13th Update – The Eye Operation

19th Sep, Wed – 25 Sep 07, Tue. The 17th week of Knee ACI.

Went for my cataract operation yesterday and saw the eye doctor today to check on the operated eye – the operation was smooth and I can already see fairly well. Although a relatively common operation nowadays, the greatest risk is still getting an infection. I have to strictly avoid any rubbing or get into contact with dust, dirt, smoke, fumes, and even water. Doctor said that owing to my past history, there is always the danger of retina detachment in my case and I should immediately go to A & E should there be any symptoms. I was granted 2 weeks medical leaves, to be extended, if needed. I know I shouldn’t strain my eye looking at computer screen and posting this blog – actually most of my draft had already been composed on Sunday and posted in the blog but not published. I only need to log in to edit a little and click “Publish”. Blogs are such powerful Internet media and relatively easy to use as you do not really need to know any programming or web building skills – everyone should try it, don't need any software and it’s free.

My left eye was fitted with an artificial lens in 1999 after a cataract operation. At that time because my right eye had a myopia of about 800°, the doctor decided then to fit a 500° lens on my left eye so that the difference between the eyes would not be that great. However, the myopia on the right eye continued to go up until the present 1,100°. The large difference often causes strain to the eyes, as the image sizes are different. This cataract operation on my right eye probably came at the right time – the doctor has now fitted a lens equivalent to 300° on the right eye. He said he could have balanced the degrees on both eyes, but a 200° difference is considered not a problem. The lower degree will enable me to read better and allow prescription of thinner and lighter spectacles. The problem now is that my present spectacles cannot be use. I had to dismantle the right lens as looking through it causes giddiness. Normally, it would be advisable to wait at least 6 weeks for the vision to stabilise before fitting a new permanent specs. In the meantime, I’ll probably get a set of temporary glasses.

Last Saturday, at NUH Ortho Gym, I informed the physio that I would skip the next physiotherapy session owing to my eye operation. He said I could still continue with light flexing of the limbs at home to prevent the muscles from stiffening. He observed that my leg has grown stronger and could support almost 100% of the body weight. I tried and was able to limp around the gym without the crutch. He suggested that I should also try moving around carefully without crutch at home, except when climbing stairs and walking outdoor. Perhaps a walking stick will help.

12th Update – From Knee to Eye

12th Sep, Wed – 18 Sep 07, Tue. D106 – D112. The 16th week.

Saw my Orthopaedic doctor/prof at NUH last Thursday. He was satisfied with the healing of my knee. Since I could now stand steadily with no pain and even limp several steps without crutch, it indicated that the implanted new cartilage cells are growing well. However, he reiterated that I should continue with the use of the crutch for the next couple of weeks in order not to exert any undue pressure on the newly grown cartilage. He advised that I should continue with the weekly physiotherapy session, but tone down the exercise intensity, if it causes the knee to ache. He prescribed lots of glucosamine to be taken thrice daily (gave me 10 weeks supply)! The load bearing on my right leg has now reached almost 95%. The physio spent some time with me on the parallel bars handrail, trying to correct my gait, which has a tendency to lean towards the left. The unassisted knee flexion has also improved and I can now also do a partial squat (left knee fully bent and right knee half bent).

Last Thursday afternoon, I also went for an appointment with my eye consultant doctor at The Eye Institute in TTSH. My right eye was diagnosed with cataract about 3 year's ago. By the end of last year, the cataract had "ripen" and the eye doctor advised me to go for the cataract operation early this year, but I decided to delay it to the middle of the year as I was expecting the knee operation then. As the knee operation was subsequently carried out on 30 May 07 - the eye operation had to be postponed a second time. The eye doctor suggested that I carry out the delayed cataract operation as soon as possible, now that my knee operation was over and I’m recovering well. The date of operation will be on next week, 24 Sep 07, although I would have preferred a later date, perhaps in Oct when I’m physically and mentally more ready. However, the doc is not available that month. The nurses were very quick and efficient, and made me complete all the necessary pre-admission checks and assessment late into the evening, so that I do not have to make another separate trip to do this. Nowadays, cataract operation is quite advanced, requiring only a tiny slit on the cornea in order to replace the lens, and vision can be restored the following day. Both The Eye Institute in TTSH and The Eye Centre in SGH have the latest equipment for advance cataract operations. It can be performed during a day surgery and you can go home within half a day.

