If you’ve been paying attention, you know that I have a great deal of respect and admiration for my father-in-law, Charlie. He’s a World War II Vet and a card carrying member of “The Greatest Generation.”  Until he began having severe pain from degenerative disease of the spine, with subsequent progressive disability, he was also one of the physically strongest men I’ve ever met. And today, he’s 84!
So my wife and I are going to drive up to visit him and take him and his wife out to dinner.
 
In addition to his WW II creds, Charlie was a mason and general contractor for over 50 years. You wouldn’t believe how beautiful his brickwork was–and he could create all these intricate patterns in multicolored brick columns and walls, freehand, right out of his head, without any design plan beforehand. And he built some of the most magnificent Georgian brick homes, years ago, in Richmond, Virginia. This was a guy who always wanted nothing more than to get up in the morning and “have a productive day.” He lived for his work. Like a lot of men from his era, his work was everything to him.
 
He can read, but he doesn’t read for pleasure. He gets most of his news from the TV. He’ll watch some TV movies, but won’t go out to the movies, and he often falls asleep during them. Ditto football games, in season. He never had hobbies, or much of any outside interests except his work. If he had excess energy at home, like as not, he’d jump up and go out and shovel a couple of tons of sand, or dig a foundation, by hand (I kid you not–I’ve seen this). Work was everything to him. It was how he defined himself.
 
When I first met my bride, we dated a few times, and then she took me home to meet her mother, Jo. We drove outside Richmond into the suburbs of Midlothian, into the neighborhood of Salisbury. As we crested a hill, we came upon these large brick pillars flanking a long gravel drive that led to one of the biggest and most stately Georgian brick homes I’d ever seen. Four stories tall it was, with a Mansard slate roof, set on the banks of Lake Patrick Henry, cream trim and shutters, and so big, the entire house I grew up in would have fit in the living room. 

“Stately Wayne Manor,” I proclaimed it. “Wow. That’s some house. Does your Mom work here?” I asked. She laughed at me (one of the first times, but by no means the last).
“No, silly. I LIVE here,” she said with a smile.
“Hot damn! Dad was right–rich women need love, too,” I thought. Of course, at that time, they didn’t tell me about the pending divorce. Oh, well…easy come, easy go.  I found out later that the magnificent Georgian was Charlie’s handiwork–built by hand, from the ground, up.
 
I didn’t meet Charlie until some time later, but we hit it off right away. This, despite the warfare between him and Jo (I make it a policy not to get involved in domestic disputes–you live longer that way). He struck me as a very down to earth guy and I admired what he could do. Shame he and his wife couldn’t get along, but I have rarely met two such formidable personalities.  When the irresistable force meets the immovable object, under the same roof, it doesn’t do either of them much good, not to mention those around them.
 
Well, since then, Charlie’s buried two wives and he’s on his third, now. He’s a very funny guy and women seem to love him. “He’s soooo cute!” they’d say. Too bad he couldn’t bottle some of that….But he does have a very charming way about him, provided he likes you.
 
While he was with wife #2 (who we nicknamed “Scarlet”– right out of “Gone With The Wind”), he had sudden pain and swelling of his knee. This was so long ago that arthroscopic techniques hadn’t been introduced yet. I actually operated on him, through a little “S” shaped incision, to remove a torn meniscus. I found a whole bunch of arthritis, too. I had to restrain myself (or, more accurately, my friend and assistant, Steve, told me “Leave it ALONE,” which was good advice) from “guilding the lilly” and debriding the joint, which likely would have resulted in more short term disability.
 
He was rehabbed with many of the same exercises I now teach in my PAIN-FREE PROGRAM and my ADVANCED
MASTERS’ COURSE, and though his back is in bad shape, his knee is still holding up fine. As it happens, BOTH of these great programs are now available, for a limited time, at 50% OFF! To celebrate America’s Birthday (and Charlie’s), I’m having a 4th of JULY
HALF OFF SALE, until 11:59PM, July 6th–  http://drbillsclinic.com/half_off.html
 
If you’ve ever wanted one of my best programs, but it was just out of reach, here’s your chance. Don’t blow it!  There are only a limited number of these programs at these low, low prices, for a very limited time. These courses will NEVER be less than they are right now.
And, I may never do this again. So if you have knee pain, and want any of these life-changing, healing programs, don’t delay. ORDER NOW! Go to    http://drbillsclinic.com/half_off.html
 
Happy Birthday, Charlie! And many more…. 

