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The diagnosis was grim. Two athletic young women could lose their legs.

Cynthia Dermody tells how bionic bones put them back in the game.

“Bone cancer survivors like Emily Land are on the move again, thanks to new limb-sparing advances.”

Emily Land and Ashley Garrett never knew each other growing up, but they have a lot in common.  For one thing, they lived just four miles apart in Collierville, Tennessee, a suburb of 47,000, complete with a Target, Chick-fil-A and eight public schools.  Both love sports: Emily, 24, was a Division 1 soccer player, and 15-year-old Ashley, an accomplished gymnast and cheerleader.  Each is a long-haired, fresh-faced beauty with impeccable Southern manners.  And then there are the scars, long and deliberate, snaking down each young woman’s athletic left leg.  The marks are so striking that when Emily wears a skirt out to dinner with her husband, Chris, or Ashley attends a high school basketball game in her cheerleading uniform, strangers often ask, “What happened to your leg?”  “Shark attack,” Emily sometimes answers.  “But you ought to see the shark!”  This isn’t what really happened to either Emily or Ashley.  For those who are genuinely concerned, Emily might fess up and say, “I had cancer.”  If she thinks her story could help someone else, she may reveal how a bone-eating tumor forced doctors to remove half her thighbone and replace it with a revolutionary metal implant that functions like real bone.  Thanks to the implant, Emily’s left leg can move just like the other.  Emily was a college sophomore when she found her tumor in April 2003, and started chemotherapy followed by the surgery and more chemo, at St. Jude Children’s Research Hospital in Memphis.  Ashley was only ten, in August 2002, when St. Jude doctors replaced her diseased shinbone with an artificial one.  As extraordinary as these state-of-the-art limb-sparing technologies are, perhaps the most remarkable thing is that, except for the young women’s scars, no one watching as they walk or climb stairs would ever guess their secret.  Decades ago, a diagnosis of osteosarcoma meant amputation and often death.  Patients were sent home with a 20 percent chance of surviving five years.  The development of chemo in the 1970s markedly improved survival rates.  Because of huge advances in research and treatment of pediatric cancers at centers such as St. Jude, the chances of a child’s beating the disease are now 75 percent over five years.  And high-tech bone replacements like Emily’s and Ashley’s are improving mobility for survivors.  Ashley’s parents, Donna and Floyd Garrett, didn’t know what to expect when Michael Neel, MD, an orthopedic surgeon at St. Jude, pointed to the X-ray and told them there was a good chance the strange bump that seemed to appear overnight on their little girl’s leg was cancer.  Ashley could barely grasp the implication of the doctor’s words.  “We don’t know what this is right now, but whatever it is, Ashley, we’re going to take good care of you,” Dr. Neel said.  Scans and a biopsy indicated that the egg-size tumor had not spread.  But Ashley would still need three months of chemotherapy to kill any wandering cells and to shrink the tumor before Dr. Neel could remove it.  Dr. Neel said it was very lucky that Ashley’s leg, severely weakened from the tumor, hadn’t fractured during gymnastics or a recent family ski trip.  The mass would have ruptured, making the tumor grow larger.  Donna Garrett was even more shocked when Dr. Neel said he’d have to remove the upper third of Ashley’s shinbone.  “We were prepared to do whatever it took to save her life,” Donna recalls, “but I was concerned about how this would affect gymnastics and things she loves to do. How was she going to be a normal little girl?”  To get a safe margin around the tumor, Dr. Neel would also have to remove the growth plate at the base of Ashley’s knee.  This plate, the source of new bone cells, was responsible for about 40 percent of the growth of her leg.  Ashley still had five more years and five inches of growth left.  So the surgeon planned to use a new implant called the Repiphysis – a bionic bone of sorts that expands when activated by an electromagnetic device.  It was a huge improvement over the previous generation of kids’ prostheses, which were lengthened manually by reopening the surgical incision and turning a screw to expand the leg.  The Repiphysis would require just one surgery and several noninvasive lengthening sessions every year or so.  After an initial recovery period, including months of physical therapy, Ashley would be able to swim, ride a bike – even do some cheerleading.

