Dear Regular Readers And Those Not So Regular,
Welcome to another edition of our weekly newsletter.
Whilst quite a lot of the rest of the world is busying itself trying to vaccinate as many people as it can as soon as it can Japan is for want of a better expression lagging behind. Apparently, the Japanese ministry of health believe that as the Corona problem is not as bad in Japan as it is in other countries in the world Japan can do its vaccinating at its own pace; also, it is commonly known that Japan famously likes to collect data, meaning they like to wait and see what happens to other people in other countries before attempting to do things themselves. There is also another issue with a percentage of Japanese people not quite trusting the ministry of health due to past issues with inoculations for measles and rubella (MMR) in which higher rates of aseptic meningitis were apparently recorded back in the 1990’s. Even though no link could be proved at that time between the inoculations and the increase in rates of aseptic meningitis the ministry of health in Japan discontinued giving such vaccinations and thus in Japan it is now not recommended to have a combined MMR vaccination. This fear and apprehension here in Japan will continue on I have no doubt and it will result in some people not getting vaccinated, but as far as yours truly and those around me are concerned we are of the opinion that the sooner we get vaccinated the better: let’s just hope that Japan does start to pick up the pace.
Last Sunday, I made some Victoria scones and they came out quite well, a little lighter than expected, but that was due to the 00 (very fine) flour I used. My family seemed to enjoy them as they were quickly devoured; they were eaten with butter and freshly made strawberry jam and washed down with a cup of hot tea: eating scones without a cup of hot tea is like committing a crime for British people, we just don’t do it – you just have to drink tea when you eat a scone. This week, I plan to try to make a very moist chocolate cake; I found a recipe on the internet that looks the business, so I’ll be reporting back to you on how that goes next week and until then keep safe and well and enjoy the weekend ahead.
Now back to my knee story ………
For the two weeks I had to wait before my next hospital appointment I went back to wrapping a crepe bandage around my knee daily and also wearing a knee supporter over the top of it. Due to frustration, more than anything, I had devised one or two techniques for wrapping the bandage around my knee; I would fold the bandage in half to make it thinner and then position it just underneath the kneecap where the fluid would collect. I would then begin to wrap the bandage whilst making sure I was lifting the fluid filled area upwards in the hope it would in turn lift up the fluid and distribute it more evenly across the knee cap, essentially pushing it back out of the bursa sac and into the joints. I would then tape it up and then put my elasticated sports supporter over the bandage. The general theory I had was if I did this with the bandage with the sports supporter over the top of it the fluid may have a better chance of being forced back to whence it came from, into the joints; however, apart from my knee looking a bit flatter when first taking off the bandage and sports supporter the fluid quickly collected back to create a kind of swollen bag hanging heavily from the bottom of my knee.
I can remember going out on work related sales visits with my creatively wrapped bandage on and often feeling like I had wrapped it too tightly, which thinking about it now, I actually had, but I was desperate to get rid of the fluid in my knee and I was ready to take whatever pain was involved to do so, even if it meant having to endure wearing a tighter than normal bandage. Of course if you wrap a bandage too tightly around any part of your body you run the risk of inhibiting the blood circulation, you can cause tissue damage and with that comes other complications, but I just was not thinking carefully enough about that I just wanted to get rid of the fluid. Thinking back now, I would keep the bandage and knee supporter on all through the day when out on sales visits, as well as in the office, and my knee would sometimes feel quite painful, but I just left it on thinking it was doing some good, but of course it wasn’t really.
Every day for those two weeks I would take my trusty bag of frozen edo mame (Japanese beans) from home to my place of work to pop into the freezer part of the fridge and I would apply the frozen bag of beans to my knee for about 20 minutes every hour all through the day and every day for the 2 week duration. I also incorporated the knee stretches into my daily routine together with massaging the front and back of my knee which didn’t do any harm I don’t think, but all of the aforementioned things I tried were never ever going to resolve my issue as I now know. It was at this point that I was seriously beginning to think about having an operation and I started to do some research; I found some videos on You tube of knee bursa removal operations and I started to read up about the procedure and the possible problems that could arise after having such an operation.
