ON HIS FEET AGAIN
Sporting brand new titanium knees, Erap proves that despite having fallen from power, being imprisoned, having suffered from bum knees and back troubles, and losing his best friend, he can still manage to get.
Michelle B. Ciriacruz
Medical Writer
On the grounds of his rest house in Tanay, Rizal, former president Joseph Estrada now walks taller (by half an inch) and brighter. Between breakfast and bedtime, he spends much of his time gardening, doing light exercises, praying, and reading the Bible, which are pretty much the only things he could do under house arrest.
But just last year, he was walking like a duck, waddling, bowlegged, because his knees were bearing the brunt of years of being arthritic. The bones of his knees were grinding together; the tissues around them inflamed.
His personal physician and medical director of the San Juan Medical Center had to inject steroid and anesthetics into the actual knee joints--at the same time, prescribe analgesics for an enhanced effect--to bring at least two days of relief from pain.
His back was also troubling him greatly. He had several slipped discs at the lumbar level. And according to Dr. Lorenzo Hocson, Estrada's gait, which was "very bad," did not help any with this problem, serving to exacerbate the pain.
The lower-back pain and the pain from arthritic knees combined to give birth to a different kind of pain.
He requested the Sandiganbayan for permission to go to Hong Kong for knee-replacement surgery for both knees.
But his action resulted in inflicting pain on a more grand scale level, inflaming several nerve endings in the body politic of the nation.
Ripples of anxiety washed over many who feared he would use it as an opportunity to walk away from legal and political entanglements, acquired primarily from two-and-a-half years of presidency.
Of course, when he came back on January 15, the deadline set by the Sandiganbayan, spurning further requests for an extended stay in Hong Kong, he walked all over these concerns--which either reassured these anxious people mightily or dashed their hopes for a vindication of their warnings--on brand new titanium knees courtesy of orthopedic surgeons Julian Chang and Christopher Mow.
Knee-deep in pain
On December 26, Estrada left for Hong Kong for surgery at the Hong Kong Adventist Hospital. Prior to this, of course, the outcry was deafening and the objections were vehement.
This was, perhaps, not surprising for someone like Estrada, who probably never had a scarcity of drama in his entire life, who was an action man all the way from being an actor, to mayor, to senator, to vice president, to president, and finally to political prisoner--at least, this is the image that most people have of him.
However, in this case, he could not just take in stride the opposition, because, literally, he could not.
He was knee-deep in osteoarthritis, a degenerative joint disease that attacks men and women equally, but men earlier because, very likely, of their more physically strenuous lifestyles.
Hocson surmises that Estrada's knee and back problems could have originated in injuries sustained playing basketball and performing stunts during his younger years.
"The osteoarthritis--we all feel started from what we call traumatic arthritis…due to injury," he shares. He explains that it has been observed that most athletes or those who suffered from physical injuries are more prone to develop osteoarthritis earlier than those who have not been as physically active.
He was still a senator when the condition started to manifest but it was only during the campaign for the vice presidency that it got bad, recalls Hocson.
And then for two years at Veterans Memorial Medical Center, where he was held following his impeachment in 2001, Estrada was not able to walk around much, not being allowed to, leading to much weight gain.
The inactivity weakened his muscles, and the added weight meant more pressure on the joints.
When Estrada was at Asian Hospital and Medical Center in October 2003, he was treated with a series of pelvic traction, a procedure in which the patient is made to lie down and a machine pulls the lower half of the body while the upper half is stable.
"The purpose of this was to lessen the pressure on the vertebral bodies," explains Hocson. The lower-back pain was lessened "markedly," he reports.
Bionic knees
Regretfully, in all the rush and with all the pressure, they weren't able to take pictures of or videotape the operation at all. At the very least, it could have served as proof that the knees were really as bad as Estrada maintained.
"We forgot," Hocson says ruefully, "with all the problems that came up prior to the operation."
Hocson was present during the operation on December 31 and he saw how there was practically no cartilage at all about the knee joints. "The bone should be smooth [but] his bones were already scratched, like you filed [them] with sandpaper," he reports.
When Chang opened up the right knee, close to 100 cubic centimeters of synovial fluid came out, and the tissues around had to be removed "because they were already useless."
