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A broken arm leads to a rare diagnosis

Last Modified: 7/22/2020

Sarcoma

Earlier this year, Warren resident Sarah Wright injured her arm. While receiving physical therapy, she suffered an additional trauma and began one of the toughest journeys of her life. Here, she shares her story about the difficult and rare diagnosis, the bond she shares with her physician and finding meaning in the struggle.

At the start of 2020, I felt healthy. Sure, I got tired sometimes, but I’m a mom and I teach fourth grade. I had type 2 diabetes, but it was well under control. I was active. I had absolutely no warning of what was to come.

On January 17, my son, 18, bought a steer for 4-H. As we were unloading it, the animal was really fighting us. We battled that thing for hours! A week or so after that, I noticed that my right arm hurt. I figured I must have done something to it while we were wrestling the cow.  I went to the ONE walk-in clinic. They did x-rays and everything looked good. They diagnosed me with bicep tendonitis and referred me to physical therapy. I started going to physical therapy in Decatur twice a week. After four weeks, I wasn’t really seeing any improvement, so I went back to ONE and they gave me a cortisone shot in my shoulder. I was supposed to follow up in two weeks.

I woke up on March 9 and told my husband I thought something was seriously wrong. By then, I was using my left arm to move my right arm. I couldn’t move my right arm on my own. I went to therapy, as usual. I always wore a tank top because my therapist, Holly, tried so many things, including ultrasound, scraping, needling and massage. During my session, Holly was helping me put on a long sleeve t-shirt. When I lifted my arm, the bone in my right arm shattered. I heard three loud pops and then felt extreme pain. I started screaming, “Oh my God, oh my God, my arm!” I was so scared. Holly yelled for the other therapist and he came and grabbed my arm. She called an ambulance to take me to the emergency room at Adams Memorial Hospital.

The ER doctor told my husband that mine was not a normal break. He believed there was something more serious going on and encouraged us to contact Christopher Johnson, DO at the Parkview Cancer Institute. Due to the circumstances, they decided to send me home with my fractured humerus in a sling. It was, without a doubt, the longest night of my life.

I saw Dr. Johnson the next morning. Looking back, it was a miracle that such an in-demand physician was able to see me so quickly. Based on the x-rays, he needed more tests. After they splinted my arm, he explained we had two options: I could make all of the necessary appointments on my own, or I could be admitted and get them all done at the hospital. I spent five days at Parkview Regional Medical Center (PRMC), and had all kinds of tests, from MRIs and bone density scans to cat scans and CT scans. After the bone biopsy, they released me to go home and wait for the results so we could develop a course of action.

At the end of my stay at PRMC, the COVID-19 pandemic began exploding. The day I was released, visitor restrictions were put in place. I didn’t really think anything of it. I waited and waited for results.

The first bone biopsy, as it turned out, showed no cancer, but Dr. Johnson was not satisfied with that answer. The imaging and bone biopsy didn’t align. He ordered a second bone biopsy. I went back to PRMC for a second test. This entire time, my arm was still broken. If I’m being honest, the first bone biopsy was excruciating. When I went back for the second, I was petrified. The technician came around the corner, and I recognized her right away and started crying. She assured me that, with extra medication, this one wouldn’t hurt at all. And she was right. She was an angel. A phenomenal, comforting angel. I had absolutely no pain.

Because of COVID-19, my husband wasn’t allowed to come in with me for any of my tests. He spent hours in the car waiting. At one point, he put a twin mattress in the back of his car so he could lay down and wait for me. I was battling inside on my own, just me and God, and he was out in the car, waiting.

The second biopsy showed the same results, no cancer. Again, Dr. Johnson was not willing to accept it. Something was not right. He wanted to do a surgical biopsy. My arm was still broken, but Dr. Johnson was adamant that if we didn’t fix it the right way I would have further complications. He wasn’t willing to just go in and put a pin or rod in my arm. In his heart and mind, he knew that wasn’t the right answer. I will admit, I was starting to get really depressed. The only way I could avoid pain was to just sit on the couch, and that just isn’t me. I had medication, but I was in a lot of pain. I wrestled with just having him fix it and moving on.  

As an affiliate of MD Anderson Cancer Network®, Parkview Cancer Institute and its certified cancer specialists are able to discuss challenging cases with experts at MD Anderson Cancer Center – a national leader in cancer care. Dr. Johnson sent the third biopsy to colleagues at MD Anderson Cancer Center for additional opinions. During this time, and throughout, he was amazing to me. I had his personal cell phone number and he checked in regularly. I could call if I needed anything, even just to talk. He was exceptionally thorough, not just in my treatment, but in how I was feeling. Everything was virtual. I would put him on speaker, with my whole family sitting around, and we would chat with Dr. Johnson about my case.

