23 Mar 2008
MRI or Multiple Resonance Imaging is a relatively recent development in medical scan devices. Though costlier than the other options, it is prefered because of the high level of detail achieved and also because there is no radiation involved which makes it safer than X-Rays and CT scans. There are complex principles of physics and maths in the background; nevertheless we can make an attempt to understand how an MRI works in simple terms.
Our body has water. Water is composed of hydrogen and oxygen. The nucleus of hydrogen is nothing but a proton.
First the scanner produces a strong magnetic field bringing all such protons to a state of alignment like a platoon of soldiers under command by a general. Next, the protons are showered with radio waves Many of the protons absorb the radio waves and lose alignment with the magnetic field. It's like circulating a boxes of chocolates through the platoon at attention. Some of the soldiers will run after the chocolates. But soon the magnetic field general growls order order and the errant protons snap back to their erstwhile positions. The cycle repeats. This falling out of alignment and snapping back produces a magnetic signal which can be tapped and mapped into an image.
The MRI section is two floors below the ground. We were late by about twenty minutes, thanks to Bangalore traffic, and I had to wait for about an hour to get another MRI slot. The lady behind the counter said MRI gets over in half an hour if the patient cooperates. One has to keep still, without a movement of the area under scan. I guess the person who went in before me did not realize this.
When my turn came, the attenders ushered me into a changing room with a pair of hospital clothes -- shirt and pajama with purple stripes. I chanced to bump into a radiologist and he told me I needn't change as far as whatever I was wearing had no metallic component. The magnet of the scanner is powerful enough to pull out anything metallic and it could ruin the scan. In fact if there are metal implants inside the body, MRI is not advised.
They made me lie down on a stretcher with a support bracket for the right knee. The arms of the bracket converged to hold the knee in place. Soon I was facing the long, deep tube of the scanner with an opening like a front loading washing machine door. The stretcher went in slowly, feet first, till only my head was outside and I could just read the buttons and symbols on the scanner.
One of the doctors had put a headphone over my ears to mute the machine noises during the scan with film music. I did not have to wait long to appreciate the step. The scanner roared and thudded for half an hour like a jet taking off and if it hadn't been for the headphone, I would have gone deaf. I watched the lightning bolt symbol (like Harry Potter's) on the machine glow on and off and other readings change though I couldn't make out much. All the while, as instructed by the doctor I kept my leg still. It was difficult with the racy music though. Chaiyan chaiyan from Dil Se is beaty enough to make a corpse get up and start jigging. So is muqabla muqabla featuring the boneless Prabhu Deva. It was hard but I managed to keep a still leg and cooperate; the scan got over in twenty five minutes, though I would have to wait for a couple of days before the processing of image and preparation of report.
The scan happened on Thursday. I visited the doctor on Saturday with the MRI report and strips upon strips of negative like images of the knee, in four sheets.
Good news! There is no damage to the ligament and hence no immediate need of any surgery. The meniscus has a tear which should heal naturally. I can resume normal life though without stressing the knee too much. I need to walk and climb steps slowly and wear a knee cap while going out. There is a simple raising-and-lowering-the-leg exercise to be done daily. However no running and no playing :-( till one month at the end of which Dr. Ramanna will examine the knee again.
18 Mar 2008
I have been getting a lot of "Kya Hua" queries in the past couple of days from friends and well wishers about how it happened. So for the benefit of everyone I am posting this blog (borelog) about the injury to my right knee.
How did it happen?
We were having a project party at a resort on Friday and were playing a cricket match with a cricket bat and tennis ball. The whole world does that. However the fact that we were playing on a tennis court coupled with a decade old hairline crack (which incidentally was during another game of cricket) at the knee joint made all the difference.
I was playing rather well, having hit three glorious fours on the off (there was no legside anyway), but I was also playing with the last man and we were in the last couple of overs in our allotted ten. I placed the ball and scampered for a risky single. A very risky single. At the non-striker's end, I slipped but did not fall; the momentum of the arrested fall hammered my knee. I knew something was wrong but had no idea of the extent. There was no need to bat any further as my partner was run out at the striker's end.
I kept wickets while the opposition batted, gloving one catch and letting two slip by. I am more of a bowler than a batsman and that hurt more than my knee as the other team murdered our bowling in cold blood. They won with a few overs (out of ten) to spare.
