Thursday, 16 April 2015

SOK HIA'S BILATERAL TKR EXPERIENCE


I am so excited to share this real experience of a bilateral total knee replacement (TKR) by a close family member as I was involved with her journey before and after TKR.

Lee Sok Hia is my eldest sister-in-law. She is 65 years old, of a small frame and relatively healthy. As you can see here, her knees were quite seriously bowed before TKR due to osteoarthritis.  When I had my bilateral TKR four years ago, I thought I could motivate her to fix her knees too. But as expected, her fears were too great and it took her until now to take the bold move.  Apart from fear, the delay was partly because she does not experience pain in her knees.  This may sound unbelievable but true and it does happen to a small percentage of people with the same problem. However, she experiences discomfort in the knees, limping, backache and difficulty in walking so much so she has avoided going to a lot of places that involves walking. Meanwhile, her bowed legs continue to deteriorate and she also experienced difficulty walking up and down staircases and had to cling to her husband for support in the fear of falling down.  It finally hit Sok Hia that she has no quality of life and she decided to do TKR about two months ago. She chose the same Orthopaedic Surgeon (OS) as mine as she was convinced that he did a good job with my TKR and that of one of our friend. And so the journey begins. 

The first visit to the OS was quite an experience. He was puzzled that she did not have pain, did not take pain killer and could still squat down. Therefore, he suggested for her to do a thorough examination before determining whether she really needed TKR. After a series of blood tests, x-rays and MRI, it was discovered that she had 30% deterioration in the spine of her neck, 5% at her back and 90% at her knees. So the OS was convinced that she needed TKR but the question remains whether she really wanted it because she did not have pain and did not take any pain killer. She said yes, simply because she wanted a better quality of life. And so a date was fixed which was only 2 days away. I thought it was superb, no long waiting period and excessive worrying.

The operation went smoothly and as you can see below, her knees were straightened. She has been very disciplined with her physical therapy exercises on her own which greatly contributed to good improvements during her recovery period. Of course, she experiences the usual stiffness, tightness and numbness which will hopefully improve in time.

There is one important thing that I would like to share with you based on this experience.  Sok Hia was advised not to have epidural but general anaesthetic. The doctor advised against doing epidural because her back wasn't in good condition. Now, if I had known this, I would not have opted for epidural when I had my bilateral TKR four years ago. I did not realise then that my on and off backaches were important to be mentioned to the doctor.  Therefore, after the surgery, I had severe discomfort in my back when lying down or resting my back on a chair which was most unpleasant during my recovery. So on hind sight, I wish I had known about this fact before my TKR.

I will gradually keep you updated on Sok Hia's recovery. Meanwhile, by sharing this experience, I hope it will motivate you to take that step towards obtaining a better quality of life. 




Before TKR




After TKR




3 weeks after TKR


Tuesday, 13 May 2014

3-YEAR UPDATE

In case you noticed that I have not been posting here for quite some time, it's because I have been so tied down with a relatively new home business. Even though its a small business but I have been putting my heart and soul into it. And the best thing is that I am able to contribute to charity at the same time.

Keeping busy has really made me stopped thinking about my knees which is quite an achievement. I have done so many things this past year besides starting my home business such as volunteering to feed the homeless in the streets twice a week, taking part in my son's surprise marriage proposal in Krabi, Thailand, enjoying my holiday trips, cooking, planning and supervising my home renovation and standing for hours doing promotion at sales events. I can also exercise without any problem and sleep really well too. Now all these would not have been possible if I did not have my total knee replacement (TKR) three years ago.

I would be kidding you if I said I do not have any stiffness and tightness in my knees now. Of course, I still do but at a lesser extent and this is the price I paid for all the damage caused by osteoarthritis and for delaying TKR. But still, I consider it as a small price to pay in return for pain free knees. Inspite of my progress, I try not to take things for granted particularly since I now know what is the root cause of arthritis and all other diseases. If you are new to this site, I suggest you read those posts related to this topic.

As mentioned before, I have been following a low carb diet since last year and managed to lose some weight and saw my belly shrunk. I am also a strong advocate of drinking green smoothies, baking soda water and consuming more alkaline food. Ever since then, my immune system has improved drastically, gas problem gone, blood sugar normalised, less aches and pain and I sleep very well. But I must admit that ever since I started my home business, I have fallen off the wagon once in a while as my business involves food and also when I am busy preparing for events. Amazingly, I discovered that when I started consuming carbs and wheat again, almost immediately I felt all the negative reactions to my body such as indigestion, gas, dark stools, aches and pain, blood sugar and pressure increasing, belly bulge and constant hunger.  The weight would just start creeping back its scary but at the same time, it proves that carbs and wheat are so unhealthy for our body. Realistically, I know its not easy to give up these unhealthy food because they are so delicious and addictive. So even though I may deviate once in a while but I make it a point that for most part of the time, I stick to eating low carb meals for the sake of my overall health and to prevent osteoarthritis in other joints.

So for those of you still contemplating TKR, I am living proof that it's the best thing that I have ever done for myself. One of the joys of TKR is being able to do things for myself, with my family and contribute to charity. Next up, is my son's wedding in September this year which involves a lot of preparation and organisation but I am all game for it. What about my little business? Well, its a passion for me and as long as I can earn some money for myself and contribute to charity at the same time, I am one happy person.

While TKR surgeries have proven to be highly successful, in reality a lot of people are put off by it due to fear. So here, I would like to encourage you to let go of the fear in order for change to happen. Seek proper medical advice and listen to the right people particularly those who have gone through TKR. You can also join one of the many TKR support groups available not only to raise your concerns but learn about other people's experiences. So good luck to you!













Friday, 6 December 2013

INFOGRAPHICS


Preparations for the home before joint replacement is crucial to help with recovery. Nordorthopaedics clinic has produced an infographic which gives useful tips on how to adjust your home in preparation for a joint replacement surgery.  I am sure you will find their write up below to be very helpful. 



Think you already did your research on joint replacement surgery? Have you given much thought to the recovery period, too?

It is crucial to understand that joint replacement surgery requires additional preparation. As a person who has not experienced joint replacement before, it might be hard to pay attention to all the necessary details that make up a safe environment for you to get better.


This infographic can help you make your home more "recovery friendly".


Inspect every room and living area carefully in order to eliminate every possible obstacle that could cause any trauma or put an extra burden on your joints.


Focus on the appropriate heights - so that you don't need to keep an extra chair in the kitchen to reach an overhead cabinet or a sponge in the bathroom when showering.


Space is also a significant factor. Make sure you have a lot of it to move around, so that a box standing on the ground would not lead to a freak accident.


Another important thing is being able to have confidence in your moves. Therefore well-lit places contribute majorly to creating a place suitable for a recovery.


Lastly, if you have pets that crave constant attention and make your life more active, consider finding them a temporary home or invite a friend or family member over to help you.


Pay attention to details and remember that small things can contribute greatly to the feeling of confidence and being able to not to worry about hurting yourself in the place you are supposed to feel safest!

