Saturday, July 19, 2014

Six Things I Like About Doug Kelsey’s New Book

I first mentioned Doug Kelsey’s latest book, The 90 Day Knee Arthritis Remedy, here. Kelsey, as anyone who read Saving My Knees knows, is the person that I credit the most with helping me figure out how to fix my knee pain -- and giving me the hope that I could be successful.

I planned to write a book review but -- yawn -- those are so 20th century, right? :) Plus, I can’t pretend impartiality here; I clearly owe him a large debt.

So instead, I give you this list of what I liked most about the book.

(1) The writing includes many examples. I like this style for a few reasons:

It makes for smoother reading.

It helps reinforce a sense of authority -- he can cite so many relevant examples because he’s seen so many patients.

It’s effective when showing how conventional wisdom for treating bad knees falls short, as with “Sue,” whose condition doesn’t improve when Kelsey, early in his career, tries applying the standard muscle-strengthening approach to fix her pain.

(2) He attacks foolish myths and exalts logical truths. For example, he talks about how, many years ago, he was perplexed by the idea that cartilage is inert and just wears out and nothing can be done -- end of story. He realizes something: This makes no sense. And it makes no sense, understandably, because it’s simply not true.

(3) You want exercises? You got exercises.

The book has plenty, with photos and video links too. Kelsey even includes multiple exercises to choose from when you have a highly sensitive and easily overwhelmed knee joint.

(4) The writing is smartly footnoted.

So Kelsey’s not just saying, “Here’s what I think” but “Here’s what I think and here’s some hard evidence why I think that.”

(5) There’s a little something for everyone.

There are abundant exercises if you’re just interested in therapeutic movement. There’s an analysis of dietary supplements if that’s what you want to know about. There’s Kelsey’s easy-to-digest explanation of the biomechanics of the knee joint.

(6) Plus, something I really like at the end: Kelsey concludes by taking a long look at “stumbling blocks.” Why, after trying so hard, have you failed to get better? This is the section that emphasizes the importance of getting your head right. How do you deal with doubt, impatience, failure to focus, worry? For some people, this part will be even more important than the description of all the exercises.

Last thing: I saw that “TriAgain,” who’s made some great, interesting contributions to this blog, made some remarks about what he saw as flaws in the book. I just wanted to say that, to be fair, Kelsey’s not a professional writer and he most probably didn’t have a professional editor helping to shape his prose. I happen to like Kelsey’s style, but that’s just me.

Also, try not to be too hard on him if he doesn’t respond to questions (or suggests you may need a “consultation,” probably at some cost). :) I can tell you, as someone who wrote a what-to-do-about-bad-knees book, that even though I lack the expertise to advise anyone, readers have approached me about essentially becoming their coach and sounding board. I always try to decline with tact and modesty, because really, I’m not qualified. So I imagine someone like Kelsey -- who clearly is very qualified -- gets scores of questions and requests. It would be overwhelming, I’m sure, for him to try to engage with everyone who wants to.

Still, I’m sure Doug Kelsey is as open to comments as I am, so anyone wishing to express an opinion on The 90 Day Knee Arthritis Remedy, whether good or bad, feel free to leave your thoughts below.

22 comments:

  1. I was a bit hard on the way the book was written book. I'm a perfectionist which is probably why I wrecked my knees (too much training), and write and read a lot at work with the aim of making difficult things simple. Finding I had to read and re-read sections to understand some of the progressions from Phase 1 to 2 bugged me.

    I can now report I've used the book to devise a modified version of Dougs exercises and followed these for nearly 8 weeks. Frankly, I didn't have time in my lunchbreaks to get through all the exercises suggested in Phase 1 (are you even supposed to do them all?), but really like the one leg squats (I use a rowing machine with the rear propped up on stands of varying heights, not the Total Trainer he suggests buying), the supermans and the hip burners.

