I was just answering a question from a subscriber, that came through the email, about swollen knees. It made me think about what made me go into orthopaedics, lo those many moons ago. I had always wanted to be a heart surgeon, until I actually got in there and DID some heart surgery. Well, actually, I assisted at the heart surgeries–they DON’T let interns actually DO those surgeries. They’re quite beyond the neophyte. 
 
But you ARE right in there, up close and personal,  and I DID hold a human heart in my hands (“Don’t DROP it, Stillwell!”), while the senior surgeon sutured a bypass graft in place. You have to admit, that’s pretty cool. Not too many people have ever had the chance to do that, so it’s a fairly unique experience.
 
Anyway, once there, I decided that whatever these guys needed to have, I didn’t have it. Mainly, the desire to spend the entire day and night in the O.R., to the exclusion of all else. I wanted to be a surgeon, but as PART of my life, not ALL of it.
 
Once I realized that, I was adrift for a little while. Didn’t know WHAT I wanted to do. I thought about Cardiology, but that would only frustrate me, seeing problems that I couldn’t then fix, like a surgeon could.
 
I considered OB/GYN (Obstetrics & Gynecology) for a brief while, dreaming that it would be pretty cool to examine all those beautiful, glamorous showgirls–”GYN to the stars”…But the reality is quite a bit different–quite mundane. So that was out.
 
Internal Medicine is an exercise in futility. Don’t get me wrong. Those guys are very smart and God knows they’ve saved my bacon many times, but…You have to be satisified in managing basically incurable conditions and accept that. Nope. I’m a man of action–always have been. Do or die! I couldn’t deal with that.
 
Urology? Nice clean specialty, but doing rectal exams all day? No thanks. Neurology? See lots of disease about which you can effectively do nothing? I don’t think so.
 
Preventive Medicine? BORING…besides, these guys all wear bowties. Radiology…interesting, but I’d be likely to fall asleep in the dark…Then, I happened to rotate onto Orthopaedics. 
 
Now, I had always held the orthopods in some degree of contempt, coming up through school. That wasn’t REAL surgery, wasn’t elegant enough, delicate enough for my uncommon powers of dexterity. Shows you that God has a sense of humor, doesn’t it?
 
Anyway, these guys were the buccaneers of the hospital. Everyone and I mean Everybody LOVED these guys. They were cheerful, and funny and didn’t take themselves, or anyone else, too seriously–a pretty good trick at MCV, where taking yourself very seriously indeed was the name of the game. But they were awesomely good at what they did.
 
I remember this giant of a guy, with bright red hair and a big handlebar mustache, that looked like he was one of the ancient Celtic warlords, named Bill King. A well-named man, if you ask me. He and another resident, Dave Snyder, took a shine to me and took me under their wing. They and their Chief resident, John Cardea, were a great bunch of guys. John went on to become the youngest Orthopaedic Department Chairman in the USA.
 
Well, the first time I saw them, they had me steady a patient who had a simple Colle’s (pronounced COL-eez) fracture of the wrist. I held the man’s arm, while Big Red smiled at the guy and then, snik-snak, manipulated his fracture, with some crunching noises, into the right position, a process called reduction.
 
Whullp! I almost gagged that first time. Those weird crunching noises got to me, much to the amusement of the residents, who thought that was a hoot. But oddly enough, it appealed to me, crunches and all. I mean, here you could actually FIX something that was broken. No dickin’ around for six weeks, to see if a medicine would work. And no six hours in the OR, either. Boom! Fixed!
 
Next time, they let me try it. And, you know, I was intuitively GOOD at this. Who knew? And the time after that, I taught another intern to do it, in the old “see one, do one, teach one” pattern that has been the mainstay of medical teaching for generations.
 
So that’s how a nice boy like me got into a specialty like this. I never would have thought it would be my cup o’ tea, as they say, but hey, you never know….
 
