36th Update – 29 Months after Surgery

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.

35th Update – 26 Months after Surgery

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!

34th Update – 2 Years after Surgery

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.

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.

33rd Update - 22nd Month after Surgery

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 my glucosamine 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.

32nd Update - the 19th Month

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!).