Dear Readers: Linda here - Every now and then something comes along that may mean a great deal to some. The following articles all concern amputation and the reasons why people with CMT sometimes have an amputation performed. They aren't easy articles to read but they testify to man's intestinal fortitude to get on with life and I hope they will help others who have reached the limits of present-day medical knowledge to decide whether amputation is the right thing for them.

Mind over matter
by Ian Thomas, Wales, U.K.
My name is Ian and I have CMT type 1A. I am a very happily married, 41-year-old father of three children, two of whom have CMT. I am also a proud young grandfather of a 15-month-old grandson.

First, a brief history of my CMT. Like many people with CMT, I had symptoms from an early age, four years old in my case, and was thought to have Duchenne muscular dystrophy. Thankfully, this wasn't so and, at 19, I was correctly diagnosed with CMT.
Over the past 22 years, I have had the following surgeries on both my left and right : triple arthrodesis; wedge tarsectomies; Dwyer osteotomies; Keller procedures; P.I.P. arthrodesis; excision of third and fourth metatarsel head; tenotomies; Steinler procedure (left); amputation of second and fourth toes (right); excision of cuboid (right); and various other small procedures.

The combination of having so much surgery only compounded the progressive nature of CMT. The result was a breakdown of my ankle joints, so much so that widespread osteoarthritis was causing so much pain. I had worn out the ankle mortice holding the bones of the leg to the feet meaning the tibia was sliding and giving way across both ankles.

Having researched options myself and their long-term prognosis, I decided to discuss the future with my family, friends and my specialist, consultant orthopaedic surgeon, Mr. Malcolm Downes. Keeping mobile and, if possible, pain free was my aim, and if that meant amputation, then I was physically and psychologically ready for it. The alternatives were ankle fusions or ankle replacements. Neither were the real answer, at least that is what I believed and my surgeon agreed.

Fortunately, in the U.K., we have a National Health Service that is free to all citizens, although waiting lists are long, and I waited for 18 months for my amputations, long enough to have changed my mind, but I knew this was the right option for me.

August 1998, my first below knee amputation took place. I have to say it was quite a painful experience, more than I had anticipated, but within seven days I was released from hospital and was walking again five weeks later at the local limb centre. Walking with an artificial limb is like walking on stilts, good balance is needed, and providing you have no tender areas on the stump, then it should be totally pain free as is in my case. Phantom pains lasted some three weeks. I also had cramps in the stump but only in the first three weeks.

November 1998, three months to the day after my first surgery, I had the second amputation. This time I had no pain, not even phantom pain or cramps.

Walking with two limbs began in earnest the beginning of December 1998, and the first week of January 1999 I was back at work, unaided, and indeed I drove myself to work. The only adaptations to my car is that I have larger foot pedals. I have worked as a volunteer advisor for seven years in a local Citizens Advice Bureau. My aim, within the next year or so, is to gain full-time salaried employment.

My walking gait is now so good that an aunt said to me recently, "Ian, I have not seen you walk so naturally since you were a young child." Indeed, whenever I visit the local limb centre, I often get asked by other amputees, "Are you calling to collect someone," not realizing that I walked in as a bilateral, below knee amputee patient and will walk out as such.

May 1999 I collected my new limbs. They are state of the art with a spring mechanism within, so I have a greater bounce when I walk. I now feel like running everywhere. When making up these new limbs, the prosthetist asked what height I was prior to amputation and whether I would like to be shorter or taller. I told him I had stood six feet tall but would like to be even taller...a big mistake! For two days I was walking around with my head in the clouds. Why? Because I was raised to six foot three, and believe me, those extra few inches make a whopper of a difference; my centre of gravity was way out and all my trousers were half mast. So, reluctantly, I had to agree with the prosthetist and he lowered to six foot one, which is quite nice.

My birth feet grew only to a U.K. size 3 shoe. Now I wear a size 10, and believe me, what a difference and probably why I now have such good balance.

I am under no illusion that amputation is a salvation for everyone but I do say if you are like me and have undergone so much traumatic surgery and can see no end to it all then carry out your own research, talk to medics, better still talk to amputees at your local limb centre. Of course, amputation will throw up its own problems, but think positive... mind over matter.

The limb centre I attend is attached to a major trauma hospital, and I have been asked by the sister in charge if I would give some of my time to speak to trauma patients who find the experience of losing limbs literally ‘the end of their world.' They just don't know it yet but just a few weeks down the road they will be walking again.