For the next game I remained a spectator. After that we adjourned to other safe games like housie (I won bottom line!), carrom, snooker. Even ludo, snakes and ladder. I am not joking. They have these big boards of ludo for adults. We pay to play what was freely available as children.
I indulged in a round of carrom, all the while aware of the unusual sensation in the knee though the absence of any excruciating pain made me feel nothing was serious. Finally we had a good dinner and we drove back. I could drive without any problem and dropped a carload of folks in our office parking lot, before returning home.
That night, I could bend and flex the knee and slept a happy man, fully aware that by morning, all unusual sensations would be history.
The Morning After
There was no pain in the morning, just a hint of swelling. I had no clue then that the swelling was because of blood pooling into the knee joint. The swelling went up with the sun and kept going up even when the sun started going down. Khatra.
For twelve long years after the hairline crack in college during the 96 cricket world cup (which I watched with one leg straight, in braces), I have had this fear hiding in some cupboard of my mind that the right knee carried a ghost of the crack which would return to haunt some day.
So we ran to Manipal hospital at about 4 PM on Saturday.
Welcome to Manipal
Manipal is a well managed hospital with the latest facilities, yet affordable to the common man. First timers get a membership card with important tel nos and a hospital no. The card needs to be produced on subsequent visits.
Fortunately the orthopedics section was on the ground floor only. The reception cum waiting room is spacious with cushioned seats and a TV. A poster on the wall deconstructs the Greek "Orthopedic" as Ortho (straight) + paedos (child).
We did not have to wait long before the fair skinned Dr. Ramanna, the head of Orthopedics summoned us for consultation. The sexagenarian (I guess) was gentle and calm like all experienced doctors. Having spent so many years with Orthopedics, a patient for him might be no more than a framework of bones with skin draped over. He asked me to describe the problem and even smiled when I mentioned cricket. After examining the knee, he said the swelling was because of some fluid, maybe blood. I was advised to take an x-ray and return in about half an hour.
The x-ray room is in the basement which has many corridors and rooms though bold signs with arrows ensure that you do not get lost. The x-rays took five minutes to shoot and half an hour to develop. We grabbed a cup of tea before returning to Orthopedics with a couple of impressive negatives of the knee.
Dr. Ramanna examined the x-ray films against the white-lit monitor. There was no damage to the bone. Thank God. However there could be ligament damage. They would first suck out the fluid with a syringe and then perform an MRI (at a later date) to determine the extent and nature of damage. I would have to wear a knee brace in the intervening period. I asked if ligaments heal naturally or require surgery. Dr. Ramanna said some of the ligaments heal themselves but there is one which is like a rubber band. He did not need to say anything further for I could see a thick band snapping in the knee. Tak!
I was then moved to a bed in the adjacent room where the junior doctors took over. They explained the simple procedure: shave the knee, administer the local anesthetic, remove blood with syringe, dress with bandage. The junior doctor added that there would be "bearable pain". I thought any pain is bearable as long as it is not happening to you. To my question about pain despite the anesthetic, he said the anesthetic’s effect is only skin deep. Once the syringe touches the pericardium (hope I got it right), there would be pain. Hence in a philosophical way, beauty is an anesthetic, maybe that's why it is intoxicating.
Anyway, the sucking syringe made three trips to retrieve 50 ml of blood from the knee. It hurt the first time and I chanted Gayatri Mantra to overcome the pain. It helps.
They dressed the knee in a layer of gauze and doubled it up with crepe bandage. Finally they strapped a brace over the knee. The brace offers soft padding to the back of the knee while keeping the leg straight. There are touch fasteners (Velcro is only a company), a couple each above and below on the thigh and shins. The central part is a stretchable fabric which covers and holds the knee cap. Ironically, with slight adjustment, a knee brace can be used as a leg pad that cricket batsmen wear.
I started to get down from the bed but the nurse motioned me to stay still. She said they would provide me with a wheelchair. I said I could walk but apparently I could do so inside my house. Given the distance till the entrance of the hospital, walking wasn't an option.
We were soon on our way with the ward boy wheeling me away while everyone around stared. Maybe people stare less when Sachin walks out to bat, I thought. I wondered what was so odd about a guy in a wheelchair. What else do you expect in a hospital. Ballet dancers skating out smoothly?
We were lucky to get an autorickshaw at the portico though it was raining heavily. The return journey with a straight leg squeezed inside a dripping auto was fun but more about that later. The MRI scan is on Thursday when we will get a clearer picture of what happens beyond. Stay tuned for further updates.