February 1, 2010

Worked my butt off this past weekend, cleaning the house for an anticipated visit by my father-in-law’s wife’s brother and his wife, from Italy. Seems the guy is reported to be allergic to cats. Heh. That would make ours the wrong house to visit, as a general rule (we’re down to 24 now, having just lost Misty, our oldest, on this past Christmas Eve Day).
 
But, as these nice folks have never been in the States before, in the interests of international diplomacy, we decided to go the extra mile and super clean the place to make it “safe” for an allergy sufferer.
 
But first, we had to trap the cats and confine them. Otherwise, you’re just spinning your wheels. Fortunately, like me and most of our friends, they’re “food sluts.” Nothing they wouldn’t do, no place they wouldn’t go, for a tasty meal. So, my wife and I cracked open a few cans of wet cat food and played “Pied Piper” with them.
 
It’s quite a sight to see them all following the aroma of the food, right into the bedrooms, where we locked them in for the day. Then, we could work in peace.
 
So, we finished the house and then set about making some food. One thing about Italians is that they know good food. So we pulled out all the stops.  Turned out pretty well, too. They seemed to like everything and had seconds….
 
Nice couple they were: Mario and Tina. Live near Naples (the real one, not the one in Florida), have four kids, the oldest of whom is now in his forties. And they speak no English. Fortunately, Anna, Charlie’s wife and Mario’s sister, is bilingual, so we had our own built-in interpreter. Very lovely people. And we had a good time.
 
During the meal, Mario mentioned to my father-in-law that his son was supposed to have surgery on his knee. Between Anna’s interpretations and sign lingo, I was made to understand that he was having arthroscopic surgery on his lateral mensicus, which according to an MRI scan, was torn. And, since he found out that I was an orthopaedic surgeon, he naturally wanted to know if I thought that surgery was necessary.
 
Pretty good question, really. I pointed out to him that if he had read my book on treating knee pain, DR. BILL’S LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN  http://www.drbillsclinic.com/eliminate_knee_pain.html  he would know the answer. And a lot has to do with the nature of the tear, where in the meniscus it is, and how active he intends to be after surgery. And all that is assuming that the tear actually exists.
 
The MRI scan is a great tool for diagnosis. On the medial side of the joint (inner side), its accuracy is about 90-95%. But, because of the screwy anatomy of the lateral compartment of the knee joint, MRI findings of the lateral meniscus are only about 60% accurate. So, actual pathology has to confirmed at arthroscopy, before you can begin to decide on appropriate treatment.
 
Apparently, he got the injury playing football. Not our idea of football, as in the Superbowl, but European football, or soccer. The rapid twisting, cutting movements in that game result in lots of meniscal tears. And, despite his age, he’d like to continue playing, after the proposed procedure. That being the case, he SHOULD have the surgery. 
 
If he was a low demand user, ie., a couch potato, then the same injury need not be treated so aggressively. In fact, the pain could then be treated with a number of the non-surgical options that I recommend, from across the entire medical spectrum, including the best alternative treatments, in my newest healing program, HOW TO AVOID KNEE SURGERY: http://www.drbillsclinic.com/avoid_knee_surgery.html  
 
The exercises I show you, plus one, or several, of the other simple, easy to apply solutions for knee pain, including the anti- inflammatory properties of my POWERHOUSE OMEGA FORMULA,  http://www.favoriteformulas.com    an ultra pure, pharmaceutical grade fish oil, can often get rid of your knee pain fast and keep it gone, for good. Two capsules, twice a day, for a couple of months should do the trick, by reducing inflammation.
 
He felt very reassured that his son was making the right decision. And he was relieved that he had every reason to believe that his recovery would be fast and uneventful. Especially after I told him that I’d had such surgery myself and obviously, did well.
 
Then, it was time for them to make the run to the Orlando International Airport. Another of his sons was flying in to visit and they were going to pick him up. Naturally, they all want to go to Disney World.
 
So, having done our bit for U.S. international relations, and made two new friends, we all said “Ciao!” and bid them farewell. After a few well-earned moments of peace, for ourselves, the bride and I released the feline hordes, who descended on the kitchen, looking for more food!  There’s no end to it!
 
And, you know, that guy, Mario, never sneezed once! Guess we did a pretty good job. Well, that’s it for today, my friend. 
 
Remember that very soon, now, I will be asking you to sign up again, if you’d like to continue getting my daily emails and commentary, when I switch to a new server to improve email reliability and delivery. I know it’s a pain in the butt, but it’s necessary. 
 
