Wednesday, April 24, 2013

The Guy That's Going to Cut My Leg Off

Collegiate Lumberjack Ryan Farr of Alabama

You probably already know collegiate lumberjack Ryan Farr.  He dominated the the Stihl Timbersports Series.  The man is a legend.  And while Ryan could handily remove my leg in just shy of two seconds, we've regrettably decided to go in a different direction.  

I'm sorry, Ryan.  We won't be using my leg in this year's Hot Saw competition.

Enter plastic surgeon Dr. Christopher Attinger.  Yesterday morning Brooke and I met with Chris and his team at the Georgetown University Hospital's Center for Wound Healing.  I went over the last three years of surgeries and explained my current pain situation.  After I finished telling my story, Dr. Attinger nodded his head and said he 100% agreed with my decision to amputate.  In his words, I gave it the "good ol' American try."  He went on the say that today's surgical culture continues to place too much emphasis on salvage without considering its impact to function.  What's the point of saving a foot if you can't use it?  

I was swooned.  

Dr. Attinger has developed a specialized below-knee amputation technique over the last few years based on the Ertl procedure.

The Ertl procedure is a below knee amputation technique where a bone bridge is formed between the tibia and fibula after the leg has been amputated.  The surgeon amputes the leg and uses a portion of the fibula from the amputated leg to create a bridge, as you can see in the image above.  The Ertl procedure is used almost exclusively on returning veterans with traumatic injuries below the knee.  According to Dr. Attinger, the bridge makes it easier to apply torque to your prosthetic and creates a strong foundation in the residual limb to bear weight.

Dr. Attinger explained how he dissects the calf muscle and attaches them to the front of the tibia.  This allows what's left of the calf muscle to continue acting like a pump for the blood flowing through the limb.  Immediately following the amputation, this technique reduces edema and swelling.  That helps reduce the pain.  The longer term benefit is a dramatic reduction of the risk of atrophy, bone loss, and bone brittleness in the residual limb.

Given a target date of mid-June for the amputation, Dr. Attinger said I'd be walking by August 1st.  Not bad at all.  We asked Dr. Attinger about how we'll manage post-operative pain.  He referred me to a pain specialist to develop a plan for managing the pain after the surgery.

Dr. Attinger also explained that I'll be admitted to the hospital for five days to receive an epidural.  Brooke and I were thrilled to hear this.  In our cursory research, we've observed that elective amputees appear to better handle phantom limb pain when they are treated for their real pain symptoms several days before the amputation.

The goal of the epidural is to make my brain forget about the ankle pain I deal with every day.  This takes about five days.  Without the epidural, there's a higher risk that I'll continue to feel the daily ankle pain I've got now after my limb is amputated.

Weird, right?  Phantom pain is ridiculously weird.

So, five days in the hospital with a tube in my back continuously feeding it opiates.  That means I won't be able to feel anything below my belly button.  For five days.

Ask yourself this question: what's below your belly button?  Specifically, what two bodily functions must you operate below your belly button on a daily basis?

It took me a while to figure this out.  I think after a few hours I realized I'd need a catheter inserted into my bladder.  No big deal, having a catheter was awesome.  Complete urination freedom.  I had one after my first surgery and loved it.  I wish I had one every St. Patrick's Day.

But for some reason, it didn't dawn on me until today.  Who does number two work for when you're facing a five-day epidural?

The exact thought that went through my head when I had this realization about Number Two.

I can tell you who he doesn't work for.  You.

That's right.  With an epidural, Number Two is self-employed.  I'm no longer Large and In Charge.  I don't set the schedule.  And the humiliation doesn't stop there.  Not only do I not set the schedule, but I won't know when Number Two is taking a break (if you catch my drift).

How sad is it that I'm totally cool and excited about the amputation, but scared to death of the epidural? Because that's exactly where I'm at.

Brooke tried to cheer me up by reminding me that opiates will back up traffic on the Tony Turnpike.  So the epidural shouldn't be too traumatizing.  I'm holding out hope that there's some way of preserving control over my bodily functions while I undergo epidural analgesia.  But soon that may be the only thing I'll be able to hold onto.  Brooke's convinced I'll be in charge of my situation because five days of "self-employment" seems a little rough.  She's a nurse practitioner, so I trust her judgement.  I have to believe she's right.

I have to.  But Dr. Attinger did specifically used the word, "epidural."

So, in summary, I think I've found my surgeon on the first attempt.  He had a great team, awesome bedside manner, suburb credentials and experience, and agreed with me (that's the most important quality).  His surgical scheduler will contact me in a few weeks after they've worked out the paperwork with my insurance.  The game plan is to schedule the amputation for the first week or two in June.

In the meantime, I'll spend the next six weeks interviewing prosthetists.

I was able to meet with another one yesterday in Dr. Attinger's office -- Charlie Crone. He's the Clinical Director of Prosthetics at the hospital.  He was extremely personable and has over 30 years of experience.  I'll update the blog in a few days to go into more details on our discussions with Charlie.


  1. I was wondering what they did with the calf muscles! What do they do with your tibial nerve? Will you still have sensation on the skin? Will the calf muscles be able to contract still?

    I cant wait to hear stories of you pooping on the hopsital floor and not even knowing it.

    also, walking by aug 1 means dancing by august 10! :)

  2. Holy cow, Tony! I'm so happy that you found a doctor you feel 100% confident with! Please please pretty please refer to him Dr Bonesaw (with arm sawing action) in all future posts. Thanks in advance for your cooperation.

    The phantom limb pain solution is amazing. As is the fact that you will have no control over your bowels. Women giving birth sometimes poo on the floor, and I will admit that was one of my biggest labor and delivery fears. It never came to pass (pun intended) but it's refreshing to hear a male express the exact same worry.

  3. Hmmm I will check with Jillian to see whether she expects heavy congestion or not on the Tony Turnpike from the epidural.

  4. This is wonderful news! All the hope in this post is almost contagious. i've been having quite a rough time with my distraction. most of it pain based. i can't take nsaids because of stomach problems and the great state of new jersey won't allow me to have the meds i need because obviously i'm going to turn into a crazed drug addled maniac if i have more dilauded than they deem necessary despite multiple attempts by many doctors to explain my situation. fun. but this...this is good. this i like. excuse me while i leech some of your hope and happiness and nurvous energy from you because damnit i need it.

    and don't worry about the poo parkway. you will be fine. you may not feel the NEED to go, but you still feel some pressure. pain and pressure are two different things. talk to any woman who has had a child and epidural. at least thats what i gather from what i've been told against my will by the ones i know. and you'll develop a patter esp because you'll be hyper aware of it. PLUS YOU WONT HAVE ANY ANKLE PAIN, JUST SOME STIFFNESS SO YOU CAN WALK TO THE BATHROOM ANY TIME YOU WANT. AS MANY TIMES AS YOU WANT. also i can design you some kickass adult diapers with some bedazzeled snowboards and shit. i'll still be laid up by the time you're in there hahaha.


  5. Epidurals happen to be my specialty. You'll be fine. Most of my patients who poop only do so because there's a head of an 8lb baby pushing down on their rectum. If you do have to go, you typically feel pressure, so hop on a bedpan and take care of it. On the other hand, you may just poop the bed. You'll get over it.