The Challenge of Elephant Leg

Transcription

1 The Challenge of Elephant Leg By Yang Ching-jung Translated by Anny Huang Edited by Margaret Hsieu He was wearing a sari skirt made from the soft fabric that is characteristic of South Asian cultures. His steps were uneven, but the smile on his face shined bright like the sun. That was the first impression Kannanyason Sababathy left on the people who greeted him in the terminal of Chiang Kai-shek International Airport. If these people had not already known about his medical condition, nobody would have guessed that underneath the sari skirt, this Indian-Malaysian man s right leg was deformed, resembling the enormous leg of an elephant. His leg had been tormented by the elephant leg disease for 15 years. 38 Medicine With Humanity Vol. 3 January 2006

2 A l l o f h i s d o c t o r s c o n c l u d e d t h a t amputation was the only solution. However, the team of doctors in Hualien Tzu Chi Medical Center accomplished an impossible task. They sculpted his enormous leg, which was long plagued by spreading tumor, back to its original slenderness. Kannanyason has seven siblings. Though growing up in a big family, he had always been loved by everyone throughout his childhood. He had a happy, optimistic personality. Later in his grown-up years, he worked at a wellcompensated job in a Japanese company based in Malaysia. He did not drink, smoke, or gamble. He lived a good and healthy lifestyle. Kannanyason thought back on his life, I even had a girlfriend that I was already planning on marrying. Everything in life was so good, so happy. From heaven to hell In 1989, Kannanyason had a car accident. The local hospital promptly operated on him to repair his femur fractures and ligament injuries, using a cast to stabilize his right leg. He was recovering well for awhile, but one day after he was discharged, he slipped and fell in the bathroom. The same bone that was broken from the car accident fractured again. This time the doctors had to use nails and pins to stabilize his thigh. After the nails and pins were removed, his entire right leg started to swell. Fluid had seeped out from the wound, making a foul smell. His perfect life shattered into pieces. He lost his job, health, and even his fiancé. Suddenly, it was as if he had fallen from heaven to hell. Kannanyason did not know what he had ever done to deserve such suffering. He fell into despair and even attempted suicide. It was his family s tears and his mother s love that kept him alive. They started to seek other doctors help with the hope of finding a cure. The swollen leg became often inflamed as the weather changed, causing Kannanyason to have frequent fevers. For long he had been tormented by the pain in his leg. He endured the pain and dragged the deformed leg to see many doctors. The only answer he got was amputation. Kannanyason did not want to lose his leg. He even traveled to as far as India to seek for a cure, but was still disappointed with the same answer. Although every doctor offered different explanations, Kannanyason had never given up on his leg. Even when his mother assured him that he would be all right after amputation, he still would not give up on his leg. Secondary Lymphatic Edema is caused by blockage in the lymphatic system, resulting in engorgement of certain parts of the body. There are several etiologies for lymphatic blockage, including parasitic infection, surgery, radiation therapy, malignant tumor, etc. Medicine With Humanity Vol. 3 January

3 Dr. Lee Chun-ta measures Kannanyason s right calve. Contact with Tzu Chi He lived and endured the pain for 15 years. Finally one day, a friend suggested Kannanyason to give Tzu Chi a try. Tzu Chi? What is Tzu Chi? he said. His friend explained that Tzu Chi is a Taiwanbased Chinese Buddhist charity foundation. Kannanyason was doubtful. Is that possible? Why would Chinese people ever help an Indian man? he asked. His friend encouraged him and said, We ll see when we give them a try. I n S e p t e m b e r o f , a d o u b t f u l Kannanyason and his mother visited Tzu Chi, s Malaysia Klang Chapter. As soon as they entered the chapter, a Tzu Chi volunteer noticed that pus and blood were coming out of his leg, leaving a bloody trail on the floor of the meditation hall. The volunteers took him to the nearby Tzu Chi Klang Free Clinic for immediate treatment. As soon as he uncovered his dressings, the nurse was surprised to see his leg swollen like an elephant s leg. A strange odor was noticeable. Kannanyason remembered how much he was touched when several nurses immediately came to treat his wound. He also remembered 40 Medicine With Humanity Vol. 3 January 2006

