Sanno Hospital and an ode to living

First and foremost, I want to give a thousand praises to the staff at Sanno Hospital in Tokyo, where I have now visited for two separate medical cases and received superior medical care. With this being my 4th year of residence in Japan, regular conversation and day-to-day tasks present very few communication barriers thanks to a LOT of independent study and continual effort. However, being sick or injured is a stressful experience in itself, and trying to communicate one's medical issues in a foreign language or understand specialized medical language can be daunting at the best of times. An acquaintance recommended Sanno Hospital, as her company has a lot of expatriate workers and this is where they are recommended to visit for their health care requirements because the hospital takes national health insurance and there are a number of English-speaking staff. From the moment I walked in the door, I was introduced to the Ritz Carlton of hospitals, and will no doubt find it difficult to go to a "regular" hospital again. (^^)

As an update to my life, I've been very sick once, last fall, and I was injured while skiing last month. Here are the gory details:

In late October I developed a severe lymph node infection in my neck, and my lymph node became red and swelled almost to the size of a golf ball. I went to a local clinic to see an internal medicine doctor, who proceeded to speak to me in rapid and difficult Japanese. He started using words such as 'cancer' (without having even taken a blood sample!) and 'hospital stay' without having even given a physical examination. Needless to say, I was very put off and required a bit more TLC in a second opinion.

As soon as I walked in the door that Saturday morning, I wondered if I had wandered into a hotel lobby-- the decor includes stuffed chairs (even in the waiting areas!), soft lighting, a grand piano, and numerous plants. No loudspeaker announcements or people running about madly. When I filled out my registration form and handed it in, the head nurse on duty saw my neck and wasn't sure if I shouldn't instead go to the dermatologist. She came to speak to me, bringing a very polite interpreter along so that we could all understand one another-- although I could understand her Japanese with no problems as she spoke TO me without being patronizing or using a lot of medical terminology. As dermatology requires appointments on Saturdays, she immediately made me an appointment to be attended after I had seen the internal medicine doctor.

The internal medicine doctor, as it turns out, lived in Wisconsin, in the US, for 15 years. In fact, she had travelled throughout the US and had a homestay family near where I grew up. She agreed with the head nurse's assessment that I would need to go to dermatology because, as she said, dermatology deals more with the neck area and there are a lot of important things there. I was sent for lab work and a CT scan to determine what the mass was made of, and then on to dermatology.

As it turns out, I had a white blood count of 7.3. Normal is 1-4, and had I been at 10 I would have been immediately hospitalized as that indicates a raging infection. The dermatologist assessed the CT scan, and before her 2 other doctors had assessed the scan and they all agreed that the lump could be drained and exactly where the cut could be made. The dermatologist echoed my other doctor's observation that "the neck has a lot of important things", so I didn't mind that they were being cautious and thorough in their work.

Draining was a minor surgical procedure for which I received local anaesthetic, but I've never experienced pain that intense in my life. The draining involved pressing on the incision to catch the fluids which had built up, and with the first pressing I could actually **hear** the wound draining. I have to say the dermatologist and the nurse were quite shocked, as was I when she showed me the first set of gauze used. 6 times she pressed, and after the 3rd time I was hoping the floor would open up and swallow me whole. I literally shook for 10 minutes after she had finished from shock. I was cleaned and dressed, given antibiotics, and instructed to visit again on Monday for follow-up care.

Monday brought a second surgical incision and more draining (which only hurt a little bit), along with IV antibiotics and having my wound packed with gauze. Because the wound hadn't been packed on Saturday, more infection had gathered. However, she hadn't wanted to pack on Saturday as the dressing needed daily changing and it would be almost 48 hours. Thus, I ended up going every day that entire week for cleaning care and IV antibiotics. But the drugs worked, finally, and a follow-up blood test revealed my white blood count had gone back to normal. I was released for at-home care to my incisions (cleaning and dressing)

Still, though, it took around 2 more weeks for the incision to heal enough that it didn't require covering. Which was a good thing, as I also developed contact dermatitis from the tape and gauze and had to deal with not scratching. In fact, I wondered if I shouldn't wear one of those lampshades they put on dogs at the vet to prevent them from scratching their faces when they've got facial lacerations etc.

I've got a bit of scarring on my neck, and there is some redness present still. But I'm cancer-free, and infection-free, and I can live with the scarring no problem.

So on to the exciting part-- my dramatic skiing accident.

