surgical nerve repair alleviated Benjamin’s chronic arm pain

a simple mistake

Benjamin was leaving the house for work, just like any other day. When he shut the back door, it wouldn’t close properly. He tried again. It still wouldn’t close. He gave it one final shove, sending his arm through the window, slicing it and causing it to bleed profusely.

Benjamin was rushed to the hospital, where he underwent emergency surgery to save his life. Fortunately, his surgeons were also able to save his arm. But after surgery, he found himself in agonizing pain.

“It felt like someone had put it [my arm] in a vice grip and was cranking on it,” Benjamin said.

The pain prevented him from sleeping more than a couple hours a night. It also severely impacted his livelihood. The pain was so unbearable that he was unable to work.

finding someone to listen

Benjamin tried to push through the chronic pain and move on with his life, but the pain was relentless. And worse, people kept dismissing his concerns.

“I was trying to get help and nobody really believed me. They just kept telling me that I needed to get back to work and move it. I kept telling them that something wasn’t right,” Benjamin said. “I have a high tolerance for pain, but people didn’t understand the pain I was going through every day, all day long.”

help at last

Finally, after struggling to find someone who understood his pain, Benjamin was referred to Dr. Brandon M. Smetana at Indiana Hand to Shoulder. Instead of dismissing Benjamin’s concerns or suggesting more pain medication, Dr. Smetana believed he could alleviate some of Benjamin’s pain with surgical nerve repair.

During surgery, Dr. Smetana discovered three or four areas along Benjamin’s forearm where his nerve was damaged and neuromas had formed after his injury and were causing the pain. Neuromas are tangled areas of scar tissue in the nerve that send inappropriate signals to the brain. He removed the neuromas and then used Avance® Nerve Graft to bridge the gap and allow the nerve to repair itself.

Dr. Smetana explained that nerve injuries like Benjamin’s can be easily missed. “With trauma, the main goal is to save your life and then your limb. It’s actually quite frequent to have smaller nerve injuries that go unrecognized for longer periods of time. I see a lot of patients that have seen a number of physicians and they’re seeking their third or fourth opinion, or have been told that there wasn’t anything that was wrong and are sent to chronic pain management to manage their continued pain. There is a growing respect for how debilitating nerve injuries can be and a growing understanding of what types of nerve injuries can cause continued pain afterwards.”

the healing continues

After a neuroma is removed, patients may experience immediate improvement. From there, the nerve continues to recover over time, which can improve function and reduce pain.

Today Benjamin is back to building his business, working nearly six hours every day.

“When I was able to get back to work, I felt really good. I could provide for my family again. That means a lot to me. I’m a survivor one way or another. And it made me feel good to start surviving again.”

Dr. Smetana is a paid consultant of Axogen Corporation.

surgical nerve repair alleviated bonnie’s chronic migraine pain

Prior to 2015, Bonnie was an avid traveler and busy professional working as a construction manager. Life was hectic, but good.

“I was very, very active. I was traveling 70% of the time nationwide and working 60 to 80 hours in any given week. I was just go, go, go, go, go all the time. Which is the way I had been all my life,” said Bonnie. “It was during that time, truly at the height of my career when my health failed.”

The sudden onset of pain

One morning that all changed. Bonnie woke up with a terrible headache—one that never went away. Instead, it only continued to intensify.

“The thing is at first it was just a bad headache. And I just don’t get headaches.” But that headache lasted for nearly five years. Unrelenting pain took over every aspect of her life. She couldn’t work or even perform mundane tasks like unloading the dishwasher or checking the mail. The pain was often so bad, she could barely open her eyes.

“It’s not like I just gave up. I tried twice to go back to work, but I ended up in the ER seven times with migraine pain, but they couldn’t help,” Bonnie said. “I lost my career and as a result we lost two thirds of our income. We had to sell our home. We had to move into small apartments, some not very nice ones.”

A loss of independence

With all this pain, Bonnie lost her sense of independence, which is very difficult for someone who’s been independent all her life.

“It made me feel very vulnerable. [Suddenly, I was] dependent on someone else, regardless of whether that’s my spouse, a friend, whomever to help take care of me, or whether that be financially, or driving me somewhere to doctor’s appointments, or sitting with me after I’ve had one of my procedures. You feel vulnerable to the world.”

