While she was losing her curls to chemotherapy, Vertika Jain drew pencil sketches of two-stunning girls, both with gorgeous tresses. “Will I get back hair as beautiful as these?” she asked her doctor. Vertika was getting treatment for osteosarcoma (cancer of the bone tissue) and a prosthesis (artificial device used to replace a missing body part) implant made it possible for her to walk and play as she did before the cancer ravaged her bones.
Along with thank you cards and poems from grateful patients, Vertika’s two sketches find prominent place in the room of Dr Manish Agarwal, an orthopedic surgeon at the Tata Memorial Hospital (TMH). Perhaps his work is best described in the words of his young patient Kshitija, who also had osteosarcoma, a rare cancer involving the bone tissues that usually affects people aged between 10 and 30 years. “Thank you for replacing my infected bone, It was like a new seed sown. It can be increased in height as I grow, Don’t you think before this modern technology, we all must bow, I owe you some chocolates for sparing me the pain, Though I lost the bet, it was my gain .”
Over the past decade, the limb-saving surgery has drastically brought down the number of amputations, with doctors salvaging limbs in 90 per cent of the cases. TMH, which is the main centre for the osteosarcoma patients in the country, gets 150 to 200 cases each year. Of them, 50 are non-treatable, but about 100 get treated.
Limbs can be salvaged using prosthesis or rotationplasty. Cosmetic superiority, better function, no interference with chemotherapy and immediate movement after surgery make prosthesis the popular choice, though it is expensive and needs revisions, with 30 per cent of imported implants and 50 per cent Indian implants failing in ten years.
Those with smaller budgets can now go for rotationplasty, a one-time surgery that compensates for growth and allows rough use, even participation in sports. The drawback is that the surgery involves partial amputation of the leg till below the knee followed by the reattachment of ankle joint with knee so that the heel faces the front. When placed in the position of the knee, the ankle joint functions like the active knee and an artificial limb completes the leg.
As compared with Rs 5 lakh needed for an imported prosthesis and Rs 1 lakh for an Indian one, rotationplasty costs Rs 5,000, including the price of an artificial limb. Besides TMH, the surgery is being done at AIIMS and in Chennai. “Though affordable and effective, the surgery is disfiguring, which is why only 20 patients needing treatment opt for it,” says Dr Agarwal.
Those who do, however, get back on their feet quickly. Anikat V Salgar, from Belgaum in Karnataka, was in Class IX when he was diagnosed of a tumour that left him with three options: prosthesis, rotationplasty and amputation. “I went for rotationplasty five years ago and have been living a normal life,” says Anikat, currently doing his engineering in electronics from Gokhale Institute of Technology. “Yes, it looks odd, but very few have actually seen my leg after surgery,” adds Anikat.
Fifteen-year-old Rahul Koli was not so lucky. “People from far flung areas used to throng our home to see my leg, making me feel like an animal in a circus. Now they know better,”says Rahul, who had his surgery when he was 12 years old after being diagnosed with bone cancer. “I was shattered with the diagnosis. I wanted to be a cricketer and dreaded the thought of losing a leg. My family didn’t have the money for a prosthetic implant, so when we went for rotationplasty on the doctor’s advice, I was thrilled,” he recalls. Three years on, he has no complaints. “I still play cricket, though I need a runner sometimes,” he says.
Prabal, 2, also underwent a rare surgery that involved removing a tumour-bearing piece of bone, treating it with high-dose radiation and implanting it back with the help of a customised plate. “Prabal has no deformity and is growing and developing normally,” says Dr Agarwal.
TMH is also focussing on making prosthesis cheaper by designing and developing indigenous expandable prosthesis for children to maintain limb length during growth. TMH researchers are working closely with a prosthesis manufacturer in South Africa to develop implants priced at Rs 2.5 lakh, which is far cheaper than the imported implants priced over Rs 9 lakh.