Hope Your Guardian Angel Knows About The Ertl!

 By Scott Sulprizio

I was four days from surgery to have my foot amputated when a guardian angle came into my life.   It’s odd how things twist and turn in your life, and this particular turn was pure destiny.  This angel came in the form of a young new Prosthetist by the name of Rod Miller.  Before my ordeal was over, I had a whole group of angels that changed my life.

 Let me step back about three years, 1999.   I had always wanted to learn to fly since I was kid.  I live in Gardnerville, Nevada at the base of the Sierra Nevada Mountains.  Right around us are peaks that shoot up 10,500 feet.  It’s a beautiful place, only about 15 minutes from Lake Tahoe.  It is a great outdoor area, offering skiing, hiking, fishing, hunting, and great glider flying.  It was a spring day in 1999 when I saw these paragliders coming down off a mountain.  To say the least, I was attracted to these large sails floating down the mountain.  I decided that paragliding looked like a great way to fly.  I contacted a local instructor and got started.  To make a long story short, two years later I had accumulated about two hundred flights.  I was lucky to have learned to fly with a very conscientious group of flyers that put safety first.  They taught me that ”it is always better to walk away than fly in unsafe conditions.“

 It was late afternoon in March of 2001 when I decided to check out the flying conditions at Duck Hill, which is just north of Carson City.  There were lots of people flying that day with the winds at about 10 mph and very steady.  The sun would be gone in about 45 minutes, so I decided to give it a try.  After take off, things went very sour … my right wing collapsed and I was spun into the mountainside.  I hit very hard and ended up being care-flighted to Washoe Medical Center with a broken shoulder, a broken left femur, and a compound fracture of my right ankle.

 At the Med Center in Reno, I underwent emergency surgery to repair my femur and ankle, and later my shoulder.  From the onset the concern was that my ankle was infected and that I might have ostomyalitis (bone infection).  I spent five weeks in the hospital and a long-term care facility.  I had made progress, was walking on crutches, and was getting up and down the halls pretty well.  My ankle was held together with screws and plates.  I had been kept on suppressive antibiotics, which were to keep any infection at bay.  The decision was made to allow me to go home  where I would wait to see if my ankle was infected, or not.  I do believe then that the medical staff thought I had an infection, but time would tell.

 It didn’t take 5 hours from the time I left the hospital that I started to run a low- grade temperature.  As the day went on things just got worse.  By the next day my temperature was hitting 103 degrees.  Needless to say, I went back into the hospital for debreadment.  This procedure left a large hole in my ankle which had to be filled with tissue.  This was the start of several weeks with a special vacuum bandage that accelerated tissue growth.  All was going well, but this was the first time that the doctor told me of a possibility of amputation.  If the tissue did not grow back, I would lose my foot.  Talk like that kind of sets you back.  All went well at this stage and the tissue came back strong.

 The next step would be plastic surgery on my ankle.  Days later it took six hours to take skin from the top of my foot and move it over the new tissue I had grown.  Over the hole they created on the top of my foot, was a skin graph.  Recovery would take six weeks in bed with my foot up.  The concern was that by lowering my foot the pressure from the blood could cause the graph to fail.  If the graph failed, the doctor said I would lose my foot. About then the bug doctor showed up.  We still had the infection to deal with.  For the period I spent allowing the graph to heal,  I was on a massive antibiotic regime.  They told me that I had very serious bugs (bacteria) and they would be hard to deal with.  Five times a day I received up to three different antibiotics through a Groshon catheter.  The graph took, the bugs were under control, but not gone, and I had a very ugly foot.  My ankle was held together with an external fixater.  All support had been removed from my ankle because Ostio loves to live on metal.  They had saved my foot, but how would they repair my ankle?   My ankle was destroyed from the accident and the bacteria.  There wasn’t much left, but I was still thinking, ”I’ll walk.“

 Upon leaving the hospital, I had three more weeks in a rehab center in Carson City.  I continued the antibiotic regime through the Groshon in rehab.  I was quite weak from the inactivity, had lost lots of weight, and could not go home until I showed I could handle crutches and a walker.  I did get stronger, was able to go home, and even saw my daughter, Ashley graduate from high school.  Once home the antibiotics continued.  Surgery to fix the ankle had to wait until the bugs were gone.  The question in my mind was what needed to be done to get me walking.  Finally the bugs were under control, and I was ready to get my ankle repaired.

