Gary Jones used to be the person everyone could count on to help out when they needed it. He was one of the hardest workers his daughter Linlee knew, usually clocking more than 20,000 steps a day and rarely sitting down to take a break. But that was all before a surgery that left him in excruciating pain 24 hours a day, every day of his life.
It started a little under five years ago when Gary had neck surgery for persistent pain. According to the surgeon, the procedure was a success and should have eliminated鈥攐r at least significantly reduced鈥攈is pain. But in a post-operative follow-up appointment, he told the surgeon he still had pain in his forearm.
The surgeon checked for all the usual issues like blood clots but couldn鈥檛 find the source. She sent him to the emergency room to get some additional tests done. Within an hour, Gary was on an operating table getting treatment for multiple severe abscesses in his lower arm. They were all infected with Methicillin-resistant Staphylococcus aureus (MRSA) bacteria. MRSA is dangerous because the bacteria is resistant to most antibiotics that doctors use to treat staph infections.
Gary鈥檚 infection was so bad they had to operate on his arm multiple times over the course of several days. The infection was still spreading at first, so Gary was sedated while doctors discussed the possibility of amputation with his family members. Fortunately, during the third surgery, doctors could see the infection stop spreading. They were able to clean the wound and put on a wound vac. Within a few days, Gary was discharged from the hospital and on the road to healing.
But there was another problem: after all those surgeries on his right arm, Gary had no function in his right hand. He couldn鈥檛 make a fist or wiggle his fingers. For a right-handed professional painter, the disability in his hand meant he couldn鈥檛 work. He also had to learn to perform daily tasks like eating and signing his name left-handed.
鈥淚t was a scary feeling after coming out of the sedation to learn that I almost lost my arm,鈥 Gary said. 鈥淏ut I felt grateful and blessed that the infection didn鈥檛 spread.鈥
As Gary was healing, he started to feel severe and excruciating pain in his right forearm. By the time he saw the surgeon for his one-year post-operative appointment, the pain was debilitating and interfering with his daily life.
The surgeon offered to perform a nerve conductive test to find out where the pain was originating. But Gary鈥檚 daughter Linlee, who is a nurse, was worried that test might increase his risk for another MRSA infection. The surgeon sent him to a pain clinic instead.
Pain specialists tried a few tests to find out what was causing the pain but could never pinpoint the source. The best they could do was prescribe opioid painkillers in ever-increasing doses as his body developed a tolerance over the years.
鈥淲hen you get on those pain medications, I don鈥檛 care who you are, it changes your personality,鈥 Gary said. 鈥淢y life went in the toilet when I was taking those drugs.鈥
His family noticed the changes too. His wife Denise knew it wasn鈥檛 safe for him to drive, so he had to be chauffeured around anytime he wanted to leave the house. He couldn鈥檛 watch the grandkids alone because he might fall asleep, and he didn鈥檛 trust himself to hold his youngest grandchild for fear his arm might fail and he would drop them. His favorite hobbies, like hiking and hunting, were off the table too.
On top of all that, he was still experiencing the most intense pain imaginable. Gary described it like the feeling of hitting your funny bone, but not for the few seconds most people experience that pain鈥攊nstead, it was all the time. 鈥淚t was a nine or 10 on the pain scale, like someone had my arm in a vice and was repeatedly smacking it with a sledgehammer all day, every day,鈥 he said.
He knew he needed a second opinion. His brother happened to be visiting a friend in Utah County who recommended a surgeon at U of U Health that might be able to help. They called Christopher Goodenough, MD, MPH, a plastic and reconstructive surgeon at 麻豆学生精品版, Assistant Professor in the Department of Surgery, Division of Plastic Surgery and scheduled an appointment.
Dr. Goodenough, an assistant professor in the Department of Surgery at trained as a plastic surgeon with a focus on nerve and reconstructive microsurgery. He specializes in complicated hand and upper extremity injuries. Most patients he sees have severe trauma after a car or motorcycle accident, or an industrial accident at work.
After their initial appointment, Dr. Goodenough spent some time researching Gary鈥檚 situation. He ordered an MRI and CT scan, along with some other tests. He consulted with the surgeon from Gary鈥檚 original procedure to confirm the details of the surgery and the postoperative course. He found where the nerve was misfiring and felt confident that surgery could help with Gary鈥檚 pain.