    As Doug alludes to in the book, you have a figure out for yourself which exercises & at what level (reps, proportion of bodyweight etc) work for you (don't increase your pain). This is where he is way ahead of most physios, GPs, PTs etc. They vaguely tell you to do 15 reps of something 3 times per day for 3 week, but if that is too much, where do you go from there? This book at least informs you that some things may be too much, and gives you clues on how to back off till you get it right - there will be some trial and error (maybe that was my problem - I expected a precise recipe?), but at least you won't be slavishly following a program that digs your knees into a deeper hole. I was working with one PT who was on the right track, had some similar exercises to Doug's book, and for a while I thought it was working. But some of the exercises and progressions proved to be too much, too fast, and my experiences and reading thankfully told me to get off the program fast or I'd be back to square one.

    I've started putting together video footage of my knee rehab attempts using Doug's ideas to remind myself of what I did after I finish that first Ironman (insert wild optimism emoticon here). It is way more complex than my old swim/bike/run repeat.

    Also, having recently started working with a pain specialist, my situation is more complex than the straight cartilage damage story, as I have nerve pain as well, so I'm on a 5-pronged attack:

    1. Plasma Rich Platelet (PRP) injections in both knees - only had one so far
    2. Drugs (natural and not = Lyrica) for nerve pain
    3. Working through a book on chronic pain the specialist suggested, to find better ways to deal with the pain mentally
    4. Exercises (mostly Doug's, plus shallow squats given by the specialist) plus swimming and boxing
    5. Eating better to control weight

    A gradual return to exercise is recommended for both nerve & chronic pain, and some of Doug's drills work well with this.

    I also subscribe to Doug's newsletter. One of the reasons I went for PRP injections is because he recommends them. However, further research, Doug's experience with PRP for torn meniscus, frustration and the insistence of the pain specialist changed my mind....and this guy only costs $110/knee not $500 (insert smiley emoticon).

    It is the most natural/least invasive option on the list if you must stick something into your knees, and the results after just one injection (in a series of 3-4) are amazing. I'd say a 50-70% pain reduction after 1-2 days, which is persisting after 2-3 weeks though I still have good and bad days. Hopefully it will be even better after 3-4 jabs. I see this as my last chance and don't want to stuff it up, which means not getting over-confident with exercise following the course of injections.

    After 2 years in denial, I finally worked out (slow learner) I'm not going to make it back to triathlon anytime soon (perhaps never?) and need to follow a careful progression from here on. But having minimal pain for much of the past 2-3 weeks has been a Godsend - and puts triathlon in perspective.

    cheers, TriAgain

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    1. This para should say:

      I also subscribe to Doug's newsletter. One of the reasons I went for PRP injections is because he recommends them. The first Sports Dr I saw actually recommended it, but it sounded a bit radical to me then. However, further research, Doug's experience with PRP for torn meniscus, frustration and the insistence of the pain specialist changed my mind....and this guy only costs $110/knee not $500 (insert smiley emoticon).

      And PRP is Platelet Rich Plasma (not the other way around as I wrote it).

      Bloody perfectionists are a PITA aren't they!

      TriAgain

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    2. First off, TriAgain: Try a patella strap under your knee (or both knees) when rowing, walking, etc., as I found that "redistributing force" helped me early on with my post-op chondral shave problems (CRPS: AKA, Crappy Result Post Surgery?). Move strap around: over, under patella/kneecap, it may help. Be mindful using strap, so it doesn't become a tourniquet. Let me know if it helps.

      Guess am a little skeptical about the possibility of a 90 day cure for arthritis, at least for what ails me. "Relief?" maybe. Unless cure is not implicit in "remedy?" My operating surgeon "discovered" (about his only discovery), grade 3 degeneration on my patella and medial fem. condyle and I suspect that grade 3 degeneration does not repair in 90 days.

      In my mind, I have a picture of cartilage healing on four layers and from the inside outward: Bone/calcified layer; deep layer; intermediate layer; and superficial layer. The area between bone and cartilage is called the "tideline." Running perpendicularly through the tideline are collagen fibers. Progenesis/chondrogenesis, the creation of new chondrocytes occurs in this region. Interestingly, the chondrocytes are roundish deep and flatten as they migrate (I assume) outward. The collagen fibers also make a 90 degree turn to "flatten," in the superficial layer. Intuitively this makes sense, if you think about the pressure of fluid over the surface on the superficial layer during activity.

