For four long years, Wayne Johnson suffered with severe back pain, the result of a badly deteriorated disc.
He gave up golf and scuba diving, activities he once enjoyed. He quit gardening. He avoided driving. And because he couldn’t exercise, he started putting on pounds.
“I needed painkillers just to get through the day,” recalls Johnson, 45, of Wilmington. “Even with my medication, I seldom slept for more than a few hours at a time at night.”
Spinal injections of cortisone helped for a while. But the pain always returned. Johnson leads a groundskeeping team at the University of Delaware and it was increasingly difficult for him to do his job.
In 2012, Johnson and his wife were expecting a baby and he wondered if his back problems would impact his ability to be an active dad.
“Would I be able to get down on the floor and wrestle with my son?” he asked. “Would I be able to give him a piggyback ride?”
His orthopedic surgeon, J. Rush Fisher, M.D., recommended a Total Disc Replacement or TDR, in which the damaged disc is removed and replaced with an artificial disc.
“It looks like two Oreo cookies stacked on top of one another,” Johnson says.
A newer treatment, TDR helps patients to regain their range of motion and get relief from pain.
“It is a good option for someone like me, who is in his 40s,” he says. “I feel very fortunate that Christiana Care offers this kind of advanced treatment.”
Within a day of surgery, Johnson was out of bed and taking his first steps on the road to recovery. Within two days, he was home and walking with a cane.
He was an active partner in his care, giving up smoking to help speed the healing process. He learned to rely on the muscles in his legs to lift objects to avoid another injury to his back. He started shedding the weight he had gained, going from 208 pounds to 180.
“I feel like I’m back in my 30s,” he says. “I’m in the gym four days a week, doing 225-pound squats.”
Johnson is on the job at UD, maintaining landscaping on campus. He also is enjoying family life with his wife and baby. The pain is completely gone.
“In the past six months, I have taken two Advil — and that was for a headache,” he says. “I used to live in constant pain — and now I am happier than I have ever been in my whole life.”
The devastating impact of Dinesh Nayak’s fall down his basement stairs in February 2010 was immediately obvious in the pain he felt radiating up from his left ankle. But today, he says his choice to seek help at Christiana Care was an “outstanding” decision.
Dr. Paul Kupcha, an ankle specialist at Christiana Care Health System, became his health care partner during the 11-month journey to recovery.
The effect of landing on his left foot resulted in a pilon fracture, a diagnosis Kupcha confirmed with a CT scan shortly after the injury. A pilon fracture refers to a high-impact injury where the tibia (the larger bone in the lower half the leg) shatters at the point where it hits the bones in the ankle.
Many people who suffer a pilon fracture never walk without crutches or a limp again. But two years after that fall down the basement stairs, Nayak has returned to everything he loves doing.
“It’s really a testament to the doctor that I’m able to walk,” Nayak said. “The fact that I can walk without even a cane is truly remarkable.” Nayak’s only lasting reminders are occasional pain and stiffness, and mild range-of-motion limitations in his ankle.
Kupcha performed surgery at Christiana Care’s Wilmington Hospital after the original injury to repair the damage.
Over the next five months Nayak used an external fixator — an external device of pins and rods — that is coupled with internal plates to stabilize the bone. They helped Nayak’s tibia knit back together. During weekly visits to Kupcha’s office, adjustments were made to keep the healing on track.
When the external fixator was removed – a few months early because Nayak was tired of keeping the weight off his foot — the healing process was well under way. Follow-up included various casts, splints and braces that allowed Nayak to gradually bear weight on his foot. When those were removed, Nayak began two months of physical therapy to build strength and learn to walk again.
At that point, a celebration was in order. Nayak decided on a trip to Antarctica. Since then, he’s traveled to destinations all over the world.
Nayak thanks Kupcha for helping him achieve that return to activity.
“I chose the emergency room at Christiana Care; I chose Dr. Kupcha; I made those choices,” Nayak said. “…My experience at Christiana Care was outstandingly good.”
Sally Cratty fights aging and the joint deterioration caused by osteoarthritis with all the tools medical technology has to offer. So when she had to make a choice about how to deal with the deteriorating condition of her right ankle, she didn’t take long to decide to add a total replacement to her collection of artificial joints that already included two hips and two knees.
