RED OAK - Florine Nix has just been cleared to walk with the aid of a cane — a step up from the walker she has been utilizing for the last few months. But the physical therapy, the inconveniences and the slow pace are all a blessing for Nix.
On March 6, Nix received excimer laser ablation treatment on both legs after undiagnosed peripheral arterial disease had significantly reduced circulation in her legs. The treatment cleared the blockages in the arteries and veins in her legs and she has been in recovery mode since the treatment. However, without the expertise of Dr. Kenneth Kollmeyer, Nix’s treatment could have been significantly different, leading to possible amputation.
Nix, 77, has lived in Red Oak since 1982, living an active life which included commuting to Dallas for work as an accountant, gardening and maintaining her home.
“I was active,” Nix said. “I worked full time, took care of my household — what any homeowner does to keep things going.”
Nix experienced severe changes in her lifestyle in the fall of 2006, when she began experiencing extreme pain in her lower extremities.
“I was in pain all the time. One doctor diagnosed it as back problems and said I needed surgery. I was definitely in pain and it got to be where I couldn’t walk on my own,” Nix said. “It took about three months to get really bad. At Christmastime I did very little shopping or anything with the holiday because I couldn’t walk.”
Nix developed swelling in her legs, as well as blisters and seepage. Nix visited a slew of doctors who suspected various things, suggested treatments, but could never put their finger on a correct diagnosis.
“They diagnosed it as cellulitis at one point. Everyone recommended antibiotics. I even went to the hospital for a few days,” Nix said. “My condition kept getting worse and I kept seeing various doctors saying various things. They never could get to the base of the problem.”
Finally, Nix’s sons suggested she have a circulation test after checking her into Methodist Health System in Dallas.
“My sons requested a circulation test, which no one had tried before,” Nix said.
The test revealed that Nix had peripheral arterial disease, which is a condition that causes blood vessels in the arms or legs to become restricted or blocked.
“It’s a progressive disease and hardening of the arteries is the cause. Everyone that lives in America has hardening of the arteries,” Kollmeyer said, explaining that the American lifestyle and diet, as well as the high percentage of people with high cholesterol and diabetes contribute to the 12 million people in the United States that suffer from PAD.
“The older you get, the more progressive it gets. By the time you get to 60, 70, 80, that disease has been working for half a century. It just builds up until the artery is shut off,” Kollmeyer said, adding that the disease is becoming more frequent in younger people.
While 12 million people live with PAD in the United States, the disease often goes undiagnosed because the common symptoms of leg swelling, leg pain or numbness are considered symptoms of aging.
“I see it all the time - I think that you’re going to find that PAD is one of the most under-recognized problems. The reason for that is that when people have leg pains and cramps, many times their primary care doctors and other caregivers think of it as no big deal and ‘you’ll get over it,’ and don’t give it an honest assessment for treatment. That’s why I thought Mrs. Nix is an excellent example of this — she kept complaining of pain in her legs and they kept blowing it off and never really recognized it,” Kollmeyer said. “A year ago she was out planting her garden. She’s not a nursing home patient. Here’s a person who lived by herself and actively gardening and now she’s lying her bed with gangrene.”
Kollmeyer had treated Nix’s husband for PAD in the past, and when Nix’s family realized she too was suffering from the disease, they immediately made contact with Kollmeyer.
In his initial consultation, Nix was in immense pain and heavily medicated, which caused hallucinations.
“I was completely out of my head for about three or four days. My sons were there and they consulted with the doctor,” Nix said. “They decided to immediately go ahead with surgery.”
“She was out of her mind because when your circulation gets bad, your nerves start dying. That’s the worst pain known to man,” Kollmeyer said. “It’s sort of like leaves on a tree. If you don’t get enough water out there, the leaves on the end are going to start dropping off. Her skin and tissue were getting ready to drop off.”
Kollmeyer said the decreased circulation was due to blockage in her abdomen and thigh, disallowing the artery to carry blood and circulation to Nix’s toes.
“The pain was uncontrollable. She was literally crazy out of her head from the pain and the narcotics,” Kollmeyer said. “I looked at her and couldn’t believe it. She had blockages in her aorta. By the time it got to her knees there was almost no circulation. She was getting a trickle, but that was it.”
Nix also had gangrene in one of her legs.
“The problem was she was already down and almost out — she’s in pain and had been in the hospital for a week,” Kollmeyer said. “She had multiple levels of problems, where, in the past, we’d have to cut your belly open and replace your aorta with a bypass. In the shape she was in she would never have recovered.”
Fortunately, Kollmeyer is one of the few doctors in North Texas who has experience using the excimer laser ablation, a laser technique that allows surgeons to vaporize blockages and restore blood flow. The process is less invasive and cuts down surgery time.
“This laser is ultraviolet and it’s cold. You don’t want to put something inside a blood vessel and cook it. This is on the opposite side of the spectrum and it generates no heat. It’s cold, but the light energy is amplified so that when it comes to contact with the plaques, it is able to vaporize the plaque and turn it into single molecules so small that is just returns to the circulation in the blood system,” Kollmeyer said, stressing that the laser does not break off large pieces of the plaque, only very small single molecules. “The lasers are pretty small — the one used on her was the size of a pencil lead treating an artery the size of your index finger.”
Kollmeyer used the laser to create a hole in the blockages in order to perform balloon angioplasty.
“With her I used every technique we know. The forefront of all this is the laser to create a hole,” Kollmeyer said. “With a five-hour procedure we were able to remove the blockage. The normal course of action without the laser would be to cut her open and replace all her arteries.”
Kollmeyer said that although lasers have been available in the medical field for about a decade, the use of excimer laser ablation is underutilized to treat PAD patients.
“The laser has been around 10 or 12 years — the problem is people have not been aware of it. It’s only the past year or two that we have used it on almost every singe one of our patients to lessen the risk of problems or complications,” Kollmeyer said, adding that with a practice in Oak Cliff, he treats many patients with PAD and uses excimer laser ablation. “It’s really a tough group to deal with. In the past I would have to operate on people and they would be in the hospital for months. Now, 90 percent of the time, using the laser I’m able to get to places I wouldn’t have been able to in the past. Their use for this particular problem is still not widespread. In my opinion, it’s way underutilized.”
Now, after a full month in the hospital and another month recovering in her home, Nix is improving with each day.
“She’s back on her feet and her wounds are all healing. The gangrene that was in her leg has to heal from the inside out, but she’s walking and taking care of herself,” Kollmeyer said. “It’s as close to a miracle as I can see.”
After a month in the hospital, Nix opted to return to her home in Red Oak for recovery rather than living in a rehabilitation facility.
“I persuaded them I would be better off at home,” Nix said. “I found a lady who stayed with me for two weeks. Home Health Care services took care of my medical needs and rehabilitation. Just this past week my therapist told me I could start walking with a cane rather than a walker.”
Since her surgery at the beginning of March, Nix has been through a tedious process of recovery, but thinks her life will return to normal very soon.
“The recovery is not painful, it just takes some time. I feel I’m going to be able to resume my normal activities very soon,” Nix said. “I haven’t been able to work but my job is still open and waiting for me.”
Looking back on her experiences and recovery, Nix is thankful that she has been able to use a walker and a cane.
“It makes me so thankful to God that I found this doctor. They didn’t give me much chance to live. I think it’s a blessing. From my experience, they aren’t very well informed. I know Dr. Kollmeyer would like people to be more informed because he could save lives. A lot of people are having amputations that are not necessary. This infection that got into my legs could have resulted in the amputation of my legs,” Nix said. “Dr. Kollmeyer is one the few doctors in the area who does this surgery. He’s very knowledgeable in this procedure. I would definitely recommend him for anyone in this situation.
“Incidentally, I have a garden planted,” Nix said. “I hope to able to pick the fruit from it.”
E-mail Mandy at firstname.lastname@example.org