Check out this link to see the infographics.


Saturday, 6 July 2013

CHRONIC INFLAMMATION


In my previous two posts on "Root Cause of Arthritis and Other Diseases", it was stated that sugar and carbohydrate food are the main culprit in causing diabetes, heart disease, osteoarthritis, rheumatoid arthritis, osteoporosis, obesity, ulcerative colitis, celiac disease, dementia, cancer and many other diseases.  It was also said that "modern wheat" is the worst carbohydrate because it causes blood sugar and insulin to rise rapidly.  It also has an addictive component called gliadin which stimulates appetite.  As explained earlier, the extra sugar molecules attaches itself to a variety of proteins which causes a reaction called glycation.  The glycated proteins are too big and sticky to get through blood vessels.  Eventually, this causes repeated injury to the blood vessel wall which then sets off chronic inflammation.


WHAT IS CHRONIC INFLAMMATION?

Now the most common type of inflammation is sudden and acute, such as when we get injured, the injured area swells, turns red and becomes tender to the touch.  This is a good kind of inflammation whereby our body's immune system will heal itself and then the problem goes away.  However, chronic inflammation is different.  It is a bad kind of inflammation and it does not go away.  It results in persistent swelling, stiffness or pain.  Sometimes we may not even experience any symptoms until the condition worsens.  A test which reveals a high blood level of C-reactive protein is an indicator of our body's overall inflammation.

Recently, I read an interesting article written by Dr. Dwight Lundell who was a heart surgeon with 25 years experience and had performed over 5,000 open-heart surgeries. Lundell said that inflammation in the artery wall is the real cause of heart disease and other chronic ailments.  He reaffirmed that sugar, flour and all the products made from them are the biggest culprits of chronic inflammation.  This also includes the excess consumption of omega-6 vegetable oils such as soybean, corn and sunflower that are found in processed foods.  How does the inflammatory process work?  According to Lundell, it is as if you are rubbing a stiff brush repeatedly over soft skin until it becomes quite red and nearly bleeding.  If we kept this up several times a day, every day for five years and if we could tolerate this painful brushing, we would have a swollen infected area that became worse with each repeated injury.  It is also like taking sand paper to the inside of our delicate blood vessels if we spike our blood sugar level several times a day, every day.

How does eating a simple sweet roll creates a cascade of inflammation to make us sick?  Lundell explained that it does not only contain sugar but it is baked in one of the many Omega-6 oils such as soybean.  While Omega-6's are essential as they are part of every cell membrane controlling what goes in and out of the cell, it must be in the correct balance with Omega-3's.  If the balance shifts by consuming excessive Omega-6, the cell membrane produces chemicals called cytokines that directly causes inflammation.  To make matter worse, the excess weight we are carrying from eating these high carbohydrate food creates overloaded fat cells that pour out large quantities of pro-inflammatory chemicals that add to the injury caused by having high blood sugar.  So the more sugar, carbohydrate food and Omega-6 oils we consume, the more problem we will have with chronic inflammation.  The human body cannot process, nor was it designed to consume foods packed with sugars and soaked in Omega-6 oils.


HOW DOES CHRONIC INFLAMMATION AFFECT ARTHRITIS?

In Part 1 of my post on "Root Cause of Arthritis & Other Diseases", I wrote about Dr. William Davis who had written the Wheat Belly book. Davis writes that it is the same inflammation that issues from visceral fat of the wheat belly that also yields inflammation of the joints. The more wheat products we consume, the higher and more frequently blood glucose increases, the more glycation occurs. The cartilage in joints is uniquely susceptible to glycation as cartilage cells are extremely long-lived and are incapable of reproducing.  Once damaged, they do not recover.  If cartilage proteins, such as collagen and aggrecan, become glycated, they become abnormally stiff.  The damage of glycation is cumulative, making cartilage brittle and unyielding, eventually crumbling.  Joint inflammation, pain, and destruction results, the hallmarks of arthritis. 

It is evident now that the risk of arthritis is even greater for someone with visceral fat of the wheat belly variety, as evidenced by the threefold greater likelihood of knee and hip replacements in people with larger waist circumference.  It also explains why joints that don't bear the added weight of obesity, such as those in the hands and fingers, also develop arthritis.  Therefore, losing weight and thereby visceral fat, improves arthritis more than can be expected from just the decreased weight load.

So high blood sugars that encourage growth of a wheat belly, coupled with inflammatory activity in visceral fat cells and glycation of cartilage, lead to destruction of bone and cartilage tissue in joints.  Over years, it results in the familiar pain and swelling of the hips, knees and hands.


PRO-INFLAMMATION

Now that we know that sugar and carbohydrate foods are the real culprit of almost all diseases, its important for us to make better food choices.  In order to do that, we need to know that the problematic food which promotes inflammation are:-  
  • Refined or granulated sugar (including sugary snacks made from them)
  • High-fructose corn syrup which can be found in soda drinks, juices and many other products in supermarkets
  • All types of flour made into bread, pasta, pizza, donuts, cookies, cakes, bagels, chapatis, noodles etc.
  • Cereals
  • Rice, grains and starches
  • Potatoes
  • Alcohol
According to Jack Challem, in his book called The Inflammation Syndrome, omega-6 fatty acids are essential for health but the modern diet provides far too much of it thereby, creating a biochemical setting that encourages chronic inflammation.  Vegetable cooking oils such as safflower, sunflower, corn, soybean, canola and peanut are processed cooking oils which are high in pro-inflammatory omega-6 fatty acids.  They are also found in many processed and packaged foods including microwave meals, breakfast bars and salad dressings. Partially hydrogenated vegetable oils such as vegetable shortenings and hard margarine which contain trans fat are among the worst of these oils because they alter how our body processes fats. 


ANTI-INFLAMMATION

So what can we eat then?  Fresh, whole foods of course.  It is something that our ancestors ate until after World War II, where technologists invented frozen meals heralding the start of the convenience/fast-food revolution.  Soon afterwards, McDonalds and the fast-food industry became a great success.  The downside of fast and highly processed foods have resulted in increased obesity,  diabetes, heart disease, arthritis, cancer etc.  To make matters worse, most of us have been brought up without proper knowledge of food and nutrition.  So I think its time for us to re-learn about nutrition and add fresh, whole foods into our diets such as:-
  • Vegetables including leafy greens which are rich in nutrients such as flavonoids and fibre
  • Fruits within limits as some fruits such as mango, banana and pineapple are high in sugar content
  • Nuts and seeds
  • Meats (preferably grass-fed)
  • Fish and seafood
  • Eggs
  • Cheese 
  • Yogurt (unsweetened and unflavoured) and pickled vegetables for their natural probiotic
  • Herbs and spices
Challem also advised that we should consume food or supplements rich in omega-3 fatty acids as they are anti-inflammatory.  This can be found in cold water fish, leafy green vegetables, flax seed and chia seeds.  We should also use good oils such as Extra Virgin Olive Oil, Extra Virgin Coconut Oil and Grape seed Oil.  However, these oils are more suitable for salads as they cannot withstand high heat. Palm fruit oil, butter and ghee are highly recommended for cooking with higher temperature. 


CONCLUSION

Based on all the information which I have gathered, I realised now why I have osteoarthritis since my 30's. You see, I was brought up on the typical high-carb and pro-inflammatory diet.  So naturally, we have a family history of  obesity, diabetes, kidney failure, heart disease, hypertension and arthritis.  But I don't blame my parents because they were ignorant about health, food and nutrition.  To make matters worse, I have continued to eat the way that I was eating before even as a married adult because I was also ignorant about food and nutrition.

Now that I have the knowledge, I decided to make a change.  I started living low-carb for four months plus now and never regretted a single moment. There is no counting of calories and no going hungry - just adding more fresh and nutritious food.   Even within this short period, the transformation were huge for me (check out my progress pictures in Part 1 of Root Cause of Arthritis  & Other Diseases). I have lost about 20 to 30 pounds and more than one dress size.  Acid reflux is almost gone and blood sugar level has reduced.  Body aches and pains have also reduced tremendously. My immune system has improved significantly so I hardly fall sick. And I have so much more energy. 

Do I still exercise?  Of course, I do.  But I have changed the way I exercised because of new improved information which is more practical and effective particularly for losing weight.  I learnt this from Jon Gabriel, the best weight loss guru that I have ever come across.  I exercised about 3 times a week for only 20 minutes each time.  The first 10 minutes, I do 20 second sprints of any cardio movement.  Then I do about 10 minutes of strength training and end up with a little bit of stretching.  I also enjoy listening to Jon Gabriel's recordings of visualisation on MP3 which is so calming and meditative.

In conclusion, I would like to say that nothing is going to change the unhealthy foods that are widely available everywhere.  The power is in our hands to make the change for our own health.  All it takes is a conscious effort in the beginning and subsequently, it becomes a natural way of healthy eating and living for the rest of our lives. 

Friday, 24 May 2013

ROOT CAUSE OF ARTHRITIS & OTHER DISEASES - PART 2


Yes, I am still writing about the dangers of modern wheat because there is just too much information to share. This is a continuation of my previous post on "Root cause of arthritis and other diseases".  If you have not read it, please read it first then continue here. 

With this shocking revelation of the dangers of modern wheat - something that is in almost all our food, what do we do next? The biggest challenge is how can we resist all these extremely attractive and delicious wheat and high carb food created by the manufacturers.  They are all around us in bakeries, supermarkets, malls, restaurants, cafes etc. And the more we eat them, the more we crave for it.  Even vegetarian restaurants serve wheat and high carb food. What about all the Chefs in cooking shows?  Most of their recipes are made of wheat and high carb food too.  Well, I don't blame them because nobody would crave for salmon, chicken or vegetables but we will crave for more wheat and high carb food.  This is the addictive component of wheat which is the worst carbohydrates.

Its been almost a month now since I published the first part of this topic and I observed that some people took it positively and tried to make changes in their diet.  Some are in denial because they feel that they do not consume much of wheat and high carb food but when I found out what they actually eat, its a different story. Some don't even care much about it even though they may know the danger now because they cannot divorce themselves from it.  This group is basically the same as smokers or addicts who know the danger but they just cannot quit. They also feel that they are not going to live that long anyway so might as well enjoy food first.  Well, I can't blame them because this was exactly how I felt before.  I even thought that eating everything in moderation should be okay but why is my belly still growing bigger, blood sugar level and everything else seemed to be going up?

In my previous post, I shared about relevant information from a book called Wheat Belly which was written by a cardiologist named Dr. William Davis which instantly became a best seller in New York Times.  In his book, Davis wrote about the dangerous effects of modern wheat on our health.  It was said earlier that wheat is not only found in many food products but in certain medicines and cosmetics such as lipsticks. It is also in wrappers of chewing gums so that it does not stick to the paper. What about oats? Yes, some of the so called "Heart Healthy" oats does contain wheat.  So we have to be careful by checking food labels and not be deceived by the so called "Healthy Whole Grains", "Healthy Heart", "Cholesterol Free", "Vitamins Enriched", "Organic" and so forth.  The reality is that no matter what the manufacturers labelled the product, it is still wheat.


THE EFFECTS OF MODERN WHEAT

According to Davis, modern wheat has been proven to cause increase in appetite and food obsession due to exorphins which is an addictive property of wheat. Wheat also causes obesity particularly in visceral fat, diabetes, heart disease, osteoarthritis, rheumatoid arthritis, acid reflux, osteoporosis due to high acidity, accelerated ageing, dementia, brain dysfunction, cancer, celiac disease, irritable bowel syndrome and the list goes on. Wheat also causes worsening of symptoms of inflammatory bowel diseases such as ulcerative colitis and Crohn's diseases. It also worsens symptoms of people with ADHD, autism, depression, schizophrenia and bipolar.  But wait - there is more.


Wheat also causes hair loss.  Have I got your attention now?  Did you say hair loss? Yes. According to Davis, hair loss is sometimes unavoidable, due to the effects of toxic drugs or dangerous diseases.  People undergoing cancer chemotherapy, temporarily lose their hair because active non-cancerous cells such as those in hair follicles are also killed in the process.  Certain inflammatory diseases such as lupus can also cause hair loss.  Wheat consumption can now be added to the list of causes of hair loss. "Alopecia areata" refers to hair loss that occurs in patches, usually from the scalp, but occasionally other parts of the body or even the entire part of the body.  Wheat consumption causes alopecia areata due to a celiac-like inflammation of the skin.  The inflamed hair follicle results in reduced hold on each individual hair, which causes shedding.  When caused by wheat, alopecia can persist for as long as wheat consumption continues.

Davis related a case about one of his patient named Gordon who had coronary disease.  For two years, Davis tried to get Gordon to drop the wheat but to no avail.  You see, Gordon owned a bakery.  Bread, rolls and muffins were part of his life every day, seven days a week.  It was only natural that he would eat his own products.  However, one day, Gordon came to see Davis and revealed that he had started to lose clumps of hair, leaving divot-like bald patches scattered over his scalp.  His primary care doctor diagnosed alopecia but couldn't explain a cause.  He was so upset with the hair loss resulting in his asking his primary care doctor for an antidepressant and concealing the embarrassing situation with a cap.  Of course, Davis's first thought was wheat.  It fitted Gordon's overall health picture; small LDL particles, wheat belly body configuration, high blood pressure, pre-diabetic blood sugars, vague stomach complaints and now hair loss.  Finally, Gordon agreed to eliminate wheat despite the difficulties that he would face but he stuck to it.  Within three weeks, Gordon reported that hair had begun to sprout up in the bald patches.  Over the next two months, vigorous growth resumed.  He also lost twelve pounds and two inches from his waist.  The intermittent abdominal distress was gone, as was his pre-diabetic blood sugar.  Six months later, reassessment of his small LDL particles showed 67 percent reduction.  Though dropping wheat was tough for Gordon judging from where he's coming from but I agree that it sure beats having to wear a toupee.


