This is the chronology of my slow recovery after the knee arthroscopy operation:
Day 1 I woke on the morning of 20th April 2006 and laid in my hospital bed. A nurse came at 8am with scrambled egg breakfast and painkillers.
At 9am, I tried to walk to the bathroom. Even with my crutches to ease the pressure, there was strong pain in my knee, particularly when bending it.
At 10am, I was taken by wheelchair to Doctor Panya for a review of the operation. He showed me the highlights of the operation, just as if I was watching the Sunday morning sports round-up.
He explained that the operation was more complex than normal. My meniscus was torn in two places, not one. There was also some slight damage to the kneecap. A straightforward arthroscopy would have taken him about 10 minutes. Mine had taken 45 minutes.
The recovery time would be about 6 months. It was made much longer than needed because I lost so much muscle during 38 days between accident and operation. However, Doctor Panya said I was fortunate that during this time, the damage to the torn meniscus did not worsen.
He instructed me to return to my hotel, rest and come back to him in 2 days time. He gave me a prescription for four drugs:
- Idarac 200mg. A painkiller. 1 tablet, 3 times per day after meals.
- Brufen 400mg. 1 tablet, 3 times per day after meals.
- Tylenol 500mg. For pain/fever. 1-2 tablets every 4-6 hours.
- Ultracet 362.5mg. 1 tablet before sleeping at night.
I returned to the hotel via taxi and used my crutches to reach my room. The pain was strong. I stayed fixed in my bed and ordered room service from the very caring Thai hotel staff. I only left my bed to visit the lavatory.
With wireless internet accessible from my room, I was content to send emails and call friends using Skype.
Day 2 I was comfortable in bed, but when I hobbled to the lavatory on crutches, the pain made me question whether or not I would be fit to fly to Kuala Lumpur in 2 days time.
I rested in bed all day and took my medicine.
One thing I did not expect after the operation was how much your backside aches after sitting up in bed for hours on end!
Day 3 After breakfast in bed, I hobbled downstairs and caught a taxi to Bumrungrad. As always, the staff were ready with a wheelchair to take me from the taxi into the hospital.
Doctor Panya saw me at 10am. He inspected the injury and then asked me to walk on crutches.
He advised me again that it would take 6 months for me to use my leg as normal. During that time I would need to gradually build the strength of the knee.
For the next 2 weeks, the swelling in the knee will make it uncomfortable to walk. I should always use crutches and keep minimal weight on the knee. I should not bend the knee or sit with bent legs.
After the swelling reduces, it should be easier to walk. I should then start doing some strengthening exercises. The Doctor suggested swimming while holding a float in front of me and paddling my straight legs as you do in front crawl. He said I should walk with crutches and gradually increase the weight on my left leg. When I feel ready, I should switch to a single crutch and then later to walking without crutches.
Doctor Panya also told me more about the operation. He had sewn the torn meniscus together in three places in the hope that cartilage would grow around it and strengthen it.
The Doctor handed me a CD he had created for me with video clips from the operation. The CD face was custom printed with titles overlaid on a photo of the Doctor in Austria. The presentation was very impressive and reflects how highly he values attention to detail and quality of work. These are two of the qualities that I can imagine make a great surgeon.
Day 4 The taxi dropped me at Bangkok airport and I checked-in for my flight. I paid an extra 120 Baht (£2) to be taken to the plane by wheelchair. (Airlines do not normally charge for wheelchair usage, but Air Asia is a low cost airline, hence the charge).
The wheelchairs at the both ends of my flight did not have leg supports that can be extended to allow the leg to rest straigtened. My leg needed to be straight, so I discovered a trick where you can sit on the end of your crutch with the handle pointed out in front. Your can lay your leg staight resting inside the handle with relative comfort.
When I needed to walk or climb stairs, I was able to do it with minimal pain by using crutches, keeping my leg straight and letting it hang down.
Today is the London Marathon. I had entered to run but like thousands of others, been declined. It was the third year in a row. That means it is more likely for me to be accepted in 2007. So, I have one year to recover my leg to full strength and attempt a marathon. Doctor Panya said it would be possible.
Day 5 I overdid it on the exercise today. It was my last day being with my girlfriend Sophia for a few weeks. We went out during the day and for much of the day I was sitting down with my leg slightly bent. I moved around a reasonable amount and climbed into / out of cars. By the evening, my knee was sore and I was really frustrated with not being able to move around as normal. The recovery is slower than I expected.
Day 6-8 I laid in bed resting in the house during the day. In the evening I would slowly descend the stairs and go out with my friend Suling to a restaurant. I would wear the bandage given to me by the hospital to help support the muscles and tendons around the knee.
The swelling was easing a little and I was using an ice pack in the evening to reduce the swelling further.
