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

This past weekend, I was at a business/marketing meeting in Tampa. One of the attendees was a fellow I had advised in the past, and one who had used the recommended exercises in my PAIN-FREE PROGRAM  http://drbillsclinic.com/exercise_eliminate.html/.  He’s  a few years older than me, but in otherwise good shape.
 
Up to now, he had done pretty well. So well in fact, that he has written a testimonial for me, which I will post, once he sends me a photo of himself to run with it. But, like many of us (me too) he got a little bit complacent and slacked off the exercises. 
 
Sure enough, he started to develop recurrent symptoms. ”Hey, what’s that vague ill-defined knee pain?” he wanted to know. I shouldn’t wonder. 
 
Knee pain, especially low grade, achey pain, is often diffuse and ill-defined. That is, unless there’s a specific injury that causes a sharp, acute pain, associated with damage to specific structures. These would be things like a fall, twist or sprain of ligaments, or strain of muscles, a tear of the meniscal cartilage, a rupture of the ACL, degenerative diseases (like chondromalacia or it’s cousin, osteoarthritis), or inflammatory conditions, including rheumatoid arthritis (and its relatives, psoriatic arthritis, lupus, spondylitis, etc.)infectious arthritis (Lyme Disease, staph or strep infection).
 
Why do these conditions cause this low grade ache? In a word, SYNOVITIS. This is an inflammation of the lining membrane of the joint. Now, synovitis is a very non-specific response to ANY stimulation, regardless of what it is–IT HURTS. The membrane also becomes thicker and more swollen, actually grows in volume, becomes red (from dilated blood vessels) and produces an excessive amount of joint fluid (which it normally makes in very small amounts, to lubricate the articular cartilage and nourish the cartilage surfaces). Lay people call this “water on the knee.” 
 
Since I was there with him, I examined my friend’s knee, right there in the conference room. Very few findings, though. Some loss of the last few degrees of motion at the extremes of flexion and extension, maybe five degrees at each end, consistent with the thickening of the synovial membrane. And he had a little bit of pain under the kneecap, when pressure was applied. Pretty much, that was it. Of course, I had no x-rays or MRI images to examine.
 
My impression was that he had developed a recurrent case of chondromalacia patellae–softening of the cartilage of the patella. Either that,or it’s first cousin, osteoarthritis. So, what to do?
 
First, he needs to resume the exercises I teach at http://drbillsclinic.com/exercise_eliminate.html  Exercise is the overall best method for long term pain relief of the knee.
 
Next, he needs to get on the anti-inflammatory regimen I present in detail in my newest healing program, HOW TO AVOID KNEE SURGERY, at  http://drbillsclinic.com/avoid_knee_surgery.html
 
With luck and some work, he should get fast pain relief in as little as one week. If he does the work…
 
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

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

As you know, before the last few days, I’d been giving you the “Readers’s Digest” version of a number of different types of knee surgery. The purpose is to alleviate your fears, based as they are on misinformation, exaggeration, outright distortion and your own imagination, by telling you exactly what’s done. This gives the fears limits, as reality limits imagination, and helps you to cope, if you actually DO need one of these procedures at some time.
 
We’ve already covered basic arthroscopy, as well as patella debridement and realignment, partial meniscectomy for a torn meniscus, and, most recently, arthroscopically assisted ACL reconstruction. Today, I will finish up the description of other miscellaneous arthroscopic procedures, that are often done simultaneously. 

Bear in mind that once you’ve entered the joint through those tiny arthroscopic portals (mini-incisions), there’s almost no limit to what you can do in there. And the postop morbidity (pain, swelling, stiffness, disablity, etc.) is pretty much the same, regardless of how much you do inside the knee, UNLESS you cut, drill, abrade, puncture, or otherwise violate the bones. 
 
If you DO get into the bones, you automatically increase postop bleeding, pain and swelling–which makes sense, right? Otherwise, however much you do, the postop limitations are a function of those tiny portal incisions. That’s the great advantage of arthroscopy and why it’s been a transformative concept in modern surgery, that’s made outpatient surgery possible.
 
All these procedures are described in much greater detail, including the conditions that require them, in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN,  available now as a book and an audio CD, too, at  http://drbillsclinic.com/eliminate_knee_pain.html
But for now, let’s look at a few other conditions for which arthroscopic surgery is often recommended, how they are treated surgically and whether other options and NON-surgical treatments are available.
 