On August 26, 2002, after four rounds of chemo, Ashley lay on a gurney.  In a pre-op room, surrounded by her family and pastor, they prayed and told Ashley angels were watching over her before heading to the waiting room to sit out the six-hour surgery.  Dr. Neel made an incision on the inside of Ashley’s left leg, from above the knee joint to her ankle.  He and St. Jude’s director of surgery, Bhaskar Rao, MD, carefully separated the muscles and blood vessels before sawing through her shinbone six inches above her ankle and lifting the diseased bone out of its socket.  Then he replaced it with the three sections of the Repiphysis.   First, he attached a titanium-alloy rod to the remaining shinbone.  Next he anchored the other end of the implant to the bottom of Ashley’s thighbone.  Then he attached the midsection containing the expanding part and joined the pieces together by inserting at the knee a pin that acts like a hinge.  The surgery and the prosthesis would normally cost over $100,000.  But St. Jude operates entirely on donations, and treats and houses all children who meet certain medical requirements and their families, regardless of income, for free.  High-tech medical innovations are not foolproof, and sometimes there are complications.  That’s what happened to Emily.  Since the 20-year-old midfielder for the University of Tennessee at Martin was full grown, Dr. Neel gave her a permanent, nonexpendable implant called the Guardian.  The surgery went well.  But a month afterward, she started experiencing pain and lack of muscle control.  “Every single step hurt like a screwdriver jamming up inside my bone,” she said.  During a trip to Hawaii with a girlfriend, an end of chemo gift from her mother, Emily was so unsteady that she frequently got caught rolling in the surf and her friend had to grab her healthy leg to drag her back to shore.  Emily limped down the aisle at her wedding in April 2006 and hobbled through her honeymoon at Disney World.  In June 2006, Dr. Neel operated again.  When he cut into Emily’s leg, he saw that the upper rod was spinning inside her thighbone.  It had never grafted to the implant.  He replaced and secured the rod.  Six weeks later, after just two weeks of physical therapy, Emily put her crutches down and walked away.  Her limp and the pain were gone.  In addition to getting regular checkups, Ashley went back to St. Jude every time her healthy leg grew more than a centimeter, about once a year, to have her implant lengthened.  First, Dr. Neel slipped a large magnetized ring, attached by a cord to a control box, around her leg so it circled the part of the implant that held a plastic-encased metal spring.  He pushed a button on the control box, sending a signal to an antenna in the plastic.  The plastic heated up and softened, allowing the spring to expand.  When an X-ray showed the spring had expanded to the desired length, a maximum of two centimeters at a time, Dr. Neel flicked the device off and the plastic hardened to freeze the spring in place.  Last April, an X-ray revealed that the growth plate in Ashley’s right leg had closed.  Now that the young woman had reached her final height of five feet, two inches, it was time for Dr. Neel to replace the Repiphysis with the stronger, more permanent Guardian.  Ashley won’t need a new rod until she’s 25 or so.  Two weeks after the second surgery, I5-year-old Ashley, wearing a leg brace and on crutches, was back to enjoying get-togethers with her friends.  She and her brother, Tyler, were even planning a dinner party for their parents’ 21st anniversary.  The one thing Ashley, Emily, and other implant recipients cannot do is high-impact sports, which could break the implant or surrounding bone.  “At first I was crushed I wouldn’t be able to cheer in a competition,” says Ashley.  “I asked God a lot, Why me?  But I’ve learned over the years there’s a reason why I went through this.”  She was back in her cheerleading uniform, on the less rigorous spirit squad, last fall and is practicing for her driver’s license exam in January.  Donna Garrett feels her daughter has been given way more than what cancer took away.  She says Ashley was always kind but is even more compassionate now, an observation she made when Ashley’s three-month-old cousin died from a heart defect in 2003.  “Ashley would tell her aunt that we’re going to get through this, that we all have a purpose,” Donna recalls.  “When Ashley’s friends call to complain about boys, she tells them it’s not a big deal in the scheme of things.  Her priorities are much different from those of a lot of other teenagers.”  For Emily, the sacrifices have been harder to swallow.  While she’s grateful to be able to hike, garden, and work out on the treadmill, what she really wants to do is take off on a full-speed run.  “I want to feel the wind in my face and get my heart rate up like I used to when I was on the soccer field,” she says, sitting on the couch of her home in Cordova, with her dachshund mix, Molly, asleep at her feet.  “It’s a harsh realization because I used to be 130 pounds of solid muscle. Now I’m much curvier and not much muscle.”  A small price to pay.  The long process of becoming a cancer survivor, she says, has allowed her to become something else.

When she returned to college after her treatment, forced to leave soccer behind, Emily’s grades soared.  She graduated summa cum laude in December 2005.  And the experience has brought her and Chris, who started dating as teenagers and are expecting a baby in May, much closer.  “When we first met, hugging was awkward for him.  After I got sick, he had to learn to hold me and make it okay.  And he can even deal with throw-up now,” Emily says.  “I always joke that cancer sucks, but a lot of really good things came out of it.”

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