Having family and friends around helped Bonnie to feel support, but her emotional support animals pulled her through dark times when she was by herself. “It doesn’t matter if you can’t get up and cook lunch. It doesn’t matter if you can wash clothes, they love you anyway. I didn’t have to feel vulnerable around them. I didn’t have to feel less-than around them because I couldn’t do the things that I’d always done in my life.”

Even more important, was the love and patience from her wife, Jody. “She sacrificed an inordinate amount of her life while she took care of me and everything else. She has stayed by my side and helped me during the toughest times, those times when I felt so helpless and hopeless. She was always there to catch me, both literally and figuratively… and always reminding me not to give up. I’m honestly, not sure I could have gotten to this point without her.”

Taking matters into her own hands

For five years, Bonnie bounced from doctor to doctor. She underwent scans, procedures and was prescribed dozens of drugs, including several addictive narcotics. She spent months in physical therapy. Nothing helped.

Most days she was barely able to walk and the doctors she visited started to dismiss her as a person just seeking more pain medication. “We all have that moment where we just yank ourselves up by the bootstraps and jump right back into it. And when I realized I was, I was killing myself with narcotics [I didn’t even want to take], that’s what I did.”

Realizing she had no hope other than to find help on her own, Bonnie decided to start looking for different answers. And that’s the advice Bonnie has for others experiencing chronic pain. “Don’t give up hope, keep trying. And if [one] doctor can’t help you, just take that file, stick it in the pile of the files you have, and go on and try and find another one. That’s what I kept doing.”

Bonnie’s search led her to Dr. Ivan Ducic at the Washington Nerve Institute. After reviewing her history and symptoms, he explained that the source of her pain was likely neuromas (tangled mass of scar tissue) that had formed in her occipital nerves as the result of several earlier surgeries Bonnie had undergone to her cervical spine. Bonnie couldn’t believe it, but it made so much sense.

A life-changing procedure

In November 2020, Dr. Ducic performed nerve surgery on Bonnie to remove the neuromas and scar tissue on Bonnie’s occipital nerves that were the source of her pain. The goal of the procedure was to restore normal signals to the brain and allow Bonnie to regain her quality of life.

Once Dr. Ducic removed the neuroma, he used a nerve cap to protect the nerve end and minimize the risk of the neuromas reforming.

Returning to normal

Today, Bonnie has her life back and is pain free.

“I had to fight and scratch and cry and bloody my knees on the crawl to get here. But I was not going to give up on the chance of having my life back.”

Bonnie is back to some of her old hobbies, tending to a growing collection of plants, as well as enjoying outdoor photography. Her life might not look the same as it did five years ago, but that’s okay she says. “My life is different, [but] my life is beautiful.”

 

Each patient outcome is dependent upon the nature and extent of nerve loss or damage, the timing between nerve loss and repair, and the natural course of the patient’s recovery. These testimonials reflect the experience of the particular individual and may not represent typical results.

surgical nerve repair got david back on his feet

surviving the worst

You can look at someone and never know what they’ve been through, and what they’ve had to survive. David is one of those people—a survivor. In 2018, when David and his wife arrived home from work, they walked in to find they were being burglarized by a violent intruder. The burglar shot and killed David’s son, and shot and injured David and his wife in the process.

David and his wife suffered the worst type of pain a parent can imagine—the loss of a child. To add to their emotional pain, the gunshot David sustained in his right leg made it difficult to walk and left him with excruciating physical pain. He was unable to work and barely able to leave the house.

a painful reminder

To make things worse, doctors struggled to find a solution for David’s leg injury. He was prescribed pain medication and sent home with crutches and a brace, but he quickly found out that neither would be much help. His leg was in very bad shape.

“I couldn’t walk and I could hardly sit,” David said. “I had my family helping me move around the house, [and even] bathing me. I couldn’t get into the front seat of the car—they had to put me into the back seat to take me to my doctor’s appointment. I couldn’t work and I was in constant pain at that time.”

a different approach

After struggling to find a physician to help, David was referred to Dr. Kolovich, a surgeon who specializes in nerve injuries. Dr. Kolovich determined that the gunshot had severed a portion of David’s sciatic nerve, impacting his ability to walk, and was also the cause of the unrelenting pain.