My dear wife, Leona, children, Ceri-Ann, Alastair and Leona, have been a tower of strength. Morever, not many 15-month-old children have the capacity to assist their grandfather in taking off his legs! Notwithstanding, my parents and extended family and friends have been fully supportive, and I am eternally grateful for that. Indeed, I cannot thank everyone at Morriston Hospital, Swansea, South Wales, enough.

Doctor-patient with CMT opts for foot-lift instead of face-lift
by Dr. E. J. Anderson, Louisiana, U.S.A.

Middle age crisis in the aging CMT male Homo sapiens may invite all sorts of death-defying acts of malcontent. In my case I was focused to correct a clubfoot that was only getting worse and not holding up to the heretofore lifesaving AFO. I was constantly nursing callouses on the outer edge of my right foot. Sometimes they festered into abscesses that put my foot out of commission for weeks on end. So, when the time was right (my pediatric practice enlisted two new pediatricians), I began to shop for an orthopedic surgeon; one who would agree to doing an ankle arthrodesis (ankle fusion) and at the same time reshape a caved-in ankle into one that is frozen upright and enabling me to walk on the bottom of my foot, not the outer edge. There were three in this area for me to choose. Once done, the date was set and I never looked back.

Undaunted, my wife and I vacationed to the northeast for the fall foliage - breathtaking vistas twice out. We even walked a five mile circle in Old Boston. Returning home, I was ready for surgery on 10-21-97, uneventful although Dr. Keith Donatto was concerned he did not wedge the ankle fusion as much as he would have liked, but in my mind's eye, another procedure was out of the question. I would just wedge the shoe to make up the difference.

Recovery was a slow tedious process, but getting about on crutches was the only alternative to being a ‘couch potato'. I can vouch for CMT patients who complain with balance problems. Crutches hardly improved my balance, except when I found myself touching ground with my surgerized foot, probably sooner than my doctor allowed. At six weeks, X-rays showed bone filling and limited weight bearing was allowed. However, I knew best, so it was limitless weight bearing henceforth.

In the next four weeks I was parading through Wal Mart for Christmas presents, riding the 4-wheeler at my farm and driving the car, all with my right foot in a walking cast. At 10 weeks I bought a right shoe with me to the doctor's office expecting to rid myself of any more casts. When the X-rays were read by Dr. Donatto to me, a deterioration of last month's healing, and even microfractures, my hopes for a renewed life of activity and less dependence on my very supportive wife were doomed. There loomed the possibility of non-union, a complication of fractures, and fusion surgery...a complication I never considered. I, being a doctor, could not entertain a complication as a possibility. I, being a doctor, knew what progress could be made and when to make it. I, being a doctor, even though admitting to pain and swelling that was not relenting, thought of nothing going wrong. So we face the music of all my actions and their consequences. Back into a cast, back to crutches, no weight bearing to the right foot was my sentence for the next four weeks.

As my eyes flooded with tears, I realized that I was no longer in control, that I had to rightfully submit to being the patient, following doctor's orders. Rationalization was a lark of the past. My only solace, fortunately, was at my side, my wife who had been there for me in all these weeks, and with her continued support, we would get through this setback.

For four weeks I no longer used stairs for fear of accidentally bearing weight on my foot. I took vitamins, used an electric bone stimulator and confined myself to the bed or the couch.

By the end of January, and with the next four week visit looming, I began to feel the anxiety of whether the X-ray would reveal bone generation. But, it was not to be to our dismay, nor would it be in the next visit a month later. Now four months post-operative and on total disability, I began to despair at the thought of losing my foot and forced early retirement. When I returned the next month and the X-rays were again unfavourable, the recommendation was surgery... repeat the fusing, repair the wedge to the angle he was hoping to improve, to remove screws and put in an L-plate and seven screws...essentially starting from scratch. My morale was so low I didn't hesitate to say, "Go for it," on Good Friday, April 10, 1998.

I consider myself an optimist, allowing the transcendence of pain and inconvenience of major surgery to the ‘other side of the mountain' with each day, week, month reaching to recovery. There were more books to read...anthologies by John Jakes, Ken Follette, Grisham, etc., were great saviours from boredom over the next four months.
Now that I was finally out of cast, driving and walking again and back to work, it all seems worthwhile. I can no longer rely on surgeons and must gather my own recuperative powers to reach the time I can wear a shoe. Hopefully the orthotist will be my saviour toward the final stages of my foot-lift.

