[Read the November 21, 2003 Forum Article on Brandon Carmichael]

I must explain something first. I had been offered cigarettes many times before, but thankfully it was drilled into me that they were very dangerous. So up to that point I had been able to say NO.

It all started when I was 15 years old. I was with two of my buddies. We were at the “free pool” park in West Fargo. One of them pulled out a pack of Marlboro Reds and started smoking a cigarette and my other friend lit his cigarette. Almost simantansly they asked me 'do you want one?' I paused and then I said “yes” not knowing what I had just started.

As time went on I found myself hanging around these guys a lot more than I should of, smoking their cigarettes. I had thought to myself 'cigarettes can't hurt me', but boy oh boy was I wrong.

Smoking up to my senior year in High School brought me to a “Reality Check”. Many of you may be confused by my use of the term “reality check”, but to me it makes perfect sense. Let me explain…

…It started in December of 1999, just a few weeks before Christmas.

I ended up cutting my big left toe on a piece of glass. There was nothing special about the glass for those who might want to blame the glass. A few days passed and I realized that it was getting worse and that it wasn't healing. So my father and I went to see Dr. Klieman, our family doctor who I had been seeing for at least twelve years. He didn't know why my toe wasn't healing. He ended up prescribing me some antibiotics to prevent an infection.

When the next day came, I went to see another doctor he told me the same thing. He also didn't know why my toe wasn't healing, so he to prescribed some antibiotics.

While my parents were getting frustrated with the situation, I was fine with it. I didn't realize the long hellish year and a half I was about to endure.

My parents and I went to see doctor after doctor after doctor. I told them 'how and when my toe was cut', and my doctors would just look at me puzzled and confused. All they could do is offer me some more antibiotics. I guess one doctor suggested me to soak my left foot in a tub of warm water with Epson salt. Another doctor sent me home with an IV in my arm that my parents had to shoot antibiotics and pain medication into. This didn't help. Another doctor suggested to my parents to give me a shot a lovanocs in my back twice a day as a blood thinner. I know that many diabetics understand what I'm talking about.

A month passed by and we received a phone call from Dr. Klieman recommending we see Dr. Wagner, a vascular surgeon at Innovis Health in Fargo. In my opinion he is one of the best in his field. Dr. Wagner was different from my other doctors even though I told him what I had told all my doctors - 'how and when I cut my toe'. Dr. Wagner had questions for me, he asked; "are you smoking?" I said yes. He then asked “how much and how long?” I told him not even a pack a day and for about 3 years. Then I asked him “what does this have to do with my toe?” He replied “you may have Buergers Disease or Diabetes”.

As time passed I had several tests done including an angiogram (which is a procedure where the doctors inject a catheter in your main artery in your leg, near your groin area). With the catheter the doctors injected a dye in your blood stream that glows with the use of an X-ray. The results showed that I had a blockage in my left knee, which was causing my toe not to heal. He told me “I need you to go to Mayo Clinic (which is in Rochester, MN) to get a second opinion whether or not you have Buergers Disease”.

For a month or so my parents and I found ourselves at Mayo many times, doing several tests, mainly vascular and other blood work. These doctors came up with the same diagnosis of Buergers Disease. They have other technologies that helped create better circulation in my left leg. For example they had a huge pump that I would be strapped into. This is actually about a half-hour procedure in the clinic, two times a day. I sat in a chair that was able to go up and down. In the “up” position my doctors would come and strap a boot (which resembled a space boot) on my legs. They then would put wires and sensors on me that would cause the boot to squeeze every heart beat. I did this for about 1 week; I was then able to go home with a miniature pump that I had to use for about 10 to 12 hours a day. They also sent me home with a lot of medications and ointments that I would use on my left big toe.

At this time I was out of school for about 2 months, which was very disturbing to me. After all, it was my senior year. I should have been hanging out with my fellow future graduates. All I know is I am very thankful that I worked hard before my senior year or I wouldn't have been able to graduate. (Also many thanks to the few friends I did have at this time, my teachers, my extended family, and my parents Jamie and Linda, my brother Josh, and my sister Nicole.) After graduation, I should been like my fellow classmates partying and getting ready for college, but my life was on pause still. What I mean is that I was still pumping my leg; I was using the medications and ointments, still seeing Dr. Wagner and my doctors in Rochester.