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

Today, being Friday the 13th, the temptation to write about this being an unlucky day is strong. Ever since the success of The DaVinci Code, pretty much everyone had heard of one of the origins of the superstition, the arrest of the Knights Templar by King Philip IV of France throughout Europe on Friday 13th, 1307, on trumped up charges (because he was deeply in debt to the Order).
Well, I’M BORED WITH IT! I mean, everyone does that. If I read one more blog about Friday the 13th, I think I’ll scream.
 
I’d rather tell you about my Dad, in honor of Fathers’ Day, this coming Sunday. I think that’s a more positive topic than yet another musing on a stupid superstition. Well, it’s my choice isn’t it? So, I will.
 
My dad was born Thomas William Stillwell (they christened me William Thomas, because both Mom and Dad didn’t like “juniors” for some reason. Go figure). He was raised in Dyker Heights in Brooklyn, New York. He finished High School and was reportedly a terrific baseball player (I was awful), who actually played semi-pro ball for a minor league team, the Adanacs (an anagram of Canada–no idea why). He was raised a Baptist, but later was a Methodist Episcopalian for a while, and eventually became an Episcopalian, when I was confirmed. He was actually a member of the Vestry (the lay governing body) at Christ Church, Bay Ridge in Brooklyn, during my teen years. 

He joined the Navy at the start of the Second World War, and qualified for the Submarine Service, which required special training. He was a Machinist’s Mate on the USS DACE and served in the Pacific theatre for the duration of the War. I’ve written before about his stories of
sweating out Japanese depth charge attacks, while submerged. And he had shore leave in Honolulu, Hawaii,  judging by some girlie pictures of Hawaiian girls in grass skirts and lais (and not much else) my brother found in his effects.
 
He met my mother when she was only 18, though she looked more mature. They got married shortly thereafter, while he was still in the Service, but I didn’t come along for three years. They made a really handsome couple, judging from the old black and white photographs that remain.
 
Like every couple, they had their issues from time to time, but as a boy growing up, I never knew that. They gave me a wonderful childhood, full of love and support, although I was reportedly quite a handful, starting out as a colicky baby and rapidly emerging as a precocious (some might say obnoxious) child. They both encouraged a lifelong love of education. After age seven, Mom was just living for the day I would be a doctor, but Dad always said, “If you graduate from college, I know you’ll do well in life, no matter what you do, and I’ll have done my job.” No one was happier than Dad when I became the first college graduate in the family.
 
It always bothered him that he never went to college, even though everyone who met him always assumed that he had. If he put on a suit, he looked like an executive, and he was by nature a very intelligent man. But he had a streak of the gambler in him–when my mother thought he was going to night classes, he was actually going to see the ponies. But he never bet the mortgage, or compromised our budget.
 
In fact, for most of my life, Dad worked three jobs,  so he could keep meat on the table every day. He had a day job, that could best be described as middle management, he did income taxes, and he sold real estate. I didn’t realize how big a burden that was when I was
growing up–like most kids, I was completely self-absorbed and didn’t really appreciate what was being done for me, quietly and without fanfare, every day.  But I do now. His family was the most important thing in his world and he just did whatever was necessary to provide for us. Quite a guy.
 
Dad only hit me twice in my life–and I deserved it, both times. The first was when, despite instructions to go to sleep, my brother and I kept on making a racket, fighting with each other. My brother instigated it, but I got caught retaliating. Dad came up and whacked me once.  It always annoyed me that my brother was responsible, but I got punished. In any case, Dad was pi$$ed. The second time was when I was age 16 and I smart mouthed my mother, in front of Dad. I didn’t curse or anything (I wouldn’t dare!), I just had a real smarta$$, mouth on me, lightning quick and hurtful, and pretty disrespectful. My remark had barely left my mouth, when I saw a blur out of the corner of my eye. CRACK! Right across my mouth, with his open hand–he said, “Don’t you EVER talk to your mother like that in front of me. She may be your mother, but she’s MY WIFE!” I was more shocked, than hurt. And then, ashamed. To this day, I remember that lesson–and I really respect my father for teaching me. And that was it. The rest of the time, a look from him or a “talking to” was sufficient.
 
Dad was happy when I graduated from Medical School, though he said, “This is really for your mother. I was happy with college.” The important thing is, he was always there, in quiet support, to provide for me, guide me, and just to be there for me. He was always there to talk to, to give me advice and to teach me how a MAN takes care of his family. While I was always grateful for him, I didn’t really appreciate him, until years later.
 