Alas! It was not to be. On Tuesday, August 14, 1998, and four months post-operative, I saw Dr. Donatto for the final visit. He was being transferred to San Francisco and a higher step on the ladder of academia. His first remark as he studied the films of my right foot was, "and the end of a saga." They showed continued bone growth up to 80% this time and probably no further X-rays were needed. "What about the swelling that never goes down until I recline in the evening," I proclaimed. "And what about the pain when I try to do more?" I knew that an AFO was going to be necessary but not until the edema (swelling) was controlled. I had many questions, none of which could be answered by the good doctor, unless he was also a shaman. Indeed, I wondered if my next visit to Dr. Donatto's replacement might be better served by those medical magicians.

The swelling and pain continued, and each night as I lay with the foot elevated, I pondered the outcome but could not yet ‘come to grips'. I had returned to my clinical practice and found that if I spent more than two hours afoot the pain and swelling was intolerable. But I held to the prescription to return for follow-up in three months, which finally took place in November.

Another quandary...I would have to place my future with an orthopedic surgeon I didn't like. He was first recommended by retiring orthopedist, Dr. Luke Bordelon, a highly sought after specialist in foot problems from CMT, who had operated on both feet twice previously, and was may saviour in the 80s. This foot specialist, a pediatric orthopedist, also operated on adults with CMT. The visit was not received well, as he suggested surgery on both feet and allowing one year to recover. His aloofness or lack of compassion didn't add to his credibility and his name had been removed from a list of candidates.

So the appointment was made and the consternation began, right up to the moment when I reported to his office only to be told that he was in emergency surgery and would not be able to see me today. My fuse was lit, as I could have been called to prevent the unnecessary trip to his office. I asked if I could at least be X-rayed, that he could read the results later. No, he couldn't do that. He would have to see me first. Understandable, if I was a ‘new' patient, but my case was a follow-up that, on appearance, wasn't even discussed with Dr. Donatto. I left, defeated and deflated.
That evening I called an old friend, a contemporary who practised general orthopedics in my area, starting out as I did, on his own and watched his practice enlarge with five more specialists, just as mine. He or his partners were always on the spot for referrals, and before this all began, I sought his advice as to which foot specialist to employ. So with X-rays (from August) in hand and my destiny in balance, I and my wife met with Dr. George Byram, retired.

It didn't take long for him to listen to my history, read the X-rays, and examine my foot. "Jim, your foot is not healing. You still have nonunion, and it's a matter of time as to when infection will begin, osteomyelitis," proclaimed Dr. George. "What's more, I suggest you undergo a Syme's amputation (stump is like a heel) so you can get on with your life." He came down hard but true, and his emphasis on "getting on with my life" made it palatable.

This is the least invasive amputation of the lower limb - at the lower level. The heel pad is salvaged as a flap, to cover and cushion the end of the stump, and allowed to heal in four to eight weeks before a prosthesis could be employed. Before Mary and I could blink our eyes and allow the pangs of devastation, a plan of attack was set in motion. George called in his youngest associate, Dr. John Burvant, who would be the surgeon and George would come out of retirement and assist, to my satisfaction. We scheduled the operation for December 10, the eve of my 63rd birthday, thus allowing two of my associates their predetermined vacation time.

The next three weeks crawled by as the pain of a very loose, swollen foot became intolerable, only because I knew its days were numbered. But I plodded along and the surgery and healing process were uneventful.

I have been discharged once more by my surgeons. I am awaiting a ‘new' foot, as the prosthetist made an impression of the stump this past week. I have no phantom pain but sensations that the foot is still there...wiggle my toes, feel an itch.
I look to the future with a positive attitude, anticipating a few more years as a pediatrician, and as someone whose right foot made the supreme sacrifice after undergoing a foot-lift, to foot-loose, to footless. What else can I ask!

Nonunion and amputation
by Dr. Robert Sampson, OR, U.S.A.

Linda here - I asked Dr. Robert Sampson, one of our long-time CMT International advisors and an orthopedic surgeon who has CMT, to write about union, nonunion and amputation to help us understand exactly what Dr. Anderson had done and how it could impact on our lives if needed. This is what he wrote:

UNION is what is supposed to happen when a fracture occurs. It is the final knitting of the bone. This same term defines the satisfactory healing of a man-made fracture such as a fusion or a reshaping of the bone (osteotomy). In both these cases a surgeon has cut the bone and when it heals in a satisfactory period of time it is united. If the time it takes to heal is too long then it is called a delayed union. If the bone heals on time, but is crooked, then the healing is called a malunion.