4 Kannanyason gets his right leg back to normal after three surgeries, without amputation. had often gotten from other people. N e a r t h e e n d o f , Kannanyason received a phone call from Tzu Chi s Malaysia Malacca Chapter, informing him that he could go to Taiwan for medical treatment. Although he was very happy to hear that, he took it lightly. He told Tzu Chi volunteers that if the doctors in Taiwan also concluded that amputation is the only cure, he would come back to Malaysia immediately. Alternative to amputation the hospitality of the nurses. When they heard that his mother was hungry, they even brought hot food for her. Since that day, the volunteers at Tzu Chi Klang Free Clinic picked him up from his home and took him to the free clinic for weekly medical treatment. After a while, every time when he stepped into the free clinic, everyone including other patients would greet him like greeting a good friend. At the free clinic, he was no longer haunted by the strange stares he Kannanyason s insisting on no amputation was a big challenge that tested the skills of the medical team in Taiwan. The medical team consisted of doctors in plastic surgery, orthopedics, anesthesia, rehabilitation, nuclear medicine, nutrition, nursing, and volunteers. In a meeting before Kannanyason s arrival in Taiwan, plastic surgeon Dr. Lee Chun-ta indicated in a presentation that although he had seen other cases of secondary lymphatic edema in the past, he had never seen a tumor this big. Dr. Chang Yao-jen, vice president of Hualien Tzu Chi Medical Center, said that after all the doctors in Malaysia and the specialists in Taiwan carefully evaluated the case, amputation was still their recommendation. Knowing that it was against Kannanyason s Medicine With Humanity Vol. 3 January

5 wish, they decided to do everything to save his leg. The doctors researched every medical journal and publication, only to discover that Kannanyason s case was not only rare, but it was also extremely difficult to treat. They could not find an alternative to amputation. After many discussions and evaluations, the medical team decided to accept this impossible mission and invited Kannanyason to Taiwan for treatment. Suffering going to be over When Kannanyason first arrived in Taiwan, he told everyone happily that his suffering was finally going to be over. Even though Kannanyason talked positively on the outside, inside his heart, he thought it probably was another futile trip. However, as soon as he walked into Hualien Tzu Chi Medical Center, he bowed in front of the wall painting of Buddha healing a patient. At that moment, his hope rekindled. The thought that this was going to be a successful treatment flashed through his mind. In order to ensure the success of this operation, the doctors must have a good understanding of the possible side-effects of removing giant tumors on the patient s circulation and metabolism. To estimate the size of the tumor, Dr. Chen Ing-ho, a well- Puerto Rico American volunteers Mr. and Mrs. Santiago come to cheer Kannanyason up. He wondered how could they volunteer for Tzu Chi if they don t speak Chinese. 42 Medicine With Humanity Vol. 3 January 2006

6 To ease Kannanyason and his mother s anxiety of coming surgery, hospital volunteers cooked their favorite curry rice for them. known orthopedic surgeon, used a technique mentioned in the ancient Chinese tale of Tsao Chung weighing the elephant. He asked the head nurse to find a large barrel with a wide opening that is approximately the height of Kannanyason s knee. The barrel s opening should be big enough for Kannanyason to place his entire right foot in it. Using the volume of water displaced by Kannanyason s right and left calves in the water-filled barrel and calculating the difference, Dr. Chen would be able to tell how much more his right leg weighed compared to the healthy left leg. Dr. Chen patiently counted every ladle of water, measuring the left leg first and then the right leg. He estimated that right leg weighed 22 kilograms more than the left, which was equivalent to the weight of a five-year-old child. According to Dr. Lee, Kannanyason s height was 178 cm. Before the operation, he weighed 135 kilograms. The size of his left thigh was 61 cm and his right thigh was 78 cm. The circumference of his left calf was only 45 cm, but his right calf was 105 cm. His right calf was twice as thick as the left calf. Since Kannanyason first arrived in Hualien on Dec. 23, 2004, the doctors conducted a series of tests to confirm that the lymphatic Medicine With Humanity Vol. 3 January

7 After first surgery, Kannanyason takes his first steps with a big smile on his face and said: My foot is so light! edema in his right leg was indeed caused by the lymphatic obstruction induced by the surgery performed for the car accident. From MRI (Magnetic Resonance Imaging) scan, they concluded that the elephant leg was caused by complete blockage of the right leg lymphatic system, causing lymphatic fluid leakage from the capillaries. Dr. Lee indicated that such severe case of lymphatic edema was very rare in the world. Due to complete lymphatic blockage, the surgeons were unable to use microvascular techniques to divert the lymphatic circulation into the veins. The fact that Kannanyason was still able to drive and walk normally indicated that the neurological functions in his right leg was normal. Therefore, the doctors decided to completely remove the tissues and skin of the lymphatic tumor, followed by a skin graft. Furthermore, due to Kannanyason s diabetic 44 Medicine With Humanity Vol. 3 January 2006