Now that I’m not able to operate anymore, it’s still a kick to be able to give people advice and teach them what’s wrong with them, show them what to do in my programs, like my LITTLE GREEN BOOK   http://drbillsclinic.com/avoid_knee_pain.html or my PAIN-FREE PROGRAM exercises for knee pain  http://drbillsclinic.com/exercise_eliminate.html
 
I still get a sense of fulfillment when people write me that they’re better because of instructions and helpful advice I’ve given them, or that they’ve gotten relief from their knee pain, without surgery, http://drbillsclinic.com/avoid_knee_surgery.html
 
So, I’m glad I can still help you to help yourself. I can teach you how, but you still have to do your part. 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

Like many, if not most interested people last night, I was listening to the Vice Presidential Debate between Senator Joe Biden and Governor Sarah Palin. I was listening because we were driving back from the airport when the battle was joined. After I arrived home in Orlando, I was able to see it, on rerun, but initially, we just got to hear the audio.
 
Like many people who were impressed with Gov. Palin’s initial performance, after her selection as Vice Presidential Candidate and her entry into the 2008 Presidential Campaign, I must say that I was pretty disheartened after her interviews with the perky Katie Couric on CBS. I actually felt sorry for her–she really DID look like “a deer in the headlights,” as the saying goes. Given what I saw, I even thought Tina Fey’s parody of her on SNL was actually fair, and on target, if not very kind.

The only Supreme Court decision she could remember was that perrenial favorite, Roe v. Wade. And there have been so many that she might have mentioned, like that abomination that now allows the taking of private property, so it can be sold to a private developer, so as to increase tax revenues. I’m no legal scholar, but I’m pretty damn sure that’s not what the Founders had in mind when they created the concept of Eminent Domain.
 
The other stuff about McCain’s legislative efforts was ridiculous and clearly “gotcha” stuff, but the questions on the Court decisions were fair and pertinent. So, like many, I was just dreading tonight’s debate, figuring that Biden would just carve her up. 
 
I had even begun mentally preparing myself for an Obama Presidency, figuring that it was all but over. Well, I thought, we survived Jimmy Carter, we can survive this. I hope.
 
I seems that every couple of generations, the American public completely forgets what its true foundations are and flirts with some iteration of  collectivism. It never lasts for long, because those policies have always failed (except perhaps in Sweden, a pretty homogeneous and orderly country, very unlike our own), especially in Europe, where all the countries are broke, from attempting to create cradle to grave security.
 
But it lasts long enough to screw things up for a while. And these are dangerous times…we may not have the luxury of screwing up this time, without severe consequences. (Incidentally, if you are one of those who think that’s the key to prosperity or security, I strongly suggest you go back and read Ayn Rand’s ATLAS SHRUGGED, again. And this time, pay attention! )
 
So, imagine my delight and surprise to hear (and later, see) that she more than held her own with the wiley Biden. She was on top of her game, for sure. Even if you disagree with her political viewpoint, you have to admit she was engaging, made emotional contact with the viewers and had a good grasp of the topics, facts and figures and defended Senator McCain’s positions very, very well.
 
Given her relatively recent arrival on the national stage, and the low expectations she engendered with her last interviews, she held her own with a 30 year veteran of Washington for a full 90 minutes and gave as good as she got. That’s a win for her, in anyone’s book.
 
So, once again, this lady has resurrected the McCain Campaign from a desultory death. And the contest goes on. And it’s ever so interesting, too. Goes to show you, like the saying goes, “it ain’t over ’til it’s over.” It’d be nice if McCain himself looked as fiesty as his V.P. pick in HIS next debate with Senator Obama. 
 
Truth to tell, though, regardless who wins, I’ll be very happy to FINALLY have this campaign OVER. Two years is just too much! I’ve had it with all these guys. And as for this “bailout” legislation…don’t even get me started.
 
One thing’s for sure though. If this bailout goes through, it won’t matter who’s elected President, because there won’t be any money to spend on all the boondoggles, universal healthcare, earmarks, pork, etc. You obviously can’t depend on the government. Good time for you to consider taking care of YOURSELF. 
 