My foot finally got better in October or early November of that year, which means I had that simple cut on my toe for about 10 months.

Thinking I was invincible and not caring about what my doctors diagnosed me with, I ended up starting to smoke again. This lasted for about 2 months. I must say it was a huge mistake. My left big toe's skin broke down and suddenly there was an ulcer there.

So once again I founded myself visiting Dr. Wagner. He immediately ordered another angiogram. The results were devastating. It showed that the blockage in my left knee was now about 6-8 inches long. This caused huge problems for me. I also had one blockage form in my right hip. The ulcer on the toe grew to be the diameter of the size of a quarter or maybe a 50 cent piece. Depth wise I could see my big toe bone. This ended up being extremely painful. I had the best pain medication and that wasn't doing anything for me. My doctors then realized that it was getting to the point of threatening a bone infection. They thought they had to amputate.

On January 20, 2000, I had a bypass surgery and the amputation of my left big toe, that lasted about 10 hours. The bypass surgery consisted of plastic tubing in my left leg from my upper thigh all the way down to my ankle. The amputation was just my big toe, but don't get me wrong, it was still a Big deal to me.

After the 106 staples were removed from my leg and foot; I realized I needed to get away from all of the stress that I was feeling also to try to help my depression. So a buddy and I went down the Texas, which was great because it was in February, and we were leaving an area that was in a Blizzard warning. We were in Texas for about 2 weeks. We then decided we would go to Arizona to visit my grandparents. On the way there, however, the transmission broke down in El Paso, TX. We had it fixed, but it broke down again somewhere in Arizona. Once again we fixed it, not realizing we were about the run out of money. That happened in Albuquerque, NM; which is were my buddy and I sat at a truck stop for three days with 5 bucks to our name. This is were I was able to pick up 3 cigarettes; knowing that cigarettes have all ready been responsible for my toe to rot, the plastic tubing in my leg.

I was able to get home with the help of my aunt, uncle, and my mom. I then was a groomsman in my friends wedding, I also moved out into the 'real' world away form my parents. At this time I was reunited with my friends, the ones who happened to leave me during my tough times. Scarred from that they will never be the good friends I thought they would've been. Life was perfect for the next few months.

Then June 21 or 22, 2000 came.

The time on my alarm clock glowed 12:34 am. I started realizing that my left leg below my knee started to get really cold; colder than a can of pop. It was turning into a dark purple color. It was so painful that I was screaming at the top of my lungs. I was shaking in such discomfort; my friends realized something had to be done. They ended up bringing me to the ER; there too I was screaming and shaking. The doctors ended up giving me a shot of morphine which only made the pain only toleratable. It still felt like needles were being poked into my leg which was cramped up like I ran across the country 10 times. So it still was painful.

Next thing I knew I was having an angiogram procedure again. I received my results in the morning around 7-8. It showed that the bypass surgery in my left leg ended up plugging up. I still had the one in the right hip, but now those three cigarettes I ended up smoking in Albuquerque, NM were responsible for a blood clot in each of my wrists (which is causing me problems now). Before I knew it, my left foot had four black toes, and one huge ulcer. I can't put it in words of how painful this was. It was so painful that my doctors and I decided it was time to amputate.

So on July 12, 2000 my left leg was amputated about 5-6 inches below my knee. I am very thankful that I still have that 5-6 inched; I couldn't imagine how anyone can walk with a prosthetic knee. (Those with a prosthetic knee deserve a pat on the back, it must be difficult)

Individuals with Buergers Disease know how difficult it is to stop smoking. Unfortunately many of them have relapses with cigarettes. I found myself being one of them.

I ended up smoking off and on for about 2 months again in 2003. Yes, I am very aware of the consequences. So now that it is late spring and early summer, I still have an ulcer on my right thumb which I have had for about 9 months. It scares me because I can't imagine life with out my right thumb.