Instead of treating the pain with medication, which often only offers temporary relief, Dr. Kolovich recommended a different approach—repairing the source of the pain through surgical nerve repair.

During the surgery, Dr. Kolovich removed a painful neuroma—a tangle of broken and damaged nerve fibers mixed with scar tissue—that had formed in David’s sciatic nerve. He then repaired the damaged nerve using Avance® Nerve Graft and Axoguard® Nerve Protector. While he knew it would take time, Dr. Kolovich was confident David could recover from the damage to his leg.

finally feeling better

Today David is living pain free and has also regained most of his mobility. At first, he began to feel his toes, then a few weeks later he had movement in his foot. Now he is walking with a nearly normal gait, and is much further along than he ever thought possible.

“I thought the pain would be something I would have to live with the rest of my life,” David said.

Sensory wise—David can feel everything now. And it will likely continue to get better. He is making a huge recovery every day, and Dr. Kolovich is just happy to know he’s out of pain.

“Thinking about what happened to me and what happened to me with my son, I know he’d look at me and want me to live my life and move on,” David said. “When I look at my life and where I’m at now, I know it’s a miracle.”

 

surgical nerve repair gave achilles his life back

the crash that changed everything

While on an afternoon motorcycle ride with friends, Achilles had to make a snap decision. When a train gate came down faster than he was ready for, would he have to speed through and try to make it, or hit the brakes? He decided to slam on the brakes and, in the process, took a dive. The motorcycle accident left Achilles with a fractured tibia and fibula.

Achilles underwent surgery on his leg two days after the accident. Doctors placed eleven screws and rods into his tibia, repairing the fractures, but after the surgery, Achilles was left with immeasurable pain.

“It kept getting worse and worse,” Achilles explained. “Nothing was helping.”

when the pain takes over

 Not even an abundance of pain medication made a difference. Achilles remembers being prescribed 300 pills at once. And these weren’t just any pills—they were narcotics—and he was told to take them as he needed for the pain. Which he did. But Achilles’ family began to notice a change in his behavior. He was in pain, he was over-medicating—he was in trouble.

“The pain was insufferable,” Achilles explained. “It had taken over my life and I wasn’t able to engage with my family or enjoy much of anything.”

Achilles tried to stop taking his pills cold turkey and ended up in the emergency room from withdrawal symptoms.

a better approach

Instead of trying to figure out what was causing Achilles’ pain, most of the treatment options he was given focused on pain management through medication. No one stopped to ask what was causing the pain, or to consider a different approach, until Achilles met Dr. Rodriguez.

In his very first appointment, Dr. Rodriguez really listened to Achilles and was able to determine the cause of the pain right away. Achilles had a nerve injury that had resulted either from the trauma of the motorcycle accident, or the surgery to repair his broken ankle. A neuroma, which is a tangle of broken or damaged nerve fibers mixed with significant scar tissue, had developed in his tibial nerve—the nerve that runs on the inside of the leg into the bottom of the foot. This nerve was the culprit for the pain Achilles was experiencing.

one procedure, a lifetime of relief

Dr. Rodriguez told Achilles that surgical nerve repair was an option. During surgery, Dr. Rodriguez removed the neuroma from Achilles’ leg, and the resulting nerve gap was repaired with Avance® Nerve Graft and Axoguard® Nerve Protector.

“It worked,” Achilles said. “He changed my life.”

Today, the pain and tingling Achilles dealt with for so long is gone. He’s a dad who can crawl, run and play with his young son. He is happy. He is back to being himself again.

 

for shirley, surgical nerve repair was the answer all along

Shirley was born just before the polio vaccine was widely available and contracted the disease when she was about 3 years old. This set the wheels in motion for a lifetime of surgeries, doctor appointments and eventual chronic pain.

As a child, she underwent multiple surgeries to correct deformities in her lower leg and foot. Unknowingly, these surgeries caused trauma and injury to the nerves in her leg.

But polio didn’t break her spirit. Shirley was determined, or “stubborn” as she would say, to live a life just like all others around her—full and happy and active. Her irritation at not being invited to play in sports developed into a drive to show the world that she was capable.

And she did just that. Shirley grew up, fell in love, started a successful career, and flourished in spite of her childhood illness.