Under normal circumstances, the type of surgery to remove a bursa sac is apparently pretty straight forward and without too much in the way of risk; nerves can get damaged sometimes and this can result in numbness, but apart from that prepatellar bursa removal operations are usually successful. In most cases, the patient will feel soreness and will have to take things easy for some weeks, but the prepatellar bursa sac will regrow after time and that should be the end of it, back to normal so to speak; however, there are those cases where things don’t go quite according to planned when having such an operation and this did pray somewhat on my mind. Also, the new doctor I was seeing had already told me that he was not an advocate of removing bursa from knees or elbows or any other part of the body which didn’t inspire me with too much in the way of confidence.
I had already decided that on my next visit to the hospital I was going to have another hydrocortisone injection and after that, if there was no change, I would opt for the surgery to remove the bursa sac altogether. The new doctor had told me that my condition was most probably chronic and it was basically a case of either living with the problem, which I was never ever going to do, or go under the knife which the doctor was not particularly recommending although he said he would perform the operation if I wanted him to. I knew that the chances were pretty slim of the next hydrocortisone injection working, but a slim chance is better than no chance at all and I was ready to try anything.
On the day of my hospital visit, which was a weekday and a working day, Tuesday I think it was, I didn’t bother with any bandaging or putting on my sports supporter; my knee looked as I had grown accustomed to seeing it, all puffed up and full of fluid, but I was determined to conquer this problem, so with a heart full of hope I left my home as usual for work. My appointment was for 09:00, so I left work at about 08:30ish and made my way to the taxi stand, the hospital takes about 30 minutes on foot from my office, so a taxi is necessary. When I arrived at the hospital I went through the usual checking in process of putting my hospital member’s card into a machine to get my appointment slip and then made my way to the reception desk to announce my arrival. I was directed to the usual waiting area and I sat peacefully trying to read a book until my name was called.
Upon being called into the doctor’s surgery, I was asked by the doctor how my knee was and I explained it was full of fluid. He asked me if the build-up of fluid had happened suddenly after the last aspiration or gradually leading up to today’s appointment. I explained it had happened pretty much as soon as I got home after the last aspiration and I also explained what I had been doing with the bandages and other things in my routine since my last visit. He told me that all the things I had been trying was okay, but clearly the problem was not improving and he again explained that my problem was a chronic one. He told me that I either had to try to live with my problem or do something about via having an operation, which he again explained he would do for me, but he reiterated that removal of the sac was not really what he wanted to do. He then asked me if I was ready to try a hydrocortisone injection and I told him that I was.
I was then asked by the doctor to hop up on to his examination table and prepare myself for an aspiration and a hydrocortisone injection. He went through the usual sterilizing routine using swabs and he performed the aspiration first; he noted that the amount of fluid (about 17ml/cc) was about the same if not a tad more than he had previously aspirated. It doesn’t sound like a lot, and it’s not really, but when it’s in the knee it looks double that volume because it’s under the skin. Quickly after performing the aspiration the doctor injected the hydrocortisone into the bursa sac; he seemed to inject quite a volume of the stuff as I could feel a little bit of pain as he was pushing the needle in to the sac and releasing the hydrocortisone into it. He then put a plaster over the puncture hole he had made and wrapped a bandage around my knee; I asked the doctor if it was necessary to ice the knee when I got back to my office and he said it would not do any harm. The doctor told me to visit him again in a month and if I felt a need to visit him sooner then I could.
I cannot explain the feeling I had after having the treatment on this day, but all I can say is I felt more confident somehow, I felt like something positive may just happen. I think it was because after this aspiration and the hydrocortisone injection my knee looked different to usual in as much as it looked flatter and less swollen; it looked like every bit of fluid had been aspirated whereas on previous occasions I had always left the hospital with a feeling that not all the fluid had been aspirated and the fluid remaining in the bursa sac had been allowing other fluid to easily enter back in to it. Of course this is not necessarily the case, but that’s what I thought at the time I was looking for answers. Anyway, I felt different and hopeful and I even threw a few prayers upstairs just for good measure, I really was at a low ebb and was willing to try anything, even divine intervention. Well, do you think my condition improved after this last treatment? You’ll have to check back in next week to find out.