      It would be an interesting experiment, somehow marking collagen fibers when they are deep, to then track their migration, from tideline to superficial layer. Then maybe there could be a guesstimate of how long cartilage takes to repair (and prove that it does heal!). Probably somewhat longer than 90 days for a degenerate like myself, I imagine? Some with grade 1 or 2 chondro though, could reasonably heal in that time frame?

      It seems like the problem facing grade 3 sufferers like myself, is getting the whole system, at least the structural 4 layer system, to heal uniformly, as overloading the system destroys its finished product, which is also its first line of defense. I say "at least the structural 4 layers," because I think causation of softening cartilage is potentially multifactorial and not always purely structural, although imagine instances where it might be.

      Good luck to all healing their knees, R-X

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    3. Hi Tri Again,deloupy, Richard,

      Here I am after few months again. I went through PT from last three months - very painful and difficult - that helps me to at lesat stand on my feet and walk for 5- 10 minute.

      Now, I am still on bed most of the time.. Cannot stand still on my feet even for 1 min.. burning , irritation and inflammation goes really really high.. I can do 10 - 15 min walk 3-4 times in a day.. that is it.. It's been 7 months I had this flare up last Dec. 2013.

      My other good knee - right one - is showing buring around knee cap too in last 3 month.. Left one is worst due to meniscus tear and Arthritis. I have severe burning in my left knee - back of my knee and front too.

      I was on Cimbalta - nerve pain blocker - so that I can go through PT a bit..

      What are my options here?

      Due to severe inflammation and buring - cannot go through PRP ? Or can I ?
      I also like to connect you

      TriAgain, what is your experience with PRP?

      Surgery is last option.. plus wiht severe burning and inflammation , cannot think of this either..

      How long sit on bed 99% - is no life either..
      I cannot bend my knee.. burning goes up..

      TriAgain,

      Can you give me name of that natural medicine for nerve pain and book for pain mangment.

      Please I need some guidance as what should be my next step?
      I also like to connect you all to get more help and guidance. Can you please give me your email address:
      Mine is saroj05@gmail.com

      Awaiting to hear from all of you.. Hope in life is diminishing with each passing day..

      Regards,
      Saroj



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    4. I Saroj

      The book is called 'Manage Your Pain: Practical and Positive Ways of Adapting to Chronic Pain ' by Nicolas Michael.

      I can't say how the PRP will go, but I've had 2 injections out of a required 3-4 and to date I'd say my pain has reduced at least 50% - but I still have to be careful as if I overdo the exercises, it flares up again.

      The natural medicine is called Normast. The chemist here in Australia has to order it from Italy! It is expensive - $100 for 40 tablets and I'm supposed to take 2 per day.
      .
      My advice would be to see a pain speclialist, like I did here in Australia. I'm sure you can still have PRP treatment with the burning - I did.

      What I like about PRP is that it is using your own blood to heal yourself. I had my 2nd injection yesterday (this method - http://www.regenexx.com/regenexx-scp-platelet-rich-plasma-prp/) & the nurse explained that it also contains some stem cells, plus it stimulates the production of growth hormone and stem cells to help repair the damage.

      I also suspect surgery would not help you at all if, like me, your problem is cartilage damage which has led to chronic pain (i.e. nerve pain). The surgeon who trimmed my torn meniscus said avoid more surgery like the plague as it would probably make me worse.

      I'd guess Richard also had a nerve pain element (though not full blown CRPS), but his strong mental approach, belief in his own method to cure, and a very well measured gradual return to exercise was enough to beat it. I'd bet not many people can beat it on their own like Richard - most would need some outside guidance and support. Finding that type of person is difficult though - you really need someone with experience in patients with chronic pain. Any pain which lasts longer than 3mths is classified as chronic pain, and almost certainly involves changes in the spinal chord and brain (as explained in the book above).

      Be very careful with PT - I had a well meaning PT who was on the right track, but took me too hard too fast.

      All the best and hang in there. I've been fighting for over 2yrs now. I expect to be fighting for at least another year or two before getting back to anywhere near my past life.

