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.