About a year before everyone’s world turned upside down because of the COVID-19 pandemic, Barb Kotzian, a 53-year-prepress graphic designer and mother of two living in Thornton, began having pain and weakness in her right leg. It progressively worsened, and soon she couldn’t put any pressure on it.
Kotzian thought it was sciatica and sought help from a physical therapist. After one visit, she learned the problem was much worse.
“The physical therapist told me, ‘Ma’am, this isn’t where you’re supposed to be. You’ve got issues here. You need to see a neurologist or orthopedist immediately,’” Kotzian recalled.
She learned from the PT that she had foot drop, a condition that results in weakness or paralysis of foot muscles. Foot drop is often a sign of a more severe condition such as nerve compression or injury.
Unfortunately, by the time she had figured out she needed to see a specialist, the world had changed. Because of safety precautions, elective surgeries had been canceled. Kotzian had the added challenge of finding a physician who felt comfortable working with someone of her stature.
Kotzian was born with achondroplasia, commonly called dwarfism, a bone growth disorder that prevents cartilage transformation into bone, resulting in short stature. Other common characterizations of achondroplasia include limited range of motion, large head size and small fingers.
“I called neurologists and orthopedists. No one would take me. Either the appointments were too far out, and I couldn’t see them for months or, with my dwarfism, they felt they didn’t have the experience for it.”
After calling numerous doctors and also trying to balance work and family life, Kotzian got a caseworker from her insurance involved. She, too, hit a wall trying to find a doctor who felt comfortable working with someone with dwarfism. She even tried out-of-state doctors.
Finally, after the caseworker involved more people in her company to find a doctor for Kotzian, she was directed to UCHealth University of Colorado Hospital and Dr. CJ Kleck, chief of spine for the University of Colorado School of Medicine Department of Orthopedics, associate professor, and program director for the orthopedic spine fellowship.
‘Dwarfism’ and spine surgery
“He said he would definitely see me and my first appointment was a couple of weeks later,” Kotzian said. By that time, she was using a wheelchair as her primary mode of ambulation and having trouble controlling her bladder and bowel functions. Her right leg was swollen, and she had lost control of her foot. She had high blood pressure for the first time in her life and was put on blood pressure medicine.
Three years earlier, Kleck and his partner had operated on a patient with similar ailments and had experience with dwarfism and complex spine cases. Kotzian came to Kleck with a lumbar MRI in hand, and he immediately ordered another MRI of her thoracic region. Her diagnosis was congenital stenosis.
“Congenital stenosis is actually a common finding for someone with achondroplasia. (Kotzian) was born with less room for the spinal cord than what we consider normal for the rest of the population. So that, along with some early arthritis, had led to significant compression of the majority of her thoracic and lumbar spinal cord. However, the degree, and as many levels as she had involved, is not typical, for anyone,” Kleck said.
The only treatment option and hope for significant improvement was surgery. The next step was scheduling it. The first date they set was Nov. 23, 2020. Then, another wave of COVID-19 hit after Halloween, and surgeries and other services were in question.
Another wave of COVID-19 strikes: surgeries about to be canceled
“Her symptoms were worsening, and we decided to move forward. We knew we had to get her in, so we selected her as the last patient we operated on before the shutdown,” Kleck said.
Kotzian’s surgery was moved up to Nov. 3, 2020. She had to go through COVID-19 safety precautions, which included getting tested for the virus three days before the surgery.
Nerve decompression surgery, or laminectomy, helps create more space in the spinal column to relieve pressure on the spinal cord or nerves. During a routine surgery, Kleck said, he works on one or two nerve decompressions. A more severe procedure entails three or four levels. Kotzian’s condition required that Kleck and his partner work on 13 levels of decompression.
Each level, Kleck said, typically takes about 30 minutes to an hour. With Kotzian, he and his partner were also fusing her spine at the same time, putting in screws and rods to help stabilize her spine.
“It’s more difficult the more levels you do and, in this case, it was more complicated because of her stature. The anatomy is slightly different. That’s why I needed one of my partners, so we could get through it quicker,” Kleck said.
The surgery was a success but that didn’t mean Kotzian was ready to walk out of the hospital. Because of the complex nature of the surgery, she had months, if not years, of rehabilitation in front of her.
Though the surgery went well, Kotzian initially felt let down after it was over. Though her swelling and blood pressure went down immediately after surgery, she still felt numbness and burning sensations.
“It was very emotional for me. I just felt like it would be so much better after, and it’s just taken time,” she said.
The long road to rehabilitation after spine surgery
After her surgery, Kotzian spent three weeks working with rehabilitation and physical medicine physician Dr. Nathan Odom at UCHealth Acute Broomfield Rehabilitation Hospital. The team also included occupational therapists, physical therapists, nurses, and others. She worked toward learning how to do daily activities such as getting out of bed, getting dressed and walking on her own. Now that Kleck’s work was over, her work was beginning.
Dr. Odom said that while her dwarfism did present unique challenges in her rehabilitation, all rehab patients have unique requirements. “Everyone has their own care needs and rehabilitation needs. There were more pieces of individual equipment, but that wasn’t an obstacle at all,” Odom said.
Sierra Bailey-Peterson, an occupational therapist, said Kotzian was extremely motivated throughout the entire experience and also very involved with her care team.
“For problem-solving, she had a lot of information from people in various support groups she reached out to and would brainstorm with us a lot of time,” Bailey-Peterson said.
Kotzian had nothing but praise for Bailey-Peterson and the team in Broomfield.
“Man, they were awesome,’’ she said. “It was a challenge to get me safely into the shower, and Sierra took on that challenge. She had all this equipment worked out. She was amazing.”
Both Odom and Bailey-Peterson noted how supportive and helpful Kotzian’s family, especially her husband, was throughout her stay. As time passed, she grew stronger and began to dress and bathe, use the bathroom on her own, and make progress toward walking. She left the facility on Dec. 2, 2020 as her husband readied their home for her continued work toward regaining full mobility and independence.
One of her short-term goals was to walk, with assistance, into her three-month appointment on Feb. 8, 2021. Fortunately, she was able to accomplish that goal.
“I walked into UCHealth using crutches, so I was very proud of myself,” Kotzian said.
With her foot drop completely resolved, her pain significantly reduced, and her ability to walk using crutches, Kleck said that Kotzian is making great progress.
“She is really doing quite phenomenal for how recent surgery was,” Kleck said.