Poh’s blog

36th Update – 29 Months after Surgery

nobody@vox.com(Poh) — Sat, 31 Oct 2009 18:17:56 +0800

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.

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35th Update – 26 Months after Surgery

nobody@vox.com(Poh) — Fri, 31 Jul 2009 21:50:27 +0800

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!

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34th Update – 2 Years after Surgery

nobody@vox.com(Poh) — Sat, 30 May 2009 11:26:30 +0800

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

I’ve also started to spend more time tending my small garden. My dwarf apple mango tree is blooming with 80-over fruits; some of it is as heavy as a kilogram each. To avoid the use of insecticides, I’ve made covers out of netting materials to protect the ripening fruits against birds, fruit flies and other insects. I’m now able to climb the A-frame ladder cautiously to cover the higher-level fruits. I have another small tree which is fruiting with green oranges, or is it large citrus fruit from calamansi or lemon variety? I’m not sure what it is - I’ve to harvest and eat it first :-).

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33rd Update - 22nd Month after Surgery

nobody@vox.com(Poh) — Tue, 31 Mar 2009 22:27:59 +0800

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.

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32nd Update - the 19th Month

nobody@vox.com(Poh) — Sun, 11 Jan 2009 19:17:39 +0800

How time passes quickly - it's now 2009 and I realised that I've not updated this blog for over 2 months. Perhaps it is a good sign - no news is good news, right? It's over one and a half year since I went for my knee surgery and I'm glad to report that my knee is pretty OK now. Saw my doctor in late November 2008 and he was pleased with my recovery. Knowing that I'm still updating this blog, he suggested that perhaps we should start a special interest group of sort for the growing number of people who have undergone similar knee operation, to share experiences. I thought it is a good idea, after all, I started this blog for the same purpose. He continued to prescribe another 6 months' supply of glucosamine pills.

I have totally weaned off the walking stick and am now walking quite normally, even going up and down staircases. At the last physiotherapy session in early December last year, the physio checked on me walking/jogging over 2.1 km on the rubberised track and certified that I've recovered sufficiently to be discharged from the rehabilitation centre. He advised that I should continue to exercise regularly on my own, without over-stressing the knee. The recovery came at just the right time as I was kept very busy running around the whole time, preparing for my daughter's wedding on Boxing Day. My leg held up quite well, especially on the big day itself, when I was practically on my feet for some 15 hours!

I've not resumed my golf game yet - it should be quite soon, I hope. Thought I should get some light practice sessions first as I'm worried about the twisting motion of swinging the gold clubs. Just 3 days ago, I had my first session of bowling - although only for 2 games. My legs weren't that steady and it was uncomfortable bending my knees, but I did OK - none of my balls went into the drain! The knee was a little sore afterwards, but rubbing some glucosamine cream relieved the aches.

My wishes for the New Year? Good health is top. Hope I can have good games of golf, that I can go jogging regularly, perhaps even cross-country running and playing social games of badminton and table-tennis (I've given up tennis and squash as it would be too demanding on my knees). Perhaps it may be too early to tell, my doctor says that eventually, I could even try snow boarding or skiing when on overseas vacation in future (but definitely no bungee jumping!).

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31st Update - the 17th Month

nobody@vox.com(Poh) — Thu, 30 Oct 2008 23:27:19 +0800

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.

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30th Update – the 16th Month

nobody@vox.com(Poh) — Tue, 30 Sep 2008 23:07:49 +0800

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.

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29th Update – the 15th month

nobody@vox.com(Poh) — Sun, 31 Aug 2008 23:18:22 +0800

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.

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28th Update – the 14th Month

nobody@vox.com(Poh) — Thu, 31 Jul 2008 18:36:05 +0800

61 weeks after Knee ACI

The knee is still not as strong as I wish it could be and I’ve still not gone for any jogging yet. At the 38th physiotherapy session, I was still trying to improve the strength and stability of the leg. Did more exercises with one leg, trying to balance without using the big toe. Walking-wise I can now walk quite briskly without tripping, although I still carry the walking stick just in case, and for climbing stairs.

I’ve also been using the Nintendo Wii Fit balance board to keep track of my training progress – with significant improvement in overall scores in the various exercises and double-digit decrease of my Wii fitness age (hey, I’m getting younger!). Just wish that I could spare more time for the various sessions.

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27th Update – 1 year and 1 month

nobody@vox.com(Poh) — Mon, 30 Jun 2008 23:56:28 +0800

57 weeks after Knee ACI

The knee is generally stable with occasional pain if I over exert it. This month I’ve been very stressed up at work and did not have much time to exercise. However, I’ve been going to physiotherapy sessions fortnightly and increasing the level of intensity. This afternoon, I was able to do stationary jog on the mini trampoline for more than 10 minutes. The physio said I could try some brisk walking.

My kids bought the Nintendo Wii Fit pad for me to exercise the leg and body posture. Wii Fit comprises a pressure board for you to stand on and 4 main categories of exercises - various Yoga poses, strength training, aerobic exercises, and improving balance & agility. In each category, there are many levels of difficulty, starting from the simple, such as, deep-breathing exercise and as one progresses, more difficult levels are unlocked. The Wii console keeps track of your training progress, measuring your weight and calculates your Body-Mass-Index (BMI); asks you to set personal target and tracks your improvement over time in a graph. Based on your performance, the program even attempts to determine your Wii age (fitness age as compared to actual). It’s a fun way to keep fit and exercise the body muscles.

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