My husband recently underwent limb sparing surgery, also called limb salvaging surgery. The experience left us feeling like we are living out parts in a science fiction movie.
Up until nine weeks ago, we didn’t know my husband had a serious problem with his left arm. Tendonitis, he was told. When it persisted, he went to an orthopedist who ordered x-rays. The x-rays revealed a 20 centimeter mass on his left humerus, the arm bone running from shoulder to elbow. In a matter of minutes, he’d moved from tendonitis to treatment aimed at saving a limb we hadn’t known was under threat.
But under threat it was. So much bone was eaten away by cancer, my husband was lucky his humerus hadn’t disintegrated, the doctor told him. We saw what he meant when we looked at the x-rays: large concave spaces where bone should have been. A cancer like this only shows up on a regular x-ray once the bone is half gone.
As soon as the talk of saving the arm began, we were haunted by the flip side of the coin — potential amputation. The surgeon confidently spoke of a positive outcome, but “what ifs” crept around inside our heads as we grasped at the safety line limb sparing surgery offered.
My husband had a kidney removed a year ago, and when this mass in his arm was diagnosed, doctors strongly suspected that the renal cell carcinoma had spread to his bone. A biopsy later confirmed this suspicion. As ominous as the diagnosis was, it took 7 weeks to get from tentative diagnosis to operating room.
Before surgery could be performed, my husband needed to undergo some tests, not only the biopsy, but a full body bone scan to look for cancer elsewhere in the skeleton and an MRI. These scans helped the surgeon determine how extensive the cancer was and where precisely it was located. The nerve bundle seemed to be intact, a promising sign for post-surgical function.
Part of the wait was due to the construction of an elbow prosthesis. Current scanning methods are so accurate that the prosthesis was constructed based solely on measurements taken from the various scans. Would a prosthesis built on the basis of such images fit, we wondered? The surgeon assured us it would.
On the morning of my husband’s surgery, I was advised that the limb salvaging surgery would probably take four hours. The surgery instead lasted eight and one-half hours, with about half devoted to removing the cancer and half devoted to reconstructing the arm. As the surgeon described it, he moved the nerve bundle to the side and carefully cut out the cancer without sacrificing any healthy tissue or muscle. He removed the elbow and much of the humerus, both of which were compromised by cancer.
Once the cancer was gone, the science fiction began. My husband’s arm was reconstructed using the prosthetic elbow and a spring-loaded titanium rod. The surgeon explained to us that the spring-loading mechanism will hold the rod in place until new bone grows around it, ensuring it remains in place long term. After he located the artificial parts just so, he moved the nerve bundle back into place and closed up the arm.
The result is nothing short of miraculous. The morning after surgery, my husband wiggled his fingers, reassuring himself he could manipulate them into the correct positions for playing saxophone upon his recovery. He told me that he had enough finger control already to play the saxophone, though his arm would need to propped up for him to do so. The next day, he was able to lift his left arm over his head with his right, without unbearable pain. On day 4, he returned home.
He wears a half cast covered with bandages to immobilize his elbow, and when the bandages were changed I saw his arm for the first time since the surgery. Other than the surgical staples, incision line, and swelling, his arm looks just like it used to look.
It will still take weeks for the swelling to recede and for my husband to be able to use his left arm and hand effectively. But all signs are good. The doctor initially suggested that he might lose some function associated with his radial nerve, the nerve that controls the ability to flex the wrist back toward the outer arm. Naturally my husband checked this out shortly after the surgery. The only obstacle to full backward flexing was the end of the cast.
My husband will suffer one permanent impairment that everyone who undergoes this surgery suffers, and for him that’s a cloud with a silver lining if ever there was one. He will never again be the guy who does the heavy lifting. But he will play his beloved saxophone with two hands and will do everything else he did before the surgery. From the outside, the only evidence of the inner prosthetics that replaced his humerus and elbow will be a scar down the inside of his arm.