about these tests, and others in my Little Green Book, which you can get at   http://drbillsclinic.com/eliminate_knee_pain.html
If you have knee pain, or know someone who does, you can’t do better for a concise but comprehensive review of the diseases that cause it and the methods to treat it.
 
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