American doctor = surgery!!!

Okay, so I met up with the good Dr. Shell in NYC. I tell him I'm feeling better, stronger, walking better, etc. "However, Dr. Shell, I just wanted your opinion on an MRI I got on India. The doctor over there said it's a partial tear that can be managed with rehab."

Sure, let's take a look. actually, let's do some physical manipulation first.

Why not? So I lie down on the bench, and he tests my knee. then he tests my right knee. Then he tests my left knee pretty forcefully, yanking and tugging on it. Even I can tell that the left knee has some "give" compared to the good, right knee.

"Yeah, there's definitely some looseness here." says he. Well, sure, I'm thinking, but isn't that more like an 70-80 percent tear?

Then he takes a look at the mri scan. Doesn't spend too much time scanning the scan, as it were. "there's nothing here," he asserts. For a one-hundreth of a second, I grow hopeful thinking he means there's no tear here. But what he means is that there is no ACL here. Damn.

Then he shows me a couple of panels. On one, he says, you would see the ACL right here, but there's nothing. On the other one, he says, "you would see...well, you do see something here, but it's useless, it's not functional."

Case closed. After that, we have a nice chat about my options for surgery. He seems really confident and competent, so part of me is already resigning itself to surgery at the end of June. But, another part of me thinks back fondly to those days of acupuncture needles. Did they really have no effect.

The Indian doctor, Dr. J, did say that the MRI I have in hand shows improvement from a complete tear, and if his system works, he expected 80% to a full healing of the ACL in 6 weeks of physical therapy. According to that timetable, then, I should be doing another MRI at the end of April or early May.

So that's what I'm going to do. Wait out another month. Get another MRI. Show it to another doctor, just to get an opinion that is unbiased from any previous reports. Now, while I feel better, I am nowhere near feeling like I can start running or playing tennis. But in a month, I am hoping to feel more inclined for sporting activity. I think that will be a telling sign, even before the mri.

So I'm going to post (4) weekly updates, until the next MRI report. Cheers to one and all!

NYC Session 1

Columbus Circle, view from Time Warner Building

Quite a change...from Hakkikat Nagar, Delhi to Columbus Circle, Manhattan, from Jatin to Jason. Jason's in his early forties and has a ready smile. The best part is that he's a tennis afficionado like myself. So the second I tell him what I really want to rehab for is to get back on the tennis courts, his interest is peaked and he guarantees me that I'm in the best hands possible for this endeavor. Of course, I don't tell him anything about a possible regeneration on my ACL. Simply, that Dr. Schell in NYC as well as Dr. Jatin in Delhi feel that I should give 6 weeks of rehab a chance before taking stock of my option for reconstructive surgery.

The therapy center is located in the back of Equinox, a high end gym in NYC. It's probably a nationwide chain. Wouldn't surprise me. What does surprise me is that "high end" for a gym still only gets you basement real estate. Of course, the location is prime--Columbus Circle, with the Trump Hotel right across the street and the Mandarin Oriental hotel adjacent. The reason I'm there, other than the fact that the therapy center takes my insurance card, is the easy commute home after I'm done.

I get a new set of exercises to do at home, similar though different. I do them at the PT center as well. My MCL is still problematic and it turns out that my leg isn't quite as straightened as it should be when straight. Ergo, says Jason, the limping walk. So now I really have to concentrate on striking my heel firmly in the ground before continuing with the rest of my stepping procedure. Even without surgery, it's a long road to rehab. But Jason's confident that he might be able to get me back to playing tennis without surgery.

Let's see. He wants me to step out on the court in about a month's time. By then, I'll know one way or another what the situation is--If am am mobile and don't need immediate surgery, or if I am shaky and need surgery by the end of June.

Session 20 - the verdict

A view of Dr. Jatin Chaudhry's Clinic, SHARNAM HEALING

I decided not to take a second MRI today. Told the doctor so. He seemed disappointed. I told him I'd take it in 6 weeks from now, in the US, when the ACL should have become healed and functional. This according to his timeline, of course. He said that's a good idea, send me the results so I can look at them.

Then, the doctor advised me to forego the last needle session! You can imagine that he didn't have to tell me twice. According to him, the body would naturally accomplish in 4 days what the needles would have accomplished in thirty minutes. I'm not going to argue with the calculus, I'm kind of relieved that Dr. JC believes so strongly in the fact that the ligament is doing its healing job now.

So what's the verdict here? The verdict, according to Dr. Chaudhary, is that the healing has accomplished the needful, that the ACL has begun regenerating itself on the femoral joint, and that in six weeks of care and exercise, I should be able to return to sports.

