You know, I just saw an ad the other day, writen by a chiropractor, who is promoting the use of a cold laser for arthritis pain relief. He cited a two year old study, published in the New England Journal of Medicine and then, MISREPRESENTED THE RESULTS, to better sell his modality.

Now, this is no slam against chiropractors. A number of them are my friends and colleagues and there’s no doubt that they help people, which is the name of the game. It IS, however, a criticism of dishonesty in advertising. Here’s what I mean.

The published study cited compared WOMAC scores (a standard statistical device for comparing clinical results of arthritis treatments) between two comparable groups. One group was treated with arthroscopic surgery (ie., debridement, or “housecleaning”), followed by medication and physical therapy.

The other group was treated only with medication and Physical Therapy. It was found after two years that there was no appreciable difference between the two groups (based on their comparative WOMAC scores). The conclusion was that there was no demonstrable clinical benefit from the arthroscopic knee surgery, when done for arthritis.

So this was the study referenced by the good doctor. But, after correctly summarizing the study’s conclusion, this doc then went further, to say this: “Once again, this study proves what conservative doctors have known all along. Non-invasive treatments are the solution to osteoarthritis knee pain.”

No. Sorry. First, that is NOT what the study proved. Second, that statement is patently absurd.

Invasive treatments, meaning ALL forms of surgery, but ALSO, strictly speaking, even injections into or around the affected arthritic joint, each have their place. You just can’t make a blanket statement that ALL non-invasive treatments alone are THE solution. It’s simply not true.

Every case is an individual situation. And no single treatment is applicable, or effective in all cases.

Look, even when I was doing joint surgery nearly every day, I encouraged people who DIDN’T need surgery to wait, try some of the many conservative treatments, from all across the medical spectrum, conventional, alternative, or some combination of the two (complementary).

Nonoperative treatments CAN be helpful and ARE effective for many cases of mild, moderate and even some severe cases of osteoarthritis.

But in other cases– where there is bone-on-bone, meaning that the underlying subchondral bone is completely exposed, by erosion of the protective cartilage layer, or even worse, cases where the bone itself has begun to wear away from friction, resulting in progressive deformities– surgery is the ONLY solution.

In these latter cases, surgery IS necessary. And frankly, treating these advanced cases with only non-invasive treatments is like pi$$ing in the wind–the results are likely to be… unfortunate. In some instances, this would be frank malpractice.

What you want is to avoid the UNNECESSARY SURGERY.

That’s why I put all the very best treatments, including the cold laser, into my newest healing program for knee pain, HOW TO AVOID KNEE SURGERY:

http://www.drbillsclinic.com/avoid_knee_surgery.html

And now, as a perfect complement to that course, I’ve released my newest healing compound, DR. BILL’S JOINT HEALTH FORMULA:

http://www.favoriteformulas.com/jointhealth

This is a wonderful amalgam of the best ingredients available for the relief of the pain of arthritis, including a secret oil from New Zealand, that dramatically reduces symptoms of pain and stiffness. Taken in conjunction with my ultra pure, enteric coated, pharmaceutical grade fish oil, POWERHOUSE OMEGA FORMULA

http://www.favoriteformulas.com

and you have a powerful combination for arthritis pain relief, that may well delay, or even eliminate any potential joint surgery. The point, though, is that you must be wary of any claims you read on the internet. Just because it’s written doesn’t mean it’s true.

Well, any time now, you’ll be getting the instructions for the big switch to another provider for this newsletter. Remember, if you want to keep receiving this daily email, you MUST re-subscribe. Otherwise, they will simply stop. I’m hoping that you find some value in this and that you’ll follow me to the new service. But, as always, the choice is yours.

Til next time, my friend, be well. Talk to you soon.

Yours for a pain-free tomorrow and optimal health,

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 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

Once released from the hospital’s RIO unit, my wife drove me home. I was set up in a spare bedroom, with a lower mattress than my usual, to make it easier to get in and out of bed.
 