I saw Dr. Wagner June 16, 2003, and he said it wasn't good. It looks like I will be doing another angiogram soon, which I'm sure won't be good.

Either way, I hope you can learn from my (and thousands and thousands of other people's) mistake and never pick up smoking or chewing tobacco.

I know if I could go back, I would never start smoking. I don't enjoy being 23 years old and having worse circulation then most of our elders. I do feel it, my body hurts all of the time, just walking hurts, even as I am typing this out my fingers our cramping up.

Is that a way to live life? In my opinion, NO!

---

October 23, 2006
I'm back. I am in the process of putting together my thoughts. I should have things ready in the next few weeks. You will be surprised to find out what has happened.

I know there are many of you wondering where my updates are. Well this is it.

I suppose some of you are wondering what the outcome was of the Dr. Wagner visit on June 16th, 2003. For the most part that visit was alright, but due to the feeling I was having with my body we decided to do some tests. The tests revealed that my circulation has only gotten worse throughout my extremities; we decided to wait and see what happens.

I woke up at 12:34 am on September 28th, 2003 and felt my right leg lock up the same way (and the same time) as when it happened with my left leg. I knew that the circulation was stopping because my leg turned cold to the touch and was starting to change color below my knee. While this was going on, the pain only increased and intensified. I found myself going to the ER that night, my mom and sister showed up sometime in the morning.

Obviously this demanded the doctors to do something - so they did. My team of doctors decided to try a stint again. This was done a few years ago with my left leg and only worked for a short period of time. This new stint didn’t work any better.

As time continued on ticking, my situation only seemed to get worse. With the stint failing and all other options disappearing fast, I found myself praying a lot, trying to deal with it as best as possible.

At that time, my brother was overseas in Iraq with the 142nd National Guard Engineer Unit out of Fargo, ND. With my brother being gone and now my foot decaying, it was difficult to find hope.

Hope came and one prayer was answered. My brother came home from Iraq the beginning of October 2003 for family emergency medical leave. It had been only a week or so since my problems first started with my right foot, so I was surprised to see my brother. It wasn’t easy for him though.

As for the trips, I don’t remember much of it at all. I’ve heard the stories, and evidently I was not the easiest person to get along with at that time.

Unfortunately nothing at Mayo Clinic was helping. I had no other options except to watch my right foot die. I do not mean to downsize Mayo Clinic at all, it’s a GREAT hospital, and I’ll continue on going there when it is recommended by one of my doctors.

So as my foot continued on getting worse I only had one option left. On November 3rd, 2003, just about 5 weeks from when my leg locked up, my right leg was amputated just below my knee. I probably didn’t need to do it then. I’m sure that I could have waited, but let’s think about that. My toes and foot were turning black, the holiday season was starting soon, and finally there was nothing helping. And it was just getting worse much faster than my body could keep up. I would guess if I would have waited, I would have maybe been able to keep my leg for an ultimate max of 2 months before it would have started to threaten my life. That time of waiting would have been nothing short of hell. After all, what can heal black toes? They’re already dead.

I was able to leave the hospital just 3 or 4 days after the surgery only to find myself at my hospital’s rehab (Dakota Clinic South University), which was a different place from where I had my amputation (Innovis Health). The rehab wasn’t all that difficult, at least for me it wasn’t. However, when I was there I met a great individual, Mike, and his family. Mike was there due to a football injury. I do not want to get into that without Mike’s permission. I was in rehab for only 3 or 4 days. I had to prove a few things before I could leave. Basically I had to show them that I was still capable of showering, using the bathroom, cooking, getting in/out of a car, and general skills needed to live on your own. I had mixed feelings about rehab. Part of me was very excited that I was given permission to go home, but the other part I was really bummed about. I didn’t want to leave Mike. While I was there he made it so much easier for me as I would like to think I did the same for him. What I mean is Mike and I were the only younger patients there, and everyone else was by far older than our parents. Mike and I did stay in contact. I actually gave a lecture at his school. I will always remember that lecture because Mike is the one who introduced me, which I thought was great! After all we were in rehab together and shared some hard times.