But one day, things changed.

a new kind of pain

“One day, in 2007, I was just sitting in my office and I had [this pain occur]. Since I was a child, I’ve experienced a lot of pain [due to polio], but nothing like this. So, I thought, ‘Well, OK, it will just go away.’”

“I’ve had pain before, but I’ve not had pain like this.”

But it didn’t. The pain stayed, and the pain progressed. And for six years, Shirley didn’t have an answer as to why it was there.

“At first, I [hoped] it would go away, because I really didn’t want to go in for another surgery on my leg,” Shirley said. “So, I would come home from work really late, and Danny, my husband, would be there with my dinner and the pain pills. And then I would just get in bed and the pain pill would take effect, and then I would have some relief for a while.”

Due to her pain, Shirley retreated from friends, family and her social life. The pain made it hard to enjoy things that she once did.

“I’m a very social person and I like to be around people and do things with friends and family. But I retreated because the pain was so bad. The pain didn’t take a weekend off. So, I just kind of became a hermit and family would say, ‘Well, why don’t you come and visit?’ And I wanted to say, ‘Do you know how much work it is to get myself out of bed, and go travel to a family member’s house, or a friend’s house, and not sit there and writhe in pain?’ It just wasn’t worth it to me.”

“I felt that I had really lost one of the most important aspects of my life that I loved. I was really, really angry at this pain for a long time.”

But Shirley’s stubbornness wouldn’t let her give up. “I thought, ‘Well, this is ridiculous. I’m not going to live the rest of my life like this. It’s gone on too long.’ So I contacted my podiatrist at the time and told them what was happening.” Her podiatrist had performed several previous surgeries for Shirley over the past decade or more.

exploring all options

Her podiatrist suggested that it was probably time for another reconstructive surgery, and that’s what was causing the pain. “I didn’t know any better. So, I went through the surgery, and it was good to have it for some reconstructive reasons, but it didn’t cure the pain,” Shirley said.

“I can’t live like this, I won’t live like this, so we need to figure out something that will work.”

So, she continued to take the pain medication and tried to go about her life—but she was in chronic pain. So, she contacted her doctor again about a year later.

“I told him ‘I can’t live like this, I won’t live like this, so we need to figure out something that will work.’ And he examined me again and he said, ‘OK, I’m going to send you for an epidural in your back and that’ll shoot pain medication down to your foot.’”

Shirley was referred to a pain management doctor, and she had the epidural.

“I was told that the epidural would give me pain relief from anywhere from six months to a year or longer, because that’s typical for most patients who were experiencing pain. Well, this particular epidural lasted maybe three weeks. So, I contacted my podiatrist again and said ‘That didn’t work, and I’m out of answers. Help me figure this out.’”

And that’s when her doctor of 10 or 15 years suggested amputating her toes. When Shirley didn’t agree right away, her doctor stood up, took her by the elbow and said, “I’m sorry. Shirley, there’s nothing else I can do for you. I wish you a happy, pain-free life.”

an amputation

“I was pretty much dismissed, and that made me angry because it’s like, it’s your job to help me figure it out. So, I thought, ‘That’s OK, I’ll find somebody else.’”

Shirley visited other podiatrists to get a second opinion. One suggested putting pins in her toes and said they didn’t need to be amputated. Another agreed with Shirley’s first podiatrist, that the amputation of the two toes would be the best. And he also agreed that was the source of her pain.

Shirley went through with the surgery and the amputation took the tips of two toes. And the doctor said the pain should be gone within a few weeks. After her surgical pain subsided, the chronic pain shouldn’t return.

“I’m sorry. I don’t know what else I can do for you.”

“Well, the chronic pain returned as soon as the anesthesia had worn off, which was the next day. And on top of that, I had surgical pain because it’s kind of a big deal to have some body parts removed. And so, I called the doctor and I said it didn’t take care of the pain,” explains Shirley. “And he said, ‘Well, I’m sorry. I don’t know what else I can do for you.’”

It was at this point that Shirley thought, “If they can amputate toes, they can amputate a foot.”

a resignation

With her fate somewhat sealed, and the pain staying put, Shirley decided to retire early.

“I retired because I couldn’t stand the pain anymore.