鈥淗e asked me, 鈥榃hat is your end goal?鈥 and I told him that I wanted to get off the pain medication,鈥 Gary said. 鈥淚f I could get function back in my hand, that would be a bonus, but if not, no big deal.鈥
Dr. Goodenough found significant scarring in the tissues where Gary had abscess surgery. It encased the nerves that go down into the hand. Most of us know them as the 鈥渇unny bone鈥 nerves.
鈥淭he first step in the surgery would be to release the scar tissue, freeing up that nerve and giving it more space,鈥 Dr. Goodenough said. Because that nerve gives function to muscles in the forearm, the entrapment was a likely suspect for Gary鈥檚 compromised hand function.
鈥淲hen your body is trying to heal, everything sort of sticks together to heal the area,鈥 Dr. Goodenough explained. 鈥淏ut after the healing is complete, that tissue often shrinks. In this case, that contraction was happening right around Gary鈥檚 nerve.鈥
There was still a risk that more scar tissue could form and the pain would come back. So Dr. Goodenough also inserted a collagen wrap around the nerve. This provides a barrier where scar tissue can adhere, keeping it away from the nerve. Eventually the wrap breaks down and the body absorbs the collagen tissue.
Before the surgery, Dr. Goodenough prepared Gary for the range of outcomes. He might need more than one surgery. He might get only partial pain relief. Other reconstructive surgery options might help Gary regain function in his hand later. As with any surgery, there were additional risks like bleeding and infection. With Gary鈥檚 history, the infection risk could be serious. But Gary was willing to take the risks.
Gary vividly remembers the feeling when he came out of anesthesia and the surgery pain medication started to wear off. 鈥淚 could immediately feel that the excruciating pain was gone,鈥 he said. He scheduled an appointment as soon as he could with the pain clinic to talk about getting off the opioids. They gave him two options since he had been taking such high doses for so long: go off completely and spend a few days in the hospital to 鈥渄etox,鈥 or wean his body by gradually lowering the dose. He chose the latter.
That was in March 2023, and he is still on track to be off the pain medication by the beginning of 2024. Gary gets emotional thinking about what a difference Dr. Goodenough and the surgery have made in his life.
鈥淚 didn鈥檛 think I would ever be able to use my hand again and not be in so much pain all the time,鈥 he said. 鈥淢y life is a lot better when I鈥檓 not in so much pain. I鈥檓 not such a grumpy old man. I feel like I鈥檓 being useful in the world now instead of just a blob on the Earth."
For his family, the difference is night and day. 鈥淢e and my brothers have our dad back,鈥 said Linlee. 鈥淏efore, it didn鈥檛 feel like we had a dad. He couldn鈥檛 do anything. He would try to help out or be present, but it wasn鈥檛 the same.鈥
Gary also notices cognitive and mental health improvements. His brain fog is gone, and he can remember things better. He also doesn鈥檛 feel so bleak about a future where the only choice was to continue on high-dose pain medication. He can go out with family on hikes and look forward to spending time with his three children and six grandchildren.
Surgery had another unexpected benefit: His 鈥渕annequin hand鈥 that had no function now has movement again. He can feel his pinky finger for the first time in years and wiggle his fingers. He still experiences some bursts of pain as his nerve function returns鈥攚hat Dr. Goodenough calls 鈥渓ittle zingers鈥濃攂ut at least he knows that temporary jolt of pain won鈥檛 last.
For Dr. Goodenough, Gary was exactly the kind of patient he wants to help. 鈥淲e have seen a lot of developments in the last 10 to 15 years taking care of patients with chronic pain from damaged nerves,鈥 he said. 鈥淏ut outside of the small group of surgeons that do this work regularly, not many people know that we can address their pain.鈥
That鈥檚 welcome news for people like Gary, who often come to believe high-dose pain medications are their only choice. Even 10 or more years following initial nerve damage, some patients could still get relief. 鈥淪urgery might not take away all the pain or completely restore function, but it can make life a lot better,鈥 Dr. Goodenough said.
鈥淒r. Goodenough has a great personality and really explained everything,鈥 Gary said. 鈥淎fter so many other doctors couldn鈥檛 do anything about the pain, it meant so much to hear him say I was in the right place and he could help me.鈥