 I was anxious to get walking and was looking forward to hearing my options.  Ankle fusion was what had really been discussed.  Never being in this position I didn’t know what to think,  but had heard that fusion was not the worst option.  I was getting stronger by the day, and in I went to the doctor’s office with a walker and my external fixater.  They shot some x-rays, and I waited.  The doctor came in, sat down, and got right to the point.  He said that I should have my foot amputated.  He was very frank and said that I would be better off without my foot.  He told me how amputees can gain there full life back with the advances in prosthetics.  I wasn’t ready to hear this.  He said my ankle was destroyed and it was not worth saving.  He suggested that I get a second opinion and set up an appointment with another orthopedic.  I was in shock!

 It was three weeks to get in to see another doctor, and  I was sure his opinion would be different -- he’d have an idea the first guy didn’t have.  This doctor specialized in feet, and I was sure a specialist would have something up his sleeve.  To my shock, he didn’t have a ”magic bullet.“  He told me, ”You need to have that foot removed.“  He knew I was not ready to hear this and suggested I see a doctor at UCSF.

 Another three weeks and my appointment came around.  Of course, the second doctor was just a specialist,  and where I was going was major medical facility at a university on the cutting edge of medicine.  To make a long story short, UCSF’s report came back suggesting that my foot be amputated.  There was a possibility that a pentailur fusion could expose the ostiomyalitis (if it was there) and drive those nasty bugs (remember those guys) further into good bone, which would cause me to lose my leg even higher.

 You don’t want to give up, but three doctors all with the same answer.  My options were running out.  Another three week to get back to see the foot specialist.  It was time I needed to come to grips with things.  It was hard.  It is amazing what your mind can come up with to cause you to worry.  How will I shower, how will I go to the bathroom at night?  There were a million things to worry about, but pretty soon you realize you’re not going to walk without the amputation.  Little by little you come to realize that amputation is not the outcome you want, but it is the only way you’re going to walk.  I was finally ready to make the decision.  When I saw the doctor, I said with lingering unsureness, let’s do it.“  He reviewed the surgery with me, and I remember asking him how they handle the bones?  He looked at me and asked what I meant?  I wanted to know how they stabilize the bones?   He told me they don’t,  that they are  left dangling, free to move.  He assured me that this was common practice and he had great success.  He said that I need a prosthetist, a specialist that would go into the surgery and then follow up while my leg healed and fit me with a new leg.  The amputation was set for two weeks away.  I had one more pre-operative meeting before the surgery.

 A prosthetist … where do you start?   He recommended several in Reno, but that was a 45 minute trip each way.  Finally we found one in Carson City.  They were nice and explained what to expect.  Four days before the surgery, we went back to see the doctor and told him that we had seen a prosthetist in Carson City.  He thought it would be wise to see a second. Ok, we called the Reno prosthetist. We phoned and explained to them about my case.  About then I thought this is ridiculous to drive clear to Reno to see these people, maybe for the rest of my life.  I cut them off and decided to forget it …  it was too far.  They said that they had just opened an office in Carson City and could see me the next day.  You have to understand that the whole ordeal to have the amputation had been a process of getting ready for the surgery.  Seeing another prosthetist was just a distraction, allowing time for my mind to play tricks on me.  I was ready go!!!!!!!  My appointment was the next day, and little did I know I was walking into a guardian angle’s office.

 So, the next day we met with Rod Miller, Ortho Pro’s new prosthetist in Carson City. He reviewed much of the same information as the first group we had seen.  His agenda, however, was not about feet or sockets …  it was about the Ertl procedure.  He told me that I couldn’t have the standard amputation procedure done.  I asked him what he meant.  Didn’t he know what it took me to get to the point of my decision?   He wanted me to change my plans four days before my surgery, and I thought he was nuts.  I was not ready to listen, but he persisted.  He was ready with information on the Ertl and people to talk to.  Needless to say, I was quite un-nerved by all this, but had agreed to look at the info.  I got home and ignored the information he had given regarding the Ertl.  It was my wife, Linda, that got up the next morning and read the packet.  She told me that I needed to read it … that it made a lot of sense.  I wasn’t ready to look, but I did.  I probably read it four times,  and each time it made more and more sense.

