“Honestly, it was a miracle that the radiologist I work for shared the [TMR] article with me."

An accident in her teens led Theresa to make a difficult decision much later in life — an above-the-knee amputation in her 50s. It was a decision she would not regret.

Theresa nearly lost her leg many years earlier. In 1980, at 16, she was in a car accident that resulted in a serious injury, crushing her left leg. At the time, her doctors made the decision to save her leg, knowing it would be risky. Hospitalized for 80 days and undergoing 12 surgeries, Theresa’s surgical team was successful in reattaching her leg. Her surgeries included fusing her femur (thighbone) to her tibia (lower leg bone) due to a staph infection in her knee joint; skin grafts to close the large open wounds; and a latisimus dorsi muscle transfer from her back to her lower leg to pad and protect her popliteal artery (a major artery behind the knee). Yet another surgery involved grafting nerves harvested from her right leg to her left leg with hopes that she would eventually regain some feeling in her foot.

Today, Theresa reflects on the decision to save her leg. “In hindsight, it may not have been the best decision ― but it was the best decision at that time. I had such bad nerve damage that I was incapable of moving my foot, ankle and toes.  Additionally, I had very poor sensation, my leg was extremely disfigured, and my knee was fused.”

Despite the disability, Theresa’s condition was not painful, and she learned to adapt and live with it. She graduated from high school and college.  Later in 1988, she moved from Kentucky to Hawaii for a job at Queens Medical Center. Hawaii was an incredible experience for Theresa.  There, she met and married her amazing husband Michael. Today they have two beautiful daughters and live in New Mexico.  

As years went by, however, something happened. “In 2015, I started experiencing pain in my leg,” she said. “It was so bad, they thought I had sciatica. But my pain was in my lower leg. It didn’t run down the back of my thigh, like sciatica.” 

Her physical therapist suggested that she might be experiencing lymphedema, a build-up of fluid in soft body tissues. As a radiologic technologist, Theresa understood anatomy and physiology. “My vascularity had been compromised at a young age,” she said. “The veins in my left leg were working harder to pump blood and lymph fluid back up.” 

A specialist confirmed her PT’s diagnosis. “There is no cure, and it was very evident that my quality of life was declining rapidly,” said Theresa. “I would go home from work feeling extremely nauseated from the pain, even when I was keeping it wrapped [as advised]. My husband always had to help me into the house when I pulled into the driveway from work. Although grateful for his help, it was not the way I wanted to live my life.” 

That was when Theresa began to consider amputation. She consulted with a surgeon, who recommended an ankle fusion instead. But given her experience with the original bone fusion, Theresa thought she would do better with the amputation and a prosthetic — especially since prosthetics have improved so much over the years.  Living an active life looked promising with lots of possibilities, like riding a bike and running, things that had been impossible since her accident.

Around this time, a colleague shared an article with her on targeted muscle reinnervation (TMR). TMR is a surgical procedure that treats post-amputation nerve pain by reconnecting amputated nerves to other nerves in nearby muscles. TMR performed at the time of amputation is called “primary TMR” and is done as a preventive measure to avoid nerve pain following amputation.

Theresa sent the article to her orthopedic surgeon, who said, “I think you should do this.”

“I felt really connected to [my surgeon],” said Theresa. “He understood the pain issue, how poorly functional my leg was, and he answered all my questions. He said I was a low risk for complications because I was in good health. After another year of researching, asking more questions, talking to amputees, family, good friends, physical therapists, and a local prosthetist, and many prayers and tears later, I finally made the decision. I told him, ‘Let’s do this.’”

Theresa was able to schedule her surgery in February 2020, just before elective surgeries were suspended for COVID. Her orthopedic surgeon performed the above-the-knee amputation on her left leg, and the surgeon she initially consulted with performed TMR during the same surgery. Up to 90% of amputees experience phantom limb pain and neuroma pain following amputation. By receiving primary TMR, Theresa hoped to avoid the post-amputation nerve pain that is so common with amputees.

Theresa was recovering well and mostly pain-free, taking a low dose of gabapentin daily. Then, about 2 weeks after surgery, she woke up one Sunday and was in a “crazy amount of pain”. 

“I was freaking out,” she said, and called a friend and mentor familiar with her situation. Her friend suggested that she was not taking enough gabapentin for this stage of her recovery — that is, until her nerves calmed down from the surgery. So, Theresa increased her gabapentin for three to four days, then started to reduce it. Slowly but surely, the pain started to decrease, she said.

Theresa was back at work just three months after her surgery. She wears her prosthetic leg daily and initially used crutches. She now uses only a cane and looks forward to the day when she won’t need it at all.

Theresa said she does get pins and needles on days when she’s been on her feet more than usual. On those days, she said she takes gabapentin in the evening. She also occasionally does desensitization exercises to calm the pins and needles sensation. But for the most part, Theresa is pain free, and experiences infrequent phantom sensation (versus pain) in her missing left foot.

“Honestly, it was a miracle that the radiologist I work for shared the [TMR] article with me,” said Theresa. “If you can plan your surgery, I would highly suggest getting TMR. It’s a game changer. Absolutely, 100%.”