That's a pretty fantastic verdict!

The question is how do I really feel right now? I feel that today is my best day so far, in terms of stability and strength. There is still swelling around the knee, but that has been there unchanged for the last few days. Do I feel sanguine that by six weeks I'll fully functional/recovered? At this point in time, I'm willing to believe. Let's see what happens six weeks from now.

I'll definitely be getting another MRI done at that time, to confirm what exactly is going on in my knee. Of course, by then I'll also have a pretty good feeling as to my walking, running, and sports playing capabilities.

I'm going to update this blog, not daily but frequently, up until that 6 week period is over. By the way, I've added some pics here and in some of the other blogs, so feel free to treasure-hunt, as it were, for some interesting visuals.

I've got to say that I've truly enjoyed working with Dr. Jatin Chaudhry and his amazing staff. Thanks Doc, and thanks Manoj, Lochan, Sashant, Anwar, Urvashi, and Sumit.

Session 19

Arjun Atwal, PGA Professional, got some Sharnam Healing

So one down, one to go. Or, to be more precise, 19 down, one to go.

Today was needles, as was yesterday and as will be tomorrow. Today, I managed to download a program called Osirix on my Mac. This allowed me to view the MRI scans on it. I took my laptop to show the doctor and get his opinion. He was pretty certain that there was practically no ligament attachment on the femur in the first MRI. Hence the "high grade to complete tear." So, in his opinion, the news is good...I've got 40 percent regenerated, and he assures me that by tomorrow, it will be close to 70-80 percent regenerated.

I hope he's right. So I'm going in for yet another MRI, expense be damned, to see if his prediction bears fruit. If it does, that means that surgery should be definitely be avoidable. So let's just say that I'm excited for the second MRI. I just hope that the MRI machine is an open machine...not a tunnel thingy. I'll find out tomorrow.

Well, it's been quite an adventure. Thanks for sticking around! Check in tomorrow for the final verdict on the Delhi treatment.

Session 18 - MRI results

Some squash player got Sharnam Healing

The MRI was an "open MRI," which was a relief. No imaginary tunnel suffocation. So I did the MRI in the morning, and had to return in the evening to get the results and chat with the doctor.

The MRI showed that the part of the ACL joined to the femur had a tear in it. the part joined to the tibia seemed pretty much okay. In the words of the report, "there is a tear of the ACL, near its femoral attachment." There are ligament fibers there, according to Dr. Chaudhry, but it is a weak bond, likely about 40 percent of attachment.

He didn't seem too pleased about this. I guess he was hoping for more. He asked me how many days I had left in Delhi. This being Friday, I told him I'm leaving on Sunday night. Good, he said, that gives us three needle sessions. We'll bring the tear up to 70-80 percent attachment. After which, you'll be able to rest it, and gradually move back into exercise and sports.

Three more days of needles? How nice. I thought I was done. I asked him when the results of the three extra days of needles would show up. He said, by Sunday itself. In fact, why don' t you do another MRI on Sunday afternoon, and we can see the difference before you leave.

Hmmm...Well, I agreed. In for a penny, in for a pound. I figured that might as well give this treatment its due, and what's 3 more days anyway. So he poked me with the needles, I lay down for the requisite 30 minutes, then came home.

Saturday is a morning session, and so is Sunday. Sunday should be interesting, what with needles in the morning and an MRI in the afternoon, and long non-stop flight back to USA in the night.

More importantly, let's see what the scan on Sunday reveals.

Session 17 - winding down

Went in for all the nice things today: Magnet machine, Electromagnet on the knee, exercise, currents, vibrating thingamajig, laser thingamajig. The doctor was away today so the clinic was really empty. There was a relaxed feel to the entire session, and seeing as it is most likely my last one, it was a nice way to wind down my experience at Dr. Jatin Chaudhry's clinic.

My MRI is scheduled for 10 am tomorrow morning. I'm anxious more than anything else. Lack of healing will necessitate surgery in a few months. So there is quite a lot at stake. The MRI technician asked me if I had any previous MRI (I do) and to bring it along so that he could compare the old one with the new one (I said sure).

But then at the clinic later this evening, Manoj told me: Don't tell them you had an MRI, don't show them anything, don't tell them anything about your condition. Let them come up with their MRI report without any help. I said, Uhmm...I already told the technician I do have an MRI and will bring it along. Manoj shook his head. Tell him you were confused, that it was an x-ray, that you know nothing about nothing.

Okay. Sure thing.

