Non-fiction Orthopedic Stories (1)
How do you feel when you lose a limb due to Malignancy?
It is bad for a person to live with only one limb. It is worse because of having cancer. It will be the worst if the patient is a 14 years old girl who want to be a footballer.
I met this girl for the first time at the out-patient department of our orthopedic hospital in one rainy day. In spite of being bad weather, a lot of patients were waiting for their treatment.
(In our hospital, there are 7 tables to consult the patient. The nurses arrange the patient entry and help in examination.)
At round about 11 am, I was a little bit tired but there were at-least 20 patients left to consult. The nurse brought a young girl who complaint of left knee pain for a month after falling on a ground while she was playing football.
Firstly, I thought that it might be a minor one, just simple knee injury after fall. Nevertheless, I tired to take full history, and examined properly. After the X-ray was taken, I was so worried about her. According to the findings and X-rays, the problem she suffered may be due to a kind of infection or a kind of Cancer.
At that time, I did not know how to explain about the conditions to her and her mother. I was in a silent for a few minutes (because it looked like a cancer), and they were also waiting for her result from me anxiously.
I started breaking the news. I had been explaining for half an hour. I was praying in my mind that it would be an infection, an abscess of thigh, please. Then, I told her to admit to the hospital for further investigation. I also had to consult this case to my Professor, too. There were many thoughts in my mind and I was thinking for the possible outcomes.
After getting some blood test’s results within a few days, our Professor decided to take MRI (Magnetic resonance imaging) to detect the tissue and other structures involvement around her knee. Unfortunately, it was a cancer, possibly Osteosarcoma (Bone tumor) according to MRI result.
(The photo of Osteosarcoma, (bone tumor in light blue colour) surrounded by blood vessels, muscles and nerves.)
At that time, I thought my mind was loaded with thoughts. How could I tell the real situation? I didn’t know whether she would be crying or what would happen after consultation. I explained her and her mother at lunch break, in my small consultation room while there was raining heavily.
I explained the possible ways of treatment and we would like to start the operation for tissue biopsy as soon as possible. (Tissue biopsy is detecting a cell which is infection or cancer by taking a sample tissue under anesthesia at the operation theater).
The photo of osteosarcoma microscopically, tissue biopsy (iStock photo)
I was upset after reading a biopsy result. Yes, she suffered a notorious bone tumor, Osteosarcoma. I felt sorry for her. I had no words to reassure her. How could I?
I would like to share the osteosarcoma briefly.
It is an aggressive bone tumor occur mostly in children and young adult (2nd decade of life). They commonly occur at lower thigh or upper leg. And they can present at upper humerus, upper thigh and pelvic. The cancer can spread to lung and other organs or bones. When the patient has osteosarcoma, he may suffer pain at the tumor region, and get fever. There may be a swelling where the tumor is located. She cannot eat well and gradually decrease in weight markedly- the tumor uses all energy to growth itself and the patient become weaker and weaker. The patient cannot sleep well due to severe pain.
This is the X-ray of the tumor at lower thigh. (X-rays AP and lateral views of knee, the arrow shows the tumor reaction on both views.) (Patrick J. Messerschmitt)
This is the morbid of the bone tumor of lower thigh and knee joint. (The distal femur osteosarcoma, the malignant cells invade the surrounding tissue) (Patrick J. Messerschmitt)
The treatment of this type of cancer depends on according to their stage. Basically, the tumor must be removed from the body after giving chemotherapy (the drugs which kill cancer cells).
We have to decide whether amputate the limbs or save the limbs.
This is the photo of limb saving surgery where all the tumor bone are removed and some artificial steel/titanium structures are used to substitute the bone for the patient to walk again. (Patrick J. Messerschmitt)
Limbs saving surgery is expensive, difficult procedure and sometimes, all the tumor tissue needed to remove for some reasons. The benefits of amputate (cut off) the limbs are safer procedure and almost all of tumor cells can be removed.
The life expectancy; about 60 to 80 % of patient can be survived next 5 year if they took treatment properly and regularly. And it is so called a bad disease.
The early treatment is really important. Sometimes, some parents accidentally ignore or neglect their child disease. In some situations, the parent applies some herbal drugs to reduce the size of the swelling-it is a wrong concept, too.
Continue my story…
Undoubtedly, that time was one of my difficult times in my career. I counselled her and her mother once again. I told the truth. I gave them a chance to choose the type of treatment. I occasionally remembered that the tears dropped from the girl’s eyes even though she was not cry. She was calm and brave. Their decision was to cut off the limbs to save a life.
Before amputated the limbs, she took chemotherapy for 3 weeks. I recognized that her hairs were gone after 3 cycles of chemotherapy. Then, she shaved all of her hairs.
At the night before operation was taken, I talked to her about the operation and gave more counselling. She asked me that she can play football once again. I did not want to lie, so I says that, there were some possible ways for you to play football again, but it was too difficult for you because of our country’s conditions. We had no proper support or sufficient resources to create the plans to support the disable people like her. But I was going to help her to get some proper prosthetic (artificial) leg later.
This is the photo of prosthetic (artificial) leg for the patient. They are expensive. (iStock photo)
This is a cheaper one. But this kind is not able to run or do sports.
(Even these kinds of prosthetic legs are not easy to buy in our country)
Her operation was successful. I participated in surgical teams as an assistant. Amputation was surely not a desire job not only for patient but also for Orthopedic surgeons.
She recovered within a week and told me that she appreciated my help. She was in comfort because the annoying pain caused by the cancer was gone. The post operative conditions were stable and she continued to take chemotherapy for next 3 weeks.
When the day she discharged and went home was arrive, she walked to my room by using a pair of crutches. I told her that this was not a big loss if she did not give up. I promised her to help in finding a prosthetic legs when she was ready to use.
She smiled to me.
“Dear Saya, can I play football again???”
This is based on true story.
We have to try our country to develop more and more.
We need to try to create the better world for this unlucky or helpless disable people.
Thank you for reading the story and the brief topic of osteosarcoma.
Next Story will be coming soon.
Any comment is appreciated.
Let’s try to build a better country.