So, in general, when a fusion becomes a delayed union three to six months have gone by without a satisfactory healing. After six months it is usually termed a nonunion. Depending on the area of fusion (ankle 20%) or hindfoot (10%) or surgical technique (arthroscopic 99%) or (open 20%) different rates of nonunion may occur.

A nonunion is treated in a variety of ways.
1. A surface coil of electromagnetic fields. This is worn over the cast. There is no perception at all of feeling electricity. These coils are 80% effective at bringing about a successful union.
2. A surface coil of ultrasonic field. Results about the same.
3. An implanted electromagnetic field. This is a small battery - the generator and coil to that is implanted right into the bone. Results: 80% effective.
4. Repeat the surgery often using a bone graft. The graft brings fresh, living bone cells into the healing area. The graft is usually harvested from the pelvic bone. Often, when redoing the fusion site, an electrical device is used in conjunction with the surgery. Combined results about 90%.

Notice that once a nonunion has occurred there is always less than 100% chance of getting a good union.

Factors creating a nonunion are: luck or no luck, general nutrition, ability to rest the fused joint, surgical technique especially getting a nice flat surface area and compressing it with screws or other hardware. Tobacco is a no-no as its use increases the rate of nonunion by 500%! Prior infection decreases successful union. Neuropathies such as diabetes or CMT also increase the risk of nonunion. My experience has been that diabetic neuropathy is far more likely to cause nonunion than is the neuropathy of CMT.

Signs of a nonunion are continued pain, swelling, redness and a feeling of heat at the surgical site. Confirmation is by regular and sometimes by special X-ray studies.
Amputation is what orthopaedic surgeons call the ultimate operation. It is the salvage for almost all orthopaedic procedures. It is met with great psychologic resistance by most people. Interestingly enough, once completed it is one of the most successful operations and one of the most appreciated. Probably its acceptance is because all else has failed and the patient is miserable. A world famous orthopaedic surgeon, who had done hundreds of amputations, suffered from a childhood infection and deformity, had his leg amputated at age 70 years. He cried for days, and when I asked him if the pain was causing him to cry he said, "No, it is the lack of pain. I wish I had had this done 50 years ago." His reaction is typical.

Amputations are done when all else fails and repeated surgeries would be fruitless or perhaps wasteful of a person's time and financial resources.

Typically, a good fusion of the foot or leg takes four months to heal and another two months to be useful. Amputations of the foot or leg usually heal in about six weeks and, in the younger person, the patient can even be fitted for the first leg prosthesis in the operating room.

Amputations can take place just about any place on the leg, but certain ones are more common and predictible.
Toes: These usually heal rapidly and, believe it or not, their loss does not usually affect how one walks.
Middle of the foot (transmetatarsal): Good for infections and ulcers under the ball of the foot. No prosthesis required. Sometimes a toe filler of foam is used, but most people just wear a regular shoe.
Just in front of the ankle, leaving the heel: This is a good amputation in the younger person, but can be tough for the limb maker to fit. It is nice because you can still get up at night and go to the bathroom without looking for your leg.
Syme's amputation: This takes the heel and the ankle bone (talus) out and leaves the end of the shin bone to walk on. One can get around some at night without a leg on but is not capable of long walks without a prosthesis. When successful it is a great amputation. It is a hard one for the prosthetist (leg maker) to fit and sometimes the heel pad migrates and must be realigned.
Below Knee: This is by far the most common major amputation of the lower limb. It tends to heal well and be quite useful, but it leaves a short leg, one that cannot be used without an artificial limb. There are a variety of sockets into which one can fit the leg stump. The type of socket depends on the intended use of the limb, the blood supply, the degree of scarring of the wound and the quality of the remaining skin. The leg itself can be made to be quite cosmetic and one can even select from a limited number of mechanical ankle selections and springiness of the foot. I have patients with this type of operation working in the logging industry, driving trucks and performing many different types of labor and sports activities.

Above the knee amputation is disabling. It takes a lot more energy to walk with this type of prosthesis and the knee joints tend to be heavy, mechanical and artificial.
Phantom pain is one of the greatest fears of anyone about to undergo an amputation. Fortunately, it is quite rare in an elective surgery, where the operation is preplanned, the patient is counselled and the surgical wounds clean and neat. Phantom pain is more common in the traumatic amputation where the wound was made by a tree or auto bumper and the nerve was crushed off rather than cut off. Phantom pain is also more common when the patient has put off the operation for too long and their pain has been ingrained on their memory. Phantom pain is difficult to treat and requires the services of a pain treatment center.

