www.BrettDaniel.com

Six years ago, almost to the day, I finished chemo treatments for bone cancer in my left ankle. About a year and three months before that, I finished treatments for a similar tumor in my right knee. Both diagnoses required surgery to remove the tumors, and both times I thought it would be the last time I would have to deal with cancer.

About halfway through last summer, I noticed some pain and swelling in the ankle that had been replaced six years earlier. I attributed it to increased activity. I had been hiking a lot [note the mention of "leg trouble" in that link], biking to work every day, and going to the gym three times per week. I cut back on hiking, biking, and workouts, but my ankle seemed to get worse. After about three weeks, the swelling had become a pronounced lump on the inside of my left leg, right above the ankle joint.

I made an appointment with a local general practitioner who sent me to the hospital for x-rays. The scans went quickly, but I would end up spending six hours in the emergency room steadily progressing up the hospital organization chart. In order, I met: an ER nurse, an ER intern, an ER resident, an ER doctor, an orthopedic intern, an orthopedic resident, and finally the orthopedic supervisor. Their eyes grew wide when they turned on the x-ray screen and saw all the hardware screwed into my ankle. None of them could say anything definitive, but my blood tests did rule out infection.

I tried to schedule an appointment with an orthopedic doctor in California, but he could only see me after the day I planned to return to Illinois.

I had the California x-rays sent to my normal orthopedic doctor in Indiana. He said everything looked fine except for what appeared to be a stress fracture around one of the screws holding the metal plate. The fracture appeared to be healing normally, so he did not know what could be causing the lump. I made plans to see him as soon as I could get back to the Midwest. That appointment, a week into the semester, was also inconclusive. Since nothing appeared on additional x-rays, he speculated that it could be a pseudoaneurysm, a mass of blood pooling in a damaged blood vessel.

He scheduled further tests and scans for after I returned from the conference in which I presented my research paper. [I may decide to write about that trip in another weblog post.]

The next appointment took place on September 17. By that point the lump had grown considerably, and the pain had gotten bad enough that I had started using crutches to walk long distances.

The doctor seemed stumped. He took a biopsy "just to rule out cancer even though the x-rays don't show anything". He barely got any tissue because of all the blood that came literally pouring out of the incision. Apparently it was enough because on September 20 he called to say it was another osteosarcoma. In his words, "there is a rind of tumor around a mass of blood."

A third tumor!? Recurrent bone tumors, especially this long after a previous diagnosis are very rare. It is likely a new occurrence, unrelated to my previous two tumors. We cannot know for sure if the stress fracture was a partial cause or effect of the tumor's growth, but I find it interesting that an "osteosarcoma usually develops from osteoblasts (the cells that make growing bone)".

Things went quickly from there. On Monday, September 24, I got a bone scan and chest CT scan to make sure the cancer hadn't spread. Fortunately, it hadn't. I met with my oncologist who admitted that treatment options were limited due to my history. If, improbable as it may be, the tumor was somehow related to the last one— say, a single cell survived chemo and "slept" for six years— then those cells would have greater resistance to chemo drugs. Also, I was skirting the maximum lifetime dosage for several of the most effective treatments. I did not have many surgical options, either, because of all the hardware already in my ankle.

My oncologist and surgeon discussed options with their network of doctors around the country. Yesterday they made their recommendations: chemo would not be effective, and limb-sparing surgery was infeasible. They will need to amputate my leg below the knee.

This a drastic approach, but I agree it is the right choice for the long term. I will not have to subject my body to months of chemotherapy, and there is a near 100% chance of getting rid of all the cancer cells. Also, the recovery time is much shorter. I will only have to stay in the hospital for a day or two after surgery. In four to six months I will get a prosthesis for my lower leg that will allow me to bike, hike, and do all of the other activities that I enjoyed so much last summer.

Surgery is on Tuesday. I will post updates as they come.