So, dear reader, if you've kept up this long, or perchance happened on this entry non-sequentially, then make sure you check out tomorrow's news--I am pretty sure I will have the report and Dr. Chaudhry's prognosis in hand to share with you.

Keeping 'em fingers crossed...

Session 16 - the end is in sight

Okay, today was needles, and I didn't shout. Figured I'd behave well for what's most likely my last needle session.

The doctor told me that I should come in tomorrow just for the regular non-needle treatment, and schedule an MRI for Friday morning, then come and talk to him later that day about the results and the follow up routine.

So, the really unique physiotherapy session in Delhi is almost at an end. I am feeling better than before. There is still swelling around the knee, but part of that must be leftover effusion, patellar bruising from my incident, and also from the torn MCL. The MCL, which was supposed to heal by itself anyhow given a window of 4-12 weeks, is still stiff and is also painful at times. Mild and bearable pain, just kind of the throbbing type.

Well, I remember how skeptical I was when I first heard about Dr. Jatin Chaudhry and his alternative healing method. Having been immersed in his process, it's been hard not to become a believer. It's reached the point where I'd be really shocked if there has been no ACL healing at all. I'd be very disappointed if there hasn't been enough healing to forestall reconstructive surgery. Looks like what I'm expecting is indeed the truly miraculous result of a reconnected ACL without a tear but one that needs 2-3 months more of caring and physical rehab for it to strengthen. That is, of course, the best case scenario for all ACL patients in the clinic. Right now there are 4 of us, and I am the first one up for the MRI scan and confirmation. Wish me luck!

Session 15 - Is there a doctor in the house?

The laser thingamajigs

Well, the doctor was away today, and I really missed not getting my needles. Seriously. All said and done, we know that that is where the magic resides. I didn't get any yesterday, was hoping to get them today, and then have a nice easy day tomorrow as I got greenlighted for the MRI day after.

So now the scenario looks more like go in and get needles tomorrow and hopefully get greenlighted for the MRI for day after.

The clinic was really deserted of its patients today. Perhaps they'd heard the doc was going to be away, I'm glad I went though, as I got my share of magnet machine, Electromagnet for the knee, exercises, accupressure vibrator, current pads, and laser thingamajigs. All nice and civilized, without me having to shout in pain at the sight of those tiny needles. It went off so smoothly that I felt compelled to ask one of the physiotherapists, "Excuse me, sir, would you happen to have any Grey Poupon?" (old silly ad tagline).

On the way back, I felt a tinge of nostalgia for this place and its people. I know my stint isn't over yet, but I realized I enjoyed the bonhomie at the clinic and its easygoing attitude.

There is always gold, if you know how to look.

Session 14

March 7, 2011

Well. this is two weeks up. So how do I feel? I feel much better than two weeks ago. That's for sure. The leg is stronger, the knee seems more stable. Nothing is near 100 percent, so who knows what's going on with the ligament. Only the MRI will reveal that truth.

So I ask the doctor when he thinks I should schedule my MRI. I notice that the first thing he jots down on my action sheet for the day is needles. Great, three days in a row. But, that's where the healing is, so better be happy. He looks up and says let's do a physical test today. Today too? I ask, we did one two days back. So he calls in Manoj and asks him for what the result of that test was. Manoj mutters a number. The doctor nods, seems satisfied and says that things are progressing.

The best part? he strikes out the needles for the day! Then he jots down the other treatment to be done and tells me that we'll do another physical on Wednesday, which would be day 16. Depending on the results of that one, I might be cleared for an MRI on Thursday itself. If not, then a day or two later.

So the moment of truth approaches. Two more days of treament for sure. It's coming up fast. I'm praying my ACL has been healing. I remember the words of the last MRI report, full partial to complete tear of the ACL. Full partial to complete tear of the MCL. I wonder what the next MRI report will disclose.

But there are procedures to be followed in the meanwhile.

Session 13 - a week to go, or less

So this is Sunday, and what have we done...

I went in spright and happy. The sun was out. Looked like winter had finally decided to leave Delhi alone. The sun was warm with an after hint of hot. I went through my routines, and then went towards the doctor's office when my name was called. To my dismay, I saw one of the ACL patients lying down on a bench with a bunch of needles in her finger! What?! I knew for a fact that she had been treated with needles yesterday, just as I had.

Could it be? Could it be a break in the one day on, one day off protocol? I found out very soon that yes, it could indeed be. The doctor even made fun of my whiny attitude towards the needles. I know, I know, no one else seems to mind or at least shout as much as I do. So poked with a bunch of needles in my middle finger this time, I went away to lay down for the prescribed thirty minutes.