And one good way to do that is to relieve your own knee pain, with conservative methods from across the entire medical spectrum, and do it WITHOUT SURGERY. Hell, you may be able to do it without a doctor at all (and save those expensive fees and co-pays)! Take a look at my latest healing program, HOW TO AVOID KNEE SURGERY at   http://drbillsclinic.com/avoid_knee_surgery.html
and see how….
 
Til next time, my friend, be well. And have a great weekend!
 
Yours for a pain-free tomorrow,
 
Dr. Bill

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

When I first arrived on the scene in August of 1973, the other orthopaedic surgeons in Smithtown weren’t exactly thrilled to see me. I didn’t find out til later on, but my new Associates had been in a struggle for dominance in town with another large group and had been sort of “rubbing their noses in it,” about my coming into their practice–the first fellowship trained joint surgeon on Long Island. So, quite naturally, but unbeknownst to me, the other guys were more than a little peeved, before they even met me.
 
I had just completed the Aufranc Fellowship, arguably the finest and most prestigious joint reconstruction fellowship in the country. But like all residents and fellows, I had been part of the house staff in the hospitals in which I trained. I had no airs, no sense of entitlement and I hope, no arrogance. Training programs are all very cooperative: The patients always come first, but everyone is in it together and we all help one another, in a spirit of good-fellowship.
 
So, the motives and behavior that the other guys in town projected onto me, were wholely undeserved and were frankly mystifying to me. I had always gotten along with everyone–my nickname was “Easy Bill.” To be treated with suspicion, paranoia and thinly veiled hostility for (to my knowledge) no reason, right out of the box, was quite a shock. I was, in short, clueless about the now competitive nature of my relationship with the other surgeons. Welcome to ”Private Practice,” kid!
 
Since I had no inkling of what had provoked this response, I tended to be a little defensive and decided, “Well, I’ll show THEM.” And I did.
 
I did procedures that I had been trained to do, complex surgeries that no one else in town had even seen, much less done. And I was adept at scooping up free patients from the ER, making friends with the ER docs and nurses, the family physicians and internists in town, and especially the rheumatologists. I did consultations and saw patients in the office and the ER with the raw energy of the newly minted doctor.
 
I was aggressive in doing surgeries, like no one but a young surgeon can be. And although I NEVER did a surgery that wasn’t warranted, I tended to view all problems through the prism of my training: “If you have a hammer, everything looks like a nail.” As a result, it was a self-fulfilling prophecy–I BECAME exactly what my collegues had feared and was soon acknowledged as THE regional expert in my field.  And yet…
 
It’s an old, but true saying: “There are OLD surgeons and there are BOLD surgeons; but there are NO old, bold surgeons.” Things I did then, though strictly indicated, I would never do, or recommend today. Certain things you only learn through time and experience. And after nearly a quarter century in the Operating Room, I’ve learned that the very best surgery is the one you AVOID. I’ve learned to respect the integrity of the body and appreciate its capacity for self-healing. 
 
In short, I learned the wisdom of the non-surgical solution.
 
That’s not to say that there aren’t times when only surgery will do. There are. But many times, patience and the use of time-tested non-surgical solutions, from across the entire medical spectrum, conventional, alternative and complimentary, will help relieve your pain and restore your function–but do that WITHOUT SURGERY. And that’s why I wrote my newest healing program, HOW TO AVOID KNEE SURGERY. See it here at:    http://drbillsclinic.com/avoid_knee_surgery.html
 
Even if you don’t have knee pain right now, the methods and strategies revealed in this program will help you PREVENT conditions that result in pain. And, of course, if you DO suffer an injury, you’ll be prepared to get the right treatment, avoid mistakes and vastly improve your chances to AVOID KNEE SURGERY, if that’s possible.  So be smart, before the fact. BE PREPARED. Get your copy of this unique program, today. Click on the link NOW:    http://drbillsclinic.com/avoid_knee_surgery.html
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

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

 Did you ever get a phone call or email out of nowhere that was from an old friend that you’d lost contact with and you thought you’d never hear from again? If you have, then you know what I felt over this past weekend, just the other morning, when my phone rang me out of a sound sleep. 

