December 4, 2009

The week doesn’t go by that I don’t get someone who writes me a tale of woe about their knee. Often, the email is one gigantic, dense paragraph of a confusion of clinical history, x-ray and scan results, their interpretation of what their doctor said was wrong, what their neighbor said was wrong, what medication they have been on, and then a litany of their fears and apprehensions. This often goes on and on and on for a full page.
 
Let me tell you something: it is very, very hard to read an interminable email that is one solid block of type. Especially if your story is a long one, for my sake, break it up! Throw a few paragraphs in there, one every time you change to a new idea, or new topic. I’m happy to help if I can, but just seeing a solid block of writing makes me want to ignore it. So, a word to the wise….
 
A common topic, repeated over and over, is the painful knee, often with recurrent swelling and fluid (water on the knee), with limited motion and most often, the diagnosis of arthritis. And it’s often a knee that has been evaluated by an orthopaedist and the patient has been told that a total knee replacement will be needed.
 
Invariably, the very next thing the patient says to me is, “But I don’t want any surgery!” 
 
Well, sure. Who does? But somehow, they think that I can tell them something different, despite my never having examined them, having no idea of their medical history, or other factors about them that would impact on that decision. It IS true that my newest healing program, HOW TO AVOID KNEE SURGERY, which you can get here at:
 
http://www.drbillsclinic.com/avoid_knee_surgery.html 
 
CAN reduce or relieve pain, even in cases of advanced osteoarthritis of the knee. Using the conservative, non-operative treatments from across the entire medical spectrum, including alternative, as well as mainstream conventional methods, symptoms can be diminished and surgery delayed or entirely avoided, until a truly mechanical issue, like a locked knee, or a collapsed joint surface, or intractable pain makes it inevitable.
 
The ideal solution is to use the techniques revealed EARLY in the course of the disease, when they’re far more likely to be effective. For example, it should be no surprise that losing 10% of your weight can make a HUGE difference in knee pain, sometimes eliminating it. Likewise, taking some POWERHOUSE OMEGA FORMULA http://www.favoriteformula.com  an ultra pure, highly concentrated, enteric coated, pharmaceutical grade fish oil, is an excellent long term way to reduce inflammation, that may result in more severe knee pain. And of course, besides reducing body weight and reducing inflammation, knee pain exercises, like those I teach in my PAIN-FREE PROGRAM   http://www.drbillsclinic.com/exercise_eliminate.html  are another great way to reduce or eliminate knee pain, restore function, currently limited by swelling and pain, and delay or avoid surgical treatment. 

Remember, no one can MAKE you have surgery. When it’s indicated and nothing else will do, surgery can be life-altering and restore your comfort and function. I spent nearly a quarter century doing just that, for thousands of patients. And very successfully, too.
 
But, you want to be sure it’s a NECESSARY surgery, that nothing else, no lesser, non-operative treatment will do and that there are very good reasons that you can’t put it off any longer. And the best way to do that is to try these conservative methods and see if they work for you, preferably BEFORE you reach the end stage of the disease. 
 
The best thing about them is that they burn no bridges. If and when they no longer help, and it’s otherwise indicated, you can still have knee surgery, without penalty. So remember, the take home message is “early intervention.” The sooner you start, the sooner you’ll feel better. 
 
Til next time, my friend, be well. Get your Christmas Shopping done early. 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 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

So this morning in my study, I was going over a number of health related blogs, reviewing them for any potential for commentary and teaching points. A number were pretty good, most often involving the back injuries one sees in sports or exercises or stretches for general fitness or specific injuries. A few had to do with joint replacements of the hip and knee, which happened to be my specialty in practice. 
 
But then, I read one that was incredible. Not good incredible, as in ‘Wow! How amazing!” but incredible as in, “I can’t believe they have this thing out there on the web!” It concerned ACL injuries and rehabilitation and it was so full of factual errors and frank mythology that I couldn’t believe it.
 
I wanted to tactfully reply, correct the most obvious misconceptions, hopefully without insulting the author, or hurting his feelings. It wasn’t a scam, or a deliberate attempt to misrepresent facts for some nefarious purpose. It was obvious that the author was sincere. He was just wrong.
 
For example, one guy said that an ACL rupture wasn’t painful. In fact, it’s one of the most painful and disabling injuries you can suffer. What he meant was that a CHRONIC ACL disruption is painless–the damage has already been done. But the resulting instability, the “wobbly knee” that results from absence of the ACL, CAN indeed cause pain, from secondary tears of the menisci, synovitis, and arthritis.
 
Further, there ARE some people with an ACL injury who DON’T require surgery. This fact is almost entirely ignored in these articles. Specific exercises, especially leg curls and calf exercises, can often compensate for people who make low demands on their injuredknee. The point is, there are options that can be offered.
 