Wheat also has destructive effects on the skin.  Now this ought to wake you up as well. According to Davis, if wheat can affect organs such as the brain, intestines, arteries and bones, it can also affect skin which is the largest organ.  Skin changes do not generally occur in isolation.  If an abnormality due to wheat is expressed on the skin surface, then it usually means that the skin is not the only organ experiencing an unwanted response.  Other organs may be involved, from intestines to brain except that we may not be aware of it.

Wheat can exert age-advancing skin effects such as wrinkles and lost elasticity through the formation of advanced glycation end products. Just as digestive by-products of wheat lead to joint inflammation, increased blood sugar and brain effects, it can also result in reactions in the skin ranging from acne, skin rashes, oral ulcers, psoriasis, dermatomyositis and many other skin conditions.

One of Davis's patient by the name of Kurt has excess small LDL particles, low HDL cholesterol and high triglycerides.  Naturally, Davis advised him to eliminate wheat and he did so.  After three months, Kurt lost eighteen pounds and his wheat belly.  But strangely, the reddish-brown rash over Kurt's right shoulder, spreading down to his elbow and upper back, that had plagued him for more than seven years had disappeared.  None of the three dermatologists whom Kurt seeked treatment from could cure him except for the temporary relief with steroid creams.  The solution was as simple as eliminating wheat.


WHAT ABOUT OTHER CARBOHYDRATES?

According to Davis, if we remove wheat, we have removed the most flagrant problem source in the diet of the people who otherwise follow healthy diets.  Wheat is the worst of the worst carbohydrates but other carbohydrates can be a problem source as well, though on a lesser extent.  However, high carbohydrates causes wide fluctuations of blood sugar and glycation, severe resistant to insulin, growth of visceral fat and inflammatory responses, all of which leads us to have tired, beaten pancreas unable to keep up with the demand to produce insulin.  Continued carbohydrate challenges forced on flagging pancreatic function leads us down the path of pre-diabetes and diabetes, hypertension, lipid abnormalities, arthritis, heart disease, stroke and all the consequences of excessive carbohydrate consumption.  Therefore, in addition to wheat elimination, an overall reduction in carbohydrates is also beneficial.


THE EFFECTS OF CARBOHYDRATES

There is another interesting book by Jonny Bowden, PhD, CNS (a nutrition expert) called "Living Low Carb". In this book, Bowden even quoted Davis's findings about the dangers of modern wheat.  I learnt a lot more about carbohydrates and its effects on our body from Bowden's book.

Many of us are aware that sugar is linked to diabetes and so it is bad for our health.  Therefore, we cut down on our consumption of sugar particularly in our drinks.  But its not sugar per se.  All the high carbohydrate food that we consume such as breads, pasta, cakes, cookies, capati, roti canai, rice, noodles, donuts etc. are eventually broken down as sugar in our body.  If we consume high amount of carbs, can you imagine how much of sugar will be floating in our system?

So what happens with all that sugar in our system?  According to Bowden, our pancreas would be hard at work to produce insulin in order to prevent blood sugar from rising too high.  Then our liver notices the amount of insulin produced and get to work.  Some of the sugar or glucose is transported to our muscle cells for energy and to the brain for function.  What happens then to all the excess sugar?  They are packaged into triglycerides (i.e. fats found in the blood and in the tissues).  The high level of insulin accompanying the high-carb meal stimulates the cholesterol-making machinery; the body starts churning out more cholesterol, which it then packages (together with triglycerides) into little containers called VLDLs (very low density lipoproteins), most of which eventually become LDLs (low density lipoproteins) or "bad" cholesterol.  This is how a high-carb diet raises both triglycerides and cholesterol.

Why sugar, you may ask?  Bowden explained that sugar is sticky while proteins are smooth and slippery.  The slippery nature of protein lets them slide around easily in the cells and do their jobs effectively.  But when excess sugar keeps bumping into proteins, the sugar eventually gums up the works and gets stuck to the protein molecules.  Such proteins are now said to have become "glycated" (this is similar to what Davis mentioned about glycation). The glycated proteins are too big and sticky to get through small blood vessels and capillaries, including the small vessels in the kidneys, eyes and feet, which is why so many diabetics are at risk of kidney disease, vision problems and amputation of toes, feet and even legs.  If our joints gets glycated, we end up with arthritis as explained in my earlier post.  So in simpler term, if certain part of our body gets glycated, we will end up with problem in that area.


IS FAT WORSE THAN SUGAR?

According to Bowden, sugar is far more damaging than fats.  But all this while, we have been inundated with the idea that fat causes high cholesterol and heart disease.  Yes, we have been misled and we never questioned its validity.  How are we supposed to know when doctors seemed to be singing the same song and happily prescribing us with more medications?  So my friends, if you have not heard of this anywhere, you are hearing it here - sugar (including all carbohydrate food which are broken down as sugar in the body) is the main culprit in causing diabetes, high cholesterol, heart disease, osteoarthritis, rheumatod arthritis, cancer as well as a host of other diseases.  As you can see,  everything is related.

Fat is the single most misunderstood component of the modern diet.  Bowden explains that saturated fat is a completely neutral fat.  It burns like any other fat.  If we are eating a high-carb diet, the effect of fat may indeed be more damaging.  But if we are eating a low-carb diet, insulin is low and saturated fat is handled more efficiently.  So when carbs are low, we are burning that saturated fat as fuel and we are also making less of it.

One recent study has shown that when obese patients are put on a high-saturated-fat diet but without starch, the body weight decreased, body-fat percentage decreased and total triglycerides decreased.  The researches concluded that a high-saturated-fat / starch-avoidance diet resulted in weight loss after six weeks without any adverse effects on serum-lipid levels.

Bowden also said that our body must have protein and animal fats which can also provide the necessary calories.  Carbohydrates only provide calories and nothing else.  They have none of the essential elements to build up or to repair the tissues of the body.  Therefore, the body does not have physiological need for carbohydrates.  Yet is has always been a world wide practise of Dietetic Associations to recommend that we consume the majority of our calories from carbohydrates as a healthy diet.  How can this be a good advice when the exact opposite happens after high consumption of carbohydrate food?  Doesn't this raise the question of why obesity, diabetes, heart disease, arthritis, cancer and other diseases are so prevalent in today's world?  It just doesn't make sense to me.

Anyway, the verdict is that saturated fat is not guilty.  It has been wrongly blamed for causing high cholesterol and heart disease.  Wait - what about eggs, seafood and red meats?  Yes, you guessed it right.  They have been wrongly blamed as well.