Just before my wedding, I remember him taking me aside and warning me that my bride-to-be was a beautiful girl, but she had “Mercedes taste,” so I’d better hold on to my wallet. Man, he had THAT right! Ironically, he was the one member of my family that my new wife really liked. But Dad was like that–everybody loved the guy.
 
I lost Dad just four months later. He had been at the beach with Mom and a bunch of the younger kids from the extended family. It had been a beautiful day, by all reports. Dad wanted to keep up with the kids in a  swimming race, thinking he was still that young athlete,
playing baseball. He came out, said he was tired, and then, his eyes just rolled up in his head and down he went. It was painless; he apparently had a ventricular arrhythmia, where the heart begins to writhe, instead of beat, and cardiac output stops. It’s like someone just turned out the light–too fast for a heart attack to develop. So, at least there’s that….
 
I had a post mortem done, so we’d know what happened.  Turns out all those unfiltered cigarettes, Old Gold, Camels, Chesterfields during the War, and the later Kent Light 100 Kingsize (his idea of “cutting back”) took their toll. He had one single blockage at the base of the Left Anterior Descending Artery (LAD) of the heart.  He was two weeks short of his 54th birthday. My brother and I have never smoked….
 
So I remember Dad fondly, with much love and deep appreciation, this Fathers’ Day. He taught me much, but most of all, what it means to meet responsibilities, what it means to be a man. I am what I am, largely because of him. And there’s no one who would have enjoyed my success in life more….
 
So this Fathers’ Day, my wife’s father is still with us, soon to be 84. We plan to visit and take him out to dinner for the day. I actually operated on him back in the early eighties, for a torn meniscus. Found a pretty good amount of arthritis in there, too. And this was before arthroscopic techniques were introduced.  I started him on the selected knee exercises I teach at
 http://drbillsclinic.com/exercise_eliminate.html    And he’s doing pretty well. He still follows my advice about using a cane to unload his joint and enhance his stability (when he feels like it). He had his heart worked on last year (coronary bypass and aortic valve 
replacement) and came through it fine. Tough guy, as I’ve said before. Probably bury us all…. 

Well, my friend, if it applies to you, Happy Fathers’ Day. May your children love and appreciate you, as I love and appreciate my Father and my Father-in-Law.  It’s the hardest job in the world to do well. 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

June 2, 2008

Over the weekend, I came across an article published in the Washington Post by Dr. Jeremy Brown, Associate Professor of Emergency Medicine at George Washington University Hospital. He described a woman in her mid-forties who came into the ER with knee pain, but
no history if trauma or other obvious reason, except that she was “close to 300 pounds.” Besides evaluation, she reportedly wanted an    x-ray of her knee.

Dr. Brown pointed out many of the reasons one would want to get an x-ray, and the fact that everyone would be happier if he did just that. But he then used this as a springboard to point out that obesity is one of the last “forbidden” topics to bring up with patients. He noted that besides past history and immunizations, allergies and HIV status can be discussed, but no one mentions the topic of obesity and its role in many diseases, including knee pain. 

While I get his point, he made kind of an either/or situation out of his example. And I really don’t think that’s entirely appropriate. In point of fact, although it’s just fine to approach the topic of obesity with a heavy patient, if a doctor actually refused to order an x-ray in such a case, I promise you, an attorney would be knocking on his/her door with a subpoena, in short order! And, for a change, the attorney would be right. 

Just because a patient is heavy is no reason to assume that obesity is the only reason for his/her pain. You know what they say about assume, right? I mean, heavy folks get intra-articular pathology too. And if you don’t look for it with x-rays, and where appropriate,
MRI, etc., you won’t even know it’s there. And the weight makes the pathology that much worse; in some cases, it actually causes, or at least contributes to the pathology. 

I’ve told you before about the extra forces that above average body weight imposes on the knee joint, especially when attempting to run, jump, or climb stairs. And, of course, there’s the whole list of attendant health problems from coronary artery disease and strokes to
pulmonary problems, higher incidence of cancer and degenerative spinal and joint changes. So it’s well accepted that being considerably overweight isn’t good for you. But, if it also prejudices an ER doc to attribute your pain to an overloaded joint, without further investigation, then that’s an additional risk of compromising your care.
 