      TriAgain

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    5. Hi Deloupy,

      Thank you so much for your reply. it gives me immense support that one day I will be able to walk, my normal routine work and being able to go to office.
      I have Moderate Arthritis and Minscus tear in my left knee.. Now, my right has started showing same buruning around knee cap too from last 4 month..- may be some softing is happening is there too.
      I cannot sit on a chair or car or anything where I have hanging leg at 90 degree.. it makes inflammation goes really high.. I have to sit with straight leg alla the time..Do you think this will improve too over time? Any suggestion based on your progress will be a help.

      Where did you buy clay poultices and Actipatch from? Can you please give me that inforamtion.
      I am planning to go for PRP to bring down my burning or inflammation. Let's see if that helps too.
      Looking forward to stay in touch with you. Thanks,
      Saroj

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    6. HI TriAgain,

      Thank you so much for your reply and all help. One more question - I also got meniscus tear in my left knee - that is where this all started - 2 yr. ago. This same leg had severe flare up 7 month ago when I became bed ridden and extreme burning since then..
      Did you go through Meniscus surgery during the time when you have this knee burning?

      The reason I am asking is that I need to come up with some treatment for my meniscus injury too to heal it. My first dr. said that it is normal and did not recommend anything. I became mobile and 100% functional after 2 month of swelling and some rest so I did not care either until I had this extreme flare up 7 months ago.
      Other dr. I saw 6 months ago told me about surgery, but that time i had severe buring and inflammation so I know I will not be able to tolrate surgery..
      I am planning to go for PRP for my meniscus and knee burning first.. What do you suggest?

      Do you think i can go through surgery if I had to as last avenue for my meniscus tear with such a burning and inflammation in my knee, If let's say, I need to go through..

      I have severe burning in back of my knee too - in left knee - I think it could be because of meniscus tear ? - What is your take on? Just to get an idea.

      Many thanks for your help and support. I really appreciate it.

      Regards,
      Saroj

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    7. Saroj

      Your symptoms sound very similar to mine, though more severe. I still go to work etc, but I have constant pain/burning of varying degrees.

      I had the meniscus surgery on my left knee, and then the burning in BOTH knees started a month or so AFTER that. So I did not have surgery while my knees were burning - the burning started afterwards.

      Also I never had any swelling. Even in the days after my surgery my knee hardly swelled at all.

      PRP is definitely worth trying for both your meniscus tear and the burning. Doug Kelsey writes that he repaired his tear with just PRP alone, not surgery.

      cheers, TriAgain

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    8. HI TriAgain,

      Thanks for reply. My swelling only happend 1.5 yr. ago when i had this meniscus injury - April 2013. I wish I had treatead this at that time but did not have enough knowledge of this problem at that time. As I said, I became 100% mobile and functional after 2 month of rest. And the doctor I saw at Stanford told that this is normal and does not require any treatment. Since I was mobile and functional without any problem, I did not care either till I had this severe flare up in Dec. 2013 and became bedridden since then.
      Not sure if my meniscus damaage and Moderate Arthritis became worst since they were found first in April 2013 in last one year which resulted in severe flare up and burning or what happend.. don't know.. did not have any other MRI after that.
      Do you think burning and severe inflammation at the back of my left knee is coming from meniscus tear? - I have two tear - complex tear of the posterior horn of the medial meniscus and free edge tear in lateral meniscus.

      Going to see a Dr. in SFO this Monday who treat patients with PRP and rejgenerative injections.
      I can hardly walk few steps in my apartment and even with inflammation and burning goes through roof and becomes unbearable.. Cannot sit even on chair.. I have to sit on bed with straight legs.
      Your fight, help and suggestions are big support to me TriAgain, to keep fighting with this condition with a hope that I will heal my knee one day and become mobile / functional again.

      Crossing my finger for healing with PRP as my last option.. I iwll keep you posted. Praying to God.

      Thanks and Regards,
      Saroj

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    9. Hi Saroj

      It sounds very much to me like your problem is the torn menisci, not the type of cartilage degeneration problem I have, and others on here describe. The fact that you have pain in the back of the knee, and that it is only in one knee makes me think that.