Someone suggested that I should perhaps start another blog on my experience with eye operations, since I’ve had several ops over the past 9 years. But I don’t intend to do so, as Singapore has very established eye treatment centres and information on eye treatment is readily available. For the record, my left eye had retina detachment in 1998, some 9 years ago. It started with internal bleeding and soon the black spot was like an eclipse enveloping almost a third of the vision. The operation was successful and my vision was fully restored. The following year, I had a cataract operation and two other operations to remove the out-of-position scleral buckle (plastic backing to prevent further retina detachment). In 2001, the eye doctor used the cryopexy procedure, using metal probe frozen by liquid gases to “burn” and scar a retinal hole, which had developed in the retina of the left eye. The healing process would seal the retinal hole. In 2002, cryopexy was applied again, this time to my right eye as a preventive measure against future problem developing. In 2004, cataract was found developing on this right eye, the myopia of which, has since gone up to almost 1,100°. I’ll post an update after my cataract operation next week.

11th Update – Return to Work

5th Sep, Wed – 11 Sep 07, Tue. D99 – D105. The 15th week.

Returned to work yesterday. Driving to work was ok, although it was a long journey and the traffic was quite heavy. Climbing the 3 flights of stairs to my office, however, required considerable efforts. My thoughtful colleagues saw me driving in and helped me with my ‘heavy’ laptop bag. It’s great to be back at work! Since I’ve been regularly accessing my office emails and the organisation’s intranet from home via VPN, I’m quite up to date with the happenings in my workplace, so there aren’t much backlog of work to clear or delayed decisions to make. My colleagues did a great job, covering my duties and keeping the Plant running well, freeing me from worries and allowing me to recover with peace of mind. I must really thank all of them. Spent some times uploading updated archived files and renewing expired passwords. We have a small gym here, at the same floor level, so there is no problem continuing with my daily exercise and workouts during lunchtime.

At the 12th physiotherapy session at NUH last Saturday, I tried out on another 2 gym equipment. The first workout was on a leg curl machine, where I have to bend my lower leg downwards against a 5 kg load to strengthen the hamstring muscles. The next workout was on the horizontal leg press where I place my right foot against a plate and flex my ankle against a load, to tone my calf muscles. My muscles still ache with the effect of that day’s exertion. The unassisted knee flexion has, in the meantime, improved to 130°. The forced bending of the knee has also improved to some 138°. The max load bearing that the right leg could bear has reached 90%, which means I could now limp several steps for a short distance, without the crutch. The physio, however, advised me to continue to use one crutch so as not to place undue stress on the right knee and also for climbing stairs.

10th Update – Stepping Up

29 Aug, Wed – 4 Sep 07, Tue. D92 – D98. The 14th week.

I’m stepping up my exercise routines to strengthen the leg muscles in preparation for my return to work next week. I’ve weaned off one crutch in order to put more load on my right leg. I could walk with one crutch with a limp on flat ground, except for the occasional in-balance, when I nearly tripped.

At the 11th physiotherapy session at NUH, I increased the leg press load to 6 kg and also tried using one leg to press 3 kg of load. At the parallel bar handrail, I tried stepping on and over a rubber cushion using the right leg – this momentarily put the full load bearing on the right leg. It was difficult at first, but once I gained the confidence, I could quickly step on and over it. I told the physio that I would have to negotiate a few flights of stair when I return to work. Climbing stair still requires fairly strenuous efforts. He demonstrated some techniques to climb stair without the crutch. I tried, but it wasn’t easy, as my leg was still not strong enough yet. The unassisted knee flexion has improved to 125°. The forced bending of the knee has also improved to 135°. The max load bearing that the right leg could bear has progressed to 80 - 85%.

Except during sleeping at night, I’ve also weaned off the use of the knee brace. However, rubbing cream and balm on my aching legs finally brought out the rashes. All along, I’ve maintained very good hygiene of the leg to avoid the rashes. It’s really ironical that, just as I was starting to wean off the brace, the rashes came. Maybe I was allergic to the capsaicin in one of the more expensive glucosamine creams. The cheaper one with chondroitin sulphate was OK.

I’ve also started to drive on a few occasions, since I’m now able to exert enough force to apply the emergency brakes. However, I always have someone accompanying me, just in case there are problems that I would not be able to handle, for example, tyre punctures. I’ve just received a letter and membership card from AA Singapore, informing me that I’m now a “life member”, meaning that I don’t need to pay annual subscription any more. This is for those who have been member for 30 years, what a long time!