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Hackensack Meridian Health JFK Johnson Rehabilitation Institute elevating standards for people with amputations 

Margaret Anderson stands on the beach after a double amputation and rehabilitation at Hackensack Meridian Health JFK Johnson Rehabilitation Center.

Margaret Anderson dismissed her sudden and unexpected exhaustion. She was, after all, keeping up with her 4-year-old son while caring for her infant daughter. So, she asked her husband, Eric, to put the children to bed and she dragged herself to the living room couch.

The next morning, she awoke to find alarming black splotches spreading across her lower body. Her husband rushed her to her local physician, who sent the couple racing to Hackensack Meridian Health JFK Medical Center as Anderson’s blood pressure dropped and her pulse became dangerously low.

Anderson, a high school English teacher, faced life-threatening septic shock. A highly specialized medical team began fighting to save her life in the emergency department and during her early days in intensive care. The team inserted a breathing tube and put Anderson in a medically induced coma — and introduced intravenous fluids and other medications as she battled multi-organ failure, and, later, bleeding in her brain.

“Her face was unrecognizable,” recalled Eric. “She looked like she was beaten up.”

Family members came to say goodbye. A priest gave Last Rites. After more than two weeks, Anderson began to improve, though she was still weak and unable to use her hands.

“My father was feeding me with a spoon,” she recalled. “My toes looked like blueberries from gangrene. It was spreading. The doctors tried everything, but I knew where things were headed.”

Her survival, she realized, required amputation of both her legs below the knees — and a journey toward a fulfilling, though different, new life.

Anderson received acute care, intensive care, highly specialized brain rehabilitation, as well as physical, occupational and cognitive therapy. She moved from intensive care to the Brain Trauma Unit to acute inpatient rehabilitation and then outpatient rehabilitation.

As she improved, the JFK Johnson Prosthetic/Orthotic Team prepared her for her artificial limbs, created at the JFK Johnson Prosthetic/Orthotic Lab. Because JFK Johnson is connected to an acute care hospital, she was able to begin rehabilitation therapy with a specialized team even while she remained hospitalized for serious medical conditions.

“Margaret was assessed by a comprehensive rehabilitation team very early on,” said Sara Cuccurullo, M.D., who oversaw Anderson’s rehabilitation during her entire time in JFK Medical Center, and who is vice president and medical director of JFK Johnson Rehabilitation Institute. “We worked each day to advance Margaret through the continuum of care.”

Anderson remembers waking up after the amputation.

“The realization came in episodes. I remember at first that I couldn’t swing my legs over the side of the bed to brush my teeth,” she recalled. “I felt helpless.”

After Anderson’s amputation, specialized physical and occupational therapy focused on pre-prosthetic training, which includes strengthening, balance, and endurance. The team performed often painful stretching exercises to protect Anderson from flexion contractures, which can reduce the range of motion in the knees and hips and make it impossible for her to ever walk with prostheses. The team also worked to strengthen her cardio and pulmonary function.

“It was all-encompassing,” Anderson recalled. “I couldn’t even sit up! I’m thinking, ‘How will I ever hold my baby?’ But every day they worked with me. Every day it was something new … Building my arm muscles, strengthening my core. They kept challenging me to do more every day.”

Once Anderson was medically stable, she was transferred to JFK Johnson Rehabilitation Institute under the care of Richard Malone, D.O., FAAPM&R. The JFK Johnson team of nurses and therapists continued to work on her medical care and pre-prosthetic goals.

She also was assessed by Heikki Uustal, M.D., medical director of the Prosthetic/Orthotic Team. As Anderson continued to improve, she was discharged to the outpatient part of the JFK Johnson continuum, where Dr. Uustal took over her care.

Dr. Uustal remembers the earliest days of Anderson’s care.

“Here you have an active mom and suddenly this horrible thing happens and her legs are amputated. It’s overwhelming,” Dr. Uustal said. “You can’t just say, ‘Here are your artificial legs.’ You have to start preparing the whole body. You have to strengthen the leg muscles that are still there. You have to strengthen the core and the arms. You need to work on balance and endurance. The goal for us is: How can we get you back to as close as possible to the life you had before?”

Anderson also worked closely with Sue Callaghan, PT, Clinical Specialist, Prosthetics and Orthotics. At the beginning, Anderson was in a wheelchair.

“Sue was pushing me to burst through milestones,” Anderson recalled. “I was lifting weights. Lifting a laundry basket. You can’t say ‘no’ to Sue. She said, ‘You will walk to your car and drive again. You will walk down a slope. Down the stairs.’ She pushed me in a way that I needed to be pushed.”

After the wheelchair, Anderson started with the artificial limbs and arm crutches, then a rolling walker, and then she stood — without support — on the prosthetic limbs. She recalls a sense of triumph, but also recalls the moment as bittersweet: “I was standing again. But it wasn’t the ‘me’ I used to be.”

Yet there was time for humor. At the Anderson household, the joke was: Who will walk first? Baby Emilia or her mother?

“I won,” Anderson said, laughing.

During the process of creating the right prostheses for each patient, Dr. Uustal asks patients about their lives. What’s most important? What activities do they care about? Anderson’s prostheses were created at the JFK Johnson Prosthetics and Orthotics Laboratory, also in Edison. First, the technicians created a mold, and then created the preliminary limbs, and finally, permanent limbs.

“I remember Dr. Uustal said, ‘Tell me what you love to do. I said I used to love the beach. He said, ‘Then we will make your legs that let you walk on the sand,’” Anderson recalled.

She was on a first-name basis with technicians at the prosthetics lab. For Anderson, the milestones were learning to drive with hand controls and passing her driver’s test on the second go-around (“I was never good with parallel parking!” she said) and then taking both her children on a shopping trip to Target.

Today she suspects her stem cell treatments for cancer more than a decade ago compromised her immune system and made her susceptible to the pneumococcal infection that caused her septic shock.

Anderson continues to rely on JFK Johnson when she needs new prostheses and support as her life changes, including after a bad fall last year that left her with broken bones.

Register to view the video premiere of Hackensack Meridian Health’s first-ever patient spotlight episode featuring Margaret Anderson airing on Jan. 12.

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