On the other hand, if you’d like to bail, but were afraid of hurting my feelings, just don’t do anything and that will be done for you–you’ll just stop getting these daily ramblings and musings. To continue, you will have to take action, when the time comes.
 
Anyway, be well. Talk to you soon. 

Yours for a pain-free tomorrow,
 
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

January 19, 2010

Last week, while I was perusing my emails for Dr. Bill’s Clinic, I came across a request from one of my older subscribers. By older, I mean (quite naturally) older than ME. Ever notice how when anyone talk about “old guys,” they always mean older than THEM. Right?
 
Anyway, this man is, shall we say, in late middle age, has stayed in good shape and has been a runner for years. Problem is that he recently had a sudden onset of severe knee pain, after running to catch a bus, or something.
 
He was seen by an orthopaedist, who after examining him, decided that he may well have a torn meniscus. 
 
As you may know, there are two crescent shaped fibrocartilages, called menisci, which lie between the end of the femur (thigh bone) and the upper tibia (shin bone), inside the knee. 
 
They act as cushions and guides for motion of the joint, especially in twisting, or cutting movements. For more about these and other causes of painful knee pathology, please refer to my LITTLE GREEN BOOK:  http://www.drbillsclinic.com/eliminate_knee_pain.html
 
Because these cartilage structures are invisible on standard x-rays, the doctor ordered an MRI scan of the offending knee. This scan is terrific, because it can show the structures and can predict if they are torn, with an accuracy of about 90-95%, on the medial (inside) compartment of the knee.
 
Sure enough, he had a torn medial meniscus. But he also had a surprise–he had almost completely bare bone exposed on the end of his femur, in the medial compartment. The guy was understandably shocked. How could he have such bad arthritis and not have felt it before this injury?
 
The answer is, this is not an uncommon picture. Sometimes, the articular cartilage becomes degenerative and gradually erodes away, exposing the bone. Though most people will feel this as significant pain, as it happens, a few will compensate (high pain threshhold, endorphins, etc.) and will feel nothing, at all. Until something happens, as did here, to DE-compensate his defenses against pain. THEN, he felt it.
 
Naturally, as a believer in natural healing, he was leery of knee surgery. And studies have demonstrated that arthroscopic surgery added nothing to just medicine, physical therapy and exercises, like those I teach in my newly updated and expanded PAIN-FREE PROGRAM & DVD:  http://www.drbillsclinic.com/exercise_eliminate.html 
 
HOWEVER…in this case, I DID recommend that he go ahead with surgery. Here’s why.
 
This man is very active and wants to remain so. He has exposed bare bone and therefore, will need at least a partial knee replacement, perhaps a total knee replacement, when his symptoms warrant it. But then, he will NOT be able to run or do any exercises involving impact, which could damage, or loosen the artificial implants.
 
He also has a significant tear, easily fixed, in addition to his arthritis. It seems reasonable to conclude that if the tear were “fixed,” he might well “buy time” and return to his asymptomatic state, at least for a while.
 
The studies that recommended against knee surgery for arthritis were talking about a general “clean out,” or debridement, NOT addressing a specific torn meniscus, with very specific mechanical symptoms, directly attributed to that damaged structure. When dealing with arthritis and knee pain, it IS best to be conservative, in most cases, where there is diffuse disease and no specific mechanical symptoms, as seen here.
 
That’s why I wrote my newest healing program, HOW TO AVOID KNEE SURGERY, which you can get here: http://www.drbillsclinic.com/avoid_knee_surgery.html 
 
The many treatments from both conventional and alternative medicine are designed to help you avoid the UNNECESSARY procedure. but if the surgery IS necssary, as it was here, then it should be done.
 
Well, he DID have the arthroscopy, he did, in fact have the tear that the MRI predicted, and he DID do very well. He’s now glad he did it, as he has returned to his preoperative state of virtually no pain. And the procedure has bought him time, which he can continue to enjoy, until further progress of his disease makes a total knee unavoidable.
 
I love being right. 
 
And the only other recommendation I gave him that I would give you, too, is to get on my Powerhouse Omega Formula, an ultra pure, highly concentrated, pharmaceutical grade fish oil, with a special enteric coating that prevents any fishy aftertaste and the dreaded “fish burps.”
 
http://www.favoriteformulas.com  
 
Omega 3′s have potent, long term anti-inflammatory properties that help to control the pain of arthritis, a as well as many heart and brain healthy effects, as well.
 
