'The next step'

Being active is just in Richard Blalock's DNA.

"I've run all my life," says the 56-year-old Mount Pleasant engineer. "My mom said I ran before I walked."

But Blalock's penchant first was challenged about 10 years ago. Arthritis started to "set in" in his right ankle, the likely result of having a school bus run over his foot when he was a child. After the arthritis, he continued to run, but the pain altered his foot strike and exacerbated his pain.

After reconstruction surgery, Blalock still couldn't walk far without suffering pain and faced a life of taking prescription anti-inflammatory pain killers and the prospect of needing a cane or crutch to walk. Needless to say, he could no longer enjoy his No. 1 passion.

"So I took the next step," says Blalock.

The choice to amputate

Blalock and his orthopedic surgeon, Dr. Blake Ohlson of the Roper-affliated Orthopaedic Specialists of Charleston, studied the prospect of amputating his lower right leg and fitting him with a prosthetic leg.

Blalock was comfortable with the prospect.

He had read about amputees not only running, but competing at elite levels, including Boston marathoner Rick Ball, South African paralympian runner Oscar Pistorius and Ironman triathlete Scott Rigsby. He researched all the details from the surgery to various kinds of prosthetics.

Like others who know Blalock, Ohlson described him as a "clear-headed thinker," and that Blalock is like many baby boomers who don't want to compromise their active lifestyles. He adds, "A person who is 60 years old today is not the same as one 20 years ago."

While an ankle fusion could have been the next step after reconstruction, he knew that would not meet his expectations. He opted for amputation.

So they looked into an Ertl "bone bridge" procedure. The surgical technique was developed by Hungarian doctor Janos Ertl in 1920 in an effort to allow World War I veterans to return to the work force.

In a nutshell, the procedure leaves portions of the fibula and tibia, which grow together and create a bridge that generally provides more weight-bearing stability for active prosthetic use. Many military amputees have it done and return to high-activity jobs and even active duty.

Blalock recalls, "I couldn't see a downside, other than if I had complications from the surgery."

His wife, Jennifer Blalock, also a runner, agreed.

"A lot of people have had their ankles amputated not because of running but because they were in pain all the time," she said.

After multiple meetings with Ohlson, physicians assistant Kate Eden and prosthetist Larry Wiley at Floyd Brace over four months, Blalock had his surgery April 14.

Back on track

After nearly five months of patience and fastidious care, Blalock ran his first mile with his prosthetic leg. And Nov. 14, he ran his first race, the Conway Rivertown 8K, and won second place in his age group. He described on his blog (http://iiagdtr.blogspot.com):

"On Saturday, November 14, 2009, after two major surgeries and no running for over two years, I completed an 8k race. Exactly seven months prior, on April 14, 2009, I was in the OR having my right foot amputated. It's hard to describe other than a sense of shock at what I've done. I have done something immense with my life, and I cannot grasp all of it. If I try, it overwhelms me. It's as if I'm deaf from an explosion, and sound is slowly coming back to me."

As of today, Blalock has run in five races, including last Saturday's Charlie Post Classic 5K on Sullivan's Island, and he's even eyeing, eventually, chasing after times he ran when he had both feet.

"Every race now, it's like I'm a new runner," says Blalock. "I had a past life and new life. Now I have new PRs."

A common alternative?

Both Ohlson and Wiley called Blalock a model patient with an extraordinary will to research options and therapies, as well as to heed all their instructions.

As an elective procedure, Ohlson says there will probably be more amputations before there are fewer. Eventually, ankle procedures and implants will improve to the point where the joint can be fully functional, but ankle surgeries still do not have great outcomes.

Wiley says the option to amputate is gaining attention especially as prosthetics continue to improve, as more people offer a testament to the option, and as the Internet offers people with a chance to learn about options.

Does he think many people who read this story will just consider Blalock a running kook?

"I can see that," says Wiley. "But the same could apply to anyone else. Just say that all your life you liked having a garden and then you couldn't garden anymore. What kind of life would that be? This man said his mother told him he came out of the womb running. It's what defined him as Richard Blalock. I think it's great that he grabbed his identity ... and took off."

Support groups

There are several support groups for amputees in Charleston.

--The Downtown Amputee Support Hub meets at 6 p.m. on the third Thursday of each month on the eighth-floor rehab unit at Roper St. Francis Hospital. Call Don at 478-0659.

--The Charleston Amputee Support Team meets at 6:30 p.m. on the first Monday of each month at HealthSouth Rehab Hospital Dining Room in North Charleston. Call Frank at 323-8893.

Blalock’s blog

Here are some excerpts from Richard Blalock's blog, http://iiagdtr.blogspot.com/, which is an abbreviation of "It is a good day to run!" The blog chronicles his journey through lower leg amputation. For those who want to read the blog, be aware that the site contains some graphic photographs.

Wednesday, April 1, 2009 (his first posting)

What I Remember

My brother is running with me through the pines. We are flying.

I think if my foot hits one of the trees that it will be unbearable. I try to tell him but nothing comes out only screams.

We were running to the school bus … I was falling. I see my foot, no sock, no shoe, some curious spots of blood, and then the crush of pain. Ten years old and broken just like that.

My brother runs with me in his arms, it is the pines I fear.

I am lying on the floor of my home. Neighbors hover over me. Mom. Dad. I recall Mr. Harley. What to do what to do … ambulance, no, we'll take him. Take him now!

I wake up ... bright light, a doctor and I go under again. Falling.

My brother flew with me in the pines My journey through foot amputation.

Sunday, April 5, 2009

Part One: How I got there from here

Where to begin ... the first real sign of a problem was after the 1997 Chicago marathon, when about two weeks post-race my right ankle ballooned as if I had sprained it. I ended up seeing an orthopedist who recommended custom orthotics.

At this point I'd like to drive home this huge lesson I've learned per my wife Jen: YOU MUST BE YOUR OWN BEST HEALTH ADVOCATE! Doctors may either not know all that is available to them or not think to tell you about things like aggressive surgery or -- yes -- amputation as an alternative.

April 14, 2009 (day of his surgery)

A journey of a thousand miles

I actually slept well last night, better than I expected. Turns out to have been a harbinger of good things to come …

I am writing this from my Roper hospital bed. Back when I was looking into ankle fusion I read all sorts of stories from people who had horrid experiences in the hospital and subsequent stays. The people providing my health care are their polar opposites, caring and helpful and just good people ...

Once we got in the OR I was moved to the operating table and I don't remember much until I woke up in the recovery room. I wasn't loopy or in any pain whatsoever! ...

I do have phantom sensations of my dearly departed doggie. Prior to the surgery it always had a dull numbness if I was just sitting and I feel that same thing right now. I can feel my heel resting on the bed and have felt tingling in the arch and ball of the foot. But nope, those little piggies have gone to the market for good. I want to impress these are sensations, not pain and should dissolve over time as the brain figures out the nerve endings reside elsewhere.

Thursday, Nov. 26, 2009

Nothing is Impossible

The Charleston Turkey Day run was to be my "return to racing" event, but despite some minor setbacks that race was the Conway 8k on November 14. Still, this would be my first local race, and I became increasing anxious about it, as nearly as nervous as the start of my high school races where I most often only raced not to be last ...

Although I am still very self-conscious of my appearance, I can't say I felt like I am being stared at by others and for this I am thankful. I'm sure the leg is noticed and I don't mind at all talking about it, at times that actually makes me less aware of it ... these ironies seem part of many aspects of being an amputee. I am different but more the same than ever.