Linda here - I've known of Brian Christie for many years through letters from his parents, Mabel and the late Charlie Christie, but I've never really heard Brian's entire story. I found it fascinating. I think you'll agree Brian is one stubborn, gutsy guy! He spoke to me by telephone from his home.

He's got his life back!
Brian Christie, 51, of Nova Scotia, Canada, is a husband to Linda, the father of three children (two girls, Rhonda and Kathie, and a son, Robert) and grandfather of three grandchildren, Chris, Cassandra and Holly.
When diagnosed with CMT 20 years ago, he was working as a diesel mechanic and had worked until five or six years ago.

How did his foot problems begin?
I had plantar's warts originally and I couldn't feel them. I had no feeling in my feet and in order to get rid of them they had to be cut out. When they cut them out, thanks to CMT, I didn't heal. Nobody had put a name to what I had, so they didn't realize that I might not heal well at the time. The incisions didn't heal; in fact they got bigger and I developed large open ulcers that I walked on for 18 years.
How could he stand the pain!
I have a pain tolerance that the doctors say is ten times that of the average person and I've lost all feeling in my hands, legs and feet. The treatment was painkillers and antibiotics. The surgeon who did the work on the open ulcers told me that he would have been in a coma if it had been him. The intensity of pain was so great that it likely would have hospitalized me instantly, if I could have felt it.
How did he live with open ulcers on his feet all the time?
My feet were always bandaged... for 18 years. I'd come home from work, take off my safety boots, cut off the bandages, wring the blood out of my socks, clean up my boots, and rebandage my feet for work the next day. If you can't feel what you are walking on or you can tolerate a lot of pain, this is hard to believe but possible. Quitting wasn't an option. I had a family to look after and I had to do something!
What finally stopped him?
Finally, I began to feel the pain big time. The painkillers I took weren't doing the trick and I couldn't do my job safely. I was working on huge tractor trailers and you can't take those on the road and not be fully in control. You've got to have all your marbles for that!

By this time, maybe 15 years ago, I went to apply for Canada and provincial pension. I had been diagnosed as having CMT Type 1 with what my doctor calls a "Wild Card"... my CMT does things it isn't supposed to do. My doctor, Joe Dooley, has researched this disease for many years and is still at it as far as I know. I have extremely limited sensation in my hands, lower arms, lower legs and feet. I'd say, I've lost 90% of the sensation in those areas and 80% of the strength.

I got into an argument with a table saw three years ago and cut off four fingers. It took six hours for surgeons to sew them back on. I only had one shot of morphine and that was immediately after I did it. I had general anesthetic while they managed to sew three of them back on but I couldn't feel much of anything when I first cut them off. Fortunately, I have about 90% movement in those fingers although my hand is very weak.

From the beginning, when I first developed open foot ulcers after the plantar wart surgery, I was running back and forth from the hospital three times a day to have the ulcers packed and my dressings changed. Needless to say, there was no time for anything else with the hospital and work. Then the doctors showed me how to change my own dressings but insurance wouldn't pay for the bandages. The cost was about $350 a month. I finally bought them from a medical supply outfit and did them myself.
I tried to make the provincial health people see that going to the hospital three time a day, 31 days a month, cost them far more ($3,000 to $4,000 a month) than it would opposed to just giving me the bandages and letting me do it at home. They said no, they didn't want to set a precedent. Four years ago, the government began paying.
To close these open wounds, they gave me every type of oral and IV antibiotic known to man, along with hyperbaric oxygen treatments which was a big waste of time. The IV antibiotics made my veins collapse so they installed a Portacath, a permanently implanted catheter, in my chest that lets them put a needle into it without interfering with my veins. The drugs didn't work although they damaged my stomach, my liver and kidneys.

Twice they tried skin grafts and they just fell off. I've tried home remedies, just everything. Anything anyone told me, I tried. I had nothing to lose.

In September of 1997, I woke up one morning and was walking from the bedroom to the living room and my son asked me, "What's with the blood?" I took off my sock and bandage to see what was happening and apparently I had an infection so bad that it had literally exploded the end of my foot. The skin was all off.

I went to the hospital and the surgeon looked at it and admitted me to try a course of antibiotics to see if he could control the infection. Five days later he said he couldn't, that amputation was my only option. At that time he didn't know how much he would have to take off. I still had these big ulcers on the sole of my foot.

He amputated right behind the ulcer on the ball of my left foot. It was called a forefoot amputation. He left the amputation open, put a couple of stitches in each end and the rest was packed with Kaltostat, a seaweed dressing. You could actually see that stuff drawing the infection out of the rest of my foot. Within three months my foot was totally healed over, the first time in 20 years. I can actually sleep without a sock on!

The right foot was worse. Between Christmas and New Years 1997, the open ulcers got infected. I went to the doctor on Jan. 2, was admitted to hospital the same day. The surgeon took one look at my foot and told me it was gas gangrene and he didn't know what he could do with it. They couldn't amputate because of the gangrene but they did operate on that foot to try to clear the gangrenous tissue. It took three months for it to heal although it still had the open ulcers. All they did was remove the gangrene. Three months later, March 1998, they did the same procedure on the right foot that they'd done on the left. I was walking on it three months later. I was even walking around a campsite, up and down hills.

After 20 years, they finally described the organism they couldn't identify in the swabs they had taken of my ulcers for so many years. Apparently, it takes four or five organisms combined to create gas gangrene. The one element that was missing was in this right foot. When they had my actual forefoot in their lab, after the amputation, they found the element they needed to confirm the diagnosis of gas gangrene.

To look at me today, and if I had on a pair of boots, you'd think I had nothing wrong with me but one finger missing. In reality, I have both feet partially amputated, and I can't feel anything from the knees and elbows down although I can move those areas. The major things that are wrong with me just don't show.

How does Brian feel about the amputations?
No problem. Best thing that ever happened to me! They have allowed me to get up and move. There is no more bleeding, no swelling and a whole lot less pain. I can sleep in my bare feet (I wore socks and bandages for 20 years) and I can get on with life. The only thing I can't do is swim because of the Portacath in my chest. I could tear it lose. It has been almost a year and everything is fine.

I was offered prosthetics to replace the parts of my feet that are missing but they wanted $1,400 apiece for them. So, I buy a pair of high-top sneakers, stuff the end of the sneakers with gauze bandage, put 'em on, tie 'em up and walk. I use a cane for balance sometimes. I have a wheelchair and a walker and a ramp on my house that I fought for years to get and a bathroom specially made for me all done through grants I had to fight for but I'm doing okay, I'm stubborn.

I've never used my CMT as an excuse. It is not an excuse. To me and my family it is an inconvenience and that's all it is. We're doing fine.

My wife, Linda, is a personal care workers (PCA) and has worked in nursing homes all her life. She takes all this in stride, but without her, I wouldn't be where I am now. I don't think she realized the marriage vows included what she's been through. I love her so much!

My family doctor, Dr. Yvonne King, has kept me alive. She is incredible. The two surgeons, Dr. Ralph Burnett and Dr. George Sanson, and Dr. Walter Shlech, head of the infectious disease centre for the Maritime Provinces, and Dr. Joe Dooley, the CMT researcher, are all to be highly commended. If it wasn't for them I wouldn't be here.
To me, family is everything, without it nothing else matters. I hung on for me and for them. Failure was not an option and now things are good.

Amputation - One Smart Move!
by Sheila Forthman, CO, U.S.A.
I began suffering with CMT when I was perhaps five or six years old. And like so many of your readers, I, too had a triple arthrodesis. The pain continued, the burning became unbearable, until in 1974 my orthopedic surgeon suggested bilateral amputation of the feet. Sounds pretty drastic, huh, but what a smart move on his part. I didn't hesitate too long before I said yes.

The recovery years were not exactly a piece of cake. I had a husband who moved out, and two young daughters to care for. All of my extended family lived 1,000 miles away. But you know the old saying...you do what you gotta do. And I did.

Twenty-seven years later, and I am still coping well. Some things are downright hard to do and others are as easy for me as they are for the ‘normal' population. I have noticed as I approach 60 that I am quite a bit stiffer. I still have pain, but sometimes I can actually block it out, and if I can't, I don't let it stop me from doing what I want to do. I had to quit working full-time four years ago because of osteoporosis. I had fractured my pelvis and the extra pain was just too much. So now I do volunteer work at the school one day a week. I take a quilting class and sew in my free time.

My greatest enjoyment, though, is the three grandchildren. We love having them here at the house overnight. I drive five miles about three times a week to take my two-year-old grandson for a walk down the street. He seems to know that I can't chase him so he never lets go of my hand.

So much of the information in the newsletter is pertinent to my situation, but then there is always the feeling that "I am better off than you are."