Since my internship, I’ve had the facility to awaken instantly and answer the phone before the first ring finishes. Call it a conditioned response. It’s sort of drilled into you, when you’re in training, because nurses have a way of calling you, just as you’re drifting off to slumber land, after an eight hour shift.
 
I subsequently learned how to anticipate this tendency (some would call it an exercise in sadism) and write orders that put my patients on autopilot. If orders were there, the nurses had their instructions and didn’t need to call me, unless there was a REAL, honest-to-God emergency. But the neural pathways that were burned into me by the training during those formative years have survived and remain with me to this day.
 
Anyway, they were on full display when the phone rang on Saturday morning. As usual I went from deep sleep to wide awake in seconds, grabbed the phone off its cradle and out of the blue, I heard the voice of my old buddy, Josh. This was really a voice from the past!
 
Josh is and was a great photographer. In fact, if you’ve ever seen those posters, sold in frame shops, of the architecture and sculpture of Grand Central Station, in New York City, done in black and white, those are Josh’s photos. We met years ago in Long Island, through my brother-in-law, John. Josh was one of those people who are so hyper, and so UP all the time, that they are really fun to be around. You just can’t be depressed or feel like lying around when he’s with you. He was funny and a really talented guy: his photos are far more than just “pictures;” they’re real art.
 
When I was writing my magnum opus, THE ART OF TOTAL HIP ARTHROPLASTY (originally published by Grune & Stratton, in 1987and now available through W. B. Saunders & Co.), Josh did many of the photos for the book, especially the antique hip implants. He shot them the way he would normally shoot jewelry, or some fashion piece, with a tent, and indirect lighting–the photos were fabulous; far superior to what normally passes for imagery in an academic text. 
 
Later on, we took Josh with us on a trip through Europe, a kind of side extension when I was presenting a lecture at the British Hip Course at the Orthopaedic Hospital in Oswestry, Wales. He brought his cameras with him, and as a result, we got some of the best “what I did on my summer vacation” photos imaginable.
 
We even went on a vacation to an exclusive resort in the Caribbean, Cap Juluca, on the Island of Anguila, with Josh and his new bride. Unfortunately, that particular liason didn’t work out–the parties were just too different. But the point is, he was very much a part of our lives, fun to be around and never boring.
 
Then, one day, he was just…gone. He apparently up and left behind his businesses and moved to North Carolina. Never said goodbye. Never wrote or called. Most odd. And of course, we missed him. At that time, though, I had my own problems, what with my back injury, winding down my practice and moving to Florida. I tried several times to track him down, but always met with frustration.
 
Finally, a couple of months ago, I was just thinking of him, having unearthed one of his masterpieces from my photo files. And I started a web search. I finally found him on a website he had posted and left a message. I encouraged him to call, but–nothing. So, I reluctantly concluded that, for whatever reason, that he didn’t really want to stay in touch. And respecting that, I let it go… 
 
Then, from out of nowhere, he called. And, ironically enough, turns out that he has a client in Winter Park, not 20 minutes South of us near Orlando, Florida. He now has a print business, where he produces high quality giclee art prints for artists and photographers, as well as his photography. And he had his reasons for just “disappearing.” Turns out that he had lost my cell phone number, we had moved from the house and that was the only number he had. 
 
Could he have found us? Probably, but everyone’s got their own priorities, right? I learned long ago that if you want someone’s friendship, you have to accept them the way they are. Try to change them, expect them to change, and you’re doomed to disappointment. The important thing is, we’re back in touch now, and that’s all that matters.
 