Luckily, the local anesthesia was in full force, so I remained comfortable and pain-free. I checked out the dressing, but it was clean and dry, with no sign of bleeding. So far, so good. Then, I got a cold seltzer to drink. Remember, I had been NPO (nothing by mouth) since 10PM the night before surgery, and only had ice chips in recovery, so I was pretty thirsty. Hungry, too. 
 
Then, I noticed I was tired. No surprise there. Surgery is a trauma to your body, so it induces a lot of stress. After drifting in and out of sleep, I had to go to the bathroom. That’s when things started to get interesting.
 
Turns out that when you try to get out of bed, especially without any leverage, you put a lot of stress on those new sutures, just placed in the surgical repair. YEOW! Only a momentary thing, but despite the local anesthetic, I felt that! I had to figure out how I was going to do this.
 
So, I decided to try using a cane, which I had handy, left over from my last surgery, an arthroscopy of my left knee in 2005. I discovered that of I pressed down with the cane in my left hand, I was able to get up with only minimal discomfort. How about that?

Further experimentation revealed that if the came was used in my left hand while walking, it relaxed my right abdominal muscles, by reflex. Now, I’ve known for years that the use of a cane reduces the joint reaction forces across the opposite hip and knee. In fact, I make a great point of that technique, as a way to minimize joint pain, in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN  http://www.drbillsclinic.com/eliminate_knee_pain.html
 
But I never heard that it also relaxes the abdominal muscles on the opposite side from the cane. I don’t believe my surgeon even knows about this (but you can be sure that I’ll let him know, for his future patients). Keep this trick in mind, if you ever need to get abdominal surgery–it makes quite a difference.
 
The other thing that made a big difference in my comfort was the use of a rectangular cooler pack, stored in our freezer against emergencies, instead of a simple ice pack. The surgeon had recommended intermittent use of ice to reduce swelling, but this solid, cold cooler pack not only chilled the tissues, reducing local pain and swelling, but also acted as a buttress against any intra-abdominal pressure. When I pressed it against my surgical site, it kept the repair under pressure, so it reduced any tension on the internal sutures.
 
Between the cane and the cooler pack, I managed very well, indeed. I was completely comfortable, when at rest in bed. I only had some momentary pain, when attempting to get in and out of bed. Even walking was not bad, so long as I went slowly, using the cane in my left hand and holding the cooler pack against my lower abdomen, on my right.
 
In bed, I found by trial and error that a slightly bent fetal position, on my left side, with a pillow between my legs, made me very comfortable. Virtually no pain, at all. I still had taken no pain medication. In that position, I slipped off to sleep and slept all night long.
 
Next day, I found the same thing. Using the cane and the ice pack, I was comfortable enough that I was not in need of any analgesics, even though the local had surely worn off by then. I just took it easy, watched TV, read a bit and periodically took a nap.
 
Long and short of it is that, despite having filled a prescription for Percocet, just in case, I have not needed a single pill. Not one, to date. Just took off the dressing and the incision is healing fine. Of course, the real issue is the internal healing. And that’s the reason that I can’t take my twice daily dose of POWERHOUSE OMEGA FORMULA   http://www.favoriteformulas.com 
 
A hernia is a defect in the tough fibrous sheath across the groin, which is pierced by the spermatic cord, on its way to the testes. The descent of the testes leaves a potential weakness there, which in some people, under some conditions, leads to a tear, or rupture in that sheath. This tear allows loops of bowel (small intestines) to protrude, causing a bulge under the skin. In some cases, that loop of bowel can twist, cutting off circulation and literally dying. This is called strangulation and it’s a surgical emergency. That’s why I wanted this fixed, pronto.
 
In the old days (when I was an intern), the only repairs sutured the edges of the tear back together and to the big oblique inguinal ligament, that runs between the “point” of the hip (anterior superior iliac spine) to the pubic bone. But that repair is under a lot of tension and ruptures can recur at a rate of around 30-40%. With a new, tension-free technique, the surgeon covers the defect with a fine mesh of polypropylene and sews that to the edges and the ligament. 
 
Eventually, fibrous tissues grow into that mesh, which acts like a scaffold, and upon maturity reconstitutes the abdominal wall, obliterating the defect and restoring integrity to the wall. The recurrence rate for this technique is only 1%. The downside is that it needs inflammation to provoke the ingrowth of the fibrous tissues. So, since fish oil is so effective at reducing inflammation, I can’t use it yet. And the rest of my joints KNOW it, too.
 