LIVING LOW CARB

There are tons of diets out there and I have personally tried so many of them but nothing has worked on a long term basis.  In one of Oprah Winfrey's talk show, it was said that the magic formula for losing weight is to burn more than we eat.  Yeah, it made sense to me at that time.  But after I exercised very hard on the treadmill in the gym for one hour, the machine tells me that I have burned 300 calories. What?? 300 calories only after all that hard work?  It was unbelievable.  I might as well eat 300 calories less.  At that time, I continued to work my butt out and ate less calories.  Eventually, I lost weight but I was hungry all the time and before I know it, all the weight came piling back on after I gave in to my cravings.

Now I understand that it is not reliable to count on exercise to lose weight.  In fact, we do not burn much calories after exercise.  The fact is that we feel a lot hungrier after exercise and therefore, we tend to eat a larger meal.  What about calories? Do we need to count calories?  Studies have shown that when people are put on high-carb meals with less calories, they still put on weight.  But when people are put on low-carb meals with higher calories, they still lost weight. So the answer is obvious that calories is not the problem.  The problem is in the type of food we eat.  Wheat and high-carb food have been proven to be the worst enemy here.  Should we still exercise if it doesn't help us to lose weight?  Of course we should because exercise helps us to improve our overall health and fitness. 

With all these information in my hands now, living low carb appears to be the most logical and sustainable way of eating for me. If it can prevent me from having arthritis in other joints, prevent other diseases or reverse any existing health problems without any medication and lose weight at the same time, it is a small price to pay.  There are tons of positive research conducted on low-carbing approach of eating which resulted in no significant harmful effects.  In fact, the only side effects are weight loss and improved health.

Well, I have been living low carb for three months now and I found it to be the easiest diet because I don't feel  hungry so it doesn't feel like I am on a diet.  To be honest, I have never eaten so healthily before. I have filled the gap with lots of fresh food such as vegetables, greens, fruits, meats, fish, seafood, eggs, tofu, cheese, nuts etc.  Living low carb is not bland, plain and boring as you might think.  Think of barbeque spare ribs, steak, cheese, grilled chicken, fish and pork, are these boring?  Definitely not for me. It is a matter of removing the bread, potatoes, rice, noodles and so forth.  It is actually more satiating after a low-carb meal and I find that I can taste the food better.  What about vegetables and fruits? Fresh salads and green smoothies can be very yummy and refreshing too. I usually have a big portion of fresh salads together with my protein.  Even though meats are acidic forming but it can be neutralised by the vegetables, greens and fruits which are alkaline.  High carb food on the other hand are very acidic and therefore, causes more health problems.

I find that Western low carb meals are a lot easier to prepare than Chinese meals.  Yes, I still cook Chinese meals for dinner maybe once or twice a week and I can eat all the dishes and drink the soup without the rice.  Its a matter of getting used to it.  Afterall, this is how we eat at Chinese wedding dinners.  Basically, it all boils down to making better food choices.

For the first time in a long while, I am enjoying seeing myself in the mirror. I have lost one dress size and still losing without much effort, without counting calories, without going hungry and without having to exercise to death. My blood sugar level has come down from 6 to 5.  I can see a significant improvement in my immune system and reduction in bad cholesterol, acid reflux and body aches.  I am still monitoring my blood pressure which I know will come down eventually. I feel energetic and still managed to climb another 547 steps at Batu Caves last weekend (see post on 2 years post BTKR).


CONCLUSION

In conclusion, I would like to say that I have changed the way I look at food.  I used to eat what I like and avoid what I don't like without a second thought about nutrition.  And I will give in to my cravings for unhealthy but attractive high carb food. But now, I make an effort to eat what is good for my body. If I have to rely on this body to last me a long time in a healthy manner, I have to take better care of it. It is a far cry from what I used to think - eat first then worry later.  Am I perfect in living low carb?  If perfection is key, I would be doomed.  Actually, I don't really find it difficult living low carb but if I do derail a little once in a while, I don't feel guilty and sweat over it.  I just get back to it on the next meal.

Now back to my earlier question  - "Does OA still exist after TKR?".  I can safely say that we may not have arthritis in our TKR joint but we may still have arthritis in other joints.   In fact, I am already feeling it in my hands.  We may also have potential to have arthritis in any joints.  The good news is that we can prevent ourselves from getting arthritis or prevent further damage to existing arthritic joints. The power is in our hands to make changes particularly in the food that we eat.

I always believe that things happen for a reason.  All these experiences with obesity, addiction and total knee replacement have been a blessing for me because if not for them, I would not have learnt about the importance of exercise and the impact of food on our body and health in general. And I would not be blogging about it. 

If eliminating wheat can reverse all the health problems that we are facing today, shouldn't it banished forever?  Logically, yes but the stakes are too high. Its the same problem with tobacco.  It will never happen because the implications are too great.  It involves the farmers, manufacturers, pharmaceutical companies, doctors, hospitals, government, workers and so forth.  Hence, we have to take this into our own hands and make the best decision for ourselves and possibly, our family members too.  After all, we are in charge of our own health.

Lose the wheat and brace yourself for better health!    ...  William Davis

Experience a myriad of health benefits and weight loss by living low carb.   ... Jonny Bowden

Just to prove to you that low carb meals are not bland, plain and boring, here are a few pictures of the low carb meals which I dished up.  They are so easy to make and you can find tons of  low carb recipes in the internet from Paleo Diet, Atkins Diet, South Beach Diet, Dukan Diet and so forth. 


Low carb pizza with cheese, pepperoni and pineapple


Grilled chicken with low carb rice and salad
 

Egg pancake with fruits and chocolate drizzle


Low carb shepherd pie with mango salsa

Grilled pork with black pepper sauce and prawn salad


Grilled salmon with dijon mustard dressing

Sunday, 5 May 2013

ROOT CAUSE OF ARTHRITIS & OTHER DISEASES - PART 1


Okay, so we have had our implants installed in our knees and we get our lives back.  But what do we do next? Similarly, if some people are lucky enough to have survived cancer and are in remission, should these people just carry on with their lives without making any changes and without knowing what went wrong in the first place in order to prevent a relapse?  My biggest fear is that I am still exposing myself to Osteoarthritis (OA) in other joints or maybe even in the TKR joints?  These are questions that have been flooding my mind.  Does OA still exist after TKR?  What can I do to prevent OA?

So here lies the most important question - what is the root cause of OA?  Most medical professionals would say that its due to ageing, overweight, genetics, overuse or injuries. If this is the case, why is it that more and more younger people are getting OA and some of them without fitting the bill for any of these given reasons. There has to be a more logical explanation for this.  So for the past several months, I have been doing some research.  I actually started out by trying to find out what is the root cause of OA but I got more than what I bargained for.  I have gathered so much of information which is impossible to capture in one post thus, there will be several more posts to come. And I want to thank some of my blog readers and TKR forum members for giving me a heads up that OA still exist after TKR.