      I think your first Dr was correct in not treating it initially (i.e. no surgery) - surgery should be the last resort, and your problem settled down after rest. I had the same - meniscus pain which settled on it's own, before it suddenly let go a year or so later and was causing my knee to catch/lock, so surgery was the only option.

      I think seeing the SFO Dr is a good idea, and perhaps trying the more conservative option of PRP etc. If that does not work, you may have to look at surgery.....but don't rush into it. And ask your surgeon to preserve as much of the meniscus as they can.

      cheers, TriAgain

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    10. Hi TryAgain,

      I saw a Dr. in SFO. She suspect that I have CRPS since I have so severe burning, inflammation and irritation around my left knee cap and behind the knee.. Same issue started shwoing up in my right knee too from last 3 months aorund knee cap.

      If I can reach to your or deloupy level, I will consider myself very lunky. At least I could live normal lifr few hours a day.

      Right now, just walking few steps to bathroom or brushing my teeth or even sitting 2 min on a chair brings my inflammation so high..

      Not sure what is this Arthritis or cartilage thinning which cause such a huge and severe problems in our body .. for me - first severe flare up and burning - then Fibromilagia and now this CRPS or nerve pain..Why this problem makes our mind works againt our body and cause so many illness? Any idea?

      Any suggestion or help to deal with or making some improvement will be a great help

      I am going to buy the book you suggested.

      Right now, life is standstill.. seeing people walking or standing on their leg makes me thing - How fortunate these people are..

      Here I am, sitting in bed all the time , praying to God

      Your success and deloupy success is a motivator facts to me. Staying positive that one day I will at leasat reach to your level, and be mobile again.

      My dr. asked to go through some blood test - hormone,suger, vitamin c etc.. and some advance three level bone scanning to see if CRPS is positive or not..

      Did you have test like this too?

      What level of thinning you have If you can share please. ? Mine is (left knee ) is modarate.

      I will keep you posted what my doctor says after test results comes out.

      Thanks and Regards,
      Saroj

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    11. Hi Saroj

      Good to see your Dr is getting all those tests done. I have not had another MRI since my bilateral problems started, so I don't know what the level of cartilage damage/thinning is now.

      When I had MRIs, I just had the typical focused chrondromalacia pain in one spot in my right knee, and the MRI showed some specific spots of damaged/thinned cartilage. Now, it feels like all the cartilage has almost gone on the back of both kneecaps! I asked my Dr did I need another MRI and he said no, because you have been doing so much less on your knees for 2 years, the MRI would not show anything new. It sure feels like it would because 2yrs ago I did not have constant pain/burning/stiffness!

      All I can say is you seem to have a good Dr who is doing some good investigations - a lot more than mine has done. Then again, your symptoms sound more severe than mine.

      Stick with it and keep looking for answers.

      TriAgain

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    12. Saroj, you are progressing. Maybe not in lessening the pain, but in investigating it. I think it's important to diagnose first what causes your pain so you can draw a plan. Hang in there, you will eventually find what works for you. You may need to work on your mobility before you start working on strengthening as it is likely that your body has lost a great deal of it. Kelsey's book has very good advice of this

      TriAgain, I wouldn't think the pain is relative to the level of thinning. I have no cartilage loss, yet I thought the MRI would reveal a warzone. Nope. Nothing. Inflammation is what it is. Puzzling, isn't it? I have a few bone spurs in my body that cause no pain at all. Apparently, there is not always a correlation between anomalies and pain. This was also confirmed by the specialist I saw, my osteopath and a few physios.
      It's also frustrating, because it would be so much easier to explain the cause of the pain by cartilage loss, then design a cure based on how much cartilage is lost.

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  2. Also to say- I too subscribe to Doug Kelsey's blog and absolutely owe a part of my recovery (ongoing but steady) to him. For example, had been to an OS who said my hamstrings were very tight and this was adding to my PFPS. Coincidentally, at exactly the right time, D.K. had sent out an article on planking to help loosen tight hamstrings- His explanation on how and why planks worked were very clear and spot on.. And it did loosen my hamstrings and also helped with back pain I was having, particularly when riding my motorcycle. I can ride for several hours at a time again... So Thanks Doug.