In early May, I had an in-person visit with Dr. Johnson. With my husband on speaker, listening in his car, Dr. Johnson said, “I, along with all of my colleagues at Parkview, believe that this is cancer. If you were in my family, I would treat this as cancer.” It sounds strange, but I felt a peace. I felt comfortable with Dr. Johnson. I knew that he wasn’t going to lead me astray. He was in it 100% for my health and my well-being, and he was telling me what he believed.

My official diagnosis was low-grade central osteosarcoma of the right humerus, which is a very rare variant of osteosarcoma. As few as 10 people are diagnosed with this type of cancer in the U.S. every year, most of which are male and have the cancer in their leg. (Hence the tough diagnosis.) The course of treatment was ultimately me and my family’s decision. I had two options.  If treated properly, the survival rate for my kind of cancer is 90%.

Dr. Johnson called in Kevin Berning, MD, who is part of the sarcoma team and a microvascular plastic surgeon. Together, they decided they should remove the fibula from my left leg and combine my fibula bone with a cadaver humerus bone to fill the empty area where the tumor had eaten away at my humerus bone. The fibula is only 10% weight-bearing, so you can remove it and the body doesn’t really notice. It also has an artery attached, which makes it more of a living organ so your body is more willing to accept it. There are a lot of blood vessels and nerves, so the procedure would be very involved.

Osteosarcoma

On May 23, I showed up for surgery. We were told it would take anywhere from 6-10 hours. My sister came with me for the 2-hour pre-op period. My husband decided to go to work rather than wait in the car. He thought that would help him get through it.

The procedure took 8.5 hours, and everything went extremely well. I had very little blood loss and Dr. Johnson was very pleased with the results. I went to the ICU for a few days before I was moved to a regular room. Everyone was amazing. They were attentive and wonderful, especially given the circumstances and not being able to have family there with me. They were so invested in my care.

On the seventh day, they were talking about sending me home, and I couldn’t wait. I was with physical therapy, doing laps in the hallway and some squats and leg lifts. The nurse came running in. “What are you doing?” she asked. My therapist and I looked at each other. “She has to get back in bed!” My heart rate had gone up 160+, so she was very alarmed. Dr. Abhijit Shukla came in and said I couldn’t go home until we did a CT scan to check for blood clots. They found a large blood clot in my right lung.

Osteosarcoma surgery

Dr. Shukla saved my life. Had I gone home, I could have had a stroke or a major heart attack. Again, I realized God had bigger plans for me. I’m not quite sure what they are yet, but so many times in the past five months, my life could have easily gone another way. I picture my Grandma, who had passed from cancer a few years before, saying, “Nope, not her! Not yet!” They started me on blood thinner and I was able to return home two days later.

They tested the margins in my arm, and everything came back negative. I go back in August for more x-rays of my arm and chest. If the cancer came back, it would likely be in my lungs. And now I’m home and healing, slowly but surely. I can take my arm out of the sling. I’m dealing with swelling and stiffness in my shoulder, a lot of which stems from not using my arm for so long. As the swelling subsides, we’re hopeful mobility will improve. I have my moments, I’ll admit. Mostly it’s the things that go through my head at night. I’m brave to others, but I certainly cry sometimes when I’m alone. I don’t have to go through chemotherapy or radiation. My battle is a different battle. My battle is coming back from the surgery. I have therapy, instead.

Hopefully in August, I’ll be able to say that I’m cancer-free. It’s been a super emotional five months for our family. My husband has been my rock, taking care of me, working 60-hour weeks and then coming home and take care of the house. Home healthcare and occupational therapy come twice a week, but I’m still very limited. It’s about baby steps. Dr. Johnson told me I may never get 100% range of motion back because of how close the plate in my arm is to my elbow, but that’s OK. As long as I can drive, teach and hold grandbabies someday, the important stuff, that’s all I care about. I look forward to returning to the classroom, possibly even this year.

I try to remain positive, but I certainly get frustrated and down on myself when I can’t do things. My family affectionately refers to me as “the baby” because I still need help with things. That gentle teasing really pushes me. I’m also amazed at the support from my family, church family and school family. I can’t imagine going through something like this without that support. My husband was really questioning his faith before this, but then you see how people show up. You open a card with a gift card in it, or your church helps with your bills, and you’re just so humbled.

I think about how persistent Dr. Johnson was in reaching my diagnosis, and I know things could have been very different. We live in Warren, so it’s almost an hour drive to get to the PRMC campus, but I don’t care. I feel I have the best of the best. The entire care team, all of the nurses, everyone has been there for me. I’ve learned that God makes everything fall into place. It just might not always me on my time. He’s working for us, but we have to be patient. Early on, my pastor prayed, “Allow Sarah to show God through her words and her actions.” If I can show someone that there is someone up there taking care of us and watching out for us, maybe that’s why I had to deal with this. Maybe my story will help just one person.


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