I also advised him to consider giving up the running, in favor of power walking, or hill sprints, which avoid the damaging shocks to the weight bearing joints, seen with running. If he listens to me, these measures may buy him even more time….
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
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

December 29, 2008 

During the second half of my surgical internship, I was assigned to the VA Hospital in Richmond. At that time, and it probably hasn’t changed, everyone wanted to go to the VA because you got to do surgeries that were way beyond your usual fare. As an intern, I got to do surgeries that I normally wouldn’t be given to do for at least another two years, or so, at the regular hospitals. 
 
When you think about it, that’s really unfair to the vets. I mean, here are guys that have sacrificed for their country and here they’re being used as guinea pigs for some young punks looking to learn surgery. But, of course, at that time, all I cared about was doing more surgery. The fairness of the situation never even entered my mind–that’s just the way things were.
 
Anyway, one of the patients on my ward was a guy who had been operated on by every house officer who had rotated through that surgical service since he had been admitted over three years before. The guy was an old man, a real basket case. 
 
He couldn’t even eat because he had NO intestines left. He was fed through a vein, by I.V. hyperalimentation–a very fancy term for total parenteral (by vein) nutrition. Every few weeks or months, he would develop some complication or another that required another surgery. There was hardly anything left of him, but he kept on chuggin’ along, educating generations of interns.
 
Then, one of the residents told me how he came to be like this and my blood just froze. You see, he originally came in for a “minor surgery.” He was just supposed to have a simple bunionectomy. But, hard luck guy that he proved to be, it got infected.
 
So he got a second surgery to drain the infection. And I.V. antibiotics, of course. But, the surgical site turned into osteomyelitis–bone infection. And of course, this required another surgery.
 
Then, he needed a toe amputation. Then another. Then, his veins clotted up, so he needed a central I.V. line, for long term antibiotics. Which also got infected and needed removal. And a new central line. Then, one day, he got horrible stomach pains, which required a full work up. Turns out he had now developed a real problem: mesenteric embolism — a shower of clots that blocked off the arteries which feed the intestines. Without blood, the intestines literally die and develop gangrene. Which requires their removal. Naturally, you try to leave what you think will live and only remove the dead or dying tissues.
 
But the same thing happened again. And again. Each time, taking more and more of the man’s intestines, until finally, he had nothing left. By the time I showed up, he was The “Phantom” of the V.A.–a shell of his former self–quite literally.
 
And then he got really sick and resistant to the antibiotics. Turns out he had developed a subphrenic abcess (a big infected collection of pus, under the liver) and it was my job to take him to the OR and drain this mess. Which I did. If that didn’t gross me out, nothing ever would again.
 
Well, he rallied, but eventually it was just too much for the poor man. He died. Finally at peace. I came upon him one morning, while making rounds, already cold. And I also noted that he had perfect vital signs charted, right up until 8AM, when I found him. Hmmmmm…Guess the VA night nurses were too busy with other things to notice that this patient had passed on. 
 
I was sent to the autopsy, to learn what had finally gotten him. And I was shocked to see that when they opened him up, there was almost nothing left–he was like a used up, empty shell. Cause of death? Organ failure–take your pick. Poor guy. No one deserves this.
 
And I reflected, not for the first or last time, that our bodies were merely machines, shells driven by an animating spirit and that whatever made us “us,” the soul, if you will, was long gone from him. 
 
The horror of all this is that it started with a “minor surgery,” a “simple procedure.” And like that poem, “For Want of a Nail, the Kingdom Was Lost,” one thing led to another, and another, until the final, pathetic denouement.
 
Lessons learned here? 1. Ain’t no such thing as a “minor surgery” (only minor surgeons). 2. “One never knows, do one?” 3. Murphy is always waiting. 4. Whenever possible, avoid surgery…and you avoid its complications.
 
And after a lifetime in the OR, I’ve distilled the lessons I’ve learned in my newest healing program, HOW TO AVOID KNEE SURGERY, which you can get here at   http://drbillsclinic.com/avoid_knee_surgery.html
 
Think you need surgery if you have a torn meniscus?  Maybe you do. But then again, maybe some of the tips I teach you in this program can relieve your pain, but keep you out of the O.R. See for yourself, at  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

If you’ve been a reader for a while, you know that I’m a long time comic book collector. I used to work as a professional artist for the comics, back in the 70′s for a brief stint and I’ve always maintained a serious interest in the art form, collected original art and kept up friendships with some of the best pros in the business.
 
This, of course, has always been a source of great embarrassment to my wife, who shares the opinion of many, who know no better, that comics are for kids, geeks and retards. I would patiently point out that there is an entire wing in the Louvre dedicated to graphic arts (ie., comic art)and many very highly creative, very wealthy and intelligent men, like George Lucas, Steven Spielberg and Clint Eastwood, to name but a few, have collected original paintings and drawings of some of the best modern illustrators, painters and comics artists. So I feel I’m in good company.
 
Anyway, as soon as I arrived back in town, in Orlando, I went straight over to my local comic shop, ACME SUPERSTORE in Longwood, to pick up the latest issues which had come out during my recent absence. While I was in there, seeing what else had come out that I might want to read, I overheard a middle aged guy talking to Penny, one of the store employees.
 
Penny had had arthroscopic surgery for her own knee in the past, after a number of conservative measures failed to relieve her very significant and disabling knee pain. I had reviewed her preop studies and her intraoperative photographs, and there’s no question she had a defined pathology that needed surgery to fix.
 
This guy knew about her experience and was asking her for advice. So, since she had come to me for advice herself and since I was there, she called me over to meet this man. Sure enough, he had episodes of pain and swelling that would come and go, after what he called a “blowout,” that is, a traumatic injury that ruptured his ACL (Anterior Cruciate Ligament) and gave him a torn meniscus.
 
Despite this, though, what bothered him the most was what he described as a sudden “shift” inside his knee and the insecure feeling this gave him. What he was actually feeling was the typical instability that results from a ruptured ACL. Naturally, he was concerned because he didn’t want ACL surgery, if he could avoid it.
 
I pointed out to him that there ARE ways to treat this condition nonsurgically, BUT there is a price to be paid–namely, if he doesn’t have arthritis yet, he soon will. The articular cartilage is damaged every time he experiences that “shift,” which is really a slippage of one bone on the other, that is usually prevented by an intact ACL.
 
However, if he is willing to accept that fact, and if his daily activities are not affected, then a number of conservative conventional treatments, combined with alternative methods, that help to relieve knee pain and resolve inflammation, appropriate bracing and vigorous specialized exercises, especially for the hamstring muscles, may be all he needs. 
 
He was amazed at this information, which was all new to him, and which is revealed in detail in my new healing program, HOW TO AVOID KNEE SURGERY (see here at http://drbillsclinic.com/avoid_knee_surgery.html )
 
He didn’t even realize that CRUCIATE means “crossed” in Latin, or that the cruciate or crossed ligaments, ACL and PCL, hold the interior of the knee together and prevent excessive, abnormal motions, front to back and back to front, between the femur and the tibia.
 
The anatomy and basic functions of these ligaments are presented in my LITTLE GREEN BOOK, together with lots of inside information on the many root causes of knee pain and disability. See what I mean at   http://drbillsclinic.com/eliminate_knee_pain.html
 
So, at the end of my “comic shop consult,” this man realized that he has options he didn’t know he had. I gave him my card and suggested he visit my website  http://drbillsclinic.com/avoid_knee_surgery.html  for more detailed information and advice. Hopefully, he’ll take my advice and get knee pain relief and joint stability back in his life.
 
At that point, I said, “My work here is done!”  Then I grabbed my comics and leaped out into the night…up, up and away……Heh.
 
Have a great weekend, my friend. I’ll be spending mine shooting the DVD version of my PAIN-FREE PROGRAM
 http://drbillsclinic.com/exercise_eliminate.html   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

I was sitting in my study this afternoon, fielding calls, writing emails and other correspondance and perusing the Google Alerts I have in place for interesting topics. I came across an interesting article from The New York Times Health Section, dated 12/09/08 (you see, there are some uses for the NYT other than lining bird cages and wrapping fish) that reminded me of the many times I faced similar diagnostic dilemmas in my years of practice. 
 
The gist of the article was that, in the quest for better and ever more sensitive noninvasive methods of diagnosis, like MRI Scans, more and more pathology is being revealed. But, the pathology observed may have nothing to do with the patient’s symptoms. 
 
This leads to a number of unnecessary surgical procedures, as doctors try to treat the pathology revealed by the scan, even if that was not the actual cause of the patient’s pain. This is the paradox of the nonsurgical study–it may result in MORE surgery, not less.
 
A good example is the common finding of a torn meniscus, inside the knee, revealed by an MRI Scan. It’s now well known that many middle aged and elderly people are walking around with torn menisci, without any resulting pain or other symptoms. So they really don’t need surgery, just because they have a torn meniscus, UNLESS they also have very specific mechanical findings or very specific pain, localized to the area where there is an identified torn meniscus. And yet, that is exactly what was happening, until recently.
 