 This package of info explained that in 1920 a Dr. Ertl developed a process that would establish the amputated leg back to a near normal anatomical state, thus reducing many problems associated with traditional amputation such as pain.  He did this by connecting the bones (tibia and fibula) together with a stabilizing bridge of bone and addressed the nerves to alleviate pain that was common with most amputees.   I had been to see the best doctors, and this procedure had never been mentioned.   How could they not have been aware of this?  It must be hoax – there’s something wrong with the info.  I’ll call the guy Rod recommended, Larry Corley, who was the second angel … they just kept showing up.

 Corley was an amputee himself and an Ertl.  He told me I had to listen to him and not to have the other procedure performed.   He would fly out to see me, if necessary, to prove to me the Ertl was the way to proceed,  and that I would not believe how it would change the quality of my life.  At this point, confusion rained.  What’s the catch????  Why hadn’t this been brought up by my doctors?  It made so much sense, yet nothing from the medical field regarding Ertl.

 The next angel came in the form of a short prosthetist in Columbus, Ohio, by the name of Raymond Francis with Ohio Willow Wood Company.  If there’s a crusader for the Ertl, it’s Raymond Francis.  His battle to get this surgery recognized in this country is an article of its own.  Raymond talked about the benefits of the Ertl to me and said that he knows a surgeon in Columbus, Ohio, who performs this procedure.  We were down to three days until my surgery, and the Ertl kept making more and more sense.   With help from my wife and family, the decision was made to cancel the surgery in Reno and go to Columbus, Ohio to have things done.

 The next angel was Dr Polka.  I was sure this was the right thing to do because it made so much sense.  So, we were off to Columbus to meet Dr Polka.  I met Dr. Polka the day before the surgery.   I hopped into his office on crutches and sat down on the exam table.  He was great with me and really put me at ease.  My foot  had a sock over it, which we removed to examine my foot.  At that point it all came together for me.  My foot was ugly and it was time to have it removed.  Dr. Polka’s manner put me at ease and I was ready.

 I had the surgery the next day.  Rod Miller flew out to Columbus to be with me during my surgery.  When I awoke I was relieved it was over, and my life was just starting again.  I had little or no pain and was released from the hospital in three days.

 My procedure was a slight modification of the Ertl procedure.  The true Ertl is what they call a periostial bridge.  The periostium is stripped from the bone and connected from the tibia to the fibula.  It’s the periostium that generates new bone. So, with the traditional Ertl the bone forms in this periostial bridge.  My procedure utilized the fibula as the bridge.  The fibula was left long, then it was brought across where a notch was cut in the tibia and the fibula was inserted. The periostium then was wrapped around these bones.  The bridge heals like a broken bone and is ready for weight bearing in eight weeks.  This form of the Ertl is called a bone bridge.  It heals much quicker than the traditional Ertl.  I was walking in eight weeks after my surgery.

 It’s now been two years since my surgery and I get along pain free.  The bone bridge is so stable that I can place full-standing force on the end of it.  My activities are not limited.  I can ski, hike, ride bikes, spend a full day at work, and even help build a small vacation home.  Since my surgery I’ve helped two people face amputation, and both have had the bone bridge version of the Ertl.  Both were up and going in eight weeks.

 If I learned anything from my experience, it’s that doctors do what they know and not what is necessarily best for you.  It’s not intentional, it’s just how they’ve been trained.  They don’t change easy.  You definitely have to be pro-active.  There is good published information on the Ertl procedure with numbers to back up the claims made about this surgery.   You can talk with Rod Miller at Ortho Pro in Carson City, Nevada,(775-841-0660), or Raymond Francis with Ohio Willow Wood just outside of Columbus, Ohio.  Feel free to call me if you want to talk about my procedure (Scott Sulprizio, 775-882-7790 ext119).  Since my procedure, two have been done that I know of out west.  One by Dr. Davis in Carson City, Nevada, and one at UC Davis in Sacramento by Dr. VanBergeyk

 Raymond Francis says I have an obligation to help and pass on information about the Ertl (bone bridge) procedure.  This is my attempt to help all those facing amputation of a lower limb.  Hopefully all of you can be as lucky as me and have a whole group of angels show up to save you as they did me.

 One last thing for all doctors to consider is that I personally believe that they look at amputation as a failure, their ultimate last option.  I want doctors to know that my life is better without my foot and that the Ertl procedure is truly giving someone back their life.  All I can do is pray that doctors will find their angel that will open their eyes to this procedure.

 Post Script-I’d also need to thank all those others who truly helped me through this especially my wife Linda. In addition I can’t thank my parents and my brother Keith enough.  There were many others that came by the hospital and my thanks go out to all those friends.