“I am bound and determined to remain as mobile as I possibly can through my aging process,” Cratty said. “That’s very important to me. I realize that I’m in my 70s, but I don’t think that way. I want to live an active life.”
Thanks to the artificial ankle implanted by Dr. Paul Kupcha at Christiana Care Health System’s Wilmington Hospital, Cratty has once again defied the mobility limitations imposed on her by osteoarthritis.
Nearly a year after her ankle replacement, Cratty maintains her own household, cooks for herself and spends time out on the town with friends and family. Most days, she can do all of that without the use of a cane or walker.
“I do all of the things for myself that I’ve done all my life,” Cratty said.
Cratty first began to feel pain and notice swelling in her right ankle in early 2011. After seeing Dr. Kupcha for the first time in May 2011, she knew that having the total ankle replacement was one option to fix the problem and an ankle fusion was another.
“I came home, and I thought about it and I thought about it. It got worse. Physically, I was really limping. My back was hurting. Everything was happening because my posture was terrible,” Cratty said.
After more than a month of considering her options, while the pain in her ankle worsened and her gait deteriorated to the point that falls were a serious problem, Cratty decided on the total ankle replacement and underwent surgery July 14, 2011, at Wilmington Hospital.
The surgery and physical therapy went well. A subsequent stress fracture in her right foot required another surgery to stabilize the fractured bone. Cratty completed more physical therapy after that surgery.
“From the beginning, I had a special feeling with Dr. Kupcha,” Cratty said. “I felt very confident. His approach is just so comforting and extremely knowledgeable.”
Now, nearly a year after the ankle replacement surgery, Cratty is back at home and living her life the way she wants to live it.
“I’m very happy that I went through the process,” she said. “Dr. Kupcha did beautiful work. He got me up on this ankle. I’m walking. … The happiest day of my life was when I stood up on this foot. I was just so thrilled I could do it. I have no regrets. I made the right decision.”
Former runner and aerobics teacher Laurie Beauchamp struggled with the forced inactivity imposed after surgery to reconstruct the posterior tibial tendon in her left ankle. But the end result – pain-free walking and exercising – made that struggle worthwhile.
“It was very intense,” Beauchamp said of her rehabilitation process. “I was basically confined to my bed with assistance from family members … I followed the letter of the directions from the doctor.”
Beauchamp had struggled with pain in her left foot for years – brought on by all of her physical activity and exacerbated by wearing the “wrong shoes,” she said.
By 2007, she was diagnosed with a ruptured posterior tibial tendon, which extends from the calf muscle through the ankle to the bones in the foot. She was finding that extended periods of walking or exercise resulted in excruciating pain.
By 2010 it became too much, and she turned to surgical options.
“Here I was just turning 50, and I thought I want to do this now when I can have a good recovery,” Beauchamp said.
So she sought the advice of an ankle specialist – Paul Kupcha, M.D., an orthopaedic surgeon with Christiana Care Health System.
“It was a huge surgery,” she said. “I just felt like [Dr. Kupcha’s office] was a very knowledgeable team. From the first phone call to getting my documents there … everyone was very attentive.”
Dr. Kupcha rebuilt Beauchamp’s posterior tibial tendon in December 2010 at Christiana Care’s Wilmington Hospital. She kept all weight off her left foot for eight weeks following the surgery.
“It was very, very scary during the whole thing, because I wasn’t used to being immobile,” Beauchamp said. “It was frustrating, but I made it fun.”
When she progressed to being able to bear partial weight on her foot and use a walker, Beauchamp decorated it with a basket to carry things around.
It took until April 2011 before Beauchamp finally graduated from physical therapy. During that five-month span, she kept in regular contact with Kupcha’s office to make sure she knew what had to be done – everything from taking care of her surgical wound to what kind of shoes to wear. Kupcha’s office also worked with the physical therapy team that Beauchamp used to keep her rehab on track.
“Every time I went to Dr. Kupcha’s office, I was just handled with the best of care. No question was a stupid question,” she said.
More than a year after she finished therapy, Beauchamp was back in the gym. She is hiking. She can do aerobics, spin class and weightlifting. She is even wearing regular shoes again – although she has forever given up on “stupid shoes.”
“Right after the surgery, I wore tennis shoes for a very long time,” Beauchamp said. “I really got educated on proper footwear. I can really wear whatever I want to [now]. … the surgery was done so beautifully that I don’t want to do anything that hurts it.”