I always got an MRI if my patient had persistent pain that failed to respond to conservative treatments, like those I describe in my newest healing program, HOW TO AVOID KNEE SURGERY, which you can see at  http://drbillsclinic.com/avoid_knee_surgery.html
But they only came to arthroscopic surgery if they had identified pathology AND specific symptoms and signs, consistent with the observed pathology.
 
I remember once, when I was much younger, I had a young man who had very specific joint line pain. He failed to get better with all the conservative treatments I prescribed–medications, local heat, physical therapy, the works. So, we got an MRI Scan. WOW! He apparently had an enormous tear of the posterior horn of his medial meniscus. Lit up like a Christmas tree! So obvious, even a lay person could see it from across the room.

Now, in a young person, job #1 is to preserve the articular cartilage at all costs: in other words, prevent arthritis, which is what happens if an untreated, unstable torn meniscus is allowed to remain, without treatment. So, with this as our goal, the patient, his parents and I were all of one mind: this kid needed surgery, pronto!
 
With all best intentions, I scoped the kid, expecting to see and repair or remove this enormous tear. Only…there WASN’T ANY TEAR. I looked and probed everywhere.  Nope.  Nada.  Well, I wasn’t about to fix what wasn’t broken, so I shaved away some inflamed synovium at the medial (inner) joint line, and got out.
 
He had what we call a “false positive” MRI Scan, a diagnostic image that appears for all the world to be a bona fide meniscus tear, only the tear doesn’t really exist. Imagine my embarrassment when I had to tell the family that I didn’t find the expected pathology, other than the inflamed synovitis (swollen, reddened lining membrane of the joint, which can get caught between the moving bones, just like a torn meniscus).  

The family was very grateful that he didn’t have a tear and all turned out well, because the patient’s preop pain was relieved, probably because I cut away that inflamed membranous tissue. But you could very easily argue that this was a completely unnecessary surgery–I was chasing the chimera of a false finding on a scan. It taught me a lesson, that’s for sure.
 
The fact is, MRI Scans are, at best, only 90-95% accurate on the medial (inner) compartment of the knee joint. This drops to only 60-70% accuracy on the outer or lateral compartment of the knee, because of the more complex anatomy of the lateral meniscus. Bottom line: MRI Scans and other diagnostic tests are NOT 100% accurate. They are just one part of the puzzle and have to be interpreted, based on the physical findings and a patient’s response to treatment. 
 
There are lots of reasons for knee pain. You can learn more about them, in layman’s English, in my best selling LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN (see here at http://drbillsclinic.com/eliminate_knee_pain.html )
 
Many, if not most of them, can be treated with effective nonsurgical treatments, including alternative and complementary methods. The trick is knowing when surgery is really warranted–and when it’s NOT. That’s why I wrote HOW TO AVOID KNEE SURGERY, which you can see here http://drbillsclinic.com/avoid_knee_surgery.html
 
Remember, the very best surgery is the one you avoid. 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

The day after Thanksgiving, often called “Black Friday,” because it is the first time all year that merchants make enough so that they are finally “in the black” (as opposed to being in debt, or ”in the red”). This is supposed to be THE biggest shopping day of the year and, of course, the start of the Christmas Season.
 
I just heard on the radio, this very morning, that one 34 year old guy was KILLED at a Wal-mart here on Greenacres Road in Long Island, when crazed shoppers stampeded through the doors (which they actually BENT) at opening, knocked the poor man onto the floor and trampled him. No joke. He was pronunced DOA at the local ER. Helluva way to start the Holidays.
 
How could this happen? Simple. People are nuts.
 
And, though I don’t KNOW this, I’ll bet that he had weak or trick knees that buckled under him, when hit with a surge of unexpected force. Poor guy was an employee of Wal-mart and couldn’t get out of the way fast enough. A pregnant woman was knocked down too, but she (and her unborn baby) are reportedly OK. I thought we were in a deep recession. Just imagine what would’ve happened had we had a record year in the GNP….
 
You know, one of the things I would tell my patients about their knee pain, during my years in practice, is that it is often not realized just how dangerous a condition it could be. Now, a torn meniscus, or an unstable knee from a chronic ACL deficiency, or a painful kneecap, from quadriceps weakness or patella maltracking, won’t kill you directly. They’re not considered life-threatening injuries or disabilities–that’s why many people put off getting active treatment. They’re not sick; they’re “broken.”  Not as high a priority, as other things going on in their lives.
 
BUT…
 
Now imagine that their knees suddenly give way at the head of a tall flight of stairs; or unexpectedly buckle on the train platform, just as the express flashes by; or crumple beneath them on a curb, causing them to fall forward into the street, right in front of speeding traffic. All of a sudden, these “benign” lesions, that all result in a sudden fall, literally become life-threatening problems.
 
