Andy: A Long Walk Back

Andy is a perfect illustration of the Chinese proverb “you can’t look at the stars if you have a stone in your shoe.”

In other words, if you’re in pain, it’s tough to see the good things in life.

And Andy had some stone in his shoe; one he’d walked with for a lifetime. But that was until he came to Mercy Medical Center, where, after a long series of stops and starts, the "stone" was finally removed, and he was able to walk pain free, and look gratefully at the stars again.

Like Standing on a Pebble All Day Without Even Knowing It

Andy, who lives in Lutherville, MD, was diagnosed early in life with a hereditary nerve disease called Charcot-Marie-Tooth (CMT) syndrome. CMT is a disorder of the peripheral nervous system characterized by a progressive loss of muscle tissue and touch sensation across various parts of the body. In Andy’s case it affected his feet, which were weakened, and did not feel much pain.

“The disease is a blessing and a curse,” Andy said. “On the one hand I couldn’t feel much pain in my foot, but on the other hand, I also couldn’t tell that a horrible infection was brewing there. After I went to Mercy, Dr. Pichney described my condition as like standing on a pebble all day and not even knowing it.”

For nearly 30 years, Andy has worked in the grocery business, and is currently managing an upscale food store in the Baltimore area. Because of the nature of his work, he spends a lot of time on his feet. In September 2011, it caught up with him.

”Because of the disease I’d sometimes get a callous on my foot,” Andy noted. “Eventually, the pressure under the callous causes the tissue to die and a wound opens up, opening the door to possible infection. That’s what happened to me.”

This time, Andy knew it. It happened to be Labor Day, and so he initially sought treatment at an Urgent Care Center, which immediately sent him to the Emergency Room at a nearby hospital. He was evaluated and admitted for the foot infection. At the hospital, the attending physician thought it best that Andy be cared for by a podiatrist. So she called the best one she knew.

Treating the Patient Not the Picture

Dr. Gary Pichney of The Institute for Foot and Ankle Reconstruction at Mercy is a Board Certified Podiatric Surgeon who practices at Mercy's Lutherville Personal Physicians. He has specialized training and expertise in forefoot, rear foot, and ankle surgical reconstruction. Andy began seeing him shortly after being released from the hospital, and Dr. Pichney surgically removed the foot infection. As part of the recovery process, Andy was required to spend 28 days off his feet and was required to keep his foot elevated with zero weight bearing allowed, meaning he was home from work and began feeling better. Unfortunately, when he did get back on his feet a month later, the infection returned with a vengeance.

“My foot blew up again,” he said. “It was disheartening. Dr. Pichney sent me right away for an MRI that indicated I possibly had osteomyelitis."

Andy says it was that moment that separated Dr. Pichney from other doctors. He told Andy that based on what he saw in the MRI, infection could be present in the bone. He also indicated that about 90 percent of doctors would proceed at that point with amputation of the big toe from the site of the infection on the ball of his foot.

“Dr. Pichney told me he treats the patient, not the picture, and would not know for sure until he was able to see for himself in the operating room.”

In December of 2011, Dr. Pichney performed exploratory surgery on Andy’s foot. “When I woke up from the surgery there was no one happier than me to look down and see my big toe still attached and bandaged up,” Andy said.

But the stone wasn’t yet removed. Over the next several months Andy would return to work and continue seeing Dr. Pichney on a regular basis. In June 2012, Andy noticed that the site of the initial wound appeared to be acting up again. Another hole had developed and he was put on a wound vac for two months, 24-hours a day to help close it.

“It really was getting to be depressing,” he noted, “I felt like I was a chapter in a medical text book.”

Getting Back on His Feet

Then there was another visit with Dr. Pichney when he informed Andy that he’d spent the weekend at a conference with a world renowned plastic surgeon, and actually showed him pictures of Andy’s foot. Dr. Pichney was shown a procedure to close the wound and asked if his patient was up for it. “Of course I jumped at the chance to put it finally all to rest,” Andy said.

But that too was a challenge. Surgery was performed in September, and once again Andy was required to be non-weight bearing and elevated for three weeks. Two weeks into the recovery, the surgical site began to break down again.

Unfazed, Dr. Pichney swabbed the wound and sent it to be cultured in the lab. The results came back positive for MRSA (Methicillin-resistant Staphylococcus aureus), an infection caused by a strain of staph bacteria that's become resistant to the antibiotics commonly used to treat ordinary staph infections. Finally, the answer they’d both been waiting for. Andy went back on a heavy antibiotic, and this time it worked.

“Dr. Pichney once again personally went out of his way for me once again by calling my insurance company and talking them into a very expensive oral antibiotic as opposed to having a pic line inserted and having to have a home nurse come out once a day. In the long run, he saved the insurance company money as well as me, plus the added aggravation that goes with it.

“Dr. Pichney really went the extra mile," he added. “You just don’t see that anymore. He tells you that he likes to treat his patients like his friends and that certainly comes through. He’s a great guy and I highly recommend him to all of my friends.”

Andy is now literally back on his feet, working again and able to play with his four children. He has no pain in his foot and walks normally. He is looking at the stars gratefully.

“Thankfully it’s fully healed,” he said. “It was a long ordeal, but Dr. Pichney was one of the good things that came out of it.

“As a Catholic I feel blessed that Dr. Pichney was put in my life. The care he provided was unbelievable. I mean, he saved my foot. The greatest thing about him was that there’s no arrogance, you feel like he’s on the same level as you.

“The whole Mercy system was great and Dr. Pichney is a great doctor. I’m just glad I met him when I did.”

Andy's Treatment Team