Naturally he wanted to know how we were doing, and what I’ve been up to. I told him about my struggle to pick up the pieces of a broken career, after my injury effectively removed my ability to do surgery, as an option. I told him about my efforts to help people with knee pain, through my web services and my publications, and I sent him to see my newest healing program, HOW TO AVOID KNEE SURGERY, at
 http://drbillsclinic.com/avoid_knee_surgery.html
 
Turns out he’s had some problems in that area, like many Boomers, so he’s looking for some slick non-surgical methods to relieve knee pain and restore his function to normal. No problem. He just needs to follow the instructions and advice I give in this new program, and his pain will be gone, for good–and without surgery, too. See what I mean at  http://drbillsclinic.com/avoid_knee_surgery.html
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

This summer, there’s been an outbreak of ticks all over our county, here in sunny Florida. Since my poor old dog, Kelly is the only pet that goes outside to take care of her business, she’s a  potential vector for bringing the damn little blood suckers into the house. I’ve had the entire yard sprayed three times now, the interior of the house sprayed, the dog given a flea and tick bath twice at the vets and sprayed her feet and belly with Frontline spray every time she goes out. And still I occasionally see one creeping around. It’s like they’re super bugs or something–really hard to kill. And I’ve heard from my landscaper that it’s the same all over, but no one knows why.  First year since we’ve been in Florida that this has been a problem. Maybe it’s the relatively mild winter we had (yes, we do get a brief winter, occasionally with freezing temperatures at night. But it only lasts for about 4-5 weeks, or so). One more thing about Florida they don’t tell you in those brochures….

But this reminded me of a story I thought I’d share with you.

A number of years ago, there was this one hard luck patient who needed to have his hip replaced. So we did the usual pre-op work-up and scheduled him for the O.R. The first time he showed up, one of his lab results was out of the normal range and Anesthesia (quite correctly)refused to anesthetize him. Of course, I agreed–better to be safe. So we corrected the electrolyte problem and rescheduled him.

Next time, his blood pressure was too high, despite his medications. Again, he was scrubbed and rescheduled. Finally, the third time, everything looked OK, he showed up in the OR and we got him anesthetized (combination  anesthesia: epidural and a light general). We then rolled him over on his side, in what we call the “lateral decubitus position,” and the nurses began to prep him.

As I usually did, I came in to inspect the prep and noted that there was one area where they hadn’t shaved the hair away. And, of course, it was right over the area  where I needed to make my incision.

So I said, “Hey. There’s a spot you missed.”

“Well, there’s a mole or skin tag there and I don’t want to cut him,” the nurse replied.

“Alright,” I said, “give it here and I’ll do it.”

And with that, I took the razor and I looked closer at the skin tag or mole. It was flesh colored, no hair on it, looked like a typical fleshy skin tag, in an odd place. So, just to see where its base was, in preparation for carefully shaving around it, I flicked it with a finger…

And suddenly,  LEGS CAME OUT!

Holy crap! It was a fat TICK embedded in this guy’s thigh, alive and so positioned that you couldn’t see it when the patient was on his back (he was a heavy guy and the flesh of his thigh neatly covered it, until he was rolled over). So we had to scrub his surgery, yet again!The risk of infection, especially with an implant, was far too high to proceed.

I removed the arachnid (not an insect: ticks have eight legs, like spiders, not six) with surgical forceps and stuck it in a specimen jar of formalin (a preservative).  Anything removed from a human body has to go to Pathology, once you’re in the OR. And an Operating Note has to be dictated. The official operation was “Removal of Foreign Body.” Probably very entertaining for the Medical Transcriptionists who typed these things up for the record, too. A variation on what they usually say: “The third time’s the TICK!”

Imagine the surprise of the patient and his family when I told them about this one! Without doubt, this was my very weirdest case. They were good sports though, and understood why we didn’t see it ahead of time. Hell! They hadn’t seen it either.

