It’s a testament to how much punishment Zack Seager’s athletic body can take that he didn’t mention the painful, mysterious lump on his right shin to his parents.
About four millimetres long, and barely perceptible under his skin, the bump was just par for the course for the 17-year old soccer, rugby, basketball, volleyball, swimming and “everything-but-hockey” star of all his teams at school and in his hometown of Dunnville, about 45 minutes south of Hamilton.
“I just thought it was a calcium deposit or something,” he says coolly. “It freaked me out at first, but then I thought it was nothing. Then it started to hurt and that freaked me out again.”
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“He’s really into sports, so a lump on his body is really not unusual,” adds his mother, Kitty, a nurse. “He also has a very high pain threshold. He had a burst appendix for almost two days before he told me that it was hurting. He lived with this lump for about a year-ish and then he said to me one day, ‘This hurts like when my appendix burst.’
“Then I knew we were in trouble.”
Kitty immediately took her son to a local emergency room, where the doctor took an X-ray and called it right away. Zack had an osteoid osteoma. A bone lesion. It’s essentially a benign tumour and this kind of growth tends to crop up in young men.
“These actually are very small lesions, but they are excruciatingly painful,” explains interventional radiologist Dr. Michael Temple, an image-guided procedure specialist at Toronto’s SickKids Hospital car warranty. “It’s quite amazing how painful.”
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Steve Russell / Toronto Star
Dr. Michael Temple injects some saline to protect the skin near the bone lesion. Zack Seager has a bone lesion that will be removed by a bone. To avoid the large incisions and long recovery of surgery, doctors at SickKids use Image Guided Care, which uses state-of-the-art imaging equipment, a mobile CT Scan and ultrasound to provide precise surgical treatment guided by real-time images.
“And (Zack’s) is tiny, just a couple of millimetres in size. These affect patients’ lives unbelievably. They’re not able to walk, to participate in social activities or athletic activities.”
In the past, surgeons would go in and either scrape the osteomas off the bone or just cut them out. The problem was they couldn’t really see where they were going and sometimes they would have to leave a really big hole in the bone.
But, with advances in computerized tomography (CAT scans or CT), X-rays which collectively produce cross-sectional imaging of the body, treating bone ablations, as they are called, is a whole new ball game.
“It’s been close to 20 years ago now, people started thinking, ‘If I can heat this area up, then I can probably kill these cells,’ ” says Dr. Temple. “So, now, this is a kind of standard therapy. Basically, what I am doing is using a CAT scan to put a needle into the centre of the lesion and I actually use laser to heat the area and kill the tissue.
“So, instead of having a very large hole in the bone and in the skin, the incision is about two to three millimetres in size. And that’s the procedure.”
For Zack, the promise is that he’ll be back on his feet in time for the start of soccer season. Dr. Temple worries that the teen might be a little optimistic in this.
“Basically, no matter what you do, whenever you do anything to the bone, when you put a hole into it, you increase the risk of fracturing afterwards,” Dr. Temple cautions. “From a conservative point of view, we don’t want anybody breaking their legs afterwards. So we want them not doing any kind of major exercise for about to six or eight weeks, but they can walk around and do minor exercise in the meantime.”
His mother laughs. “Zack thinks he is going to be the person who walks out of the O.R. and have no trouble recovering. He is a suck-it-up-and-move-on kind of kid. He did ask the doctor if he could go for the surgery between the end of February and the first of April, because he has too many sports to do and he needs to be recovered.”
It’s the end of March and Zack, Kitty and his dad, Jim, are at SickKids, sitting and waiting for the procedure to begin. They’re in a busy waiting area close to the Star Trek-like operating room, which is filled with giant, white CT machines. There’s a control room, just like the bridge of the Enterprise.
Steve Russell / Toronto Star
Zack Seager’s leg sports a tiny bandage after having a bone lesion that will be removed by a bone. To avoid the large incisions and long recovery of surgery, doctors at SickKids use Image Guided Care, which uses state-of-the-art imaging equipment, a mobile CT Scan and ultrasound to provide precise surgical treatment guided by real-time images.
Zack isn’t nervous; he just wants to get this over extended service warranties. His parents seem understandably tense, as nurse Kim Evanoff checks his vital signs and prepares him for surgery. He’s told to strip to his boxers. And, yes, he must even take off his Lord of the Rings ring, which hangs on a chain around his neck.
Zack is lucky that he lives close to SickKids where image-guided therapy is used.
“In most of North America, they use something called radio-frequency ablation, which is basically an electrical kind of current,” says Dr. Temple. “The laser here is actually, smaller, cheaper and easier on the patient.
“The next thing that we’re going to be doing is using sound waves to treat these without actually breaking through the skin. We’re going to be able to take a person, lie them on a MRI table, put them into the MRI, focus sound waves into their body and burn the tissues inside their body without making an incision.
“We’re going to be starting our first patient case hopefully within the next couple of months.”
Zack feels there’s no time to waste. On this day, he goes into the O.R. at noon, and spends a few hours in recovery.
By 8:30 p.m., he and his parents are back home in Dunnville.
The next day, he’s on his feet, with a cane and “just a bandage” over the incision.
“It was good,” he says. “It only hurts a little bit. Not too much.”
Now the pain of sitting out part of his sports season begins.
Mobile users: Click to view interactive graphic of Zack’s operation