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Photo courtesy of John Floyd
In July 2002, John Floyd, 15, was enjoying an exceptional summer vacation. Instead of working a job or hanging out with friends like most teenagers, he was cycling through the Alps on the route of the Tour de France in a group that preceded the race competitors. Passionate about cycling, John had set the goal to one day compete in the race himself.
But, that winter, John's goals changed dramatically. After suffering a severe brachial plexus injury, he went from daily training on his cycle to daily physical therapy sessions in hopes of moving his left arm and hand again. In between, John went through two highly complex surgeries that involved cutting-edge technology and required the combined expertise of three Mayo Clinic Rochester surgeons.
On Nov. 19, 2002, John was cycling through a residential section of Atlanta, Ga., when he was hit by a car. The accident tore his bike apart and threw him across the hood of the vehicle. His injuries included a broken arm, a broken leg and a concussion. Several days after the accident, doctors determined that John's left arm was not only broken, it was paralyzed.
"The initial tests gave us hope John's nerve injury might not be too serious," says his mother, Ellen Bramblett. "But on Dec. 19, he had an EMG (electromyograph) to test for nerve reaction, and there was zero response. That was when we began to get a sense that the situation might be pretty bleak."
The accident had torn John's left brachial plexus — a group of five nerves that control feeling and movement in the arm — away from his spinal cord. Because the injury severely damaged the nerves, they would never work again. The only option to restore function in his arm was complicated reconstructive surgery.
Determined to obtain the best care possible for her son, Ellen began extensive research on the Internet regarding treatment for brachial plexus injuries. That research, along with recommendations from local physicians, led her to make an appointment for John at Mayo Clinic in Rochester, Minn.
John, his father, mother and stepfather arrived at Mayo Clinic Rochester in early February 2003, expecting they would listen to what the physicians had to say, and then go to several other medical centers for input before making any decisions.
The team they met at Mayo included Robert Spinner, M.D., a neurosurgeon specializing in brachial plexus reconstruction; Allen Bishop, M.D., an orthopedic surgeon and chair of Mayo's Division of Hand Surgery; and Alexander Shin, M.D., an orthopedic hand surgeon.
"Interestingly and unexpectedly for us, when we met with these three doctors, we knew we were where we needed to be," says Ellen Bramblett. "We were blown away, not only by their expertise, but by their personal connection with us. They seemed truly concerned about John as an individual."
Mayo Clinic's team approach was particularly appealing. "We had wanted to get three opinions. What really sold us on Mayo was that we got our three opinions, right there. Dr. Spinner, Dr. Bishop and Dr. Shin were independent thinkers," says Ellen. "With their different areas of specialty, they brought in different perspectives. That's what we wanted: people to be honest and share from their backgrounds what they thought, and then reach a consensus together."
Instead of staying two days for consultations, the family remained at Mayo Clinic for two weeks. On Feb. 14, 2003, John underwent the first of two operations on his arm and hand. He went home to Atlanta to recover, and then returned to Rochester in April to undergo the second surgery.
The idea behind both surgeries was to substitute live nerves for the dead ones in John's arm. To accomplish this, the Mayo physicians moved muscles from his legs into his arm and shoulder. They also rerouted live nerves into his arm to create new neuropathways to power the muscles and to supply sensation in his hand. All three of John's surgeons were involved in both complex operations, with each surgery taking more than 10 hours.
This type of two-stage surgery for severe brachial plexus injuries is uncommon. Part of John's procedure involved rerouting a nerve that's normally involved in breathing, as well as using part of a nerve from his other arm. These techniques are rarely performed in the United States. Although John is still in the early stages of overall recovery, the innovative procedures appear to have been successful.
Eight months after his second surgery, John's doctors are pleased with his progress. He is able to bend his arm and move it toward his chest, and he also has some movement in his hand. But, these steps forward haven't come easily. Each week, John has four therapy sessions for his arm and hand. In addition, he works at home on therapy to help him gain more movement and strength and to keep his muscles from deteriorating.
"For John, our visits to Mayo Clinic were a wake-up call because the answers he wanted were not frequently the ones he got," says Ellen Bramblett. "At age 15 with a passion for cycling, he wanted to get back on his bike and use two arms. In reality, the function John would need in that left arm to bear his weight and use his fingers for gear shifting and braking were simply not going to be there due to the total injury that he had."
His disability hasn't diminished his zest for the sport or kept him off his cycle, though. His new bike is configured so he can access everything he needs with one hand. As a protective measure, he cycles with his left arm securely strapped to his chest.
John now has his sights set on competing in the Paralympics, an elite sporting event for disabled athletes that is held the same year and in the same venue as the Olympic Games. He's training hard to achieve his ambition, sometimes riding six hours at a time. In June, he went to the Olympic Training Center in Colorado Springs, Colo., to participate in a camp for disabled cyclists. In September, John was able to complete a one-day, 100-mile ride to promote bicycle safety in Atlanta.
"It could be another two years before the full extent of John's recovery will be known," says his mother. "But, thanks to the doctors at Mayo, John is still able to compete at a very high level within the limitations of his disability. And, beyond cycling, he is able to look to the rest of his life and know he'll have a level of function with his arm that he couldn't have had without these amazing surgeries."
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