First up is SYNOVITIS, an inflammation of the lining of the joint (any joint that has freely moving parts, not just the knee). I alluded to this with a brief remark, last Wednesday. When the lining of the joint gets irritated, it gets bigger, actually grows, often in an irregular way, resulting in flaps, shelves, clumps and masses, that can flop around inside the joint, occasionally getting trapped between the moving parts. This entrapment causes pain, and further swelling and inflammation. The irritated membrane produces lots of joint fluid, resulting in “water on the knee,” as well as pain.
 
The arthrocopic removal, or resection, of this diseased membrane is executed with an electronic motorized shaver. This is a stainless steel tube, with a small window at its end. The window encloses a rotating (or reciprocating) blade, that nips off small morsels of synovium, which are then sucked out by a vacuum pump and collected in a trap, for pathological study. Using this technique, you can systematically resect almost ALL the lining, as in cases of Rheumatoid Arthritis, or Bacterial Infection, where you want to rapidly “debulk” the mass of diseased membrane. But guess what? A new membrane grows back very rapidly, hopefully in an uninflamed, relatively normal state.
 
DEBRIDEMENT is a French term, meaning “house cleaning,” and it’s pronounced “De-BREED-mont,” not de-BRIDE-mont. I had an Australian professor once, who use to say “Da BRIDE is whut walk down de aisle wit’ de groom. Gentlemen, it’s deBREEDmont.” This refers to shaving off loose shreds of degenerative cartilage from the articular surfaces, to smooth them out. It’s important to remember that you can only REMOVE tissue; you can’t put anything back. 
 
Normally, the shaver is used to do this and it’s combined with synovectomy and LAVAGE, essentially washing out the joint with irrigation fluid. This is controversial in the treatment of arthritis, but if you’re there for other reasons, you might as well “clean house.” Today, you can also do this with radiofrequency probes and lasers, too.
 
And, as I also mentioned last Wednesday, LOOSE BODIES and FOREIGN BODIES can be grasped by forceps and extracted through the arthroscopic portals.
 
Areas of bare bone, if they’re small enough, can be treated through the scope to restore some kind of cartilage covering, but as I mentioned above, the morbidity and pain is greater once you penetrate the bone surface. Arthroscopic awls are sharp, pointed steel spikes that are used to put multiple shallow punctures into the bone, a procedure called MICROFRACTURE. Another way to do the same thing is to use a high speed burr to “sand” the surface and stimulate bleeding. This is called ABRASION CHONDROPLASTY. Both these techniques result in blood clot, which is changed into fibrocartilage over the bare area.
 
An alternative is to restore actual hyaline cartilage, in one of two ways: CHONDROCYTE TRANSPLANTATION, in
which cells initially harvested from non-articular parts of the knee are cultured, then reimplanted to grow new cartilage; and OATS (Osteochonral Articular Transplanation ) which transposes plugs of bone, with its articular cartilage attached, into drill holes in the bare area. Pretty cool stuff, no?
 
And, really, NOT so scarey, now that you KNOW what’s involved, right? Whatever it is in your life, if you KNOW what you have to deal with, you can DO it, if you have to.
 
But, there are many times that you DON’T need any of these techniques. Those are the times that surgery ISN’T warranted, because conservative methods will work to relieve your pain and restore your function just fine, thank you very much. If you want to AVOID An
UNNECESSARY SURGERY, then you need my newest healing program, HOW TO AVOID KNEE SURGERY. Get it here, at
 http://drbillsclinic.com/avoid_knee_surgery.html
 
Next up, osteotomies and realignment surgeries. Talk to you tomorrow, my friend. 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 Friday, my wife and I had to put down one of our cats, Chelsea. I couldn’t even write about it, til now.  As I’ve said before, I’ve had a number of people die in my presence, occasionally even in my arms. I can handle that just fine, even though it’s always sad.  But the animals just GET to me…
 
We were there when Chelsea was born. Her mother, Molly, a beautiful calico longhair had wandered into our garage, pregnant. And she decided to deliver on the night before I was scheduled to fly to Boston for a yearly conference on Total Hip Replacement, hosted by Harvard School of Medicine. Naturally, she pulled this about two o’clock in the morning.
 
There we were, watching the miracle of birth as, one by one, four little wet kittens popped out and took their first halting steps in this world. I finally bailed and went to bed–I had to get up at six AM to make my flight. My wife stayed up all night, talking to the mother in labor and continuing to give her soothing encouragement and comfort. I think it’s a woman thing, that no man can fully grasp….
 
