the-doctor-is-inRecently I ran across an article entitled, “4 Things I Learned in Medical Training That Still Apply Today.”

You can read that article  here

The wisdom is timeless and applicable to many settings.   The first principle discussed was …

“Common things are common.” (The alternate version of this that might have more appeal to zoologists: “When you hear hoofbeats, think horses, not zebras.”) 

This is an admonition to look for the most likely cause first and would have been extremely useful if it had been applied by a vet that misfortunately got the opportunity to treat one of my havanese dogs. I had been traveling for a few days between PT assignments and Rusty woke up and vomited several times in the morning, the final one looking a bit pinkish. I decided to take him in to a local vet fearing that perhaps he had eaten something bad or harmful since he had been in unfamiliar surroundings and I had not been able to supervise him the entire time.

The vet decided to rule out Parvo first, which admittedly is a deadly disease but one which Rusty had been properly vaccinated against.  When I objected that this seemed like an unlikely reason for my dogs illness I was informed that sometimes dogs that have been vaccinated still come down with the disease.

While I do not know the exact number of vaccinated dogs afflicted with parvo, I can’t imagine it being more than say 5%. After a $30 test, we determined that Rusty did not have Parvo and went on to consider much more likely scenarios. It’s not that $30 was too much to pay for my dog’s health but that observation and common sense should have dictated that the most likely cause be looked into first, not last. Needless to say I did not return to a vet with such poor clinical skills.  Be on the lookout for those who are testing the least likely thing first.

Here is what comes to mind when these maxims are applied to knee replacement recovery.

“Common things are common.”  If you are not progressing with your therapy and specifically your range of not jump to the conclusion that your knee is infected or that the doctor badly messed up your knee for life. The most likely causes of failure to progress are not taking enough pain medicine, not doing your exercises at the proper frequency, and not having a feedback mechanism so that you can monitor progress gained each session. Walking too much in the early stages and doing too much in outpatient therapy are other common errors . (See my book for a more in-depth discussion)

“Treat the patient, not the number.” ( Or “Treat the patient, not the x- ray”) Recently I friend of mine who has been heavy for years had trouble with one knee and went to see a orthopedic doctor. She had had two onsets of pain that were rather sudden. The first one had resolved and she was presently still unresolved with the second bout. The doctor did an x ray and told her she needed bilateral knee replacements. This is a true story.

If you are un-symptomatic, meaning that you are not experiencing any knee pain you would NEVER get your knee replaced no matter how ‘bad” the radiographs looked. I have spoken with many people who go to the orthopedic surgeon and are told they are “bone on bone”.  They become unglued because they think this means they must have the surgery. All that matters are your symptoms and how debilitating they are to you in your present life. That is the criteria needed to dictate whether or not to proceed.

“The longer someone stays in the hospital, the longer he stays in the hospital.”(Or” The longer someone stays in a facility, the more likely they are to catch something) By all means go home as soon as you are able after your knee replacement. Your home is cleaner, you are not surrounded with people who are coming to work sick and other patients who may be immuno-compromised. And it is very likely that if you get educated you can do a better job with your rehab at home than in a facility


“When you only have a hammer, everything is a nail.” Orthopedic surgeons perform well…surgery. If you want to look at alternative methods of saving or healing your knee. Traditional medicine is not your friend.  Lose weight, walk more, learn to walk properly, avoid low squats or getting up from low furniture, and change your job mechanics if possible to maintain your knee health.

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Michelle, PT
Michelle, PT

Michelle Stiles called "the no nonsense" therapist, by her patients, created a company called Cowboy Up Recovery after recognizing the bankruptcy of the present medical model. Too many people regard conventional medical wisdom as gospel, ignoring the subversive influences of Big Pharma and Big Medicine. She believes, Americans in general are being trained from an early age to defer to experts in numerous areas of life and losing the impulses for self-responsibility and self-reliance in the process. Over-diagnosis and over-medicating has become endemic. While thankful for the best miracles of modern medicine, she encourages people of all persuasions to listen to their bodies and seek out answers to maintain not just an absence of disease but optimal health. Her advice is: Cowboy Up, no one cares more about your health than you do.

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