After the little bite wound healed, we finally got him done, without any complications at all. I guess he used up all the bad luck in his previous attempts to get into the OR. And he ended up doing great! Now admittedly, (and thankfully) this was a pretty rare set of circumstances. But if you ever needed yet another reason to stay out of the OR…J

And speaking of staying out of the OR, if you have knee pain and want to get relief, but WITHOUT SURGERY, click the link below to see my most recent healing program, HOW TO AVOID KNEE SURGERY  http://drbillsclinic.com/avoid_knee_surgery.html

Til next time, my friend, be well (and stay out of the tall grass…).

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

The week doesn’t go by that I don’t hear from someone that they were told they need surgery, but they’re scared to death of it! Now, even when I was doing a great deal of surgery, I was NEVER doing anything that wasn’t absolutely necessary. I often tell people that over 90% of the patients who were referred to me were treated NONSURGICALLY.
 
Why was this? After all, I was paid quite a bit to do surgery. Why wouldn’t I push it more?
 
Very simple. 

If you develop the reputation of being very conservative when it comes to recommending surgery, ironically enough, you end up doing MORE surgery than if you had been very aggressive initially.
 
You see, the physicians who refer patients, and other patients who refer their friends, want to have confidence that they are sending these people to someone with integrity, who won’t push an unnecessary procedure, and will only recommend surgery when that’s the only option, or sometimes, the best option.
 
They believe, quite accurately, that their recommendation reflects on them. And they want their patients/friends to feel good about the guy they sent them to. So they tend to refer to the surgeon who is SLOW to operate. Over time, this results in a very large volume of surgery with EXCELLENT RESULTS, because the procedures were properly indicated and the surgery therefore worked.
 
I learned this very early on in my practice, from one of the senior men in my group. This guy was a truly outstanding hand surgeon–gifted, in fact.  As a young guy, just out of training, I naturally wanted to do surgery. That’s why I trained so long–I wanted to DO something to help people. 

And, like many young guys just out of training, I believed there wasn’t ANYTHING I couldn’t do. Time and maturity have a way of humbling the best of us, but at that time, I BELIEVED in my own abilities.
 
Well, this older man, who had much more experience, but understood the drives of a younger man, told me, point blank, what I just told you: 

“Bill, restrain yourself and try conservative treatment first, with every patient. Not only is this the right thing to do, but mark my words, you’ll end up doing MORE surgery than if you’re too aggressive.”
 
And because I had seen this man in action and greatly admired his extraordinary skills, I respected anything he told me. In short, I did exactly what he told me to do. 

And you know what? He was right.
 
In time, I came to appreciate that this was the ethically correct approach, as well. But at first, I learned to be this way as a matter of enlightened self-interest. With maturity, I developed personal guidelines to PROVE that any procedure was indicated and it was the correct approach for the patient. 

And, I incorporated a number of alternative measures into my practice, as well (despite the odd looks and derisive remarks of my colleagues), as they seemed to work and they often offered improved results in non-surgical cases, of which there were many more than the surgeries.
 
So, many people told they need surgery tend to panic. They’ve all heard horror stories and imagine every evil result imaginable, if they allow themselves to go “under the knife.” And in some cases, where surgery really IS the right thing to do, they miss the opportunity to get an excellent result, or worse, because of misplaced fear and ignorance.
 
I don’t want that to happen to you. 

So, for the rest of this week, each day, I’m going to teach you exactly what’s done in a number of the most popular orthopaedic surgeries. You might as well know what’s really involved. In this way, you can face what you fear. And I’ve always found that learning the truth robs fear of its power over you.
 