WHEAT BELLY

 In 2010 , a brilliant cardiologist named William Davis, MD, published a book called Wheat Belly, which instantly became a best seller in the New York Times.  One of my blog readers, Barbara K. left me a comment about wheat belly (Barbara, if you are reading this, thank you so much for sharing this information). I checked out the wheat belly blog and also got hold of the book and read it.  Davis explained that the wheat we are consuming today is a genetically modified kind of wheat (to increase yield-per-acre) that had never been seen on earth before about 50 years ago.  This wheat is called "dwarf" wheat and it has replaced most of the other strains of wheat in the United States (and in much of the world). Davis says that  "Modern wheat, despite all the genetic alterations to modify hundreds, if not thousands, of its genetically determined characteristics, made its way to the worldwide human food supply without nary a question surrounding its suitability for human consumption".


In 2011, journalist/educator Tom Naughton interviewed Davis on the subject of wheat.  Here is an extract of the interview which you can find on Naughton's website which explains how Davis started noticing the problem with wheat.

Quote

Naughton:  "You're a cardiologist by profession, yet you just wrote an in-depth book about the negative effects of consuming wheat.  How did wheat end up on your radar? What first made you suspect wheat might be behind many of our modern health problems?

Davis:  If foods made from wheat raise blood sugar higher than nearly all other foods (due to its high-glycemic index), including table sugar, then removing wheat should reduce blood sugar.  I was concerned about high blood sugar since around 80% of the people coming to my office had diabetes, pre-diabetes, or what I call "pre-pre-diabetes".  In short, the vast majority of people showed abnormal metabolic markers.

I provided patients with a simple two-page handout on how to do this i.e. how to eliminate wheat and replace the lost calories with healthy foods like more vegetables, raw nuts, meats, eggs, avocados, olives, olive oil etc.  They'd come back three months later with lower fasting blood sugars, lower haemoglobin A1c (a reflection of the previous 60 days' blood sugar); some diabetics became non-diabetics, pre-diabetics became non-pre-diabetic.  They'd also be around 30 pounds lighter.

Then they began to tell me about other experiences: Relief from arthritis and joint pains, chronic rashes disappearing, asthma improved sufficiently to stop inhalers, chronic sinus infections gone, leg swelling gone, migraine headaches gone for the first time in decades, acid reflux and irritable bowel symptoms relieved.  At first, I told patients it was just an odd coincidence.  But it happened so many times to so many people that it became clear this was no coincidence: this was a real and reproducible phenomenon.

That's when I began to systematically remove wheat from everyone's diet and continued to witness similar turnarounds in health across dozens of conditions.  There has been no turning back since."

Unquote


Now I know what all of you must be thinking.  What are the foods we eat that has wheat in it?  Its breads, roti canai, capati, pasta, cereals, cookies, cakes, donuts, noodles, french fries, chips, frozen food, canned foods, soya sauce, oyster sauce, snacks, candies and the list goes on.  Its virtually in every product you see on the shelf of supermarkets.  Okay, I know some of you might want to throw stones at me right now.  What??  You must be kidding!  Are we supposed to give up all these foods?  All these attractive and yummy foods?

Before you continue to rant, let's learn more about this wheat that is supposed to be dangerous for us.

WHAT DOES WHEAT DO TO US?


According to Davis, besides raising blood sugar and insulin, wheat has an addictive component called gliadin.  Gliadin is the most abundant protein found in wheat, contained within gluten polymers. Upon digestion, gliadin is reduced to a collection of 5 polypeptides, each 4 or 5 amino acids long, that bind to the opiate receptors of the brain. Unlike opiates such as morphine and heroin, gliadin-derived polypeptides don’t provide pain relief nor euphoria, but only stimulate appetite. Therefore, we tend to eat a lot more calories per day and after two hours, we crave for more carbohydrate foods again.  Then we eat again and then we crave for more - much like an addiction and withdrawal symptom.

Wheat contains Amylopectin A which raises blood sugar and if there is repetitive high sugar, it increases visceral fat or as Davis called it "wheat belly".  So food that contains wheat makes us fat and it is the main cause of obesity and diabetes.  Its not our fault then that we become fat and sick.  Its not that we are lazy and we ate too much.  We just didn't know about the effects of wheat.  Nobody told us, not our doctors, not our health department and definitely not the commercial giants. On the contrary, we are encouraged to eat more "healthy whole grains" which is wheat as well.  I wonder why wheat is in almost every food even some cosmetics and medicines.  Could it be that the manufacturers already know about the addictive component of wheat? It just doesn't make sense to me.

Lean people are not spared too.  They are also susceptible to a wheat belly and some of Davis's patients reported that no matter how hard they exercised, cut down on fats and increased consumption of "healthy whole grains", the belly would not budge. But the minute they lose the wheat, they lose their bellies.  This is evident that wheat is the culprit, not fat.  To further prove a point - if you look at vegetarians, why is it that quite a number of them are overweight with bellies and health problems such as diabetes, heart disease, fatty liver, arthritis etc.?  If they consume only vegetables, they should be slim and healthy. It doesn't make sense, isn't it?  The reason is that they  substitute animal protein and fats with lots of food made from wheat and carbs which are the culprits. So fat has been wrongly blamed for many heallth problems such as high cholesterol, heart disease, fatty liver and other diseases.  Learn more about this in my other forthcoming posts.

Wheat does not cause weight problem only. It causes almost all the diseases known to us. It causes body wide inflammation and increases acidity in the body which causes a chronic acid burden that eats away at bone health.  It was also reported that the elimination of wheat has  helped to reduce the symptoms for people with ADHD, autism, depression, schizophrenia and bipolar.  In some cases, these people were even able to recover from their symptoms.  This is an effect of wheat on mental function. 

Davis related in his book that he had also seen the dramatic turnaround in health for a 38 year old woman with ulcerative colitis.  She lived with constant cramping, diarrhea and frequent bleeding.  Her gastroenterologist advised colon removal with creation of an ileostomy which is an artifical orifice for the small intestine (ileum) at the abdominal surface, the sort to which you affix a bag to catch the continually emptying stool.  Davis advised her to try to eliminate wheat in her diet because she has got nothing to lose.  So even though she was skeptical, she agreed to try.  She returned to Davis's office three months later, no ileostomy bag in sight, lost 38 pounds and her ulcerative colitis is nearly gone.  No more cramps or diarrhea.  She is off all medications and she felt great. 

In another case, Davis wrote about a 63 year old grandmother who had undergone two heart catheterizations and received three stents in the past two years despite taking a cholesterol reducing statin drug.  She had low HDL cholesterol, high triglycerides and high small LDL particles.  She was also diagnosed with diabetes and was on metformin.  Her dosage kept increasing until her doctor started talking about the possibility of insulin injection.  Davis asked her to eliminate wheat and restrict other carbohydrates such as cornstarch, sugars, oats, beans, rice and potatoes because the small LDL pattern, low HDL and high triglycerides are closely linked to diabetes.  Within the first three months of starting her diet, she lost 28 pounds of her starting weight of 247 and her glucose level kept coming down.  After a year, she lost a total of 51 pounds and she is still gradually losing weight.  She became non-diabetic and essentially cured.

All these amazing results just by eliminating wheat and reduction of carbs? Sounds like a simple cure.

