John Witteman was two months away from finishing his tour of duty in Afghanistan when the blast from an improvised explosive device tore through his right leg in October 2006.
The US Army medic endured 40 surgeries over the next several years in a failed effort to save the leg, but infections continued to plague him.
"Finally, the doctors told me they were going to have to remove the leg or it was going to kill me," he said.
Two years later, John's prosthetic leg malfunctioned, causing him to fall and break his left leg. Following surgery at an Army hospital, John experienced a new and unimaginably severe pain in his left leg.
"It was horrible, beyond the pain of losing my right leg," John said.
The leg burned like fire, but could also feel frozen. His foot became swollen, while the skin on his leg, ankle and foot hardened and became sweaty. Eventually he was diagnosed as having Complex Regional Pain Syndrome (CRPS), which is an excruciating pain caused by nerve damage.
Not finding the answers
To ease the pain, physicians repeatedly injected John with a powerful drug called Ketamine. This provided some relief, but came with horrible side effects. He became confused, began to hallucinate, depression set in, and his Post Traumatic Stress Disorder from his war experience re-emerged.
"If I could have gotten out of bed and walked, I would have thrown myself off the top of the building," he recalled.
The referral that changed everything
Desperate for relief, John obtained a referral from the military doctors and met with Xiaobin Yi, MD, medical director of the Pain Management Center at Missouri Baptist Medical Center. The Center, a joint effort between Washington University Physicians and Missouri Baptist, brings together an interdisciplinary pain management team.
Dr. Yi, who is board-certified in pain management and anesthesiology, realized John was in an advanced stage of CRPS and needed immediate relief. He began a series of spinal block injections called a Lumbar Sympathetic Block, using a local anesthetic.
From temporary to permanent solution
The treatments improved John's pain significantly, but there was a catch: "The injections could only provide a short-term benefit because his leg pain was so intractable and severe," said Dr. Yi.
Any pain medication has that same limitation, he noted.
"Our staff spends a lot of time explaining the risks and limitations of pain medication," said Dr. Yi, especially considering guidelines from the Centers for Disease Control and Prevention to combat the overuse of opioid pain medications
John needed a more permanent solution, so Dr. Yi recommended a spinal cord stimulator. A spinal cord stimulation is a device implanted under the skin near the spinal cord that delivers electrical impulses masking pain signals that travel via nerves to the brain. An implanted battery pack powers the stimulator, which is controlled by a cordless remote.
John underwent a successful trial with a temporary device, and the relief from the CRPS was immediate and total.
"I told them to wheel me into the operating room and put in the permanent stimulator right then," he said.
On May 27, 2016, Dr. Yi implanted the permanent stimulator, and adjusted the device in August 2017. For the first time in years, John enjoyed an extended period of pain relief.
John's philosophy of pain
Having spent years in hospitals and battling pain, John and his wife, Christa, have developed strong bond and even stronger will to overcome.
"At first you think the next procedure is going to solve it all," said John. "Then 40 surgeries later nothing is solved. In the end, you either go on or you give up, and I'm too hardheaded to give up.
"It's been a long road," he admits. "And a curvy one," Christa adds.
In it together
Christa, who John calls his "amazing wife," oversees his medications and provides updates for the hospital records, before and after surgery, with his more than 20 medications. She schedules his appointments and drives him to those appointments from their home, which is two hours away from St. Louis.
He has a host of health problems related to his confinement in a wheelchair and the treatments he has received over the years. He credits Christa with keeping him safe and on schedule and putting up with him when he couldn't stand to be around anyone.
The future looks better
Dr. Yi says John's prognosis is good. John has a deep faith in Dr. Yi and the Pain Management Center staff.
"They know me as a person," he said. "They really get involved in your care. When it comes to a medical staff and how I've been treated, I don't think there is anyone better than Dr. Yi and the staff at the Center."
John set a goal. "You can't get anywhere if you don't set goals," he said. He wants to be walking by September. He is still on the journey that began so painfully in 2006, but he is not alone. He believes in the team of medical professionals who are focused on his care and his "amazing wife" who will walk with him.
If you have questions about pain management, call 314-996-7200.