Unfortunately, it was a major pain to reply. First, you have to register in order to reply. Then, the registry doesn’t accept the information and erased all the info I had just input. Finally, I just gave up in disgust. Too bad. Some people are going to read that blog and accept what it says uncritically. As a result, they’ll absorb information that’s just incorrect. And who knows what the consequences will be?
 
Funny thing is, people will believe almost anything they read on the net, even though it’s well known that there’s no filter. That’s one of the internet’s chief charms. But it’s also one of its chief problems, when you really have a need to know the facts about a topic. Without a bit of comparative research on your own, there’s often no way to tell what’s fact and what’s fiction.
 
You may read it on a website, but “it ain’t necessarily so.” But the written word has power to persuade, whether it’s accurate or not. So, especially in seeking medical information, it’s best to go with a trusted source. Hey, that’s one of the major reasons for the existence of Dr. Bill’s Clinic. I’m here to try to provide some guidance and practical advice, based on my nearly quarter century in clinical practice in orthopaedic surgery. That’s why I wrote my healing programs: to help those of you with knee pain, grinding, instability, arthritis, water on the knee, deformities, and any other problems with a variety of treatments, conventional, alternative, and complimentary, from across the entire medical spectrum.
 
DR. BILL’S LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN is a concise, but complete guide to all the root causes of knee pain and the treatments that I know from experience, professional and personal, do work. You can get your own copy, including an audio CD, at  http://drbillsclinic.com/eliminate_knee_pain.html
 
But, just so you know, the LGB does NOT include the recommended knee exercises. Those are given in a separate companion manual: DR. BILL’S PAIN-FREE PROGRAM, a selection of exercises and stretches that helps to prevent or eliminate knee pain–once & for all! You can get it here, at this link:   http://drbillsclinic.com/exercise_eliminate.html
 
Most recently, based on what people seemed to want, I created my newest healing program, HOW TO AVOID KNEE SURGERY, in both written and audio CD formats. This is a blend of the former two programs, and in addition, adds a great deal of new material, especially on herbs and nutriceuticals and other alternative treatments to help you avoid the unnecessary knee surgery, or at least delay the most invasive procedures, like total knee replacement, in the case of end stage disease, like arthritis. 
 
If you’ve been thinking about having surgery, but would like to delay or avoid it, you can get it here: http://drbillsclinic.com/avoid_knee_surgery.html
 
So, above all, don’t believe everything you read. DO your due dilligence before you accept whatever is out there on the net. The right advice can make a big difference in your life, but you need to be sure of the facts, before you act.
 
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

Well, as might be expected, the article in last week’s New England Journal of Medicine has spawned dozens of additional articles and blog posts across the infosphere. This, of course, was the article by Canadian researchers that found that arthroscopic surgery offered no real  benefits, when used to treat arthritis. And, as I pointed out a couple of days ago, this study reiterated the findings of earlier studies which found pretty much the same thing.
 
Dr. Robert Litchfield, the head of the Kennedy Fowler Sport Medicine Clinic and the one of the study’s co-investigators, suggested that in view of their findings, “surgeons need to think about other ways of treating patients, rather than jumping immediately to surgery.”
 
Well, DUH! I was always under the impression that that was what we were supposed to so ALL the time. Ah well, the fat’s in the fire, now. Every purveyor of alternative measures is out there, beating the drum for their own special brand of remedy. Physical therapists, in particular, are in high cotton over this report, since exercise is one of the alternatives that the study found to be just as effective as surgery in improving arthritis symptoms. And it is. And so is exercise without the benefit of a therapist, like the exercise I teach in my PAIN-FREE PROGRAM at http://drbillsclinic.com/exercise_eliminate.html
 
Now the NEJM article has led to a derivitive article in U.S. News & World Report, that promotes “six alternatives to surgery for treating arthritis.”  These not-so-secret six are well known to everyone, and in fact are included in my newest healing program,
 HOW TO AVOID KNEE SURGERY, as you can see at   http://drbillsclinic.com/avoid_knee_surgery.html
But the trick is knowing HOW and WHEN to use them, and in WHAT MANNER.
 
The six alternatives treatments that are known to be effective include 1. weight loss & exercise,  2. physical therapy (read, supervised EXERCISE),  3. medications, 4. glucosamine & chondroitin (read, NUTRICEUTICALS), 5. Viscosupplementation and 6. total knee replacement.
 
Given the message that arthroscopic surgery for arthritis was to be avoided, I was kind of amused that the sixth “alternative” to arthroscopic surgery was total knee replacement. I mean, that’s the definitive treatment for end stage arthritis, from virtually any source. But that’s pretty major–it’s as big a surgical intervention as there is, with regard to arthritis. So their recommendations range from exercises and naturopathic measures to complete joint replacement. That’s quite a jump!
 