“And I was at my job for 20 years as an executive managing the human resources function of the company. And it was a very demanding job. But [after the pain started] my life, just kind of went on hold. And so I decided one day, ‘I can’t stand this, I’m just going to retire,’ and I gave them my resignation.”

Shirley also resigned herself to life without a foot. Though she hadn’t shared this decision with her husband, she started Googling to find the right doctor for her needs.

“I didn’t tell anybody. I didn’t tell my husband. I didn’t tell my family members or friends because I didn’t want anybody to talk me out of it.”

“The first hit that I got was a team of doctors, one who was a podiatrist in Chicago and the other one who was a neurologist, and they worked in tandem. And I saw that they did all of these very complicated procedures, so I thought, ‘Well, if they know how to do all these things, certainly they know how to take off my foot.’ So, I made an appointment with them.”

At the appointment, Shirley and her husband sat in the office and the doctor asked her, “What is your pain level on a scale of one to 10 right now?”

“And I didn’t even answer that. I said, ‘I’m here because I want you to amputate my foot. It’s just, I can’t live with this anymore.’ Well, my husband was shocked. The doctor laughed and said, I’m not going to do that, but I have a feeling I know what’s wrong with your foot.”

a different diagnosis

From the start, this doctor was different. Working with a neurologist as his partner, they ran tests and talked to Shirley and really got to know and understand her situation. After a couple of visits, she went back to him and he said, “I’ve got the answer.”

The source of Shirley’s pain was three neuromas (tangled masses of scar tissue) in the nerves of her lower legs likely caused by her previous surgeries from years ago. Nothing that she had tried before would have made a difference, because it wasn’t removing and repairing the source of the pain. Her doctor let Shirley know that this time, she could be helped. Through surgical nerve repair, he could identify and remove the neuromas sending pain signals to the brain. From there, he could repair the resulting nerve gaps using nerve grafts from donor tissue as a bridge to allow the nerves to heal and restore more normal signals. “I’m reasonably certain removing the neuromas and then repairing the nerve will be a solution for you,” he said.

“I had so many conflicting emotions because it’s like, ‘Are you kidding, me?’ Because I had to tell him, you know, I’ve heard it all before, ‘If I do this procedure, I can fix your pain,’ and that’s not necessarily true in my experience. I was skeptical and I was a little bit angry, but I was also very, very, very curious.”

“Transplanting human donor nerve tissue was something I had never heard about before.”

Shirley looked into the procedure and learned more about what it meant to be trained in surgical nerve repair. She learned about the process involved, and how human donors make it all possible. It was new, but it was promising.

With nothing else to lose, Shirley had the surgery on Friday, Dec. 13, of 2013. It was a seven-and-a-half-hour procedure, and Shirley woke up the next day thinking the pain would return along with the surgical pain. But she says, “I haven’t had it since.”

pain free after all this time

“I fully expected the pain to return because I was still skeptical.”

“Every day I kept waiting for the pain to return, and every day my husband would ask ‘Any pain?’ And I would say ‘No, I don’t get it,’” said Shirley. “This hadn’t happened before, and it took me a little bit of time, but it finally hit me that it was not coming back … I was over the moon.”

“My husband is my biggest cheerleader and my biggest supporter. He is. He’s been an incredible support person for me through this entire journey. And so have our families and my two best friends.”

And now? Shirley says, “Now I can do everything that I used to do before. I can do all the fun stuff and all the necessary stuff.”

becoming an advocate

Shirley knows that it is not without help that she got where she is. “I thank my donor and my donor’s family every single day for the gift that they gave me, because without them, I don’t know where I would be. There was a couple of thoughts of suicide in there, too, which I never told my husband at the time. So, I’m just incredibly grateful for that donor and their family.”

Since her recovery, Shirley has become an incredible advocate for organ and tissue donation because of the impact that donated nerve tissue had on her life. She’s a volunteer and educates others on the importance of organ and tissue donation.

Becoming an advocate for others seemed like a natural progression after learning to advocate for herself. Shirley says, “Become your own advocate. If you’re not seeing the relief that you’re looking for, don’t necessarily say ‘yes’ to all these different surgeries. Instead, do some of your own research … It’s quite important that you become your own advocate and you find your solution.”