The next morning, on my way out the door to the airport, I was surprised to discover that Molly had delivered two MORE babies, six in total. And one was this little longhair, with a leonine face and a bright orange splotch on her head. My wife named her Chelsea.
 
She had a problem, though–hypothermia, a condition wherein the body gets too cold, and the core temperature drops. Left alone, it’s fatal. My father-in-law, who was visiting, said “Well, she’s gone,” as they drove to the local vet. But my wife refused to give up on her. And she survived, for over 13 years.
 
It’s funny, and people who don’t live with cats don’t understand this, but right from birth, each kitten has a very distinct personality, with very specific quirks. She had this penchant for biting my watch, whenever she got the chance, don’t ask me why. And of all our cats, she had the face that most resembled a little lion. She fit in very well to our happy little family, with all her littermates. This was the group that got us started down the road to insanity, taking in all these strays, as soon as it was safe, after they were born.
 
While all our babies are getting older, even as we are, Chelsea had a special problem. For the last year or so, she had been throwing up periodically, which was making her very thin. She would eat like mad, then projectile vomit impossible volumes for a little cat. This happened every few days.
 
We had the full workup: laboratory tests, physical exam, x-rays, even an ultrasound exam, in an effort to find out what was wrong with her. I suspected a type of cancer, but all the studies pointed to IBC: inflammatory bowel disease. So, we did what we could for her. Fed her special food, and cleaned up after her, when she had an episode. But despite our best efforts, she got so very thin.
 
Then, one day last week, she suddenly got very quiet and just stopped eating or drinking. And this was a cat who lived for food. So we knew the time had come….
 
You wouldn’t think that a little, barely five pound cat could affect us so much. Maybe it’s the complete trust and the innocent acceptance, love and companionship they give us that makes the pathos of ending their lives so poignant. Maybe it’s the implications of our own mortality. I only know that we were there at her beginning; we were there at her end…and we go on.
 
I know it was a kindness to her. I like to think she’s in a better place, now–no pain, no sickness, no hunger. But it’s always hard, and it’s so final…Sic transit Chelsea.
 
Well, we have quite a few more to care for. You know, one of the reasons we admire cats is their innate grace. And the reason cats are so graceful is the enormous amount of muscle, compared with the size of their frames. Cats are Nature’s perfect predator–a seamless blend of  power, speed, and balance. 

If you watch them, you can learn a lot about how we should train. They stretch, they scratch their claws, they run in bursts of speed and they spend a great deal of time resting. When you think about it, they exemplify exactly how we should treat our own bodies. Exercise for strength, stretch for flexibility, get proper nutrition and plenty of rest–just the formula I use in my PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, which you can get at  http://drbillsclinic.com/exercise_eliminate.html
 
To get rid of nagging knee pain, patella problems, giving way, water on the knee, and other painful maladies, the best long term, non-surgical option is exercise–specific, specially modified exercise to stretch and strengthen the knee. See how at
 http://drbillsclinic.com/exercise_eliminate.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

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

The pool resurfacing and tile upgrade that I reported on last week really looks great. It’s amazing what a little change like that can do for the appearance of the entire back of the house. Anyway, it looks so good that we decided to seal and resurface the surrounding deck, as well. Anyone who’s ever done any home renovation will understand this perfectly–whatever you do is never enough; one improvement always leads to another, and another.
 
So, today, a team descended on the pool area, power washing off the accumulated mold and black algae that is typical of Florida, due to all the humidity and heat. Then, they actually filled and sealed any cracks and seams in the deck surface and the pool coping, to prevent future ingress of water, which is what promotes the growth of algae and mold. Finally, they then applied an acrylic colored stain, that will compliment the new tile and the stones that make up the pool’s waterfall.
 
After the power washing, the rest of this operation, all phases, is done by hand, while kneeling on the hard concrete deck. It’s tedious work, tough on the back and tough on the knees. With my back and my knees, I’m glad I’m not trying to do it myself. 

As it happens, we got a beautiful day today, after torrential downpours yesterday. So the guys out back were baking in the sun, as they worked. I went out to offer them some cold cokes when I noticed that one man had his kneepads on, but another one had none.
 