The fact is, no one in their right mind would suggest a total knee, unless ALL other measures had been exhausted, first. It’s kind of axiomatic. It’s what I refer to as my “Ladder Principle:” you start at the bottom rung, with the least invasive, least aggressive therapy you can find. Then, you “climb the ladder” until you find that treatment that works for you.
 
The problem is that you don’t need information–there’s a world of information out there. But without a filter, without a guide to teach you what’s effective and what’s not, you’ll be spinning your wheels a long time and wasting a lot of money in the process. That’s why I wrote my healing program, HOW TO AVOID KNEE SURGERY   http://drbillsclinic.com/avoid_knee_surgery.html
 
It’s a guide to all those treatments that are out there, conventional, alternative, and complementary, that shows you, step by step, what to do, how to do it, how much of any medication or nutriceutical to take, and most important, what to AVOID. You see, you don’t need more information. You need ADVICE. And that’s what I provide. That’s what I do.
 
So, if you or someone you care about has arthritis, or some other type of joint pain, and you want to know what to do to get FAST relief of knee pain and do it WITHOUT SURGERY, click on this link for my latest and best program http://drbillsclinic.com/avoid_knee_surgery.html
 
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

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

Today, to round this all out, is the ultimate option: ARTHROPLASTY, more commonly called joint replacement. Though the term actually means “creation of a joint,” it’s come to be identified with joint replacment, and is now virtually synonymous. This was initially TOTAL knee replacement, but today, through many technical advancements, it encompasses PARTIAL or UNICOMPARTMENTAL joint replacement, as well. These options are explained in great detail, though in layman’s language, in my LITTLE GREEN BOOK at http://drbillsclinic.com/eliminate_knee_pain.html
 
This is really a misnomer, though. Unlike a total hip replacement, a total knee DOES NOT replace the entire joint, nor does it remove the bony segments of the joint. Instead, only the SURFACES are replaced with man-made shells of polished metal, articulating on very tough plastic. Technically, the operation is a joint resurfacing arthroplasty. If there’s severe arthritis on only one side of the joint, then only that side has its surfaces replaced. The so-called UNI (unicondylar knee replacement) can be done through a very small incision, sometimes even on an outpatient basis. The trick is for the surgeon to balance the ligaments and align the knee properly, so the kneecap tracks properly.
 
Small power saws are used, with special saw guides and alignment tools, to cut thin slivers off the ends of the bones, the femur and the tibia. This removes the arthritic surfaces and “opens up” the spongy (cancellous) bone, for acrylic cement intrusion, which holds the implants in place on the respective bones. The properly sized implants are then selected and implanted. 
 
A total knee replacement, like the name implies, resurfaces all three compartments, medial lateral and patellofemoral. It’s done for more extensive, or end stage disease, in two or all three compartments. It needs a larger incision, generally involves somewhat more pain, swelling and potential bleeding. It has a greater potential to develop adhesions, and limited motion, after surgery.
 
In both cases, weight bearing is initially limited by pain, and the use of crutches or a walker. Motion is started right away. Pain is controlled with medications, and physical therapy and rehabilitation are essential. Many of the exercises used are those I teach in my PAIN-FREE PROGRAM, at   http://drbillsclinic.com/exercise_eliminate.html
 
But here’s the thing. Although the success rate, in the right hands, is very good with joint replacement, you NEVER do this without the right indications. The truth is, nothing made by man is as good as what God gave you. Man-made parts can wear out, can get loose, even get infected…and there’s always the chance of a technical problem or human error, even in the best of hands. 
 
So you need to be SURE that if TKR or a UNI is recommended, it’s NECESSARY. And if you can get relief from ANY more conservative methods, conventional, alternative, or complementary, provided you don’t have a lot of bone loss in the joint or severe deformity, then it’s an UNNECESSARY SURGERY and should be delayed, or avoided. And it was to help you do just that, that I wrote my new healing program, HOW TO AVOID KNEE SURGERY   http://drbillsclinic.com/avoid_knee_surgery.html
 
Well, I hope that this series on knee surgeries has been informative for you and that I accomplished my goal: to tell you exactly what goes on in the O.R., give you some perspective and relieve your anxiety and fears about surgery. If you NEED surgery, by all means, accept the risks and get the benefits.  Odds are, you’ll do great. But if you’re not sure, or if all non-surgical measures have NOT been exhausted, then there’s at least the possibility that you may be headed for an UNNECESSARY SURGERY.
 
In that case, get my program and be prepared. Don’t guess, when you can KNOW. Click on the link and get HOW TO AVOID KNEE SURGERY today, right NOW, at   http://drbillsclinic.com/avoid_knee_surgery.html   to relieve your pain, restore your function and do it WITHOUT SURGERY.
 