And the worst thing is, that this type of knee instability may or may not be accompanied by pain. In general, people are a whole lot more likely to address something that causes them pain. This is why acute pain is said to be a survival mechanism–it tends to demand attention.
 
But when instability is intermittent, people tend to disregard the warning. They don’t realize the danger. So they put off treatment, sometimes until it’s too late.
 
The Hospital Administrator came to see me for knee pain and giving way, only a few months after I arrived in Smithtown. He snuck in late at night, so no one would see him coming to see the “new kid,” instead of one of the old “warhorses” on his hospital staff. After examining him, I determined that his only problem was weakness of his quadriceps. He could not resist me, when I pushed down on his straightened leg with my  hands. Now, THAT’S abnormal.

The thigh muscles should be stronger than my hands, stronger than ANY hands. If they’re not, then the knee is “hanging in the breeze,” with no dynamic stability. This leads to patella maltracking, which may lead to pain, and knee instability, as that joint cannot maintain a stable stance, if suddenly attacked by an abnormal force, because of muscular weakness.
 
These symptoms have led many to have knee surgery, when it really wasn’t necessary. Once you have knee pain, of course, you DO need to treat the inflammation, the pain and then, the muscular weakness. Measures for eliminating pain and inflammation are detailed in my newest program, HOW TO ELIMINATE KNEE PAIN. See it here at http://drbillsclinic.com/avoid_knee_surgery.html 
 
Once the pain has been controlled, restoring function becomes the priority. That means exercise, especially exercise to strengthen the quadiceps, such as specially modified Hindu Squats, or my personal favorite, Hack Squats, which are among the best to improve knee pain and are just part of my PAIN-FREE PROGRAM. See it here at http://drbillsclinic.com/eliminate_knee_pain.html
 
BTW, if you get the AVOID KNEE SURGERY program, you DON’T need the PAIN-FREE PROGRAM, as many (but not all) of the exercises are included in that. But you might want to get the LITTLE GREEN BOOK instead,  http://drbillsclinic.com/eliminate_knee_pain.html  to learn about your symptoms and signs, so you know what’s wrong with you.
 
And of course, keeping your weight down will help, as well. After all, if you lose a pound, that’s almost the same as having your muscles grow in strength enough to support, or lift one more pound (It’s a little more complicated than that, but you get the idea).
 
What’s that?  You say you ate too much last night,  ’cause it was Thanksgiving?  Fear not.  I understand.  And as a compassionate orthopaedic authority, who happens to love food as much as you do,  I absolve you all.  Now go and sin no more….:)
 
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

When I switched on the compouter this morning in my study, I clicked on my email, as I usually do, to see what, beside spam and junk, was in the inbox. As you might imagine, I get lots of emails and referrals and requests for advice about knee pain, hip and back pain, arthritis and all the rest of it. Whenever possible, I try to help, if I can.
 
Oftentimes, that means referring the enquirer to one of my healing programs or books. Sometimes, I can give them some short term advice that may help. Of course, I’m limited by the fact that I can’t see, much less examine them, and I’m further limited by their description of their problems. 
 
Lay people know what they mean, but they often can’t express it well enough for me to understand what the problem is. We don’t share the same vocabulary when it comes to medical problems. That’s one of the most important contributions of my LITTLE GREEN BOOK (see it  at http://drbillsclinic.com/eliminate_knee_pain.html ), which translates a number of medical problems from “medicalese” into everyday plain English, so the average person can understand what we’re talking about.
 
Anyway, recently, I’ve had a number of questions from people who have already HAD surgery, usually arthroscopic surgery, but STILL have pain. As is typical in my experience, many tend to blame the doctor for screwing up the surgery. But in fact, persistent pain may be from residual arthritic changes inside the joint. And it’s now well accepted, backed up by two large studies, that arthroscopic  surgery for arthritis is pretty ineffective. So, it’s not uncommon to have persistent pain after that procedure.
 
Let me give you an example of what I mean. This is the most recent email from someone in this very situation:
 
“I have had arthroscopic surgery on both knees. My right knee is in really bad shape after surgery. I think the surgeon really must have botched it because I am in constant knee pain after being on my feet for a few hours. How will your exercises help with no meniscus left in my knee? By the way, I am 57 and the surgeon says I am too young for knee replacement. Can you help me strengthen my knees through exercising?  Thanks…”
 
And here was my reply:
 
“…Your problem is not uncommon. You may have had a torn meniscus, which the surgeon probably removed PARTIALLY (you generally try to leave some of it as a cushion, unless it is already completely shredded from degeneration).  However, most likely, he did NOT “botch it.” It’s just that you undoubtedly have ARTHRITIS in that joint, which arthroscopy CANNOT CURE. That’s the most likely source of your pain. 