I asked the guy without the pads if he wanted a set of pads or a cushion to kneel on. “Oh, no, I’m fine so far,”  he said. Sounding dubious, I said, “Okay…” and went to the other man, with his soda. “I see you’ve got your pads on,” I said.”Oh yes, sir. Wouldn’t be without ‘em,” he
replied. “Well, you’d better talk to your friend over there,” I said. “He’s doing damage that he doesn’t realize, because it doesn’t hurt, right NOW. But if he keeps it up, he’s going to have trouble in the future.”
 
With that, I went back in the house, reflecting on how many times throughout my years in practice I faced this same problem. Working men who don’t realize what they’re doing to themselves by kneeling on hard surfaces, without padding or protection. I can understand if a guy isn’t
comfortable wearing knee pads. Let’s face it, they’re really not very comfortable. But then, they could carry a work pad, a folded towel, a gel pad, even a pillow, something, anything to avoid the punishment of direct pressure of their kneecaps, on a rock hard surface.
 
You see, the knee is designed to carry weight from top to bottom, NOT front to back. So concentrating force directly on the kneecaps, on a hard surface, is just begging for multiple problems, like prepatellar bursitis (“Housemaid’s Knee”), synovitis and effusion (water on the knee), chondromalacia patellae  (degenerative softening of kneecap cartilage) and eventually, arthritis.  Each of these conditions, and more, is described in my LITTLE GREEN BOOK. Go see at  http://drbillsclinic.com/eliminate_knee_pain.html
Not only will you learn about “the ills that flesh is heir to,” but you’ll learn how to prevent them and how to treat them, if you do get them.
 
Besides the preventive measures that will help you avoid pain and disability, the importance of properly modified exercises, like those I teach at   http://drbillsclinic.com/exercise_eliminate.html   cannot be overemphasized. If you had to choose only one preventative activity, for the maximum benefits, it would be exercise. That, and common sense, of course.  So, whenever you have reason to be on your knees, don’t
forget your knee pads.
 
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

Went today for my periodic ear lifting, so I’ll look a little more presentable in public. One of the girls at the salon, Nanetta, was gimping around, so I asked her what was the matter. Turns out she has been moving, so she’s been up and down the stairs many multiple times with boxes of stuff. Now, she’s complaining of painful swelling all around her kneecap and an achey swelling in the back of the knee, too.
 
Last few days, she’s noticed that when she kneels, it not only really hurts, but she can’t get up. But she couldn’t recall any recent injury that would have caused this. It never occurred to her that the unaccustomed trips up and down the stairs
ARE a source of injury. She’s got a lot of company in that regard–most people think of one sudden, big injury, rather than a series of small insults that result in an overuse syndrome.
 
Naturally, her pain is much worse when she stands on her feet. And her job, cutting hair, is nothing but…. So it’s not altogether too surprising that she’s been getting worse, not better. And she’s strapped for cash, so a visit to the doctor is out.
 
Lucky I happened to be in the next chair when she began reciting her litany of woes. I asked a few questions and quickly determined that she had a nice case of chondromalacia patellae, with a knee effusion (water on the knee) and probably, a  Baker’s Cyst, too. 

That’s one of the coolest things about being a retired knee maven–I never know when I’m going to bump into someone I can help with what I know.  From their point of view, it’s like a stroke of luck. But I’m the one who’s lucky, lucky to be able to help people who need it.
 
Anyway, I explained to Nanetta what was causing her pain and a number of measures that would help her get relief. She has a common degenerative condition of the cartilage behind the kneecap, called chondromalacia patellae, which I have myself. She got it by slacking off on her prior habit of daily exercise, by getting older and fatter, and then, by applying unaccustomed stresses to her knees.
 
I advised her to avoid deep flexion, especially kneeling and stair climbing. I told her to apply local heat, to start doing quarter squats to strengthen her VMO muscles, and to reduce the inflammation, by using a combination of OTC meds and dietary modifications.
 
And I strongly advised her to get the full story as well as the detailed instructions for relief in DR. BILL’S LITTLE GREEN BOOK, at  http://drbillsclinic.com/eliminate_knee_pain.html   Then, we talked some more about what exercises
would help her get rid of her pain, and keep it gone, like those in the companion book, my  PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, which you can get at http://drbillsclinic.com/exercise_eliminate.html
 
For a one-time price, less than many office visit copays, you can have all this information at your fingertips, against future problems with your knees.  So, we’ll see how my friend Nanetta does with my advice. My bet is, she’ll have her pain relieved by next week, if she does what I told her to do.  That’s the problem, my friend: I can tell you, but YOU have to take action.
 
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