Day 9 I continued to rest as normal. The pain was reduced and I decided to stop taking the painkillers today. I could bend my leg about 30 degrees by now but if I sat with it bent for over an hour it would start to ache.
Day 10-13 My insurance company called me to see how I was recovering from the operation. My annual insurance policy lasts only 45 days per trip, so they wanted to fly me home on May 3rd (day 14). I accepted their offer, particularly as they would fly me home business class meaning I could keep my leg straight.
Day 14 Taking no chances, my insurace company had arranged for an ambulance to take me from my friends house to the airport! The driver arrived late (deliberatly I believe) so he put the siren on and weaved through the traffic at breakneck speed to get me to the terminal on time.
I was greeted by a wheelchair, pushed to the check-in, then through duty-free and on to the business class lounge. Kuala Lumpur International Airport is modern, spacious, clean and efficient. (Unlike Heathrow Terminal 3 which is dated, crowded, worn and hectic). You can read more about my business class experience.
All-in-all, the trip home was faily painless and it was a relief to be back home where to continue convalescing.
Day 16 I can now bend my leg about 70 degrees.
The stairs at home are quite narrow so I need to be very careful ascending and decending them with crutches.
Day 19 Two days ago I actually sat at my computer desk for the whole day. It was the first time I have been able to sit for a full day in comfort.
I can now bend the knee about 80 degrees. I feel that I am nearly ready to start exercising the leg and building the muscle. The NHS has given me an appointment with a physiotherapist next Monday (10 days after seeing the doctor which is pretty good going for the NHS).
I am still on crutches and have very little muscle in my left leg. The knee is very sensitive to twisting / sideways pressure.
Comparing now to the days after the knee arthroscopy operation, my recovery is definitely continuing. Patience is required – there is a long way to go yet.
Day 22 Over the last 3 days I have gradually started exercising the knee. While I have been sitting at my desk, I have bent the knee as much as possible without being forceful and then sat in that position. This has helped stretch the tendons that I have not used for 2 months. The knee can now bend to about 105 degrees and sitting for long periods with a 90 degree bend is comfortable.
The knee remains quite swollen and the area around where the main incisions (about 8mm each) were made is still a little sore to the touch. The muscles remain very wasted but the physiotherapist should give me exercises to build them back up.
I have started walking normally on crutches (i.e. instead of holding my left leg up, I am putting some pressure on it as if walking normally but keeping most of my body weight on the crutches).
Day 24 I visited the physiotherapist, Linda, at Amersham General Hospital today. She saw me promptly at 10.45am and then questioned me the events that brought me to the hospital. She inspected my knee and leg and gave me 3 exercises to practice to build up the muscle.
- Lie on the floor. Put a rolled up towel under your knee. Lift your lower leg up so that it is straight. Hold for 10 seconds and release back to the floor. Repeat 30 times.
- Sit on a high chair or table. Bend your leg under the table as far as it will go (without pain). Hold it for 10 seconds. Relax, wait, repeat 10 times.
- Still sitting on the table/chair, cross your feet. Imagine you are about to lift your injured leg up towards your body but do not actually move it. Leave the muscles tense in this position for 10 seconds then relax. Repeat 10 times.
Linda said the knee might take only 3 months to get back to normal (when I can start to do things as before like jogging).
She showed me how to walk with one crutch only. I practiced this and although it felt unusually to put weight on my left leg, I managed to walk fairly normally. The crutch went under my right arm. She also showed me a good technique for going up and down stairs with only one crutch (providing there is a bannister).
Day 28 I just spoke to my friend Pauline and she had a similar accident (but also with damage to tendons) skiing in France 5 weeks ago. She had her arthroscopy 3 days ago and is now in bed recovering. She can walk with crutches between rooms and can move her knee through 5 to 30 degrees.
During the 4-5 weeks between accident and arthroscopy, Pauline was given exercises by the physiotherapist and this kept her leg relatively strong. This is the major mistake the I made – I was not maintaining strength in my leg after the accident and this is why it will take me up to 6 months to recover.
Day 30 Breakthrough!
Today I walked without crutches! I have been building up to this in recent days as my leg has strengthened. My leg felt fragile and I walked with a limp, trying not to put too much weight on the leg. I stayed at home all day but walked almost entirely without crutches. Towards the end of the day, the limp was reducing as I became more confident.
I have been waiting for this day for over 2 months.
Day 36 Disaster.
I overdid the walking. My progress had been good since I started walking 6 days ago. But today I went to town and with my new found freedom I walked around the shops for about 30 minutes.
As I walked back to the car, my knee gave way with a sharp pain. I hobbled to the car and went home to rest it. Throughout the day I would get a surge of pain if I walked and caught the knee in a certain position.