WHAT IS THE CONNECTION BETWEEN WHEAT & ARTHRITIS?

According to Davis, gliadin opens intestine barrier allowing foreign substances to enter the blood stream.  One of the undesirable effects is autoimmunity - i.e. the body's immune response is tricked into activation and attacks normal organs such as thyroid gland or joint tissue.  This can lead to autoimmune conditions such as Hashimoto's thyroiditis and rheumatoid arthritis. The same inflammation that issues from the visceral fat of the wheat belly and results in diabetes, heart disease, rheumatoid arthritis, osteoporosis, ulcerative colitis, celiac disease, dementia, cancer and other diseases also yields inflammation of joints.  Inflammation-mediating hormones have been shown to inflame and erode joint tissue. 

Leptin is a protein hormone that plays a key role in regulating energy intake and energy expenditure, including appetite and metabolism.  Leptin has demonstrated direct joint destructive effects:  The greater the degree of overweight (i.e. higher BMI), the higher the quantity of leptin within the joint fluid and the greater the severity of cartilage and joint damage. The risk of arthritis is even greater for someone with visceral fat of the wheat belly variety.  Losing weight, and thereby losing visceral fat, improves arthritis more than can be expected from just the decreased weight load.

Davis writes that another phenomenon that adds to the wheat-induced pounding that joints sustain over the years is glycation.  Glycation is a reaction that takes place when simple sugar molecules become attached to proteins or lipid fats without the moderation of an enzyme.  The more wheat products we consume, the higher and more frequently blood glucose increases, the more glycation occurs. The cartilage in joints is uniquely susceptible to glycation, since cartilage cells are extremely long-lived and are incapable of reproducing.  Once damaged, they do not recover.  If cartilage proteins, such as collagen and aggrecan, become glycated, they become abnormally stiff.  The damage of glycation is cumulative, making cartilage brittle and unyielding, eventually crumbling.  Joint inflammation, pain, and destruction results, the hallmarks of arthritis.

So high blood sugars that encourage growth of a wheat belly, coupled with inflammatory activity in visceral fat cells and glycation of cartilage, lead to destruction of bone and cartilage tissue in joints.  Over years, it results in the familiar pain and swelling of the hips, knees and hands.

In his book, Davis wrote about one of his 26 year old patient who had undergone repair of a complex congenital heart defect as an infant and was told that he might need a heart transplant because he was always breathless.  He could also barely walk because all his joints were hurting.  None of the rheumatologists which he had seen could tell him what was wrong so they just prescribed him anti-inflammatories and pain medicines.  So Davis suggested that he eliminate all wheat from his diet which includes white bread, whole wheat bread, multigrain bread, bagels, muffins, pretzels, crackers, breakfast cereals, pasta, noodles, pancakes and waffles.  Even though he was reluctant but he tried.  He returned to Davis's office three months later without a hint of joint pain.  He said that after five days, he had experienced no pain whatsoever.  He did not believe it and thought it could be a coincidence.  So he had a sandwich and within five minutes, about 80% of the pain came back.  Along with the relief from joint pain, there was no evidence of heart failure.  His breathing improved and he could start exercising and playing sports.

BENEFITS OF LOSING THE WHEAT

In a video recording on a live presentation by Davis to promote wheat belly which I viewed from the internet, he said that if we eliminate wheat, we will see the following benefits:-
  • weight loss - dramatic, substantial
  • reduced appetite, food obsession and calorie intake
  • reduction in blood sugar
  • reduced joint pain
  • reduced inflammation (C-reactive protein)
  • reduction in triglyceride, increased HDL and reduced LDL
  • pH balance shifted to alkaline
  • increased energy
  • improved sleep
  • reduced acid reflux and irritable bowel syndrome

MY OWN EXPERIENCE WITH LOSING THE WHEAT

Well my friends, I know what your next question will be.  What should we eat then?   Cardboards?  Absolutely not!  We should re-introduce lots of fresh vegetables, greens, fruits, meats, fish, seafood, nuts, seeds, eggs, fats, cheese and so forth.  These are healthy food with lots of nutrients.  Actually, our body is starving for nutrients but we keep feeding it with the wrong food.  So if we cut the carbs, we cut the wheat and we have more room for nutritious food.  Dont forget that we have to drink water and lots of it too (see post on Water & Arthritis).    
                              
In this context, I have changed my concept of eating to low carbs two months plus ago and I am thrilled to report that I have lost one dress size without any effort.  I did not count calories and neither did I have to go hungry.  I also did not have to exercise to death as I just did moderate exercise three times a week about 20 to 30 minutes each time. Even my acid reflux has improved so much, I hardly touched my Gaviscon. I still take my yummy green smoothies (refer post on Green Smoothies & Arthritis) everyday.  How do I feel? I feel great with improved immunity, lots of energy and vitality. If you saw the previous post on my 2-year post BTKR update, I still managed to climb 544 steps  in Batu Caves.  Was it hard?  Yes, it was initially as with any change but eventually it got easier. 

You see, my weight has been on a yo-yo my whole life.  I have tried all the diets that I have come across in the past but nothing worked.  The last time that I lost weight was a few years ago when I did all the gruelling Jillian Michaels' workout 5 to 6 times a week and cut down on my calories.  Even though I was thrilled with the weight loss, it was hard work I tell you.  I was craving for food all the time and before I know it, the weight just came piling back on after I gave in to those cravings.  However, with this new concept of eating (I call this a concept and not a diet because diets doesn't work), my cravings for carbs have reduced tremendously and I do not feel hungry until my next meal. 

Its funny, I used to think - what is life for if we do not enjoy eating whatever we want as long as we eat moderately and exercise regularly.  But then I find that I keep putting on weight, the belly keeps getting bigger, blood pressure keeps escalating and acid reflux keeps getting worse.  I am worried.  I dont want to end up like my parents with diabetes, heart disease and kidney failure and feeling so incapacitated.  I want to grow old in a healthier manner.

I think its easier this time for me because I now know how destructive carbs and wheat are to my body so I have been more determined to change the way I eat.  Its simple logic.  If we know that drugs are bad for us, we stay away from it.  Its the same thing here.  Additionally, if I can prevent OA, diabetes and cancer which are my biggest fears and a host of other diseases, losing weight along the way would be a big bonus for me.  Most importantly, we now know that OA may still exist after TKR due to chronic inflammation.  So if we do not make any changes to our concept of eating and lifestyle, we may still be exposed to it. 

While its hard to change to this concept of eating, its not impossible. When I have a Chinese meal, I do not eat the rice but I eat more of the food from the dishes such as the vegetables, fish, meat, seafood, soup etc. and I actually get more nutrients.  Now I wonder why we ate so much rice when there is no nutrients in it and we eat so much less of the dishes with nutrients in them.  I could still eat a western breakfast of eggs, bacon, and beans by just eliminating the bread. If I have to eat a burger, I just eat it without the bread. I love omelettes so I eat lots of it and just throw in whatever I have in the fridge such as prawns, tuna, tomatoes etc. Nowadays, I have learnt to enjoy having lots of fresh salads in various dressings with grilled salmon, chicken or seafood.  Its a matter of making better choices. You can google low carb recipes and there are so many of them available.  I am also trying out various recipes now and will try to share them with you later on.  More posts to come on this related topic, so stay tune.