Since my brother was in Iraq, and I just had a major surgery, which was very challenging in many ways, my sister decided to move in with me. My brother and I had our own 3 bedroom apartment that was empty for the most part. That meant there was plenty of room so she stayed in the extra room. While my sister was helping me with my every day things, our relationship only grew stronger.

After the holidays, I remember getting my prosthetic for my right leg. On New Years Eve I started to take my first steps as a bilateral below knee amputee. Shortly after that I was walking as if nothing had happened. However, I was still dealing with an ulcer on my right thumb, which finally healed in June 2004.

As things were finally looking up for me, I felt great. I decided to go back to MSUM. So in the fall of 2004, I went back to school for another semester, and then again in the spring. During that time I was trying to balance my public speaking with college. At certain times it was very difficult, but I was able to pull through just fine like so many other students.

In August of 2005, my brother and I decided to move. Renting a 3 bedroom apartment downtown wasn’t exactly cheap. My brother ended up buying a town home/condo in the neighborhood we grew up in. During the move, I ended up doing majority of it with the help of some friends. I ended up going up and down, and down and up the stairs several times during the move. I was causing a lot of stress on my legs, so much so that my legs were starting to bleed. I continued on unpacking and doing what needed to be done. I figured I would take it easy once we were done. It sounded great in my head anyways. It turned out though, I didn’t take it very easy, what I should of done was stayed off my legs 99.9% of the time, and use them only when absolutely needed. Well I didn’t do that. I tended to still use them on a regular basis even though my legs would continue on bleeding. At that point I should have absolutely stopped using my legs, but I didn’t. I ignored the sores that would bleed when pressure was applied. I ignored my doctors that were telling me to stop using them. My doctors wanted me to use my wheelchair. Stupidly, I still continued on using them. I continued on using them until it got so bad that I had absolutely no choice but to stop walking. It was a major blow. Looking back at that time, I wonder why I didn’t listen. The only thing I can think of is that I love walking. I love wearing my legs. They make me whole again. I took walking for granted for so many years along with many other things. I wasn’t the happiest person when I was in my wheelchair. Daily life was much more difficult in the chair. There was going to be nothing that stood in my way of wearing my legs and using them even though my legs were bleeding and at that time my prosthetics were very painful to use. Some people may be saying, “Gosh you don’t need to complain about being in a wheel chair.” I’m not complaining about being in a chair, I just prefer my life with my prosthetics on. It’s just the way I like it. Walking with my legs on when they were bleeding was a major mistake, and needless to say, I learned a valuable, two-year lesson, and I will not be doing that ever again.

The bleeding sores became a major problem. It got so bad it affected my life for two and half years. It started out with just a couple of small sores on each leg with a visit to the doctor’s office about once a month. Dr. Wags would tell me that I needed to stop walking. I would agree to stop, but secretly I would continue on walking which only made the problem worse. I did this for a few months until I no longer could walk. Those couple of sores turned into many on each leg that took some time to heal.

Because my life has been so up and down the last few years it is very hard to remember everything. I remember at one time, because of moving and doing lectures, the sores on my legs were so bad that I had to cancel two major contracts down south in April of 2006. I was in so much pain that I just couldn’t do it. Besides I couldn’t use my legs. I had absolutely no business traveling for a week at a time in the condition I was in.

I don’t know if I can blame it all on the canceling of those big contracts or the condition my legs were in. Whatever the reason was, I found myself dealing with another relapse. Stupid I know. The relapse to tobacco definitely didn’t help any with the sores on my legs, it only made things worse.

How much worse you may be wondering. Well it’s hard to remember everything, but I’ll do my best. The smoking that I did made things really bad. I’ve had so many sores that it’s hard to remember. The smoking caused the sores on my leg to get bigger, and more of them. But besides that, I was starting to develop sores on my fingers as well. I always knew that would happen if I didn’t get my addiction to cigarettes under control.

As you can see three fingers are being affected in a serious way. Stupid smoking is all I can think now. I’m sure you are thinking stupid Brandon. I don’t have pictures that show this, but I could have sworn I had both hands affected. At one point I had 15 sores on my body from my finger tips to my legs.

As you can see there was an improvement, yet two fingers still got worse. Eventually the black area on my index finger fell off, exposing the bone underneath. That’s what the next picture shows.

On August 15th, 2006 I went in for surgery, this time it was to remove the bone sticking out of my right index finger. They also did a little cutting on the pinky finger.

During that surgery, it wasn’t just my fingers that they worked on. Without me knowing (until I woke up) Dr. Wagner decided to do a little cutting on the major sore I had on my right leg. All of the little sores on my right leg turned into one major one.

As time went on, I still wasn’t doing any lectures at all since the time I cancelled my two big contracts. I was pretty much at home and occasionally at the doctor’s office trying my best to deal with the pain both emotionally and physically. Time just seemed to sit still. But now as I think about it all, I cannot believe it has been two and a half years since I turned the towel in, since I canceled my contracts and had to worry about my health.

2007 was just as stressful as 2006 as I dealt with my stupidity of relapse after relapse. It’s no wonder my body didn’t heal any faster. It wasn’t just my right hand being affected, my left hand started to do some of the same things my right hand went through. If I remember correctly, I ended up squishing my left index finger in my wheelchair brakes around the spring/summer of 2007. I squished it so hard it actually affected my blood flow. Of course it didn’t help at all that I still had a struggle letting go those stupid cigarettes. So I was trying to prevent myself from bumping my right index finger. It is still very sensitive probably because my index finger is almost a whole knuckle shorter than it should be. I was really surprised how much padding and cushion we have at our finger tips. Well I lack that cushion. Still to this day it hurts like crazy when I bump my index fingers. It’s way worse than stubbing your big toe on the coffee table. Ya, I know I have a plastic big toe, but I still remember what it’s like. And I see how others react when they smack their big toe, they dance crazily while screaming. You get the picture…

As time went on, I still had sores on my legs.

As time went on, you can see the decaying continued.

I dealt with a black index finger for over 6 months. Maybe even 10 months. Doctor Wagner wanted the body to self amputate that finger tip. That is why I had to wait so long to have the black tip removed.

In the beginning of 2008, I got a letter stating that doctor Wagner was leaving the clinic/hospital which was just devastating to hear. After all he had been there since the beginning. He was the one who diagnosed me. After receiving that letter I really didn’t know what to think, and I had absolutely no idea what I was going to do about my left index finger that was black. I decided it would probably be best to go see one of the doctors that were taking Doctor Wagner’s patients. I decided to ask my dad to come along. I figured that it would be a good idea being my parents have played a major roll in my life while dealing with Buerger’s disease.

As I was showing my dad my black left index finger tip, the new doctor came in. He took a quick look at it and said “you don’t need that.” And as I was saying, “don’t need what?” it was already done. The new doctor actually ripped my black finger tip off, which took me completely by surprise. After all, how many times do you meet someone and within a minute he has ripped off a piece of your body. Sounds a little ridiculous when I put it like that, but that’s exactly what happened.

Not a lot, but enough where I did not feel comfortable leaving my finger uncovered, as recommended by the new doctor. The visit was less than 5 minutes. Needless to say I have not gone back to him. I didn’t like him. He just wasn’t Doctor Wagner.

So I continued on panicking, wondering if I will ever get to see my doctor. Well after talking to some people, I was able to find him, thank God. Since he left, I have seen him three or four times. Sure I have to drive almost three hours to see him, but to me it’s worth it!

During one of my visits with him we discussed what should be done with the bone sticking out on my left hand. On July 12th, 2008 I had the bone on the left index finger removed. Since then, I still have had some healing to do. I don’t have it covered and I’m not doing anything with it. Basically in the center I have a scab like thing, that’s the healing I was referring to.
I’m guessing a few may wonder if I’m still smoking, thank God, I can say I’m not! Right now everything is pretty good. I really do not having anything that I can complain about. In regards to Buerger’s disease, I have no current problems!