The Hong Kong Adventist Hospital-based surgeon had to take over from Mow, an American based in Stanford University Medical Center in Palo Alto, California, when Mow failed to secure a working permit from the Hong Kong Medical Council in time for the scheduled surgery.
Anyway, the three-and-a-half hour operation went smoothly. Bone and cartilage at the end of the thighbones and top of shinbones were removed and titanium implants were cemented into place to function as the new knee joints.
If he had not had this surgery, Estrada risked not being able to walk for the rest of his life.
Why Hong Kong?
This was the one of the top questions in everyone's mind last December, probably second only to whether he was going to run as soon as he could. Most people jumped to conclusions, earning the ire of many of our medical professionals here as well.
But stresses Hocson: "The expertise of our Filipino orthopedic surgeons was never a question."
But he qualifies: "Wouldn't you rather be operated on by a doctor that you have confidence in…you know…has treated you for two to three years?"
And that doctor was Mow, whom Estrada has known since 1998.
Another consideration, Hocson revealed, was the history of two of Estrada's acquaintances--"I won't mention names"--that had the same bum knees as his, got operated on here, but were not able to walk for a year following surgery.
A few months after surgery, one had to be flown to New York City for another operation. "You know, that made him (Estrada) think," shrugs Hocson.
Mow could have operated here, yes, Hocson confirms. But Mow himself was apprehensive about doing so, having been advised by the United States State Department that he could be arrested here if he refused Sandiganbayan's orders to testify regarding Estrada's medical condition and treatment.
Walking on
Estrada was supposed to leave on the 19th but deferred his departure so he could attend the funeral of his best friend Fernando Poe Jr., whose death he took very badly.
Hocson, family, and friends were concerned that his emotional suffering might affect the outcome of the medical tests and surgery later. They talked to him but Estrada was determined. Hocson quotes Estrada: "I also had to think of myself. I have to get better to be able to continue and pursue what my good friend has started."
Hocson agrees. That was the chance he was given, he points out, "which [Estrada] has been wanting…been postponing for a number of years."
On January 15, Estrada came back to the country as intended. He was accompanied by physical-rehabilitation specialist Cheung Yu Kar, who stayed for a week to instruct a local therapist on what stretching and muscle strengthening exercises Estrada should do.
Hocson says Estrada still walks with a limp--when he forgets he doesn't need to now. "He got used to it. It became a habit--even if there's no more pain," observes Hocson.
There's this slight movement to the right when he walks, clarifies Hocson.
But, he notes, "every time he's reminded of it, he walks straight."
An Erap Time Line
PRESIDENT TO PRISONER TO PATIENT
1998
Stanford University-based surgeon Christopher Mow examines Estrada for the first time; recommends knee-replacement surgery
June
Estrada tells Asiaweek he is quitting smoking before he assumes office
June 30
Starts term as president. Scheduled knee-replacement operation postponed several times
2000
October
Ilocos Sur governor Luis "Chavit" Singson exposes Estrada's link to jueteng
November
House of Representatives impeaches Estrada
December 4
Senate starts trial
2001
January 17
Senate votes 11-10 against opening envelope containing reportedly incriminating evidence
People start gathering at the EDSA shrine
January 19
Protest mounts; Estrada promises to step down in May
January 20
Estrada and family leave Malacañang
Supreme Court declares presidency vacant; swears in Gloria Arroyo
April 25
Arrested with son Jinggoy, detained at Camp Crame
May 11
Detained at Veterans Memorial Medical Center
May 21
Estrada reported to suffer from emphysema, chronic bronchitis, and arthritic pains in both knees and right shoulder; ordered to quit smoking
June
Mow examines Estrada's knees at Veterans Hospital; Estrada expresses interest to undergo knee-replacement surgery in the United States
June 27
Trial starts
November 5
Mow writes Justice officials that Estrada needs to undergo knee-replacement surgery "before excessive damage occurs"
November
Requests a three-day leave to undergo cataract surgery
December
Cataract in left eye extracted at Asian Eye Institute
2002
January
Cataract in right eye extracted at Asian Eye Institute
2003
October 16
Moves to Camp Capinpin, Tanay, Rizal
October 27
Undergoes MRI and CAT scan at Makati Medical Center; undergoes pelvic traction at Asian Hospital
December 23
Given a three-month travel permit for "humanitarian consideration"
2004
March
Withdraws travel request; requests instead to be treated at Cardinal Santos Medical Center or Asian Hospital, under Dr. Tyrone Reyes
April
Requests that physical-therapy equipment be set up in his villa, for weekly therapy
July 12
Sandiganbayan grants request to stay at his villa in Tanay, Rizal
December 14
"Devastated" by the death of best friend Fernando Poe Jr.