Anyway, that’s what happened next. So far, so good. I walked a bit more today and went out for the first time. So, little by little, day by day…it’s getting better. Til next time, my friend, be well. 
 
Yours for a pain-free tomorrow and your 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

Finally, the Holidays are over. The confetti and tinsel are over for another year. And here we are in the beginning of a new year, of a new decade. Here’s hoping it’s a good one….
 
As for me, I’m recovering from my recent herniorrhaphy (inguinal hernia repair), which I had done last Thursday morning, New Year’s Eve Day. The idea was to get this problem fixed, while in the old year, so I could begin the New Year with the surgery behind me and start a new chapter of my life, with healing. 
 
Now, my wife has a dim view of all things Floridian and would have preferred that I have my surgery in New York, with one of my old compadres. But my attitude was that, if I’m living down here, I’d better learn who’s good, on an elective basis, before any emergency occurs.
 
I was referred to Dr. Possada, a general surgeon recommended by my cardiologist, of whom I think very highly. I asked the correct question of him: “Who would YOU use, for this procedure, for YOU or YOUR FAMILY?” 
 
Very important point and the best teaching, with which to start the New Year: Never just ask for a referral. Depending on the doctor (or nurse) and the relationship they have with the specialist, you may get lucky, or you may get referred because of business reasons. I saw this many times in my years in private practice.
 
I got many a back-handed compliment: these guys would send all their referrals to other docs, for business reasons, but when it was someone from their own family, why then, they wanted them to come to me.
 
It’s considered “unethical” for nurses or docs in the ER, for example, to refer to the docs who they KNOW are the best. Instead, if asked for a referral, they are required to refer to the person on the ER call roster, who may or may NOT be the best choice for you.
 
The case for this is that they can otherwise “steer” referrals to their favorites and away from those not so favored. However, what they are NOT doing is looking out for YOU. They don’t know you. They have to live with all these guys, long after you’re gone and forgotten.
 
So, be smart. Ask instead who THEY use, personally. Different question. And not unethical to answer. Repeat this a few times, with different health professionals and the same two or three names are going to keep coming up. THAT’S who you pick from.
 
In Medicine, as in Life, “birds of a feather DO flock together.” The best hang around with the best. Always did. Always will.
 
Anyway, I met this guy and was immediately impressed with his manner, his confidence, his over 20 years of experience in doing this procedure. I trust my gut. And I like and trust my cardiologist. So that’s how I made my choice. I didn’t look up his credentials, or whether he had any malpractice suits, or any of that other crap that people think matters. It doesn’t. I know a good man when I meet him.
 
So we scheduled the surgery, in accordance with my wishes that it be done in 2009. And he accomodated me, despite a solidly booked schedule (another indicator that he has a good reputation and a busy practice–which he wouldn’t, if he was leaving dead bodies all over).
 
So, Tuesday, I went to the Florida Hospital, Orlando, for presurgical testing–simple blood work, interviews and collection of my medical history. Early…and I mean EARLY…Thursday morning, I got up at a little after 4AM, showered, dressed and drove with my wife to the FLORIDA HOSPITAL outpatient surgery unit, what they call their RIO, an acronym for Rapid In and Out. 
 
When you think about it, that’s a sort of unfortunate name they’ve chosen, with echoes of “A Clockwork Orange.”
 
Contrary to my usual tardiness, we were precisely on time, at 5:30AM. A nurse picked me up and took me, with my wife, to a patient station in the preop staging area. I undressed, put on thigh-high TED (thromboembolic disease) stockings, a prophylactic measure to minimize the risk of blood clots, during the immobility of surgery, a pair of socks with rubber treads, to provide non-slip surfaces, and a johnnie (those ridiculous patient gowns that tie up in the back, leaving your naked butt exposed).
 