Til next time, my friend, be well and have a great weekend.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

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

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

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

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

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

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

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

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

Now, mind you, there ARE non-surgical methods that can help relieve pain, and forstall the need for surgery. But actually re-grow cartilage? No. ‘Fraid not. Maybe some day, with stem cells or some such, but not now.
 
So the best advice I can give this lady is to follow the many measures, from across the entire medical spectrum, that I teach in my newest healing program,  HOW TO AVOID KNEE SURGERY, which you, too, can see at http://drbillsclinic.com/avoid_knee_surgery.html
 
These methods, conventional and alternative alike, when used together, create a SYNERGY, where the combination is far more effective than any single component alone. And these methods are proven and safe. They won’t grow new cartilage. Nothing short of a very sophisticated, two-stage surgical technique can, at this time. But they CAN give you relief of pain, buy you time, and delay a joint replacement. See how at  http://drbillsclinic.com/avoid_knee_surgery.html
 
That’s all for today, my friend. Talk to you soon. Meanwhile, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

 Last week, I got an email from an old friend and patient of mine that she and her husband would be visiting the Orlando area this week, as they were staying at a local time share, near Sea World. She wanted to know if we could all get together for dinner this week. So last night was the night.
 
Now this lady, a lovely woman who was a teacher, was one of my very first patients in private practice.  I opened my doors in August of 1979 and I first met her in 1980. She had been badly injured in an auto accident, and was originally told that she would lose her leg and possibly her life. She had a severe fracture of the upper three inches of the tibia, or shin bone. Now this is a tough injury to treat, regardless of the method used, because the hamstring and biceps femoris tendons are attached to that fracture fragment. So these tendons tend to pull back on the small upper wafer of bone, making it very difficult to control and therefore, very difficult to set straight (ie., reduce). 

Added to these technical problems was the fact that right behind her fracture were all the big blood vessels and nerves, on their way down to the lower leg. So the potential for nerve or blood vessel injury, or even clots in the veins (deep vein thrombosis), was very real. To cap it all off, she was very high strung and very anxious and she didn’t want surgery, nohow–period!
 
Fortunately, I was young enough to still be in my “there’s nothin’ I can’t do” phase. I honestly believed, with all my heart, that I could do almost anything and pull it off ( I smile, with the acquired wisdom of a lot more years, at my niave belief in my own invincibility, at that time). So, despite the fact that this fracture should probably have been treated surgically, I proceded to treat her in accordance with her wishes, with closed methods: multiple, repetitive castings, with x-rays. Had she met me ten years later, when I was a lot more experienced and a good deal wiser, I would have insisted on surgery and talked her into it. 

As it was, against all odds, I was successful. As I always say, “Better lucky than smart!” But she did indeed heal in virtually perfect alignment, meaning that the upper tibial plateau healed perpendicular to the long axis of the rest of the tibia and parallel to the ground. Because of the pull of those muscles, however, which could not be overcome with just a cast, that upper sliver of tibia had displaced backward, about an inch — what we call “lightning bolt” apposition.
 
Well, she recovered, got her motion and function back, and did really well for over 20 years, until the year 2000. By that time, she had developed end stage arthritis in that knee and finally needed her knee replaced. So conservative measures bought her two decades, before surgery was finally needed. The total knee replacement was uneventful and clinically, she’s done really well.

Over the years, she’s evolved from patient to friend.  Whenever I was giving a talk, or running a public forum,  I could always count on this lady and her husband, also a retired teacher, to be right there in the front row,  for moral support and as “living proof.” So, it was really great to see them again. We talked and laughed about old times and people we knew. They wouldn’t allow me to pay anything toward the meal, either. My wife and I had just a wonderful time.
 
On the way out of the restaurant, I asked her, “So,  how’s the knee?” “Okay,” she said, somewhat guardedly.  Hmmm. Further questioning found some aching and she admitted she has some trouble getting out of a chair.  Turns out, she hasn’t seen anyone for followup since my retirement and, even more important, she hasn’t been doing any knee exercises, like she’d been taught.  Oh, when the cat’s away….
 
Anyway, I advised her to work on strengthening her quads, especially with quarter squats and half squats, and wall sitting, just like the exercises I teach at   http://drbillsclinic.com/exercise_eliminate.html     And she can recapture more flexion by sitting and going back and forth in a rocking chair. I made sure to go over this with her husband, to be sure she’ll really do them. And I gave her a good doc, to followup
with, since I’m out of action. Hell, if she gets her strength back, she’s likely to make it for the duration with her first knee replacement and never need another.
 
So, all in all, a good night and a wonderful time. It’s good to see old friends and remember past glories. It helps to remember what it was all for…and that it was well worth it. Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
http://drbillsclinic.com/exercise_eliminate.html

P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved