Young Josalyn Kaldenberg and her bionic funny bone have everyone smiling.
This April, the Iowa 8-year-old became the first kid in the U.S. to receive an expandable humerus bone replacement -- a landmark procedure that saved her arm from amputation.
Just a few months ago, it seemed inevitable that Josalyn would lose her arm to the cancer that had invaded the bones of her upper arm, elbow, and shoulder. Thanks to the first-of-its-kind funny bone replacement, however, Josalyn is now back coloring, writing and playing the piano at her Woodward, Iowa home.
"It's just amazing what they can do now, reattaching all the tendons and blood vessels and nerves and have the arm actually work. Obviously we don't wish this would have happened, but it's neat to see what can come about," says Josalyn's mother, Heidi Kaldenberg.
"I like my new arm a lot," says Josalyn, who is fiercely proud of the 12 inch scar that now graces her upper arm.
The only downside, the family jokes, is that Josalyn has to get patted down at the airport as her bionic bone sets off the metal detectors.
Josalyn's new funny bone has prompted plenty of jokes, but the laughter comes more from relief than the quality of the punch line. The six months before the surgery was a scary time for Josalyn and her parents and they were days away from having to amputate the arm at the shoulder.
"We always knew amputation was a possibility, but it was still a shock when the doctors told us that they couldn't save her arm," Heidi Kaldenberg said. "I never wanted to give up hope [that we could save her arm]"
The home schooled third grader was diagnosed with osteosarcoma in November, a rare bone cancer that affects only a few hundred kids each year.
The First U.S. Expandable Funny Bone Replacement
The cancerous tumor takes over the long bones of the arms or legs, destroying the bone tissue and spreading throughout the body. Decades ago, the only treatment was swift amputation of the limb, but even then the prognosis was poor. With a combination of chemotherapy and artificial or cadaver bone transplant, saving the limbs later became possible, but it was rare in children, whose bones are still growing.
"It used to be that you could only do a salvage procedure on a child that was fully grown because when you replace it, you won't get growth," says Dr. Eugenie Kleinerman, professor and head of the division of pediatrics at MD Anderson Cancer Center. "Now we have expandable prostheses," she says.
Josalyn was only four days away from having her right arm amputated when her mother reached out to Moffitt Cancer Center in Tampa, Fla., one of the few centers in the U.S. that specializes in prosthetic bone surgery.
An adjustable arm bone prosthetic had never been placed in a child in the U.S. and the family's insurance wouldn't cover the procedure, but "everyone pitched in" to make the procedure possible for Josalyn, says the girl's surgeon, Dr. G. Douglas Letson, chairman of the Sarcoma Program at Moffitt Cancer Center.
Letson offered to do the eight hour surgery for free, the hospital offered its facilities free of charge and Letson was able to get the British company that produced the prosthesis to discount the price.
Surgeons removed Josalyn's humerus bone -- which extends from the elbow to the shoulder -- and parts of her elbow and shoulder, including some of the muslce that had been invaded by the cancer.
Next, every muscle, ligament, nerve, and blood vessel had to be reattached to the new metal bone in order to preserve her use of the arm. The surgery was a success and Josalyn will retain almost all of her mobility and most of the strength in her arm.
"Her shoulder will be weaker, but her elbow and wrist are functioning normally already. Her goal was to be able to play the piano and she's already playing the piano again," says Letson.
As Josalyn grows, surgeons will have to make a small incision in her shoulder about once a year in order to turn a screw that lengthens the prosthetic, but aside from this minor, out-patient procedure, the new funny bone will last her a lifetime.
Josalyn's osteosarcoma has responded well to chemotherapy as well, which puts her chance at surviving cancer free at over 80 percent, Letson says.
"It all just came together. Everything was really in her favor," he says.