But remember, MOST cases can be treated WITHOUT  surgery. That’s why I created my newest healing program, HOW TO AVOID KNEE SURGERY   http://drbillsclinic.com/avoid_knee_surgery.html
 
So if you, or someone you know, has knee pain, or been told you need surgery, check this out. With the very best techniques from across the medical spectrum, conventional, alternative and complementary methods, you may well be able to relieve your pain–WITHOUT SURGERY. Try it. You have nothing to lose, but your pain. Click the link below and see:
 http://drbillsclinic.com/avoid_knee_surgery.html
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

Just today, I was driving along in my car, listening, as I usually do, to a talk show on AM radio. The traffic was miserable, the weather was lousy, but the kitties need food, so there I was. Anyway, one caller came on and said, quite emphatically, to the host of the show, “Healthcare is a RIGHT! It’s a disgrace that there are people who are uninsured in this country…We’re the only major industrialized country in the world that doesn’t provide care for everyone…Yada, yada, yada…(with apologies to Seinfeld)”.
 
Like many people who hold this viewpoint, the man who called into the show was long on passion, but short on facts and true knowledge of the problem. Which is to say, he was clueless about the real situation, but he gets points for compassion for his fellow human beings.
 
Here are a few things to consider. First, yes, there are a large number of people who do not have insurance coverage. BUT, and this is a big “but,” for many, this is a CHOICE. I know this seems like heresy, but in this country, people still have the freedom to make some choices. 

A young guy with no dependents, in the full flower of his life and strength, often thinks he’s near invulnerable and feels like he’s immortal. He may choose not to spend his money on an insurance policy (health OR life), because the need for it seems very far away and he’d much rather spend it on something else. 

Now, there are people who need coverage and can’t afford it, or maybe they can afford it but they’re disqualified by a “pre-existing condition.” That last is a real problem in anyone who is younger than Medicare-eligible age. Finally, there are a horde of ILLEGAL ALIENS included in that number of the uninsured–not only can they not afford it, or qualify for it, but they’re NOT supposed to be here, at all! And yet, their every emergency is treated FREE, if necessary, in the local ER, by law. WE pay for that, BTW.
 
Now, I’m not going to say that there aren’t problems with the current system–there are. But politicians are attempting to use this situation to seize control of yet MORE of our freedom and our money by attempting the government takeover of the healthcare industry. 

And underlying all of it is the idea, popular on the left, that health care is a RIGHT. Sorry, but it’s NOT a right. A need, obviously; desirable, certainly; but not a right. Why? Well, any other right guaranteed by our system and our constitution can be freely expressed by an individual and IT DOESN”T IMPOSE A COST ON ANYONE ELSE. That is, if I want to speak my mind and express an opinion, my “right” of free speech, it doesn’t cost anyone else a dime for me to do that. 

It’s true that in at least some of these cases, there is a true need. And that should be addressed. There are ways to deal with that. But NOT by putting the ponderous federal government in charge. These people can’t do anything right! Do you really want to trust your health to a bureaucrat? Think about it–it’s better for their budget if you die.
 
And do you want to stifle the innovation, investment and effciency of the private model? I mean, already a whole lot of physicians are from elsewhere–because our best and brightest, right out of college, have already figured out that they don’t want to be under a government thumb. They’ve gone into other fields, where they can prosper to the limts of their own talents and drive, free from government regulation. And the old dogs (like me), who have decided to retire, rather than put up with ever more regulation, litigation, and decreasing revenues, further decrease the physician pool. 
 
Then there’s convenience. Tear your meniscus? Today, you can see a doc, get an MRI that afternoon, and if needed, get surgery done a day or two later. So you can be back at work or play in a few days to a week or so. Done. Want to give that up, so some government fool can tell you that you have to wait a few months to get the MRI and then, another 6-12 months to get the surgery? I don’t.

Then just think about this: now you have cancer. And some drone tells you, sorry, you’ll have to WAIT to get that CT scan and then WAIT again to get the surgery. And all the while, the cancer is eating you alive, spreading through your system with unseen virulence…while you WAIT. That’s what the future holds if we let this happen.
 
And then, there’s the financial argument. Create a “right” to care and you create an endless demand–which YOU will pay for. Take a look at Europe and Canada. Anywhere this idea has been tried, it has all but bankrupted the country. We can’t afford this. The American taxpayer is not a bottomless well.

