Poh’s blog

I know I have not been updating this blog regularly. Apologies to my many friends who have inquired about my progress. I was thinking of updating this blog only after my appointment with my Professor doctor, but the appointment is now postponed to Jan 2010. Both my knees are holding out fairly well, although there are still pains from time to time, especially after prolonged standing or walking. What worries me most is my left knee (the good knee), as it starts to ache and climbing stairs has become painful. There is, however, no symptoms of buckling nor locking up of the knees. The pain would go away after rubbing with some glucosamine cream. Not sure whether the pain could also have been induced by stress, which I'm currently experiencing. In the meantime, I'm still swallowing glucosamine pills three times a day.

My knee is holding up quite well, although from time to time, I do experience some rheumatic pain. But it is not serious and usually goes away the following day. However, one should never be too complacent. Last month, after bringing visitors around my workplace, we have to go down several flights of stairs. As usual, I held on to the railing when going down. However, I was distracted when someone asked me a question and I must have lifted my arms to gesticulate when my knee suddenly buckled and I tumbled downward. Fortunately, it was probably at the last few steps and I wasn’t injured. Except for some embarrassment, I was all right – there was no pain, but some soreness at the knee afterward. I still need to constantly remind myself to be careful.

At my last posting, I mentioned that my citrus tree is fruiting with green oranges. It grew to be larger than a normal orange as can be seen in the photo. Well, we couldn’t resist the temptation and finally harvested a few. Somewhat to our disappointment, it wasn’t oranges, but some kind of calamansi lemon-lime variety – it was quite sour. Anyway we juiced it and sweetened it with pandan leaves flavoured syrup – it makes a really refreshing drink when chilled. Cheers!

Today is the second anniversary of my knee surgery; the operation was carried out on 30 May 2007 at the National University Hospital, Singapore. To recap, the procedure is called autologous chondrocyte implantation or ACI in short. This involves harvesting stem cells from one’s own bone marrow or removing healthy tissue cells form your own knee or other joint, growing them in culture in a laboratory, and injecting them back into the knee cartilage to repair the cartilage damage. As this involves “growing” your own cartilage, there is no danger of the body rejecting a foreign object. The cartilage comprises hard outer surface of collagen fibers on the surface and a porous underlying substructure, allowing the cartilage to have a slippery, wear-resistant surface, and yet remains flexible and providing a shock-absorbing substrate. The cartilage of the knee is a living tissue but it has no blood vessels (avascular). Once degenerated through arthritis or injury, the cartilage cannot repair itself and has limited regenerative capability. Advances in tissues engineering and stem cell techniques have however, allow the body to repair itself naturally, although it is a rather slow recovery process.

I saw my Professor doctor last week; he was very pleased with my progress so far. He said there are now more than 200 patients who has undergone similar type of operations in NUH and he would really like to start a web site or blog to allow such patients to share their experiences, except that he is too busy to start one. I suggested to him that he could give it as an assignment to a group of his medical students and they could use any resources found in my blog, as I’m willing to share my experience with others. He examined my leg and determined that it can be straightened and stretched without pain, although the right knee still cannot bend fully when squatting. I would say that I have regained most the normal function of the knee, except that I wouldn’t want to test how well I can hop or jump! He continued to prescribe another 6-months supply of Glucosamine capsules. Addressing my concerns about the effect of the long-term consumption, he said that this type of products is considered a health supplement and should have no long-term ill effects, except for those allergic to seashell as they are made from it. For such people however, there are now vegetarian Glucosamine extracted from plants. Glucosamine can also be absorbed transdermally by rubbing the affected area with Glucosamine cream or ointment.

I’ve been playing golf more regularly now, 2 to 3 times or more a month and the knees have been holding up quite well. There may be some soreness and stiffness after each game, but they would go away after a day or two. 