Then, I was visited in turn by the preop nurse, who started an IV, gave me some preop antibiotics and worked through her checklist, then the OR circulator nurse, the nurse anesthetist and the anesthesiologist. The plan was for LMA anesthesia–laryngeal mask airway.  This is used for light general anesthesia, which my surgeon prefers, as it provides maximal muscle relaxation, a must for a good hernia repair.
 
I advised the anesthesiologist to forget that I was a surgeon, myself, treat me like any other guy off the street and do whatever he thought was necessary, at any time, even if that meant full intubation, with an endotracheal tube. That’s always the best way to survive. It’s when they think they’re doing you a “favor” and treat you different from the standard of care that you get into trouble.
 
Then, they slipped a little Versed (a very short acting hypnotic agent and relaxant, that causes retrograde amnesia, as one of its little benefits) into my IV, started wheeling me out to the OR and….
 
When they roused me, a little later, I thought I had just dozed off and was now in the OR, ready to begin. But the procedure had already been done. I felt no pain, at all. My surgeon had infiltrated the repair and all the tissues with a long acting local anesthetic, with epinephrine (adrenaline, which constricts blood vessels, minimizing bleeding and allowing the local anesthetic to stay much longer in the tissues, keeping them stone numb).
 
Thanks to the short acting anesthetic agents, like Propofol (Deprivan, the same stuff that killed Michael Jackson, used incorrectly, but a great drug, when used by pros and monitored correctly), I was wide awake in a very short time. Very chatty, according to my wife, but hopefully, not too obnoxious to the nurses, who I’m sure are used to this. 
 
Hey, it’s like the old movie title–”Blame it on RIO.”  The residual anesthesia inhibits your inhibitions, like you were a little high. Well, that was my “drink” for the night….
 
A few hours later, once I was able to walk, urinate on my own and appeared to be stable, I was ready to leave. And so we did. All in all, everyone involved, start to finish, in the RIO did a simply an exemplary job. I was very favorably impressed. And comfortable, the entire time.
 
And that’s how I spent my New Year’s Eve, this year.
 
Tomorrow, I’ll tell you about the early recovery process and the new things I learned from this experience, that I didn’t know before. I still can’t start my fish oil, which I really do miss,   http://www.favoriteformulas.com   but for reasons I’ll explain, I can’t suppress my inflammatory response, just yet. Neither can I start my isometric exercises, as yet, for fear of stirring up bleeding. But soon, I’ll begin with these fundamentals from my newly expanded, completely redone PAIN-FREE PROGRAM & brand new DVD:
 http://www.drbillsclinic.com/execise_eliminate.html 
 
2010: This will be a different year, a new chance to get healthy, get fit and leave your bad habits and health care problems behind. And despite the wretched economy and the forces arrayed against us, from ignorant & arrogant fools in our own government, who would dare to use your life, your health and that of your family, as a political means to power, to Big Pharma plots to make statin drugs “preventive care” for everyone, to internationalist efforts to interfere in our personal rights, to use supplements as we see fit (Codex Alimentarius), against all these and more, we will join together and fight back, with the truth and with actions. 
 
This year, we will explore, together, the best ways to relieve pain, restore function, prevent disease and disability, lose weight; to be better, stronger, leaner, fitter, happier, healthier; to live as we ought to live, in optimal health, for as long as we may….plus many new surprises, new products, new features and more emails, to educate, entertain and amuse you.
 
And if you will stick with me, this year, continue to be part of our extended family of friends, one of “Dr. Bill’s Wellness Warriors,”TM and DO what I teach you to do, together we can all enjoy a brighter, happier, healthier future. So stick around and I’ll promise to do my very best to make you glad you did. Til next time, my friend, be well….
 
Yours for a pain-free tomorrow, with optimal health & wellness,
 
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, 2009 by William Thomas Stillwell, MD, FACS
All rights reserved

Today I’m in the final countdown before my surgery tomorrow morning. I’m trying to anticipate all the things that will need doing prior to my recovery period, when I expect to be incapacitated by abdominal postop pain. 
 
Though a number of people think I’m crazy getting surgery on New Year’s Eve Day, my wife among them, my attitude is that if you recognize a problem, it’s best taken care of ASAP. Were I to wait, the damn hernia would likely just get bigger and more painful. And there’s always the chance of strangulating a loop of bowel, entrapped in the abdominal wall defect. Now, that would be a problem.
 