So the conclusion is that food matters, it really does!   


"Opt for total wheat replacement instead of total hip or knee replacement"   .... William Davis


Pictures below shows how I looked before and after living low-carb. I had already gained weight in December 2012 and the picture in February 2013 was a wake up call for me.  I prefer to measure by my clothes than weighing.  I have gone down from size 20 to 18 and now I can wear size 16.  Will keep posting pictures here at certain interval so you can see my progress.

December 2012

February 2013



April 2013 - Two months after living low-carb


May 2013 - Three months after living low-carb
  

June 2013 - 4 mths & 20 + lbs lighter


August 2013 - 6 mths & 30+ lbs lighter

Friday, 12 April 2013

2 YEARS POST BTKR

Yes, its been two years since I had my bilateral TKR, 14 April to be exact.  Actually, I have never been so excited about anniversaries but this is a special one for me.  Its so personal, its part of my body and it has given me my life back.  So I try not to take things for granted and be grateful everyday for my pain free knees.  Some people told me that after a few years out of TKR, they have already forgotten about it.  But for me, I still have vivid memories of the events leading up to my surgery and the recovery itself.  Perhaps with all the research that I am doing and the constant observation of my knees, its hard for me to forget.  In fact, I don't want to forget and I want to learn more about it.  I have never been so passionate about anything but this TKR experience has certainly stirred up some serious interest in me.  And looking at the bright side, it has become a blessing for me because I have made some positive changes in my life. 
 

Its interesting that I still experienced improvements in my knees even in the last few months.   In January 2012, I went to Bangkok, Thailand for a holiday and that was about nine months after my bilateral TKR.  At that time, I walked a lot but my knees felt quite stiff and tight.  In Bangkok, the most convenient way to travel is by tut-tuts (see picture on the left). It is a really cool way to travel and we loved it. However, I struggled to climb into the tut-tut because it was quite high and my knees could not bend so much.  So the driver had to stop at the curb by the road side just like the picture shown here so that its easier for me to climb in.  As for getting out of the tut-tut, I had to literally slide myself out on my butt.  It was quite embarrassing actually.

Now fast forward another year in January 2013, I went there again for another holiday and this time, I could feel the difference.  The stiffness was reduced even after the long walks and I could climb in and out of the tut-tut much more easily.  So that was a pleasant surprise for me.  In fact, I was so grateful that I could go shopping for hours everyday that I was there without any pain and that also means that I could go anywhere to enjoy the food and the sights.

The other thing I noticed recently is that I could get out of the back seat of a car much more easily than before.  You see, I have no problem getting out of cars from the front seat because it is much more spacious and I usually drive myself.  However, sometimes when I sit in the back of someone else's car, I always struggled to get out from the car as the space is much more constrained and my knees could not bend as much.  But I noticed recently that it is easier to get out from the back seat because my knees could bend more which means that my range of motion has improved.  Each time an improvement like this took place, my mind will be conscious of it and I will be smiling away as if I am congratulating myself for another milestone achievement.

I also noticed that the clunking sensation (i.e. the friction between metal and plastic) has reduced.  Actually, when I walk, it feels quite natural now in the knees.  Its only when I bend my knees or climb staircase that I could feel the tightness and the clunking.  For a long time after TKR, I did not feel comfortable wearing heels so I would wear flats most of the time.  Now, I feel comfortable wearing a two inch heels but I prefer them to be platform heels instead of stilletos.

Of course, I still have stiffness after prolonged walking, sitting and standing but it has reduced.  I am happy to see this slight improvement because realistically, I know that the stiffness may not completely heal due to damage of muscles and ligaments caused by the progression of OA.  Even the tight band feeling is still there but it has improved.  I have been diligently doing my deep tissue massage on a daily basis and about three times a week, I will practise my improvised method of kneeling and walking as described in my post on Massage for stiffness and tightness.  Since then, I can now kneel on the pad and walk a little back and forth without any support.  I can't do it for very long though as it is painful but I know that it will get better in time.  Already it has helped me to overcome my fears of kneeling especially when I get up from the floor.


On the health front, my regular consumption of green smoothies and alkaline diet (see posts on green smoothies and pH balance) has proven to be very effective.  And I am glad to see quite a lot of interest from readers lately on these two topics.  Overall, I feel so much healthier with more energy and vitality.  My immune system has improved tremendously and as a result, I am saving on medical costs.  These days, I am doing more indoor walking exercises with a DVD program which progresses to light jogging and prancing and some core exercises with light weights.

Recently, I started to go back to Batu Caves for exercise (haven't been there for a few years).  Batu Caves is a sacred place for the Hindus in Malaysia.  It consist of three main caves and a number of smaller ones.  The caves are made of limestone and there is a long staircase of 272 steps to reach the entrance of the cave (see picture on the left).  I went there twice and the first time was about a month ago.  At that time, I could only climb up once and my legs were already wobbly and I was huffing and puffing away. The second time I went there, I did a lot better.  I was able to climb up twice i.e. a total of 544 steps!  Its another milestone achivement for me and you know what? The knees felt great. Actually, before my bilateral TKR, I could also climb up twice but after that, my knees would be so sore, stiff and painful.  The big difference now is that I do not have to take pain killers and use medicated plasters for the knees.  Now my goal is to get fitter and be able to climb up three times, hopefully.  After learning that more activities is okay for the implants (see Exercise post TKR), I do not worry anymore about it while exercising as long as I know that I am not overdoing anything.

Another interesting thing which I did recently was going bowling with my children and their partners and it was so much fun.  It felt good being able to bowl and thereafter, did not have to suffer from stiffness, soreness and pain in the knees.  In fact, I felt so energetic and was standing up most of the time.  My highest score was 114 out of three games which was not  bad considering that I haven't bowled for so many years.  Well, I can certainly see more bowling activities in the future for me.

So after two years, do I have any complaints?  Absolutely not. In fact, I am happy to report that after so long, improvements can still happen.  I believe that its due to being physically active with daily activities,  regular exercise and massage. Would there be more improvements? I don't know but I recently had two similar dreams that I was squatting down all the way and sorting out some books at the bottom of the shelf.  Then I woke up and for a moment, I was confused.  I thought to myself - am I able to squat down all the way now?  Then I realised that it was just a dream.  Is this some kind of a sign?   I really don't know and  I don't expect any miracle to happen soon. Anyway, what's important is that my overall function is not impaired and I am able to lead an active lifestyle   In fact, I feel that this experience with TKR is a blessing for me because I have learnt so much about arthritis, diets and health in general and I will be sharing more on this with you.  So watch out for it!


Bangkok Intl Airport