    R-X

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  3. Want to add and in doing so, in no way intend to reduce Richards accomplishment saving his own knees... Only want to point out that causation of arthritis is potentially multifactorial and while it may be possible two people share enough risk factors to also share a cure, it is also possible, they don't, and no amount of hope will/can transcend those differences. That said, another avenue to pursue when figuring out why one's cartilage has gone south, is dietary and a book that has a lot of info in it is "Conquering Arthritis," by Barbara Allen.

    I think we do a disservice to the cure and to the complexity of the disease that is arthritis, if we don't entertain the possibility that the potential cause's and cure's
    for arthritis are complex and unfortunately, oft times not falsifiable.

    R-X

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    1. I've gotten a lot of great responses to my book -- a lot of people do say "This really helped my knee!" -- but this blog has been humbling in the sense that, as R-X says, the causes and cures for knee pain can be very complex. I see that by reading the comments from a lot of earnest, smart people who are really struggling. Anyway, I'm very hopeful that one of you -- Knee Pain, R-X, Tri Again -- if not more than one, will beat this thing eventually, and I'll be eager to hear your observations about what was useful and what wasn't when you're ready to do your victory laps.

      Yes, as Tri Again says, there was probably some nerve element in my knee pain, or something systemic ... sometimes I had the feeling of a ghost in the machine, like a poltergeist of irritation and inflammation loose in my body. I very much doubt it was CRPS, at least based on the symptoms I've read, but there seemed to be something strange going on at times that went beyond basic damage to the structures in the knee. Happily, that's all gone now.

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    2. Richard, re. nerve inflamation, I remember you mentioned in your book asking a specialist about pain 'spreading' to the rest of the body and he laughed it off. It wasn't a stupid suggestion. There is a condition called fibromyalgia that sends pain message through the entire body and that is also linked to arthritis. I experiment that 'pain travel' too when my pelvis locks: the pain radiates through my whole body, I sometimes wake up with pain in my toes, my fingers, etc. Thankfully, it's only temporary and once the pelvis is released everything returns to normal. But my ostopath explained that not only the back pain can affect the rest of the body for structural reasons, but also due to the nervous system responding to the inflamation by going into overdrive.

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    3. Hi deloupy,

      I have been experiencing fibromyaligia symptoms too from last 6 months too. It started after one of month of having this severe flare up in my knee buring.. Initially, it was too much.. Now, I still feel it occasionally in my toes, lower leg and my elbows. Did it start because I had extreme burning in my knee and I still have? My mind starting malfunction on pain..? deloupy, if possible, I would like to have your email address to stay connected with you. I put mine in my post above. Thanks for all help and support, best regards, saroj

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    4. Hi Saroj, I don't give my email address online, but I'm happy to exchange with you on this blog. Our experiences also benefit other readers.
      I found the clay on Amazon. It needs to be mixed with water, using a non metal spoon, to a thick consistency. Spread on the knee, cover lightly with a gauze and bandage and keep overnight. Brush off and rinse the next morning
      The Actipatch, I found at my local chemist, but I'm in Ireland and I saw that it's not yet FDA approved in the States. Other electromagnetic Pulse therapy devices might be available. Just a word of warning: I'm experimenting a bit of a relapse today, I think it's due to the fact that I couldn't feel any pain after first using the Actipatch, so I may have overdone it (duh!)

      I'm giving it a few days, and if it doesn't settle, I'll book an appointment with the physician I first saw for my knee. However, this time, I'll make him listen to me and he won't send me to that 'running rehab' to do squats! I might ask him about these PRP injections

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  4. Just FYI potential fraud alert:
    purchased doug's book 90 day arthritis remedy 1.5 hours ago, received 2 emails thanking me for my purchase, paypal amount has been deducted, and yet... NO BOOK!
    sent their team 3 emails, no response yet.

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    1. FYI it's an E book. their website specifically states NO physical book will be shipped, everything is downloaded.

      That's why it's a concern about possible scam

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    2. Update: they emailed me a link for dling, weren't sure why it was never sent to begin with. But yes, I did get the ebook after sending email inquiry

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