December 23
Sandiganbayan grants Estrada's request to undergo knee-replacement surgery in Hong Kong
December 26
Leaves for Hong Kong with family, close friends, and police escorts
December 30
Surgery postponed, when US-based Mow fails to secure permit to conduct surgery from Hong Kong medical authorities
December 31
Surgery pushes through at Hong Kong Adventist Hospital, but with Hong Kong-based Dr. Julian Chang
2005
January 15
Estrada returns, is immediately flown to Tanay
February 8
Rushed to Cardinal Santos Medical Center because of pneumonia
February 11
Returns to Tanay
February 18
Returns to Cardinal Santos Medical Center for check-up
J. P. de Guzman
A MEDICAL OBSERVER exclusive
A humbled Erap turns spiritual
Because of everything that has happened since 2001, did you ever perceive yourself as suffering or being persecuted?
Yes. It is not only a perception but reality. A case in point is the plunder case that they filed against me. After 77 witnesses and voluminous documents, the prosecution failed to prove their case. In fact, buoyed up by this confidence, I asked my lawyers to file a motion to [dismiss based on] demurrer to evidence, meaning that I am willing to have the case submitted for resolution by the Sandiganbayan based only on the evidence of the prosecution. These would have abbreviated the proceedings of the case significantly, but the prosecution objected and the Sandiganbayan denied my motion. Do they want me incarcerated forever despite my innocence?
Did you ever feel depressed after you left Malacañang?
Yes. When I left Malacañang, I left with the presidency. I left because I wanted to avoid bloodshed, but this was used by my detractors as a justification to grab the presidency. Now we know that after five years, the power-grabbers cannot lead this government. They led this country to extreme poverty and corruption. With such a sorry state of the country and its people, who would not feel depressed?
What did you do to cope with it?
I went to God. And thanks to Him, I'm stronger physically.
Did you ever feel betrayed by your friends? If so, how did you deal with it?
Yes. But if God can forgive, why not me?
How did the death of FPJ affect you? How did you cope with it?
I was so devastated with the death of a dear friend. He was more than family to me. The only way to cope with it is to pick up the cudgels for him. As I promised as he laid in his casket, I will continue his fight and continue to light up the torch that will alleviate the Filipino masses from the oppression of those who stole the presidency from me and those who cheated him of the presidency.
How is your intimate relation with Loi, now that your knees are working fine and your back pain not as bad as before?
Better than ever!
Please describe a typical day at your rest house in Tanay.
I start the day with my prayers. After my morning amenities, I visit and tend my vegetable and flower gardens. After lunch, I do my rehabilitation exercises. In the evening I read the Scriptures. I keep on conversing with God and I place all my trust and faith in Him.
How do you cope with all the adversities you are now facing?
Because of my renewed relationship with God.
Where do you get your strength? Whom do you share your troubles with?
Spiritual strength from God. Physical strength from my daily workouts and support and inspiration from my loved ones.
Describe your spiritual life. Are you still able to go to church?
I cannot leave my detention area thus, much as I want to, I cannot go to church. My spiritual life is a work in progress. Every day God showers me with spiritual and material blessings.
What is your outlook for yourself? Your family? Your country?
I believe that in due time, I will be a free man. The people and the court will confirm in unison my innocence.
The masses have spoken--they have elected my wife, my son as senators, and the two of them are continuing with the programs which I started especially those that give preferential option to the poor.
As to the outlook for the country, as long as the power-grabbers are lording it over, the Filipino masses will continue to wallow in poverty. I just pray to God that He will soon unleash His might to correct the situation.
I have received enormous blessings from the Lord. Whatever years remain in my life, I shall dedicate it to the service of God and country.
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