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

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