When I was in training at Metropolitan Hospital in New York City, back in the early 70′s, I remember that one of the key points that was drilled into us was to NEVER ASSUME. That drunk with the slurred speech and the bump on his head might just be drunk, but he also
might have a subdural hematoma from a hairline skull fracture, which will kill him, if you don’t work him up, just like everyone else, and discover it in time.
 
In the same way, you can’t just assume that an obese patient with knee or other joint pain is suffering because of the obesity. There might well be a torn cartilage (meniscus), or arthritis, that will usually respond to treatments, like those I teach at
 http://drbillsclinic.com/eliminate_knee_pain.html      The point is, if you don’t look, you can’t know.
 
So, according to Dr. Brown, when a doctor is evaluating the obese patient with a painful knee, but no obvious history to explain it, the physician has a choice between counselling the patient about weight control measures, versus conventional workup and x-ray. For the reasons I’ve outlined above, I don’t think they’re mutually exclusive. In fact, I have a modest proposal–Why not do both?
 
In practice, that’s what’s done anyway. Too much chance of missing something pertinent if you don’t, and like I said, you just can’t assume. So, if you’re ever in an ER and some guy tries to blow you off, counselling you about your weight (especially if it IS a problem), you INSIST on an x-ray and any other appropriate tests. Once you KNOW there’s no other pathology causing your pain, THEN  try dieting and knee exercises, like those I teach at    http://drbillsclinic.com/exercise_eliminate.html
Just remember, pain from overloading, like pain from overuse, is what we call a DIAGNOSIS OF EXCLUSION. And that means, you have to PROVE there’s not another reason.  Don’t settle for less! 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

Today, my father-in-law, Charlie, is coming over to visit us, but if truth be told, he’s probably coming over to get away from the chaos in his own house, too.  Charlie’s will be 84 his next birthday and a tougher, more self-reliant guy you’ll never meet. He’s on his third wife (having buried the other two), who was also previously married. She has a daughter, now divorced, and two granddaughters, all of whom are living with her and Charlie in a house he built with his own two hands, only a couple of years ago, if you can believe it. On the one hand, they wait on him hand and foot. But three women under one roof, yelling and screaming at each other (did I mention they’re of Italian extraction?) drives him nuts. Hence, the need for a break…
 
Charlie, like many of us, is frustrated as hell at the limitations age imposes on us all. He’s a very physical guy, whose sole goal in daily life was to get up and “have a productive day.” And produce, he did. 

He was a bona fide member of the “Greatest Generation,” volunteering to join the Navy in WW II at age 17. He lied about his age to get into the service (just like the 17 year olds today!). He saw action on LST’s (flat bottomed amphibious landing crafts) and then joined the Air Force Reserve after the War, to complete 20 years of service to the nation. Then, he put in the next 50 years as a general contractor and mason. He built homes and office buildings and small shopping centers, mostly with his own two hands and a few paid by the day bricklayers and helpers. And his brickwork and stonework were just spectacular–and self-taught.

Though only about 5 foot seven, pound for pound, I never met anyone stronger than Charlie. Once, in the mid-1980′s, my wife and I, Charlie and my brother-in-law were trying to leave New York City, for Long Island, by way of the Queens Midtown Tunnel, when our SUV threw a bolt and stopped dead in the street, blocking traffic at the entrance. Charlie put up the hood and took a look (I was clueless–hey, I was a surgeon, not a mechanic!). Then, he jumped UNDER the hood, and with one arm, HE LIFTED THE ENTIRE ENGINE BLOCK, while he rethreaded and spun the nut onto the bolt with the other hand! This, like it was nothing. Then, he jumped out, with his arm still  smoking from the hot engine block, just swiped at the blisters on his forearm. “Ahh, this is nothin’,” he said. Second degree burns and he just blew them off.

This was just one of the nearly superhuman feats of strength that I saw over the years. The guy lived to work. If he was too full of energy at night, he’d go out and shovel a ton of sand, or dig a foundation, by hand, with a shovel, just for exercise. No exaggeration. Just shaking hands with this guy was like putting your mitt in a vice. Unbelievable. Luckily, he always liked me.
 
As it happens, I operated on Charlie’s knee over 25 years ago, for a torn meniscus. At that time, there were no arthroscopic techniques, so it was an “open” procedure (arthrotomy), although it was only about  1 – 1/2 inches long in a gentle “S” curve (this serves to give greater exposure; it has nothing to do with “branding” my patients with the Stillwell “S”, contrary to popular belief). I saw some arthritis in there, too, and I was sorely tempted to debride it, drill it, try to smooth it out, and in general, “polish the apple” a bit. 

My assistant and friend, Steve, told me, “Bill, just leave him alone. Don’t mess with it. You’ll just make him worse.” So, I did as he bade me. You see, knowing my tendency to be a perfectionist, I asked Steve to assist me, ’cause he had very good judgment. We agreed that if we had differing opinions during the case, his call would rule. And he was right. It’s tough to be objective when it’s friend or family, so I substituted
HIS judgment for mine, while I was able to execute my own technical facility for the surgery. 

The combination worked. It’s been well over a quarter century and Charlie still hasn’t needed a total knee replacement.  He did great after surgery, using the foundational knee exercises that eventually evolved into my PAIN-FREE PROGRAM (which you can see at
 http://drbillsclinic.com/exercise_eliminate.html )  He would have done even better, faster, had it been five years later, after the arthroscopic techniques had been introduced.
 
Today, his back is shot; he’s paying the price for the excessive stresses he loaded on it for all those years. And he walks with a cane. Like the rest of us,  Charlie isn’t quite what he once was, but he’s still one helluva really tough guy in my book. So I think we’ll go out for dinner and take it easy. It’s been a tough week. We can all use a break. Til next time, my friend, be well. 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

It was 1975, during my first residency year at St. Luke’s Hospital in New York, that I saw for myself, for the very first time, the destructive nature of a torn meniscus. While not as intense as internship, orthopaedic residency was still a lot of scut work for the junior guys on the team. In that year, that was me and my mates. But there were a few opportunities
for us to relax and have some fun. One of the ways was basketball games, between the orthopaedic residents and the general surgery guys.
 
One of the senior general surgery residents was a real good, aggressive player, who was terrific at jump shots. During one game, he suddenly twisted, and spun away, in an effort to avoid the player guarding him and set up a jump shot at the basket. Suddenly, everyone heard a loud “pop,” as he screamed in pain and fell to the floor. He wasn’t able to finish the game and, in fact, had to be helped off the court by two other players.  He had real difficulty putting any weight on his knee, as well as severe pain.
 
He had to sit out the rest of the game on the sidelines, with his leg elevated and packed in ice. Later on, he was carried in to see my old professor, Dr. Bob Zickel  (a very famous guy in orthopaedic circles), or “Zick,” as he was affectionately known. In those days, there was no such thing as an MRI scan. Plain x-rays, physical exam and clinical judgment was the extent of diagnosis, at that time. And according to Zick, one of the best and wisest clinicians around, our surgical pal had really done a good job on his medial meniscus. 

Zick ordered an arthrogram for the knee, to confirm his clinical impression. This was the test that was used, before there was such a thing as the MRI scan. These were specialized x-rays, taken after the knee was injected with an iodine-containing dye. Iodine blocks x-rays, so the liquid dye would outline all the normally invisible structures inside the knee joint, and sink into any abnormal crevices, like a tear in the meniscal cartilage, thereby making it visible. You got even more contrast and greater accuracy, if you also injected air into the joint. Only problem with this procedure was that it HURT, and of course, there was a small risk of infection from the needle. But it was pretty accurate.
 
Anyway, the test confirmed that sure enough, our friend had a nice “bucket handle” tear of his meniscus, and at that time, the only treatment was to surgically remove it. Well, the man wasn’t happy, I can tell you that! He was in this great training program and he wasn’t about to lose time by having surgery. Besides, his swelling and pain had gone down, and his knee was feeling pretty good, by this time. So, he refused surgery and went about his business for the next few weeks, including our basketball sessions.
 
But three weeks later, during a game, his knee locked up in flexion, and down he went. This time, he couldn’t even stand up and couldn’t straighten his knee. He was in agony. They carried him straight up to the OR, where I assisted Dr. Zickel in operating and removing the locked and torn meniscus. Here’s the thing: in just three weeks, the torn meniscus had severely shredded the cartilage coating of the femoral condyle. In other words, he got full blown arthritis in just three weeks!
 
That’s the danger of ignoring a torn meniscus. If not treated, it can destroy your knee. Fortunately, today we have MRI scans that are noninvasive, don’t hurt, and are super accurate at diagnosis, and surgical techniques to repair bad tears, instead of just removing them. You can learn even more about these injuries and many others  in my LITTLE GREEN BOOK, which you can get at    http://drbillsclinic.com/eliminate_knee_pain.html 

Our friend ended up doing well in the short term. He worked hard at the physical therapy, the forerunner of exercises I teach in my PAIN-FREE PROGRAM today, at   http://drbillsclinic.com/exercise_eliminate.html
But, he had severe and permanent damage. I lost track of him over the years since then, but I’ll bet he has a knee replacement by now. Well, it made an indelible impression on me. And I hope it made one on you, too. The lesson is, don’t ignore a knee injury–or you may pay a higher price than you needed to, in the future. 

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

Given the significance of the Easter Season that culminates this weekend with Easter Sunday, I thought it only appropriate to tell you about a friend of ours who’s literally “walking on water.” Of course, the ”water” is in both her knees, not under her feet.  And it’s a sign of some significant internal knee problems that need to be identified and treated.

Water on the knee, as I’ve mentioned before, is a sign of an internal derangement (think “torn meniscus“), until proven otherwise, unless it immediately follows a specific injury, or is associated with a known disease, like Rheumatoid Arthritis. That’s especially true if the “water,” or joint fluid, accumulates gradually, without pain. A painless effusion is an
indication that something is wrong inside the joint.

I’ve also mentioned before that menisci can tear just from chronic degeneration, ie. getting older, from the thousands of repetitive stresses applied to the cartilage structures over the decades. So, it’s not just the sudden injury that can tear the menisci. The reason this is important to understand is that many non-orthopaedist physicians, though well-meaning, try to treat the effusion, often by aspirating the joint (sucking out the fluid through a needle), rather than addressing its underlying cause.

Now, I’m not a big fan of aspirating a swollen knee, unless it’s so tensely swollen that it’s causing the patient severe pain, or if joint fluid is needed for accurate diagnosis, especially if infection, gout, or one of the inflammatory arthridites (Rheumatoid Arthritis, etc.) is suspected, or the swelling is due to massive bleeding into the joint. 

Why? Well, any time you stick a needle into a joint, even under strict sterile conditions, you take the risk of introducing bacteria into a previously sterile joint (ain’t no such thing as a completely sterile field). That can lead to disaster, should an infection result. A rip-roaring staph infection can destroy all the articular cartilage in the joint in 48 hours–the enzymes, produced by the bacteria, just dissolve it.  And once gone, the cartilage isn’t coming back. 

Even worse, a history of infection is a relative contraindication to a total knee replacement.  So, if this happens, you’re potentially screwed. In this situation, an ounce of prevention is worth a few tons of cure. 
 
This is just one reason why you should have some understanding of what conditions within your knee cause what signs and symptoms. You and your family doctor could both benefit from the information and advice in my LITTLE GREEN BOOK. See what I mean at    http://drbillsclinic.com/eliminate_knee_pain.html

Our friend is seeing an orthopaedist and, if you suspect a real internal joint problem, you should insist on a referral to a specialist. That’s your best chance for an accurate diagnosis, appropriate treatment and not wasting your time, or prolonging your pain. Remember that in Medicine today, the HMO or insurance company will resist that, ’cause it costs them more money. But it’s YOUR health and YOUR body. Insist.

Anyway, he has started her on an anti-inflammatory med to reduce the swelling. I’m sure he’s also recommended a cane, to keep her from falling, if the knees give out.  But she’s stubborn, like lots of folks, and probably won’t use it. Hell, she’s read my book, but she doesn’t do the things I recommend. Reading it is not enough. It doesn’t work through osmosis. You have to DO what is recommended. Otherwise, it can’t help you.
 
It’s like the old saw, “You can lead a horse to water, but you can’t make her drink.”
 
She will probably need an MRI scan, which can disclose tears in the menisci, with an accuracy up to about 95%,  on the inner, or medial, side of the knee. Just so you know, NOTHING is 100% accurate. Even arthroscopic examination, the most accurate of all, is said to be 99% accurate–1% is subtracted, just for potential human error.
 
Based on these results, she may well need surgery, after many years of neglect. Had she been doing the exercises I recommend in my PAIN-FREE PROGRAM, which you can see at   http://drbillsclinic.com/exercise_eliminate.html
she might not be in this situation today. These are the same exercises that I prescribed for my patients with knee pain and the same ones I used myself for my own knee problems. So, when I tell you that they work, I know what I’m talking about. If you have knee pain, or want to prevent it, give these a try. You won’t be sorry.
 
And if you are one of the many who celebrate it, have a Happy Easter! 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