Beauchamp makes smart footwear choices and spent months following specific instructions for taking care of her new ankle. The results, she said, have been outstanding.
“I can walk for extended periods of time. I can wear the shoes that I want to wear,” Beauchamp said. “I’m so grateful that I did it.
“I cannot say enough about Dr. Kupcha and his team. … It’s just a very comprehensive, caring program, always making sure that I had what I needed even though I was two counties away.”
A couple of years ago, Scott Reilly – an electrician in his 30s – was in an aerial bucket working on a power pole, pushing a heavy object up over his head. His job requires him to regularly lift and hold heavy cables and equipment while he installs or repairs electrical lines.
Reilly relies on a full functioning upper body to work. In this instance, the object came back down and Reilly quickly reacted, injuring his shoulder. At first, he felt pain in his back. He felt better the next day and went back to work.
Within a few days, he began to experience pain when he lifted his arm very high. He sought treatment from Evan Crain, M.D., an orthopaedic surgeon with Christiana Care’s Center for Advanced Joint Replacement. Dr. Crain initially thought Reilly had injured his rotator cuff. He treated Reilly with medication and recommended rehabilitative exercises.
Reilly kept working but still had pain, especially when lifting overhead or when pulling things such as cables. Dr. Crain treated Reilly with a cortisone shot several times, but the symptoms returned.
In January 2010, Dr. Crain performed arthroscopic surgery on Reilly’s shoulder, repairing a tear in his rotator cuff and treating the bursitis that was aggravating the situation. At the insistence of Dr. Crain, Reilly did light exercise with his shoulder the day after surgery. Within four weeks, he was able to do light work, and within eight weeks he was able to return to his normal work duties.
Reilly felt noticeable pain for a couple of days after surgery, but it subsided quickly, and full function of his shoulder returned. Reilly is back to work and able to do everything he could before. He appreciated Dr. Crain’s conservative, thoughtful approach to his injury.
“In orthopaedics, we have many therapies that help patients to quickly return to work. Reilly was an active participant in his recovery; he did all exercises and most importantly shared when he thought a therapy was not working,” said Dr. Crain.
According to Dr. Crain, many people who work in occupations that require repetitive motion, strength and stamina work through the pain. They feel pain is part of the job. Unfortunately, this often leads to debilitating injury.
Fortunately, Reilly realized that his pain was not normal and sought help from a Christiana Care orthopaedic surgeon.
Marjorie Miller was plagued with severe, constant foot pain for more than two years. It interfered with activities she enjoys with her husband, such as long walks on the beach and ballroom dancing. It even disturbed her sleep.
The pain began one evening after some light ballroom dancing. Marjorie felt sharp, intense pain when stepping even if she avoided dances that were harder on her feet and ankles. She was, in her words, “crippled.”
After some attempts with other treatments, Marjorie consulted with Dr. Robert Steele, an orthopaedic surgeon with Christiana Care’s Department of Orthopaedic Surgery. Marjorie was immediately impressed by how Dr. Steele listened to her and respected her opinions and observations. He quickly diagnosed her condition as adult-onset flat-foot deformity, a common condition found in women over 50. It is a painful affliction that occurs in those with no history of previous foot problems.
In most cases, this condition is successfully treated without surgery. Patients are fitted with a custom-made brace for three to four months. In 75 to 80 percent of cases, patients do well with the brace, which corrects the foot position so that the inflamed tendon can rest. After three to four months, patients switch to a smaller arch support.
Unfortunately, the brace did not help Marjorie, and she ultimately required surgery, which, for this condition, involves cutting and repositioning the heel bone and adding a screw to hold it in the proper position. Resecting the diseased tendon and replacing it with a tendon transplanted from another part of the foot is also part of the procedure.
After the surgery, Marjorie wore a supportive boot for 10 to 12 weeks and strengthened her foot with physical therapy. According to Dr. Steele, her foot is now “close to 100 percent” functional.
Marjorie is “ecstatic,” she said. She returned to long walks on the beach and ballroom dancing. She and her husband have even taken two-hour Argentine tango lessons. She is delighted to be able to say to her friends, “Look! I can wear my ‘pretty’ shoes again.” In a nutshell, she says, “I feel like my life has been given back to me!”