Each patient outcome is dependent upon the nature and extent of nerve loss or damage, the timing between nerve loss and repair, and the natural course of the patient’s recovery. These testimonials reflect the experience of the particular individual and may not represent typical results.

surgical nerve repair alleviated Beth’s chronic foot pain

anything but routine

Beth had an old high school injury that occasionally required surgical “clean up.” This was typically a routine procedure. However, after Beth’s most recent visit to her surgeon, she’d begun experiencing electrifying jolts of pain in her foot throughout the day. Normally very active, Beth found the pain debilitating.

“I couldn’t step on my foot or really use it at all,” Beth said.

life on hold

Unable to take care of her farm or do the things she loved, Beth began to feel depressed and increasingly hopeless. She decided it was time to seek help. While doing internet research, she stumbled upon Dr. Thomajan, a surgeon who specializes in nerve injuries.

“At my first appointment, he stood outside the doorway and just looked at my leg and knew there was a severe nerve injury going on,” Beth said.

After closer inspection, Dr. Thomajan confirmed his suspicions. Beth’s previous surgeon had damaged the main nerve to her foot, causing a painful neuroma to form—a tangled mass of scar tissue mixed with broken and damaged nerve fibers. Not all neuromas are painful, but others, like Beth’s, cause unbearable, life-altering pain.

a smarter approach

Instead of managing the pain with medication, Dr. Thomajan recommended repairing the source of the pain through surgical nerve repair. This involved removing the neuroma, in order to stop the pain signals to the brain.

During the surgery, Dr. Thomajan identified and surgically removed the neuroma. To bridge the gap created by its removal, he used Avance® Nerve Graft, which would provide a healthy structure for the nerve to regenerate. This technique made it possible to remove the painful stimulus and restore the normal signals to the brain.

fast fix

Almost immediately after surgery, Beth felt better.

“The next day I knew there was a change,” she said. “Even with the extensive surgery that was performed, the pain dulled in comparison to what I had been in. For the next few weeks, while everything was healing, I had no pain. I could get on crutches and move around. I could cook for the family again. It was absolutely amazing. I even went out to the animals when I wasn’t supposed to.”

Beth is now pain-free and back to her busy life on the farm and her favorite hobby—endurance horse racing.

“The conditioning took a while, but overall, I am so physically fit right now,” Beth said. “I have a 60-mile race ahead of me. I cannot wait. The horse looks good. I’m feeling good. I have high hopes.”

Dr. Thomajan is paid consultant of Axogen Corporation.

after amputation, surgical nerve repair gave Ronnie a new lease on life

the moment everything changed

In September of 2017, Ronnie was working at a sawmill when his arm was accidentally caught in a conveyor belt, resulting in amputation of most of his arm. Adjusting to life after this devastating injury was difficult, but about a year after the injury, he also started to suffer from phantom pain. Progressively, the pain continued to get worse. By November of 2018, it was unrelenting.

Pain after a traumatic injury is understandable, but after months with no relief, Ronnie realized he needed to find someone who could help. Fortunately, he was referred to Dr. Ducic, a nerve specialist from the Washington Nerve Institute.

addressing the source of pain

Dr. Ducic explained that several nerves injured as the result of the amputation were causing Ronnie’s chronic arm pain. Rather than offering a temporary solution like pain medication, Dr. Ducic recommended surgical nerve repair. During the procedure, he would remove the source of the pain—several neuromas (masses of scar tissue that form in the nerve and can disrupt normal nerve function) that had formed—and then repair the nerves to restore more normal nerve function.

a fresh start

Dr. Ducic explained that because nerves are destined to grow, he needed to provide a structure for them to regrow more properly or neuromas might recur. After removing the neuromas, Dr. Ducic reconstructed the nerves by connecting them to nerves located in Ronnie’s muscle. In order to make that possible, there were large gaps that needed to be bridged. Dr. Ducic used Avance® Nerve Graft to bridge those gaps, allowing Ronnie’s nerves to regenerate and restore normal signals to his brain.

“We really live in a new era of nerve surgery,” said Dr. Ducic. “Prior to Avance Nerve Graft, it would have been very difficult to reconstruct nerves like I was able to do in Ronnie’s case.”

Nerve repair surgery gave Ronnie his life back. Today he’s back on the job and adjusting to his new life, pain-free.

Dr. Ducic is the Medical Director for Axogen Corporation.