No, better to get it behind me, face the issue head-on and fix the damn thing. Compared to what I used to do, this is pretty straightforward stuff. But of course, no surgery is minor surgery when you’re the patient. All in all, I like being the operator better than being the operatee, if you know what I mean.
 
However, this episode gives me a chance to teach you something that I normally wouldn’t think about much. And that is ISOMETRIC EXERCISES.
 
Now, after a surgery like this, any contraction of my core muscles is going to hurt like Hell, at least for the first few days. So after the immediate period of rest, to allow postop bleeding to stop and postop swelling to recede, I have to be able to maintain and then rebuild my leg strength. 
 
This is especially true since I’m not going to be able to restart my fish oil for a while. And I feel it in every joint. There are a couple of reasons for this.
 
First, fish oil’s omega 3 fatty acids act to reduce platelet adhesiveness, or stickiness. That’s great when you want to reduce your risk of heart attack or stroke, by reducing clot formation. Not so great, when you WANT clot formation during and after surgery.
 
Then, there are the known anti-inflammatory properties of fish oil. Well, normally that’s exactly what you want. But in this surgery, inflammation is a part of the initial healing process. So, if I want a good repair, I have to suffer the lack of my POWERHOUSE OMEGA FORMULA  http://www.favoriteformulas.com  for a few weeks. But the other parts of my body, like my back and my joints can definitely feel the difference when I don’t take it. And that’s why YOU should.
 
The kind of hernia repair I’m getting is called a “tension-free” (Lichtenstein) repair, which uses a polypropylene mesh, to cover the abdominal wall defect. This mesh acts like a scaffold, to allow fibroblasts (fiber producing cells) to infiltrate it and rebuild a fibrous layer over the defect. Inflammation plays a role in initiating this process. So, I just have to grin ‘n’ bear it.
 
In the aftermath, when the abdominal wall is sore, active exercise for my knees simply wouldn’t be possible. Nor would it be wise, as it might compromise the repair, before it was strong enough to bear extra tension or intrabdominal pressure. So, what I plan to do is to use the isometric exercises that I teach in my newest edition of my PAIN-FREE PROGRAM & DVD http://www.drbillsclinic.com/exercise_eliminate.html 
 
Isometric exercise generate muscular contraction, without shortening of the muscle. That’s how they’re defined. The advantage is that I can strengthen my knee with these static postures, without putting any pressure on my sure to be sore belly and groin. 
 
The Wall Chair and the Horse Stance, derived from the martial arts, like karate and kung fu, are ideal for this purpose. And they’re safe. They’re ideal for the person just starting out, or the morbidly obese, who want to eliminate their knee pain, but lack any strength, at present. These are a great way to build a foundation of strength, for more aggressive exercises, later on. Just strike the position, and hold it for time. It’s as simple as that. 
 
So that’s what I’ll be doing, after surgery. And what YOU should be doing, if you’d like to start on the road to pain-free knees, safely and effectively. Well, my friend, that’s about it for today. This was my last lesson on eliminating knee pain for 2009. 
 
My wish for you, as we enter a new year and a new decade, is one of peace, happiness, health and prosperity. Have a Happy and Healthy New Year, my friend. All the best, as always. Talk to you again in 2010.
 
Yours for a pain-free tomorrow and optimal health,
 
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 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, 2009 by William Thomas Stillwell, MD, FACS
All rights reserved

No, because if you don’t get one of those best trained, most experienced surgeons, then your risks of complications is greatly increased. These would include soft tissue injuries, from stretching the smaller incision so the surgeon can see; incorrect bone cuts with incorrect angles, simply because the surgeon just can’t see enough of the bones to make accurate cuts; debris left in the joint, because the small incision obscures the joint so the surgeon can’t see to remove it. Also included are fractures of the bones, when attempting to impact the implants into place, malposition of the implants, often leading to dislocations, or joint instablity; and nerve injuries from traction, again in an attempt to see better through the small incision.
 
