On June 17, 2013, while in Ecuador, I was a pedestrian hit by a pick-up truck traveling 60 mph. Miraculously, my only injuries were a pulmonary edema, a few broken ribs, and five breaks in my tibia and fibula – including an open fracture. Unfortunately, since I was in a rural part of the country, I didn’t receive sufficient medical care for 72 hours – long after an infection had developed. Once in Quito, in addition to addressing my other injuries, doctors cleaned my leg and inserted a rod into my tibia. While I didn’t know it at the time, this initial debridement was insufficient to rid my leg of the infection. Escorted by my parents, I flew home to the United States on July 4, 2013.
Once in the states, the medical community, including my general practitioner, two orthopaedic surgeons, and multiple physical therapists – were unaware of the severity of my condition. As a result, I did not receive appropriate “limb salvage” medical care, and the infection continued to progress for three months. Eventually, the second orthopaedic surgeon recognized the infection, however, I left my last appointment feeling patronized and neglected. Upon hearing that I had sought a second opinion, he prescribed a general antibiotic and terminated care.
From the second opinion onward, I realized how lucky I was to come into contact with Drs. Doreen DiPasquale and V. Franklin Sechriest, II. I fought hard for appropriate orthopaedic care, and I am continuously amazed by the serendipity of our meeting. Dr. DiPasquale, with 30 years experience, was quite literally, the most qualified surgeon for my case of limb reconstruction. Dr. Sechriest is a Navy surgeon with deep understanding of how to care for traumatic orthopaedic injuries in young people. Together, they identified my case of Stage IV Osteomyelitis and treated me with a respect I hadn’t yet encountered. Both acknowledged my need to be a participant in my own healing by taking the time to inform and support me.
Prior to our first surgery, Dr. Sechriest told me, “Assemble your team and get yourself ready for the upcoming marathon.” This moment marks the beginning of my orthopaedic care and the end of any doubt in either my doctors’ abilities or my capacity to heal. Even though my accident and consequent medical neglect was traumatic, I am grateful that it brought me into contact with two of the best orthopaedic surgeons in the country.
My treatment and recovery
Since my initial open fracture had degenerated into a case of Stage IV Osteomyelitis, my orthopaedic care was complicated and prolonged, yet ultimately successful. My medical team – Drs. DiPasquale and Sechriest – performed 5 surgeries over the course of 1.5 years.
Care followed three distinct phases: eradicating the infection, compensating for the lost bone, and strengthening the new bone. Under Dr. DiPasquale’s expertise, my “limb salvage” treatment was aggressive. In the first surgery, she removed 6 cm of necrotic tibial bone and inserted antibiotic beads into the area.
Dr. Sechriest explained the procedure to my parents as “an amputation with the foot still attached.” Once identifying the bacteria as Staph Auerus and Strept Mitis, doctors placed me on an intravenous antibiotic chemotherapy treatment. For perspective, a single dose of one of these antibiotics is used to treat Giardia – I administered over 300 doses.
In the next surgery, less than three weeks later, all inoperative cultures returned negative. I went underwent five operations in less than three months. In the third, bolstered by another negative cultures test, doctors began establishing how best to compensate for the lost bone. After navigating around my shattered fibula, they surgically attached an Illizarov External Fixator via 16 pins into my tibia.
Dr. DiPasquale trained in Siberia, where Gavriil Ilizarov created the bone lengthening technique, which bears his name. Dr. DiPasquale instructed me to crank, or reduce, the device ¼ of a millimeter every 8 hours to lengthen the tibia 1 mm every day. Since I had lost a substantial amount of bone, doctors also took bone from my Illiac Crest (hip) and grafted it into the fracture site.
After this fifth, final, and most critical limb-salvage procedure Dr. DiPasquale passed away. Dr. Sechriest told me later that she continued to discuss my recovery until her last day; ensuring he was as prepared as possible to finish treatment. After five months of reduction, I finished lengthening with no further setbacks. While the initial bone loss was 6 cm, the final limb discrepancy is currently 6 mm, about half of a centimeter. Once the tibia was at the correct length, it needed time to strengthen. I remained in the fixator for another five months before my “team” decided it was ready to be removed and replaced with a plaster cast. In September 2014, a full 16 months after the accident, my new leg emerged whole and healthy from its medical cocoon.
After facing a likely amputation due to imminent systemic infection, orthopaedic care quite literally saved my life and limb. For over a year my recovery was a full-time responsibility inhibiting me from walking or working. My lowest point was in December 2013, after enduring five surgeries and intensive chemotherapy treatment within three months. I had insomnia, was nauseous with no appetite, was experiencing substantial PTSD, had lost 20 lbs, and was in agonizing pain. Caterpillars going into metamorphosis create a place of self-enclosed darkness to completely transform, fueled by the primal belief that one day they will emerge a new creature. Similarly, I retreated into myself, committed all my energy to healing, and maintained a deep faith that I would one day walk again.
Drs. DiPasquale and Sechriest facilitated my physical recovery and emotional growth by recognizing how crucial a patient’s emotional well-being is to successful care. Their trust and compassion alongside professional expertise facilitated my healing. I am now working full time, walking up to 5 miles, and functioning at about 80%. I continue to do alternative physical therapy and believe I will make a full recovery. I am overwhelmed with gratitude for both Drs. DiPasquale and Sechriest. When I look at my healthy leg, I see Dr. DiPasquale’s last masterpiece. I am proud to own this living piece of art and consider every step a testament to her.
Before my accident, I traveled extensively and was an avid outdoor enthusiast. I sea kayaked in Alaska, snowboarded on the Continental Divide, and backpacked in Patagonia. In moments of darkness, I feared I would never again be physically active. A few weeks ago, for the first time, I was able to hike up Cowells Mountain in San Diego. In addition to the smaller firsts, such as, carrying a cup of coffee to the next room, this accomplishment was enormous.