I went skiing last month at Hakuba, where some of the Winter Olympic events were held in 1998. I was getting ready to turn, to bring my speed down, when somehow I caught my left ski. My leg was immobilized whilst my body continued to hurl forward. My leg straightened, then there was a big 'pop' in my left knee, followed by a dramatic somersaulting finish. When the 'pop' happened, I thought to myself, 'oh lordy, here we go...', as I flew through the air. I landed with my left ski vertical in the air (my boot hadn't popped out of the ski, which is kind of interesting actually), right ski strewn beneath me. I lay on my back and waited for the severe pain to start, which, thankfully, didn't. Apparently my crash was dramatic enough that another foreigner skiing stopped to ask if I was all right, and could I get up or did I need assistance. He was kind enough to side step up the mountain to retrieve my poles so I could use them to get up.

Having done research on knee injuries, I realized that a 'pop' often meant a torn ligament, but, miraculously, I had no pain and could put weight on my leg. Turning was out of the question, so I slid my way down to the rest house, around 50 meters down the hill. I took off my skis and went inside, and just sat for a bit with a bowl of ramen (it was around 1pm and I was about to stop for lunch anyway) and a coffee to warm up. There was a beginners run which led to the base, so I took my time and got myself down to the base and on the shuttle bus back to my accommodation.

I knew I needed a doctor, even though I could gimp along. I've sprained my knee before, but this was much different. I made it home from Nagano on a Monday, and returned to Sanno Hospital on Wednesday morning to see an orthopedics doctor. She was in immediate agreement that ACL damage was a highly suspect result of the 'pop', and sent me to x-ray to confirm that I hadn't broken any bones. Everything was intact, so I was scheduled for an MRI on Saturday afternoon-- there is only 1 machine, and I wasn't a priority case, so this was literally the first open time slot available.

The MRI was an interesting experience. I had to remove all the metal objects from my body-- even a forgotten bobby pin can break this expensive, expensive machine-- and lay absolutely still for 30 minutes, or the image would be damaged and they would have to redo some or all of the work. Even with the headphones on, I could hear the various noises of the machine as it did its work. Image processing took 2-3 days (again, I wasn't a priority case so join the queue no problem), and I was back the next Wednesday for the result.

The image was really, really cool! It's a 3D picture that the doctor can turn left, right, up, down... she had a knee model and explained what I was seeing on the screen.

Sure enough, I have a torn ACL. Unlike other parts of the body, ACLs can't repair themselves, nor can they be repaired in most cases even with the advancement of medicine, so fixing the problem completely requires reconstructive surgery.

However, the doctor is not definitely recommending surgery in my case. I had a knee injury in high school which was diagnosed as a sprain, but no images were taken. So she isn't sure if all the damage is new, or if I have been functioning with some damage for over 10 years. There is no way to tell new damage from old from the MRI, or any other procedure (yes, I did ask but already suspected this). Also, right now, a major problem is that the muscles around my knee are stiff and weak. ACL reconstruction surgery rehabilitation is a long and tedious process, and definitely not for the weak at heart. So, at this point, to have surgery would mean that trying to complete the rehab with weakened muscles would complicate matters further. So I have been given at-home rehabilitation to do, and I also have a knee brace which I am wearing for support. Thus far the rehabilitation seems to be doing some good. Even after the first day I noticed a definite improvement in my walking, and I most certainly wasn't as stiff. However, if I start experiencing pain, or another bad pop, or have instability, then surgery becomes more of a requirement.

I'm quite lucky. I haven't had a lot of pain, and I do have to be careful not to overdo physical activity. I am slowly improving, and I know that recovery will take time. Staying positive is important in any illness or injury, and I am thankful that my accident wasn't worse. I could have easily broken my leg, requiring pins and plates, or landed wrong and ended up sitting for the rest of my life. I am walking, and will no doubt eventually regain more and more functionality. This may mean that I can't take part in contact sports such as rugby, but then again I hadn't joined the rugby squad before I got hurt and was getting on okay, so I can continue to do so. I am not sure if I can take part in kendo again due to the force placed on the left leg, and chances are arts such as judo or karate are out, but there are other things I CAN do. Bicycling is good as it isn't placing weight on my leg, and surely swimming will also be good, as will diving.

My friend once pointed out that mountain climbers and hikers have a saying, "The mountain will be there tomorrow. The question is, will you?" I sincerely hope to ski again someday, but I know that this season is over because the chances of reinjury are just too high still. On the other hand, since skiing is a high impact sport on knees, if this means that my days on the slopes are done, then I will accept this truth and get on with things. Meanwhile, though, I can count my blessings and prepare for the next adventure in my life : a working holiday in Australia. But more on that later!