Green-Oranges

It's already the end of Mar 2009 and good news everyone! I've already resumed playing golf.  I started lightly, practiced at the driving range several times, taking it really easy before playing my first game on the golf course.  I was really rusty, missing shots and hitting the balls all over the places as expected, since I've not had a game for almost 2 years. To date, I've already played 4 games, and improving my swings and shots with each game. The outdoor and lush greenery is good for me and really uplifted my spirit - if only the score can come down more quickly to enjoy the game more...... I'd to get new golf shoes, though, since all my old shoes were rotten and hardened through long disuse. There were some aches and slight cramps on both legs immediately after each game but it usually recovered the following day. This is probably muscle aches owing to lack of prolonged exercise rather than any problem with the knee itself. As a precaution, I wore knee guards for the game and make sure I take myglucosamine tablets conscientiously everyday.

Generally, the operated knee is trouble free, but I still do not feel fully recovered yet. I still experience dull pain once in a while.  After prolonged sitting, I sometimes feel some pain when straightening the leg, and have to massage the knee a bit before it can support the full body weight when walking. This is probably the final stage of recovery, as warned by the doctor as full recovery can take as long as 3 years or more.

74 weeks after Knee ACI

The knee is generally stable although I still have slight occasional pain. I’ve continued to take the prescribed glucosamine 3 times a day and exercise conscientiously during the fortnightly physiotherapy session. Last week I was able to brisk walk about 600m to warm up and slow jog about 1.5 km on the rubberised track at the Ortho Gym. Someone recommended that I should jog on the beach – may be I’ll try it the next time. Nowadays, I don’t need the walking stick indoor, but I still use it outdoor, as a precaution. I intend to wean off this since I have not encountered any knee buckling recently. I’ll be seeing my doctor next month and hopefully, can resume most of my outdoor activities and perhaps play a round of golf.

70 weeks after Knee ACI

Today is the 70^th week since my knee operation. Someone whom I’ve not met for some time was surprised that I have still not recovered fully and commented that I should perhaps change doctor and seek alternative treatment. He said others recovered from knee surgery in much shorter time. I told him that for ACI cases, it might take 2 or even 3 years to fully recover. For my case, I’m making steady progress, but it is still early, being only 1 year and 4 months since the operation. I told him that I’ve read up a lot on this subject, including alternative treatment methods. Even Tiger Wood would probably need to rest his knee for more than a year before attempting to play golf again. His final comment that having too much information is also not good left me quite puzzled…

I told the physio that when ‘cold’, the knee was sometimes quite stiff, especially after sitting for a prolonged period of time. It would take some flexing to warm up the knee. He suggested some leg stretching exercises while sitting before getting up. In addition to all the exercises at the Otho Gym, I’ve also started brisk walking and slow jogging on the 150m soft rubberised track next to the Gym. Wearing my new ‘max cushion’ jogging shoes, my knee seemed to hold out quite well over 10 laps, about 1.5 km. I’m proceeding cautiously, as I do not want to stress up the knee. There was no pain and no knee buckling, although I felt a little soreness afterward.

65 weeks after Knee ACI

I just realised that I’d already attended the 40^th physiotherapy session this week. Although one of the physio has been attending to me most of the time, I’ve also seen 4 others, each with a slightly different approach and emphasis on the rehabilitation programme. I think this is all right, as I’ve learnt quite a variety of exercise techniques from them. My knee is growing stronger and it is more stable this month. Adjacent to, but outside the NUH Otho Gym, there is a winding 150m soft rubberised track that I’ve started practicing brisk-walking. I’ve even attempted a slow trot over several laps. Although the physio observed that I’m still limping and putting most of the weight on the good leg, I hope that I can progressively start my long awaited jogging session, a milestone in my recovery progress.

I didn’t use the Nintendo Wii Fit balance board for some times owing to the Beijing Olympics, as the TV was fully occupied for the live and delayed telecasts of the various events on the numerous cable channels. I should have resumed my Yoga sessions, but felt a little lethargic after 2 weeks of watching the Olympics.