As you can see, the trade off is a chance for faster healing versus higher risks for multiple complications. All of these, the good and the bad, are a consequence of the smaller incision.
 
Funny thing is, my teachers always said to make a larger incision, because 1. you can see what you’re doing and all the anatomy and 2. there is less tension and therefore less trauma to the tissues, less edema (swelling) and 3. you can see and stop any bleeding blood vessels (“It heals from side to side, not end to end...”). 
 
But the MIS is in vogue right now–despite NO long term evidence that its results are as good as standard surgical approaches. You didn’t know that there are actual fashions in surgery? Oh, yes. Very much so. 
 
I’ve seen this before. At first, there’s a rush of enthusiasm and the public (who only know about the supposed benefits) DEMAND the new, in vogue procedure. Then, as its indications are expanded and surgeons, who are NOT as experienced, feel pressured to do the new procedure (or risk losing patients), the complications begin to emerge. As the problems begin to mount, and some true disasters are reported, the enthusiasm wanes and finally everyone goes back to the traditional approaches, or at least modifies the indications for the “new” technique.
 
As if you needed another reason to stay OUT of the operating room…. Or, you can try one of a number of proven, reliable, simple, non-surgical treatments that can help you AVOID SURGERY. It’s your choice. There are lots of cases in which surgery is UNNECESSARY. You lose nothing by trying one of the conservative, non-operative treatments I teach in HOW TO AVOID KNEE SURGERY. See it here at http://drbillsclinic.com/avoid_knee_surgery.html
 
If you want to see treatments to relieve knee pain and specially modified exercises to restore function, using conventional, alternative and complimentary methods from across the entire medical spectrum, go NOW to http://drbillsclinic.com/avoid_knee_surgery.html
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill 
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

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

If you develop the reputation of being very conservative when it comes to recommending surgery, ironically enough, you end up doing MORE surgery than if you had been very aggressive initially.
 
You see, the physicians who refer patients, and other patients who refer their friends, want to have confidence that they are sending these people to someone with integrity, who won’t push an unnecessary procedure, and will only recommend surgery when that’s the only option, or sometimes, the best option.
 
They believe, quite accurately, that their recommendation reflects on them. And they want their patients/friends to feel good about the guy they sent them to. So they tend to refer to the surgeon who is SLOW to operate. Over time, this results in a very large volume of surgery with EXCELLENT RESULTS, because the procedures were properly indicated and the surgery therefore worked.
 
I learned this very early on in my practice, from one of the senior men in my group. This guy was a truly outstanding hand surgeon–gifted, in fact.  As a young guy, just out of training, I naturally wanted to do surgery. That’s why I trained so long–I wanted to DO something to help people. 

And, like many young guys just out of training, I believed there wasn’t ANYTHING I couldn’t do. Time and maturity have a way of humbling the best of us, but at that time, I BELIEVED in my own abilities.
 
Well, this older man, who had much more experience, but understood the drives of a younger man, told me, point blank, what I just told you: 

“Bill, restrain yourself and try conservative treatment first, with every patient. Not only is this the right thing to do, but mark my words, you’ll end up doing MORE surgery than if you’re too aggressive.”
 
And because I had seen this man in action and greatly admired his extraordinary skills, I respected anything he told me. In short, I did exactly what he told me to do. 

And you know what? He was right.
 
In time, I came to appreciate that this was the ethically correct approach, as well. But at first, I learned to be this way as a matter of enlightened self-interest. With maturity, I developed personal guidelines to PROVE that any procedure was indicated and it was the correct approach for the patient. 

And, I incorporated a number of alternative measures into my practice, as well (despite the odd looks and derisive remarks of my colleagues), as they seemed to work and they often offered improved results in non-surgical cases, of which there were many more than the surgeries.
 
So, many people told they need surgery tend to panic. They’ve all heard horror stories and imagine every evil result imaginable, if they allow themselves to go “under the knife.” And in some cases, where surgery really IS the right thing to do, they miss the opportunity to get an excellent result, or worse, because of misplaced fear and ignorance.
 
I don’t want that to happen to you. 