There are problems that need to be solved in healthcare. But the government is NOT the solution. It’s part of the problem.
 
So next time you hear someone tell you how healthcare for all is a “right,” you now should know better. Your best bet for your future healthcare is to STAY HEALTHY.
 
This rant has been brought to you by HOW TO AVOID KNEE SURGERY, where you can avail yourself of the latest cutting edge techniques, from across the entire treatment spectrum for eliminating knee pain, without surgery, at
 http://drbillsclinic.com/avoid_knee_surgery.html
Thank 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

Besides the fact that I am a hip & knee specialist, albeit retired from active practice, the reason that I decided to focus on knee productsfor the start of my “second career” on this web site is that knee pain seems to be a very common, nearly universal problem, especially in people of my age group, The Boomers.  It happens almost every day–someone will mention that they have a painful knee, or they have arthritis, or they have a knee that “gives out,” or some other problem. It doesn’t get the “press” that back pain does, but everybody seems to have it, in one form or another.
 
Hell, I’ve had it myself–as many of you know. There’s nothing quite like having the same problem as your patients to give you a whole new appreciation of what they’re going through. They call that empathy. When I had my arthroscopic surgery on April 15, 2000 (Tax Day–might as well get all the agony over with at one time), believe me, I had a brand new understanding of what all my patients over the years had been experiencing. 

The need for the surgery, as you might expect, was well documented by physical exam, and a positive MRI, that demonstrated a torn medial meniscus. It had been interfering with my walking and exercising and I had just had enough. I called two of my best buds in the Department; one was busy and didn’t return my call, but the other saw me right away. Hey, rank has its privileges, right? Well, he agreed that I needed the ’scope. So we booked it for the local Surgi-Center, which specializes in outpatient surgeries.
 
So on the big day, they rolled me into the OR, smiles all around. They started an IV and slipped me a little IV Versed (a short acting relaxant that has the side effect of short term amnesia). Very relaxing, almost pleasurable. I remember just a tiny stab of sharp pain in my left knee, where I needed a little more local anesthetic, otherwise, nothing. Woke up gradually in recovery, feeling fine. If you ever need to have surgery, this is called “conscious sedation” and it’s definitely the way to go.
 
As soon as I woke up sufficiently, they let me go and I went home. Set myself up in bed with my leg well elevated, with a big bag of crushed ice on it, to reduce swelling. At first, I was quite comfortable…then, the local anesthetic, injected into the knee at surgery, wore off. Oh boy! That was sore and even worse when I had to put it down to limp to the bathroom on crutches. So THAT’S what they were all complaining about. I suspected that MY surgeon had given me less anesthetic than I gave my patients. Took at least 2-3 days, before I could put some pressure on it.
 
Turns out I had a whole lot more pathology in that knee than I initially thought. That’s the thing about MRI’s and other interpretive examinations: the real thing is always worse than the scan indicates. In my case, a small area of bare bone under the residual meniscal rim, in other words, some arthritis. Now, with time, and me doing my own therapy, with the same exercises I teach at http://drbillsclinic.com/exercise_eliminate.html   I gradually improved, more and more.
 
But after my left knee recovered, the right started acting up. I thought about going through the same process that I had just finished on my left knee, and decided that the odds were good that I had a “mirror image” lesion (in other words, the very same pathology) in my right knee. THIS time, I opted to AVOID SURGERY and treated myself with all the various options I knew about from across the entire treatment spectrum: the best of conventional therapy, alternative measures, dietary changes, nutriceuticals, the works.

And it’s worked–so far, I haven’t had to have surgery on my right knee. And these same measures are those that I used for the over 90% of my patients, who I was able to treat without surgery. Now, I’ve put all these strategies and a number of healing programs into my newest product: HOW TO AVOID KNEE SURGERY. Go see it at    http://drbillsclinic.com/avoid_knee_surgery.html
Get rid of 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