“57 is NOT too young to have a total knee. But, there are a number of proven, very effective non-surgical methods that can help to relieve your pain, and restore your function, at least for a while. You may wish to get my newest healing program, HOW TO AVOID KNEE SURGERY   at http://drbillsclinic.com/avoid_knee_surgery.html
 
“Exercises help by increasing the stability and the support of the arthritic joint by increasing the mass and strength of the surrounding muscles. But they are only one method, among many others, that can delay surgery. If you have end stage arthritis, eventually you WILL come to a total knee. 
 
” But that day can be delayed in many cases–I had one patient I carried in this way for TEN YEARS,before he finally got it done. But remember, everyone is different, so you can’t predict how well these methods will work for you. Still, isn’t it worth a shot? 
 
” BTW, be sure you have your Total Knee done by a specialist in joint replacement, when the time comes. It’s a very technique dependent procedure, so a guy who’s doing a LOT of them will have better results and fewer problems and complications. Hope these  tips help. Good luck to you!…”
 
Hopefully, he’ll take my advice and click on   http://drbillsclinic.com/avoid_knee_surgery.html  He’s likely to find a highly effective combination of conventional and alternative measures and exercises that will give him FAST RELIEF from his knee pain and help him AVOID SURGERY, if that’s possible. How about you?
 
Til next time, my friend, be well. 
 
Yours for a pain-free tomorrow, 
 
Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

There’s always a first time for everything in life. Yesterday was my first invitation to a dog memorial.  It seems a friend of our friend, who watches our animals for us, lost her dog last Sunday. He was a sweet black lab, “Cooper” who apparently ran away from home. I got the alert by email last week. But at that time, I was still in Florida and these events all occurred in Southampton. Anyway, the followup email carried the worst news for dog-lovers–Cooper had been found, dead at 4AM last Sunday.

So this Sunday, my wife and I were invited to a “memorial” for Cooper. And, since I’d spent the last week in Southampton, enjoying “The Season,” we were in town and decided to go.

Now, I’m a big animal fan, as you know, but I’d just never been to something like this before. So, we brought some cookie and pastry platters from the local bakery (we hate to go anywhere with empty hands) and arrived about 10:30 AM, not quite knowing exactly what to expect.

There was an interesting group of people, very casual, all of whom knew each other through walking or running their dogs on the beach. Lots of good, home made food, bagels, smoked salmon, cream cheese, apple cake, and a chocolate birthday cake for our friend’s husband, whose birthday happened to coincide with the dog’s memorial, and so was included in the affair. Whole bunch of dogs were there, too, all underfoot, but remarkably well behaved–tiny little dogs and big labs and collies. And all of them were mooching around, hoping for some goodies from the table.

We met the lady who had owned Cooper, and she and others reminisced about that big black lab with his “goofy smile.” Having lost the occasional pet to a car when they’d escape from our yard, we could certainly empathize. The lady seemed to have come to terms with the incident, however, and the whole affair wasn’t sad, at all. Instead, it was a celebration of the dog’s life and the joy he had brought to those around him.

If you’re not an “animal person,” this probably sounds a bit bizarre; if you are, you know exactly what I’m talking about.

Anyway, while we were there, as with any group of middle aged people, talk turned to their various ailments, and as luck would have it, a number of them had orthopaedic problems.

One woman had an orthopaedic boot on, for a chronic ankle sprain. Our friend, who had hosted the gathering, had persistent tenderness and swelling of her calf  from a Baker’s Cyst. She’d had prior arthroscopic surgery for a torn meniscus, but the Baker’s Cyst had taken on a life of its own, as they sometimes will. As it happened, she had a CD copy of her preop MRI, so I took a look, on her computer.

Then, I explained what measures she could use to try to resolve some of her symptoms. First, I had her start some Fish Oil, for its anti-inflammatory properties. Then, I suggested she try some OTC Aleve, with the usual precautions (these and other non-surgical methods are reviewed in some detail in my LITTLE GREEN BOOK  http://drbillsclinic.com/eliminate_knee_pain.html).
I also suggested she raise the foot of her bed up on some phone books, to help resolve the fluid accumulation in her legs, and use elastic stockings during the day.

Then, I showed her some simple exercises to strengthen her knee muscles and centralize her kneecap, which the MRI showed was pulled a bit off to the outside (lateral side). Straight leg raising, quarter squats, and wall sitting should help her feel better, without applying undue stress across the joints. These and other specially modified knee exercises are described in detail in my PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN (designed as a companion to the LGB) http://drbillsclinic.com/exercise_eliminate.html

Then, there was a guy with bad ankles, shoulders and ribs from a fall, another guy with a bad back, and an older woman, with chronic knee swelling (probably arthritis). I gave them all advice and suggested they visit my website for further tips.

So, I not only got to meet some nice new “animal”  people, but I had some good food and got to reminisce about all our pets. And I got to “keep my hand in” too, by running an informal orthopaedic clinic. Too bad I’m not still in practice–this would have been like at least a half day of new patients

Well, if my advice can help anyone feel better, I’m glad to do it–that’s what it’s aways been about. That’s it for 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

“Everyone…this is Bill.”

 ”Hi, Bill.”

 Just kidding. This has nothing to do with THAT twelve step program. It has to do with one way you can get rid of your chronic knee pain. 

You see, if you’re a boomer, like me, or just a guy or gal who has annoying or even severe anterior knee pain, most likely, it’s because of a kneecap problem. And most kneecap problems are NOT due to injury, but rather to a weakness of the quadriceps muscles in the thigh.
 
Why should this be so? Well, just think about it for a minute. Today, many people live in single story homes, drive everywhere they go, and haven’t been on a bicycle since their early teens. Eventually, this sedentary lifestyle catches up with you and, as you age, the cartilage behind your kneecap begins to soften, or worse. We, in the trade, call that chondromalacia patellae: literally “soft cartilage” in Greek.
 
This is a degenerative disease, kind of a first cousin of arthritis. And, oddly enough, up to a certain point, it’s actually reversible. The key is to reverse the muscular weakness with exercise. Now, I know this is anathema for a whole lot of folks, but it’s hard to overstate the importance of exercise in preventing, or eliminating knee pain.
 
I saw a great example of this in my first year of practice. The Hospital Administrator of St. John’s Episcopal Hospital came in for a late evening appointment. For political reasons, he had to avoid the appearance of favoritism to any single office. But, hey, he had knee pain, did his homework, and decided that I could help him. Hence, the late visit.

He had begun having pain in the front of his knee, as well as giving way. He was afraid that he had torn a meniscus and that he would need surgery. It was enough of a worry for him that he wanted to be treated by the best available surgeon, if that indeed turned out to be necessary (that would be me). So, despite his misgivings, he came in.

After his initial history, I did a thorough examination of his knees. Sure enough, he had temderness under his kneecap, and more diffuse tenderness at his inner (medial) joint line. But most striking of all was quad weakness that was amazing! I mean, he couldn’t even begin to resist my efforts to bend his straightened knee. Anyone’s thigh muscles should be strong enough to resist an examiner’s arm–there’s no comparison in the relative strength of these muscles. I was dumbfounded. I’d never seen that level of weakness in an otherwise healthy, fairly normal, middle aged man. It was bad enough that I actually worried about a potential neurological disease, at first.
 
Turns out that he almost never did any exercise, not even stair climbing. Well, that was better than a neurological disease. At least it was potentially reversible. But, it required a real effort on his part and a real change in behavior. I started him on a course of Physical Therapy, including the exercises that eventually became my PAIN-FREE PROGRAM  http://drbillsclinic.com/exercise_eliminate.html
 
In addition to quad setting and straight leg raising, quarter squats and leg extensions, I had him climb stairs. All these exercises helped him strengthen his quadriceps, especially the VMO. And as his strength improved, his pain simply went away. He was amazed and, as you might expect, very, very happy. He had avoided surgery, or even an arthrogram (this was in the early eighties, before MRI’s were available. Naturally, from this point on, I was “golden” with this guy. But the key thing is the importance and the potency of simple exercise in the relief of knee pain.
 
This is a simple test you can try yourself, if you have anterior knee pain. Try climbing a staircase–most have twelve, sometimes thirteen, steps, and do it for repetitions, several times a day. Give it a week or so, and I’ll bet you feel better. Not perfect perhaps, but better. This twelve step program is a good way to strengthen those quads. That’s why I included stair climbing in my PAIN-FREE PROGRAM, which you can see at
 http://drbillsclinic.com/exercise_eliminate.html   as well as a number of other excellent exercises to prevent or eliminate your knee pain. Give it a try!
 
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

Let me tell you about my first big joint replacement case. All my surgical cases up to that point had been pretty straightforward closed fractures, hip fractures and minor surgeries. This patient was a big woman named Mabel, who had end stage arthritis of the hip. 

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