So, for the rest of this week, each day, I’m going to teach you exactly what’s done in a number of the most popular orthopaedic surgeries. You might as well know what’s really involved. In this way, you can face what you fear. And I’ve always found that learning the truth robs fear of its power over you.
 
But remember, MOST cases can be treated WITHOUT  surgery. That’s why I created my newest healing program, HOW TO AVOID KNEE SURGERY   http://drbillsclinic.com/avoid_knee_surgery.html
 
So if you, or someone you know, has knee pain, or been told you need surgery, check this out. With the very best techniques from across the medical spectrum, conventional, alternative and complementary methods, you may well be able to relieve your pain–WITHOUT SURGERY. Try it. You have nothing to lose, but your pain. Click the link below and see:
 http://drbillsclinic.com/avoid_knee_surgery.html
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

Having just finished my fellowship in joint reconstruction at the New England Baptist Hospital, in Boston, I had been told and I was convinced that I was “hot stuff.” I was the first fellowship trained joint surgeon on Long island, to my knowledge. I had more technical experience in these procedures and had done more of them than everyone in town had EVER done, COMBINED. And I wanted to do a surface replacement, which at that time was the latest development in the field. I had been fully trained and done a bunch of them at the Baptist. So I was ready and wanted to do that procedure in the worst way.
 
So my pal and first assistant, Steve, and I were all set. The patient was anesthetized, positioned, prepped and draped. We were ready to roll. All the other surgeons were drifting past the little window in the door of OR Room 5. Curiosity was running high and about half the guys that were peeking in were kind of hoping that I’d fall flat on my face.
 
No such luck. We started and made the standard exposure of the hip. Then, I brought the femoral head up into the field and started to prepare it with the special head reamers, that work sort of like a hemispherical, concave parmesan cheese grater, to grind away the arthritic surface and reshape the head into a perfect sphere.  Everything was going well, when I noticed that the reamed bone of the head wasn’t bleeding. 

When you see a bone, it’s usually dried out, in a museum or even in a butcher shop, hence the term “dry as a bone.” But in life, bones are anything BUT dry. They are chock full of blood and the rigid bony walls of the bone keep the openings open; they can’t contract like blood vessels in the soft tissues do. So, when they are broken, or cut in surgery, they bleed like crazy. At least they do when the circulation is normal.
 
Problem was, Mabel’s femoral head was reamed and should have been bleeding freely–and it wasn’t. No blood at all. Not good. Turns out she didn’t mention that she had been a heavy drinker for many moons in her history. And heavy drinkers may develop a disease called Avascular Necrosis, which means that the blood supply to the femoral head is blocked. Now I had to reason this out, while we were in surgery, because the patient hadn’t told us about her drinking history.
 
So there we were. All set to do the first surface replacement on Long Island, suspicious guys peeking into the room, and the damn head isn’t bleeding–meaning it’s DEAD, and therefore, will collapse after a while, if we go ahead with the planned surface replacement. Crap. Well, nothing for it, but to change course in midstream. 

I grabbed the power saw and cut off that dead head. We then went ahead with a standard cemented total hip replacement.
 
Everyone was kind of disappointed, but hey, you’ve gotta do what’s right for the patient. Turns out that she was lucky, in a way. Subsequent studies proved that the surface replacement of that period was a flawed design, that often failed and destroyed a lot of bone in the process. The standard total hip, even then, had a success rate in the high nineties. Like I always say, “better lucky than smart.”
 
Mabel, meanwhile, did terrific and went on to a very succesful result for the rest of her life. She died years later, from old age. And she kept her total hip the whole time. 

For years, the standard treatment for a knee injury that suggested a torn meniscus was surgery. But many people don’t want surgery, regardless of objective findings. Most of them will do well with the methods I teach in HOW TO AVOID KNEE SURGERY
 http://drbillsclinic.com/avoid_knee_surgery.html   But, if they fail to improve, and/or they are proven to have irreparable disease, the facts have changed and to continue with non-surgical measures despite them is fruitless. 

So, what did we learn? Well, I think the take home message is that you have to be able to change your mind when circumstances change. You can’t be afraid of being inconsistent. Emerson once said “foolish consistency is the hobgoblin of small minds.” I think he was right.
 
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

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