The crutches are back in use.
Day 40 The Bank Holiday Monday is now finished and I went to see my local GP. She referred me to a knee arthroscopy specialist at the nearby private hospital The Chiltern.
I have been continuing my physiotherapy but am not weight bearing again to try not to damage the knee any more. The difference in diameter of my thigh is now 45.0cm (right leg) to 41.5cm (left leg).
Day 46 I went to see Mr Ruiz, the knee arthroscopy specialist at The Chiltern. I showed him my knee arthroscopy videos and he examined my knee.
He told me that the strange lumps under the skin around the knee are sutures that were used to hold the repaired meniscus together. These will dissolve given time.
After watching the video, Mr Ruiz explained that I had not torn meniscus on both sides, only the outer side which is the medial meniscus. He was impressed with the quality of Doctor Panya's knee arthroscopy surgery. The technique is one that Mr Ruiz used to use and said that it is a good one.
He said that I may have broken the repair. Apparently, 20-40% of attempts to repair a torn meniscus fail. The way my leg gave way and the subsequent intense pain suggests that my repair has torn. However, in the last 10 days, the pain has stopped returning frequently so I may not have broken the repair. Mr Ruiz advised me to continue my physiotherapy and see what happens over the next two weeks. If the pain returns, he will need to perform another knee arthroscopy to see inside what the problem is.
Day 79 We returned from holiday last night. It was stressful not being able to carry bags or go sightseeing with Sophia – I would not recommend going on holiday when you have a serious injury! Walking was uncomfortable and over long distances (more than 500 metres) I had to use Sophia as a crutch.
I exercised in the swimming pool to help strengthen my leg, although I could not exercise for long without overdoing it. When walking around, it felt like I was pushing it a bit too much and had I been at home, I would have done more strengthening exercises than walking. It still feels as though my muscle is not providing enough support to my knee joint.
Day 85 Sophia and I went to London and walked a lot further than I expected. By the time we reached our destination, we had walked for about 40 minutes and my knee felt vulnerable. This was much more non-stop walking than I had done in the last few months. It felt as though the knee had not repaired and I would need another operation. I was not confident.
Day 89 I arranged with Dr McDermott to be put onto the waiting list to see a specialist with the NHS. The wait should be around 13 weeks and I am likely to see Dr Ruiz – the same surgeon to whom I paid £150 in order to have an opinion privately (waiting time: 2 days). He will tell me in 13 weeks time whether or not I need more surgery. In that time I intend on strengthening my knee as much as possible. If I can avoid another operation, I would like to!
Day 111 I measured my left leg today (around the thigh, 6 inches above my knee) and it is still 2.5cm (1 inch) smaller than my right leg. This is an improvement of 1cm since Day 40. I still have some way to go.
- Left thigh = 42.5cm
- Right thigh = 45.0cm
Day 120 Breakthrough!
I visited Linda today, my physiotherapist. She put me onto a running machine for 4 minutes and then speeded it up to a slow jog. I was unsure how this would go – my first jog for 5 months – but it felt OK on my knee. After jogging for 4 minutes, she turned the machine off. My legs ached due to lack of use. My ankles and hips have forgotten what it is like to run and have not been exerted in the way that running stresses them.
Linda recommended that I walk for 30 minutes every day and every now and again jog a little. She said I should go by my own feeling and not overdo it. I said I could walk 3-4 times a week as this would fit into my life better and she was fine with this. Then, she told me I was making good progress and would not need to come back to see her again! Thanks Linda.
Day 143 Today (9th September 2006) I jogged with Carl today for about 50 yards. It is the first jog I have done since Linda suggested I start running a little. It felt comfortable enough.
Day 339 It is coming up to one year since my knee arthroscopy operation.
For the last 6 months I have been exercising more often, mainly walking with a little running, swimming and cycling. I have not been exercising as much as I probably should and I have stopped specifically exercising my left leg only. Nevertheless, it has continued to strengthen and the difference in diameter between my two thighs has been reduced to half an inch.
In December, after my 4th application, I received a place in the 2007 London Marathon! I decided to postpone my place for one year (you can do this, but only once) so I will be running in the 2008 London Marathon. From now, I have 13 months to train. That is plenty of time and I will start my training schedule soon. I want to build up my left leg muscles as much as possible to give the knee maximum support.
My knee is now fine for daily activities. I do not feel any pain or discomfort. If I enter the lotus position (crossed legs with feet overlapping thighs) there is a little discomfort in the knee because it is twisting it into an unusual position. If I practised this regularly, I think this feeling would fade away.
THIS BRINGS YOU UP-TO-DATE.
My recovery is ongoing right now and I will update this page throughout.