A New Surgery

Targeted Muscle Reinnervation (TMR)

THE PAIN – I have been in a higher-than-normal range of pain for below knee amputees since an automobile accident six years ago in 2016. I have two types of pain. First, in the stump, where I have tissue damage from the initial trauma of the accident and additional damage from a subsequent staph infection in the surgical wound site. Second, phantom limb pain, caused by severed nerves that have not healed properly. My nerve endings split and transmit electrical impulses across the split ends, much like loose live wires in a storm. The nerves fire pain signals to the brain, which registers the activity at the point in the missing limb where the transmitting nerve originally reached (calf, toe, etc.). The sensations are a chronic 24-hour burn with needles, which covers most of the missing limb, and occasional, sudden, short, localized bursts of electrical shock, like being zapped with a cattle prod on the ankle or foot that is no longer there. Hence the term, “phantom limb pain”.

PAIN MANAGEMENT – My physician prescribes Duragesic (a daily fentanyl opiate patch), Ultram (the narcotic, tramadol), Neurontin (the antispasmodic, gabapentin), and a time-released high dosage of prescription Ibuprofen. While these generally work most of the time to keep the pain down to a functional level, the pain is always with me, and it flares as meds wear off between dosages, or when sitting, standing, or walking for too long. The meds also keep me lethargic, especially when just sitting at a computer, driving long distances, or catching a movie.

A NEW SURGERY – Targeted Muscle Reinnervation (TMR) is a relatively new surgical technique that trims improperly healed sensory nerves (the ones responsible for touch and pain) and attaches them to motor nerves (the ones that control muscles and movement). The process promotes proper healing of the sensory nerve, since it now has a task (it effectively becomes a motor nerve). A six-hour surgery was performed last Thursday (28-Jul-2022). Got home from the hospital about midnight, with significant pain from the surgery. Friday and Saturday, the pain was more tolerable. By Sunday, the pain was getting closer to “normal daily pain” – about what it was prior to surgery – but I was still a bit unsteady and sore. Had a routine pain management doctor visit on Monday.

THE PROGNOSIS – Met with the plastic surgeon for the post-op visit on Tuesday (five days after surgery) who reported that he had accomplished everything he intended during the surgery, I had no signs of infection, I was healing well, and he was pleased. The surgical scar is about 9 inches long. Of some concern is a small sore that has since appeared at the bottom of the stitches at the bend of the back of my knee where the surgical tape is starting to pull away. The surgeon said to keep it clean and bandaged with antibiotic ointment until I return to him in two weeks, at which time hopefully I will be healed enough to begin trying to wear my prosthetic leg again. In the meantime, I am confined to a wheelchair, but use a walker to transition in the bathroom (I stand up on one leg and use it to hop around into position for toilet or shower chair). I should not expect to know how successful the surgery may have been until about the six-week mark.

PRAYER – Thank you for caring about me and praying for me. The good surgeon report leaves me with no doubt that God responded to your petitions for me – I thank and praise and glorify Him for His mercies through the kindness of your prayers. I have learned over many years of walking with the Lord through some pretty deep water, that prayer is essential, productive, and real for the true, born-again believer. God has answered prayers in my life so consistently, and in so many obvious ways, as to preclude their relegation to imagination or happenstance. If you can pray with me a bit longer, my requests are as you might expect: