Donated Bone Enhances Teen’s Life (continued)

A Different Kind Of Surgery

Fortunately, the surgery was delayed until the third week of January, giving Erica one glorious, chemo-free month.

“I felt great,” Erica said. “I went out places; my hair even started growing back.”

But on Jan. 29, 2005, she was back in the hospital, this time to see Travis Heare, MD, director of orthopedic oncology at Children’s and one of just four orthopedic oncologists in Colorado. The affected bones of Ewing’s patients and other patients with bone cancers are commonly removed, Dr. Heare said.

“With primary tumors of the bone in kids, there are a lot of different techniques you can use to reconstruct the skeleton after you take out large segments,” he said.

Until the late 1970s and early 1980s, surgeons would remove a bone affected by a tumor and replace it with a metal or metal and plastic prosthesis, he said, or even amputate.

But the process changed when doctors discovered that using cadaver bone – called an allograft – instead of a prosthesis was possible. The donated bone would heal itself to the patient’s bone, and that method became a common treatment, he said.

“If you reconstruct the bone with metal, there’s often a problem with fixation – with loosening over time,” said Dr. Heare, who performs five to 10 allografts a year. “When you use a transplant, the bone heals and the fixation is permanent. With Erica’s tumor, it’s better to replace the bone with bone. It provides good long-term structure.”

And unlike other donated organs, such as livers or kidneys, a donated bone doesn’t have to be a blood-type match or even a same-sex or same-age match, Dr. Heare said. Cadaver bones also can be frozen for up to five years, as opposed to livers and hearts, which must be used within hours of recovery.

“The rejection risk is very low,” he said. “There are only a few cells inside the bone graft that are exposed to the patient’s immune system. Therefore, the patient does not require immuno suppressive drugs to avoid rejection.”

The idea of replacing her bone with a cadaver bone surprised Erica, her family and even Dr. Sue.

“I didn’t know about the concept of replacing bone with cadaver bone until I became a fellow,” Dr. Sue said. “It seems to be the better physiologic answer. It’s a fascinating concept.”

Dr. Heare said, “What I do is so unusual – most people don’t understand.”

And when Erica and her family told friends about the procedure, many of them didn’t understand either.

“Everybody was like, does that mean your arm is going to be shorter? They didn’t have a clue.”

A New Bone and a Funny Bone

Erica thought that since her tumor was so small, Dr. Heare would only remove a couple of inches of bone.

“I was thinking the tumor was this big,” Erica said, holding her index finger and thumb about 2 inches apart on her arm, “so maybe they’d remove this much bone.”

“Later we found out that she’d have to have 9 inches of bone removed,” Carol said.

Before the surgery, Dr. Heare called Allosource, a bone and tissue bank in Littleton, and ordered a 9-inch section of right humerus with a canal diameter approximately equal to Erica’s, he said.

“Erica was lucky,” Dr. Heare said. “Her tumor spared the elbow and shoulder joints,” which are extremely difficult to rebuild.

Right before Erica went in for surgery, Dr. Heare met with Erica to see if she had any questions.

“There he was in his jeans, his big ol’ belt buckle and his cowboy boots,” Erica said of Dr. Heare, who lives in Greeley and raises, trains and shows reined cow-horses in his spare time. “He asked me ‘Are you ready to go back?’ And I said, ‘Are YOU? I’m the one in the gown here.’”

That trademark humor is one of the things that helps Erica get by, Carol said.

“The whole time, we’ve looked for humor in this,” she said. “You have to. If you don’t have your faith and some fun, this is horrible.”

Most patients need a body cast after a surgery like Erica’s, Dr. Heare said. But Erica got another small piece of good news: she wouldn’t need one – the surgery had been that successful.

A few weeks later, Erica got more good news.

On Feb. 1 during rare few hours alone at home, Erica got the call with the results from a biopsy taken after the surgery. She called her mom at work with the incredible news: the biopsy results showed a 100 percent “kill rate.”

“This was the best that could happen,” said Carol, who was called out of a meeting at work for the news. “I looked at my boss – who has been incredibly supportive – and said, ‘meeting over.’”

Erica and Carol journeyed to the hospital, this time for a happy occasion.

“It was one of the best days of our lives,” Carol said.

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