“TMR made a world of difference. Today I’m completely, one hundred percent drug free.”

Lisa Doll was 4-1/2 years old when she slipped out of her house after breakfast to play. Her father was busy mowing the lawn at their Rochester, Michigan, home and didn’t notice Lisa was out in the yard. Lisa entertained herself, skipping down the sidewalk while her father made several passes with his riding mower. As he backed up the mower to make another pass, she slipped on the wet grass clippings, and her left leg was caught under the blades as she fell.

The damage to her leg was extensive, requiring more than 25 reconstructive surgeries throughout Lisa’s childhood and adolescence. The goal of the surgeries was to keep her walking. The surgeries were successful in allowing Lisa to walk, but she couldn’t bend her leg because her kneecap was gone. Further, the injuries to her leg from the accident left her with drop foot, as well as persistent pain that would not be addressed until well into her adulthood.

Nevertheless, Lisa remained active. “I tried to do what most other kids and young adults do. I rode a bicycle, rode snowmobiles, went swimming in the river where we lived. It was a very nice childhood, even though I had this injury to my leg,” she said.

In pursuit of a “normal” life, Lisa enrolled at Northwestern Community College and earned her commercial art degree. In 1990, Lisa married and moved with her new husband to Arkansas to support her husband’s family’s business. Her daughter was born two years later. Over the next few years, Lisa’s young family moved frequently as her husband pursued various business opportunities.

Lisa and her husband divorced in 2003, and she returned to northern Michigan. It was a fresh start in a small community where she would raise her daughter. There she met Rick, her current life partner, and they bought a house together. Life was better!

Lisa’s fresh start was stalled by persistent pain in her left leg. She began consulting with various orthopedic surgeons to explore her options. One surgeon’s answer was to slide a prescription for narcotics across his desk to her.

“That’s not going to work for me,” replied Lisa, who did not want to take narcotics for the long term. It wasn’t the life she envisioned for herself.

After an exhaustive search, Lisa was referred to Dr. Julie Gronek, a physiatrist in Traverse City, Michigan. Dr. Gronek performed nerve testing on Lisa’s injured left leg and lower back. Based on the results, and the fact that advanced prosthetics were available, she recommended an above-the-knee amputation. Eventually, Lisa met with Dr. Herbert Kaufer, at the time the head of cardiovascular surgery at the University of Michigan in Ann Arbor.

“[Dr. Kaufer] told me he’d be glad to do my amputation. Then he hugged me. Hugged me! A surgeon who had a wonderful bedside manner and showed human emotion, a remarkable combination,” said Lisa.

“Before leaving that day, Dr. Kaufer asked me to meet with the prosthetics team. She met with Chris Casteel, an above-the-knee amputee himself, who was to become her mentor and advisor throughout her journey. “He strolled into the physical therapy room, and I had no idea he was an amputee until he pulled up his pant leg and showed me his computerized leg.”

In 2008 at age 46, Lisa had the amputation, hoping to eliminate the pain she had suffered with for so many years. Unfortunately, she developed an infection following the surgery that caused pain so severe she couldn’t walk. For that pain, she was given morphine. Once the infection was healed, her pain persisted, limiting her rehabilitation and keeping her on meds. Scans revealed bone spurs, which she had surgery to remove. Still, the pain persisted. Unable to get relief, she saw a pain management specialist who then put her on methadone.

Along with methadone, Lisa received sympathetic nerve block injections to help with the nerve pain. “This initially worked well, but as I got to walking on my prosthetic, I began having more pain. Three years later I was still getting nerve blocks and still on methadone,” she said.

Then one day Lisa realized she had forgotten to take her pain pill and realized she no longer felt the need for it. “I finally [told my pain management specialist], ‘I’m going to fire you if you don’t get me off these drugs! The whole point of having my leg removed was so I didn’t become addicted to these narcotics.’ It was devastating.”

In 2015, Lisa flew to Florida to visit her daughter and grandchild. A family emergency extended her stay, which may have been fortuitous, as it ultimately brought her into contact with a TMR surgeon.

In addition to orthopedic (bone) pain following the amputation, Lisa had been experiencing nerve-related pain in the form of neuroma and phantom limb pain. She commented that her phantom pain could be traced to her original injury at 4-1/2 years of age and the many surgeries afterward. Lisa experienced phantom pain where tendon transfer was performed to repair her drop foot. She felt pain where surgeons reattached the third, fourth and fifth digit of her left foot, and where they lengthened her Achilles tendon. “It’s funny how our bodies manage to remember all this trauma,” she said.

Lisa consulted with an orthopedic surgeon at the Florida Orthopedic Institute. After explaining her history, the surgeon asked if he could bring in one of his associates, Dr. Jason Nydick. Dr. Nydick had been trained in the military to do a new procedure called TMR (targeted muscle reinnervation). He believed that Lisa’s pain was caused by several neuromas and that she would benefit from TMR surgery. Dr. Nydick performed Lisa’s TMR surgery at the Tampa General Hospital.

“Three days later, I was back at my daughter’s home and on minimal pain meds,” she said. “Recovery was unlike my previous revision [surgery]. There was less pain, and I was up and walking without stabbing nerve pain!”

TMR surgery turned out to be the answer Lisa had been seeking. “[TMR] made a world of difference. I don’t need to take any pain meds,” said Lisa. “Today I’m completely, one hundred percent drug free.”

TMR was originally developed for advanced prosthetic control, mainly for the upper limb, but also has tremendous post-amputation pain management benefits. Lydia’s sights were set on only getting a prosthetic, but her doctor wanted her to fully understand the benefits of TMR nerve surgery, as well. 

Like most patients who first learn about it, she was a little overwhelmed. Add to this that the accident coincided with the early stages of the COVID shutdown. Lydia had to put all her faith in the medical community that was caring for her. 

For others who experience amputation, she wants them to know their feelings of loss are very real. When she first came home after losing her hand, she dealt with the sense of not being able to do anything. She says, “You come home and realize, I don’t have a hand. The accident has taken away my independence and self-esteem.” 

She credits a local Christian wellness center with helping her navigate the psychological challenges she faced. She couldn't do in-person physical therapy due to the timing of the accident and struggled with the sense of isolation she’d faced as a child. She was alone and embarrassed but had a deep well of resourcefulness she had built as an orphan in West Africa. 

Lydia also credits her strength to her commitment to her 19 year-old daughter. For her daughter’s sake, she was unwilling to stay down. She is in the process of launching a nonprofit foundation to help other amputees. A 5K walk and popcorn sale are planned to raise money and awareness. Giving back to society helps her through the tough times and also enables her to spread the word to the families of amputees. “Often people will lose hope because their families abandoned them and they don't realize the resources out there. I want to show that amputees are human beings. I am trying to change the notion that we are limited,” says Lydia. 

Today Lydia is back at her auditing position, with hopes of eventually returning to pursuing a baking career. 

Lydia advises people with limb loss to find a reputable, experienced doctor who will provide a clear understanding of what's involved in TMR nerve surgery. She says her prosthetic has been wonderful, and it's only possible because of the nerve transfer through the surgery. She also credits Alta Fried, of Atlantic Physical Therapy for helping her through.

“The prosthetic is the first thing I put on in the morning and the last thing I take off when I go to bed. It's become part of me and I enjoy it. I don't know how I would live without it. I've been asked if I feel imbalanced but I don't. I would advise anyone to get the TMR surgery to help make use of their prosthetic easier,” Lydia said.