Meanwhile, the guy whose turn it was to get his MRI done and bring in his report finally brought it in. He looked happy enough walking in the clinic carrying his MRI film, so I figured the news wasn't all bad. He had a complete tear before he started the treatment. And now? The radiologist said a bunch of things that were summarized by something to effect of "he has a posterior tear in ACL." Whatever that meant. We didn't know. The doctor would elucidate for him and the rest of us.

After the doctor saw the MRI, he said that you've got a thinly repaired ACL which will need care and attention and exercise for 3 months for it to become fully healed and regenerated. Sounded good to all of us. The bottomline was that the first MRI report unequivocally stated "complete tear of the ACL," whereas this one said a bunch of things but nowhere did it say "a complete tear."

So there is hope for the rest of us. Keep focused, keep taking the needles and the rest of the treatment. Then wait and see how much of the ACL seems to have reappeared. I guess each body heals differently, and also that age must be a factor, and I've crossed the four-oh. so let's see where that'll get me.

Right now, chances are pretty good that I will be doing treatment for 18 days (at least), and should most likely be scheduling an MRI for next Saturday. So that next Sunday, I can visit the doctor and get his verdict. Bottomest line: if this entire procedure allows me to get back to sports without surgery, it'll be beyond amazing!

Gotta keep the faith!!!

Session 12 - it's not as bad as before

Vibrating acupressure thingamajigs

At the end of today's session, Manoj did a superquick physical exam on my knee. I think it lasted all of 5 seconds. He flexed my leg and pulled upwards on the shin, the straightened my leg and pulled the shin gently away from the knee. Then he said, "You had a complete tear?" Yes, told him. "It's better than before." Perhaps he said "it's not as bad as before." Anyway, I didn't know how to react. I guess I was hoping for him to say something like, "wow! this is an amazing improvement!" or, "Incredible! I've never seen anything like it! Can I get your autograph?!" or, "It's a miracle! I believe!!!"

As it was, Manoj uttered what he had to utter and walked away without further ado. When I asked for more information, he said he couldn't pull/push hard on the knee so there isn't much more he can say at this point.  I just had to reconcile myself with the fact that hopefully there has been some improvement. What seems certain now is that it will be 18-20 treatments. Which means a whole bunch of needles more.

Speaking of which. today I got needles on the middle finger. They didn't hurt as much as previously. So either I'm getting used to it, or the doc didn't hit those little nerves that really hurt. Likely the latter. If so, this begs the no pain, no gain question. The next round, due on Monday, I'm sure will make up for this little lull. But while I was needled up, They put the vibrating accupressure thingamajigs under my arms, on the side of my torso, and then also gave me the laser treatment. It was like an all out assault, all stations active at once. Felt kind of good, I must say.

Today was Saturday, so it was a day session. I wonder if a day treatment has better energy to it than a night session.

How strongly will the sun be shining on me after day 20?

Session 11

No doctor in the house today--and I didn't have needles scheduled anyway. Just as well, I didn't lose any ground in this recovery process. I did all the other routines from yesterday and, because of the handheld laser machines being only two, and patients needing to be treated by it seeming to be over one million, the process took inordinately long.

Other than that, I'm going to keep this short and simple. Saturday is a morning session. So is Sunday. Tuesday is day 15.

When will my MRI day be?

Session 10 - And the preliminary news is...

The rubber pads and apparatus for electric current therapy

 Nothing.

Well, not nothing as in nothing to be felt or seen on the ACL front, but nothing as in the doctor didn't suggest I do a preliminary manipulation test to see if there was evidence of progress. I didn't suggest such a test either. We did talk about my progress, and he feels confident as always that I'm on the right track. I mentioned I feel a bit better everyday, that the swelling is less but still there, that there is stiffness around the MCL, but all in all, I feel greater stability around the knee area. Good signs, right?

Yup, he concurred. Then he reassured me that the needles' magic makes it so that bones and ligaments have no option than to heal. The needles are irresistible! He mentioned two prominent Indian cricketers (Sreeshanth, Yuvraj) who had hairline fractures that healed in one, yes one, day of needles and treatment. Granted, they were hairline fractures, but they healed in a day. So I guess that's why the unhealable ACL takes an eternity of 15-20 days to heal.

Anyway, day 10 is the day that the healing should be happening in earnest, so I am going to be extra careful these next 5-7 days. I'm anxious for the day he tells me to get the MRI for verification. Another fellow, who is on day 18 today, said he would come back for treatment tomorrow even though he was cleared to get MRI done tomorrow. Why rush, he says, might as well get the MRI on day 20. I guess so. Though I think I won't be that patient when I'm told to get mine done. That' assuming I get the clearance closer to 15 days and not 20 days.


Today, I got the royal treatment. I noticed that one of my quads had lost some size, so I got electric pads applied for some shock therapy. I had those vibrating thingamajig accupressure devices on my sides and on my gut. I had the needles on my forefinger (I never can quite manage to get used to the pain--I shouted and remonstrated at the universe all over again). And of course, there were those magnetic things too.

I haven't mentioned the best part of my experience here--I am at home with my parents and they're really pampering me as if I were an invalid. Oh wait, I kind of am. Oh well. Anyway, it's great to be looked after while all this is going on. Thanks mom, thanks dad.

So, day 11 (no needles), day 12 (needles), day 13 (no needles), day 14 (needles), day 15 (no needles).

Who knows how many total needles await in my future...

Session 9

March 2, 2011

Well, tomorrow is the day that I might have to do my first test to see if there is any semblance of an ACL in my knee. Today wasn't a needle day, except for one in each leg. However, the doctor did wrap up my ring finger, the one that was last pierced, with a sprinkling of fenugreek seeds and told me to keep the bandage on for 24 hours. All the better to season it for the needles. He didn't actually say that, but that is what I thought for sure.

Other than that, I was given a new thingamajig treatment. Two accupressure vibrating machines were held to my torso for about 10 minutes. I'm guessing that they're for stimulating my nerves or my energy flow or chi or something. The good thing about this treatment is that you don't think, don't ask, you just do. Kind of takes the pressure off.

Just do and believe.

The doc did ask me how I'm feeling today, to which I replied with the usual "feel a bit stronger, but am doing zero movement and exercise as directed." I also added that straightening my leg has been feeling better every day, so that today was my best day with a straight leg. That's a good sign for the ACl, said he. I sure hope so.

I marvel at the small clinic, the number of patients, at how patient the assistants/physiotherapists are, at the great work Dr. Jatin Chaudhary does, at the fact that the pricing is so reasonable even by Indian standards. I marvel at this and much more. This place seems disorganized and chaos, but it functions because everyone checks their ego at the door. And the staff is hugely responsible for this. They are always cheerful and polite. caring and respectful. Hats off to them.

Come to think of it, a physiotherapist is a pretty cool job to have. You help people get better, see tangible results quite soon and under your supervision, and generally don't have to deal with any blood and gore the way a physician has to. Not bad, eh?

Anyway, the doctor's the man, especially if he can regenerate ACLs. Let's see. Day 10 is tomorrow, and soon, there will be no more suspense.

Sometimes suspense gives greater comfort than imminent revelation.

Session 8 -- it's too early to tell, but soon

So I walk in with the biggest of grins into the doctor's office. What's the big smile for? he asks. Isn't it needles today? Yes, it is, I confirm. The big smile is to mask my palpable sense of fear. He asks me how I'm doing. I tell him I'm fine, as far as I can tell from not walking or going anywhere and staying put in the house as much as possible for as long as possible. I think it's stronger. The swelling is still there, but when I tighten my leg in full extension, it doesn't look too bad compared to the right knee and right leg. Now remember, the right knee is scarred from ACL resconstruction 17 years ago. So basically, you're looking at two pretty shoddy knees, all said and done.

What day of treatment is this, he asks as he consults the file. I say, day 8 today. Too early to do a strength test to see if you've started rebuilding the ACL. We'll have to wait for at least 10 days. Day after tomorrow? I ask, somewhat excited, incredulous, anxious, hopeful yet not wanting to hope too much. Yes, he replies, before 10 days there's no point. Cool. And now, why don't you just bring on the needles and pain.

The entrance to Sharnam Clinic, up one flight

And he does. This time, the rotation of fingers takes me back to the ring finger on the left hand (it's always on the left hand). I think he puts only about 8-10, of which 3 hurt a lot. For all the others, I whinge and whine expecting a lot of pain. When there is actually a painful sensation, I make sounds of resentment, like, "whAAAT THE F@*#&!!! Then I apologize. Then when it's over, I say thanks and sheepishly head out of his office.

Well, Thursday or Friday might prove to be interesting. I'll get a sense of whether anything is having an effect or what. I am walking a bit straighter now, following Lochan's advice on how to walk. But since I'm not really walking anywhere, it's hard to say if I've gotten over my fear of ACL absence which forced me to limp in the first place. Anyway, like I said earlier, this is a patience game and as such, it's not even that bad a wait. 15-20 days to heal the ACL is pretty ridiculous or amazing, or both, or neither if it doesn't heal at all.

Time reveals all mysteries but waits for no one.