8 history, the doctors decided to perform the surgery in two phases. The first phase is to remove the giant tumor, and the second phase is to reconstruct the entire right leg, as well as removing the area of lymphatic blockage. Surgery lasts 10 hours The first phase of surgery was performed on Dec. 31. The entire surgery took 10 hours. Because the tumor was filled with lymph, with the first incision, lymphatic fluid and blood flowed out profusely. They transfused him with 5,000 cc of blood product. The tumor removed consisted mostly of fat and lymphatic tissue, weighing 12 kilograms, with a thickness of 7 cm, width of 40cm, and girth of 65 cm. Initially they estimated that the surgery could be completed in four hours, but because Kannanyason s calf was thick and stiff, the doctors were not able to control the blood flow using pressure bandages. The duration of the surgery extended to 10 hours. For the right calf skin graft, two-thirds of the skin was taken from the tumor, and the rest from the left leg. The tumor even spread to his toes. Dr. Chang indicated, The specialists, initial recommendation was to amputate the toes, but we were able to keep all the toes after great care and treatment following the surgery. After the surgery, the head surgeon Dr. Lee Chun-ta and anesthesiologist Dr. Shyr Ming-hwang walked out of the surgery room and informed Kannanyason s mother, who was waiting anxiously, that the surgery was successful. Upon hearing this good news, Kannanayson s mother embraced Dr. Lee with great excitement. She even got down on one knee and kissed the hands of Dr. Lee and Dr. Shyr. It was her way of expressing her utmost gratitude and respect for them. Because the surface area of right calf was too big, two-thirds of the skin was taken from the healthier part of the tumor. However, because the tumor was colonized by bacteria, despite antiseptic measures and antibiotic therapy, the graft still became infected. Following the surgery, Kannanyson was febrile for several days. After the fever defervesced, Kannanyason finally got out of the bed and took his first steps. With a big smile on his face, he said, My foot is so light! It feels like a cotton rod that is ready to fly! After Kannanayson s condition stabilized, he was no longer getting fevers from the infection. The second phase of surgery was performed on Jan. 20, The doctors removed the leg lymph nodes and treated the infection in his right calf. The total duration of There are three treatment options for lymphatic blockage: In mild or moderate cases, lymphatic blockage can be removed by microvascular surgery techniques.the lymphatic edema can be completely resected, and then skin graft may be performed.in cases where knee or ankle joints have lost their functions and have become stiffened, amputation may need to be performed. Medicine With Humanity Vol. 3 January

9 the second surgery was five hours. Blood transfusion was not necessary this time. The removed lymph nodes weighed one kilogram. The followed-up surgery w a s o n F e b T h e y removed the excessive tissue growth from the right leg, and replaced it with skin taken from the right and left legs, a total length of 1,210 cm. The subsequent skin condition was good. Able to wear pants again After three surgeries a n d t h r e e m o n t h s o f rehabilitation, a farewell party was organized for Kannanyason s discharge. He finally was able to wear pants, which he had been longing to do for 15 years. K a n n a n y a s o n t o l d everyone with a less than fluent Chinese, Thanks to Master Cheng Yen, thanks to the doctors, thanks to the Finally he can wear pants, which he had been longing for 15 years. nurses, thanks to the volunteers for giving me a him a new life. His mother also stood up to brand new leg. The size of his right calf was give a speech, but she was already in tears and reduced from 105 cm when he first entered the could hardly speak. hospital to 45 cm at the end of his hospital stay. Kannanyason s trip to Taiwan signifies Kannanyason said he was very grateful to a surgery that accomplished two impossible Hualien hospital s doctors for removing the tasks, said Dr. Chang Yao-jen, who proudly suffering that had lasted 15 years and for giving shared the experience. One was to prove 46 Medicine With Humanity Vol. 3 January 2006

10 Before Kannanyason s leaving the hospital, resident volunteer Ms. Yen sends him a pair of new sandals, blessing him to walk on the bodhisattva path. Kannanyason s initial presumption wrong that Chinese people would never help an Indian man. The second was to prove that no amputation was possible. We are so happy that the medical team in Hualien hospital was able to accomplish this impossible mission with all the good wishes from Tzu Chi members all over the world. Regarding treating the wound after leaving the hospital, Dr. Lee reminded Kannanayason that although the wound was recovering well, the newly transplanted skin was still very fragile. Within half a year, some of the transplanted skins may possibly peel off. Kannanyason must avoid cuts or injuries to the new skin. If he ever gets hurt, he must go back to Tzu Chi s Malaysia Klang Free Clinic to seek immediately medical treatment. A relatively simple bone fracture operation tragically turned into a foul-smelling, pusforming tumor, tormenting Kannanyason for 15 years, whose strength and determination shined through. The medical team in Hualien hospital took three months to turn Kannanyason s wish into a dream come true. His legs are now light and agile. It was a continuous effort of Tzu Chi volunteers, from Malaysia to Taiwan, then back to Malaysia again. For the medical team, they were only fulfilling their duties. But to Kannanyason, it was a new chance to live again. Medicine With Humanity Vol. 3 January