Eric Williams, M.D.

Eric H. Williams, MD, graduated from Johns Hopkins School of Medicine in 1999 after receiving his undergraduate degree in Biology from Swarthmore College in the suburbs of Philadelphia, Pennsylvania. Dr. Williams completed his General Surgery Residency at Vanderbilt University Medical Center in Nashville, Tennessee in 2004. He then completed his Plastic Surgery Residency at the University of Alabama in Birmingham in June of 2006. Dr. Williams then completed another full year of fellowship training in Peripheral Nerve Surgery with Dr. A. Lee Dellon, a world-renowned specialist in peripheral nerve surgery, in 2007.

Dr. Williams is board-certified in Plastic and Reconstructive Surgery. After his fellowship, he was employed by The Dellon Institute for Peripheral Nerve Surgery for two additional years until he became a full partner at The Dellon Institute in Baltimore, Maryland, in 2010, dedicating the majority of his time to caring for nerve-injured patients.

His focus since 2007 has been centered on the surgical care and rehabilitation of lower extremity and upper extremity complex peripheral nerve syndromes with an emphasis in nerve injury, entrapment, and chronic regional pain syndromes, and diabetic peripheral neuropathy.   Other areas of interest and expertise include groin pain, knee pain after knee replacement, intercostal nerve injury, and migraine headaches, piriformis syndrome, and low back pain due to superior cluneal nerve entrapment.

He has independently developed procedures to improve the sensation, pain, and muscle function in the lower extremity, and has been part of a team that has helped describe many other advancements in peripheral nerve surgery and peripheral nerve imaging.  He has written and is a co-author of many publications in the field.

While working in private practice, he is an Assistant Professor of Plastic and Reconstructive Surgery at Johns Hopkins University Medical Center in Baltimore, Maryland.

Dr. Lee Dellon & Luiann Greer 

Lee Dellon:

Lee Dellon graduated from Johns Hopkins University (1966), and its school of Medicine (1970). He spent two years of research at the NIH (National Cancer Institute, Surgery Branch, 1972-74). He completed a Plastic Surgery Residency and Hand Surgery Fellowship at Johns Hopkins Hospital (1978). He received his PhD from University of Utrecht, Netherlands (2007) for work in preventing ulceration and amputation by lower extremity neurolysis in patients with diabetic neuropathy and superimposed nerve compressions. He is author of 5 books related to peripheral nerve surgery, and more than 450 peer-reviewed scientific papers.

Luiann Greer:

Luiann Olivia Greer is the former CEO of the Dellon Institutes, where she played a key role in developing and orchestrating, 30 cutting edge surgical training

workshops. These workshops were designed to train qualified surgeons to perform unique procedures, pioneered by Dr. Dellon, including the groundbreaking surgery performed on Alex Lukas.

With more than 20 years of experience, Luiann is a recognized expert in guiding patients and hospitals through complex insurance negotiations, ensuring insurance companies say “yes” making life-changing care possible.

Alex Lukas

Alex is 18 years old and is excited to begin his freshman year at The Catholic University of America this fall. Alex will major in Architecture and Planning. In his spare time, Alex enjoys competitive fencing, hiking, hanging out with friends and drawing.

Amy Lukas

Amy is a licensed clinical social worker and Catholic speaker. Amy is blessed to have 3 amazing sons and a wonderful husband of 31 years.

Amy is beginning to write her first book about her son’s journey with CRPS and the importance of perseverance in faith.

00:00 – 01:12 Introduction

• Dr. Barrett introduces the episode focusing on a CRPS case study
• Highlights the collaborative approach between surgeons, patient, and family
• Emphasizes how surgery can be life-changing for CRPS patients despite common medical dogma against surgical intervention

01:12 – 02:35 Opening and Context Setting

• Formal introductions of all participants
• Dr. Barrett frames this as an illustrative case that could help many people
• Amy invited to share Alex’s journey from trauma to recovery

02:35 – 05:15 Initial Injury and Early Symptoms

Amy’s Account:

• Alex was 15, hit by car while biking to school (day before freshman year)
• Hit-and-run accident affecting left side/leg
• Initial assessment showed only bruising, deemed “fine”
• Over next year: multiple athletic injuries to same left leg
• Major incident: Running with new football cleats, fell on wooden bridge, leg trapped under slats
• Progressive symptoms: foot color changes, numbness

05:15 – 06:34 Medical Journey Begins

• Saw 20+ doctors across multiple specialties:
  • Vascular surgeons
  • Cardiologists
  • Multiple orthopedic surgeons
  • Physical therapists
  • Chiropractors
• No definitive diagnosis initially
• Found connection to Dr. Dellon through neighbor relationship

06:34 – 07:46 CRPS Diagnosis

• Eventually entered specialized pediatric CRPS program
• Received official CRPS diagnosis – “first time we had a name”
• Treatment protocol: nerve blocker (gabapentin), physical therapy, counseling
• Told repeatedly “pain will go away, but we don’t know when”
• Nerve conduction study showed entrapment, but doctors didn’t consider it significant enough for surgery

08:39 – 11:20 Dr. Dellon’s Assessment

Dr. Dellon’s Perspective:

• Alex was in “very bad mental situation” by the time he saw him
• Could detect nerve problems through physical examination
• Identified nerve near knee affecting foot/toe control
• Tinel’s sign positive at ankle – nerve stuck and trapped
• Recommended Dr. Williams for surgical evaluation

Luanne’s Role:

• Read medical records, immediately recognized nerve compressions
• Facilitated house visit for preliminary diagnosis
• Quote: “My husband’s going to give your son his life back”

11:55 – 13:47 Alex’s Mental Health Impact

Alex’s Account:

• Initially didn’t tell anyone about mental struggles
• Became “very, very depressed” and “very suicidal”
• Quote: “I don’t see a great future if I have to live with this pain”
• Pain completely redirected his life negatively
• Receiving mental health treatment alongside physical treatment

13:47 – 14:27 Immediate Post-Surgery Response

Alex’s Recovery:

• Day after surgery: father tickled foot – it was actually ticklish, not painful
• First genuine laugh of relief in years
• Quote: “I actually felt good… something’s actually like, good”
• Mental state improved almost immediately
• Recognized this was a step toward recovery

14:44 – 20:55 Dr. Williams’ Surgical Approach

Diagnostic Process:

• Careful examination of 15-year-old patient (higher stakes with minors)
• Peripheral nerve exam revealed multiple compression sites
• Three distinct nerve problems affecting different areas:
  • Top of foot (common peroneal nerve)
  • Bottom of foot (tibial nerve)
  • Inside calf/ankle (saphenous nerve)
• Physical findings consistent with nerve compression, not idiopathic CRPS

Key Point: Even had positive EMG for tarsal tunnel syndrome, but previous physicians didn’t think surgery was indicated

21:14 – 22:36 CRPS Type 1 vs Type 2

Dr. Williams Explains:

• Alex diagnosed with CRPS Type 1 (considered non-surgical)
• Type 1 typically treated with:
  • Psychiatry/psychology (appropriate for depression/pain cycle)
  • Pain management (long-term medication management)
  • Physical therapy
• Medical dogma: “Do not operate on CRPS Type 1 patients”

24:52 – 28:29 Challenging Medical Dogma

Dr. Williams’ Philosophy:

• Different medical specialties have different “toolboxes” and “languages”
• Surgery: “A chance to cut is a chance to cure”
• Pain Management: Long-term symptom management
• When conservative treatment fails for 2+ years, must reconsider approach
• Importance of keeping open mind, especially with suffering patients

28:40 – 31:17 Diagnostic Nerve Blocks

Confirmation Testing:

• Ultrasound-guided nerve blocks performed
• Lateral cutaneous nerve of calf: immediate numbness in expected distribution
• Saphenous nerve block: pain relief in appropriate area
• Blocks confirmed surgical targets were correct
• Results gave Alex hope: “there is a possibility I can get better”

33:13 – 35:37 Nerve Compression vs. Nerve Repair

Dr. Williams Clarifies:

• Compression injuries (Alex’s case): nerves intact but pinched
• Decompression allows immediate nerve function restoration
• Repair injuries (gunshot, knife): require nerve grafting, slower recovery
• Compression surgery generally safer with better immediate outcomes

35:37 – 39:39 Dr. Dellon on CRPS Surgery Philosophy

Key Statistics from Dr. Dellon’s Experience:

• Of 100 CRPS patients examined: 70% had identifiable peripheral nerve problems
• Of those 70 surgical patients: 80% significantly improved
• Emphasized that entire foot pain can result from 2-3 separate nerve injuries
• Medical education poorly covers peripheral nerve anatomy

Critical Point: Most doctors incorrectly assume pain outside single nerve distribution cannot be surgically treated

41:49 – 44:00 Surgical Procedure Details

Dr. Williams’ Surgical Plan: Multiple compressions addressed in single operation:

1. Common peroneal nerve (top of foot symptoms)
2. Proximal tibial nerve (toe movement problems)
3. Tarsal tunnel syndrome (confirmed by EMG)
4. Saphenous nerve (medial leg pain)
5. Lateral cutaneous nerve of calf (lateral calf pain)

Strategic Decision: Performed all procedures simultaneously using overlapping incisions to minimize trauma while addressing all identified problems

47:51 – 50:50 Surgical Decision-Making Process

Complex Clinical Reasoning:

• Considered doing procedures separately vs. all at once
• Time sensitivity: 17-year-old needing to return to normal life
• “Double crush” concept: upstream and downstream compressions
• EMG confirmation made tarsal tunnel release essential
• Used existing incisions to access multiple nerve sites efficiently

50:50 – 51:39 Dr. Dellon on Complete Treatment

Important Principle: In CRPS patients, central nervous system is hyperactive – better to address all identifiable nerve problems simultaneously rather than leaving any source of ongoing pain input

52:04 – 53:42 Alex’s Recovery Process

Progressive Improvement:

• Post-operative instructions: “each day, try to do a little more”
• Took trip to Florida, became active again
• Started fencing – received compliments on exceptional footwork
• 10+ year fencers commented on his superior technique
• Complete return to athletic activities without fear of reinjury

54:09 – 57:51 Amy’s Advice for Other Families

Key Recommendations:

1. Prayer/spiritual support – “could not have gotten through without the Lord”
2. Tell your story to everyone – “you never know who knows who”
3. Question repetitive treatment – after 2 years of same protocol, seek alternatives
4. Seek medical consultation – find doctors willing to think outside the box
5. Advocate persistently – like Shirley MacLaine in “Terms of Endearment”

Contrast in Care:

• Previous doctors: 9-5 availability only, strict “no surgery” dogma
• Dr. Williams: “You’re going to call me” – 24/7 availability and support

58:08 – 58:29 Timeline Confirmation

• Surgery date: July 3, 2024
• Episode recording: ~14 months post-surgery
• Alex graduated high school, heading to college
• Sustained improvement confirmed

58:30 – 1:04:56 Dr. Williams’ Final Thoughts

Important Caveats:

• Not every patient achieves Alex’s outcome
• Success requires appropriate patient selection
• Careful risk-benefit analysis essential
• Team approach with pain management, neurology, PT crucial
• Warns against “recreational” nerve surgeons without proper experience

Professional Reflection:

• Discusses challenges of surgical failures
• Importance of collaboration vs. competition between specialties
• Need for balanced conversation with pain management colleagues

1:05:39 – 1:08:57 Closing and Sponsors

• Dr. Barrett thanks all participants
• Nitric oxide supplement sponsorship message
• Legal disclaimers and contact information

Key Medical Learning Points

1. CRPS can involve multiple peripheral nerve compressions masquerading as systemic pain disorder
2. Positive EMG findings should not be ignored even in CRPS patients
3. Conservative treatment failure after 2+ years warrants surgical consultation
4. Complete nerve decompression in single operation often preferable in CRPS
5. Mental health component critical but shouldn’t preclude addressing underlying nerve pathology
6. Patient advocacy and persistence essential for complex cases
7. Multidisciplinary approach improves outcomes when specialists collaborate rather than compete

Outcome:

Alex transformed from suicidal, non-ambulatory teenager to high-functioning college-bound athlete within 14 months of comprehensive nerve decompression surgery.

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