When September rolls around, Eleanor, 15, will join her classmates at Glen Rock High School for the start of another school year. The day will probably be fairly routine for her fellow juniors. But for Eleanor it will be a day to celebrate her return to school after missing most of her sophomore year to fight and survive bone cancer that attacked her upper left arm and shoulder. Eleanor's doctors at the John Theurer Cancer Center and the Tomorrows Children's Institute (TCI) for Cancer and Blood Disorders at Hackensack University Medical Center saved Eleanor's arm and shoulder and kept the cancer from spreading to other areas of her body.
Cancer is Discovered
Just days after Eleanor celebrated her 15th birthday on September 13, 2007, she began experiencing pain in her upper left arm. By the end of the month, she couldn't lift her arm above her head or carry her books to school. Her pediatrician referred her to an orthopedist, who ordered an X-ray and MRI. An ominous mass was discovered in the upper part of the humerus bone in her left arm. She was referred to James C. Wittig, M.D., an orthopedic oncologist and chief of the Division of Sarcoma and Skin Cancer at the John Theurer Cancer Center at Hackensack University Medical Center.
"On November 2, we met with Dr. Wittig," recalls Mrs. Hahn. "He spoke directly and compassionately to Eleanor and told her there was a mass in her arm and that it was growing so he had to take it out. He made us feel very comfortable at a very dark time."
A biopsy performed by Dr. Wittig on November 6 revealed that the mass was an osteosarcoma, a cancerous tumor of the bone that most often develops in the arms, legs, or pelvis. Just 20 years ago, the majority of patients with osteosarcomas lost their limbs to the cancer. During the biopsy, Dr. Wittig carefully made his incision in exactly the same place as he would for the surgery, which was to take place three months later -- after chemotherapy killed the tumor. Making the incision in precisely the same spot is crucial so that normal tissue in the area does not become contaminated with cancer cells when the suspicious tissue is removed for the biopsy.
Several days later, Eleanor and her parents met with Michael B. Harris, M.D., director of TCI, and nurse practitioner Carlene Cord, R.N., A.P.N., C., to discuss the journey that lay ahead for Eleanor and her family.
"We were enveloped by this wonderful team of physicians, nurses, social workers, child-life specialists, music therapists, learning consultants, psychologists, and other individuals at Hackensack University Medical Center who supported all of us - Eleanor, myself, my husband, John, and our 12-year-old son, Tim," says Mrs. Hahn.
The Tomorrows Children's Institute (TCI) for Cancer and Blood Disorders is part of the Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center. TCI provides world-class medicine, cutting-edge research, and compassionate care for children and adolescents with cancer and life-threatening blood disorders. The TCI team offers a multidisciplinary approach to treating their young patients that includes not only medical treatment but music and art therapy, psychological counseling, social work services, nutrition counseling, tutoring, learning consultant services, and supportive care for the patient's siblings and parents.
Dr. Wittig and Dr. Harris worked together and decided to treat Eleanor with a highly structured protocol of six pre-surgical intravenous chemotherapy treatments that would kill the osteosarcoma before Dr. Wittig removed it during surgery. Twelve post-surgical chemotherapy treatments would follow. This regimen is part of a two-year Children's Oncology Group clinical research trial that is evaluating whether a weekly injection of interferon -- which is known to boost the immune system -- helps to fight cancer and reduce patients' risks of developing future sarcomas. As a member of the National Cancer Institute-funded Children's Oncology Group, TCI participates in breakthrough clinical research with cancer facilities all over the United States. By enrolling in this clinical trial, Eleanor will generously and courageously help other children with osteosarcomas.
A Rigorous Treatment
By November 19, on the day she was admitted to TCI to begin chemotherapy, Eleanor's arm had swollen to about three times its normal size. The tumor was pressing against nerves and blood vessels. The chemotherapy treatments required Eleanor to spend several days in the hospital, then several at home, then back to the hospital time and again for more hospitalizations. Over the next 10 weeks, Eleanor underwent six intravenous chemotherapy treatments. Her arm was immobilized to prevent further damage to the affected bone. Mrs. Hahn stayed with Eleanor in her TCI room during every hospitalization for chemotherapy. Tutors, both at TCI and from Glen Rock High School, helped her keep up with her studies because she was unable to attend school.
Despite the loss of her light brown hair, terrible pain in her arm, and nausea that affected her appetite and resulted in the loss of 25 pounds, Eleanor soldiered on. By December 3, X-rays showed Dr. Wittig that the tumor was dead.
Surgery to remove the tumor was scheduled for February 8.
"By 5 a.m. that morning, Dr. Wittig was in Eleanor's room smiling and reassuring her," recalls Mrs. Hahn. "You can tell he experiences real joy in doing what he does and in saving the lives of his patients. Here's this brilliant, world-class orthopedic surgeon smiling like he just won a billion dollars, making sure that we were all ready for what was to happen next. I didn't fear the surgery for Eleanor because I knew she was in the best hands possible."
For the next eight hours, the Hahns waited with family, friends, their pastor and other members of their church, West Side Presbyterian of Ridgewood, while Dr. Wittig performed a radical limb-sparing procedure that saved Eleanor's arm and shoulder. He separated and removed the tumor from the nerves, blood vessels, and bone involved and then reconstructed Eleanor's upper arm and shoulder. He replaced the diseased upper part of her humerus bone with a metallic prosthesis and reconstructed flaps from nearby muscles to stabilize the shoulder and preserve the functioning of her hand and elbow. Without this surgery, Eleanor would have lost her left arm and the scapula bone in her left shoulder.
In her own unique way, Eleanor reassured her loved ones that all would be fine by writing the words to the song "Don't Worry, Be Happy" to be read while she was in surgery. When Dr. Wittig came into the waiting room at 3:30 p.m. to inform Eleanor's loved ones that the surgery "went perfectly," the entire room heaved a collective sigh of relief. Eleanor's best friend, Katie, spent the evening with her in the pediatric intensive care unit playing Eleanor's favorite music and watching while her long-time friend from preschool slept. Four days later, on Valentine's Day, Eleanor went home.
The Fight Continues
Over the next several months, Eleanor continued chemotherapy treatments. She was buoyed by the music therapy conducted by Susanna Scott-Moncrieff and learned to play several songs on the piano. Because Eleanor lost 25 pounds, a gastric tube had to be placed into her stomach so she could be fed liquid food and nutritional supplements.
"She never complained and experienced only about five minutes of pity during her entire ordeal," marvels her mother.
As winter passed into spring, Eleanor began to gain enough strength to enjoy some activities, such as seeing the movie "Juno" and keeping up with friends on FaceBook and her journal entries at www.CaringBridge.com. Thanks to the Marty Lyons Foundation, which fulfills the wishes of seriously ill children, and her social worker, Greg Hedler, who arranged the trip, Eleanor and her family were whisked away in a limousine to see "Wicked" on Broadway. Eleanor and her dad were able to attend a Yankees game during Fleet Week in New York City, where she watched second baseman Robinson Cano play, the day after meeting him at the hospital during inpatient treatment. Soldiers and sailors who were at the game parted the crowd so that Eleanor, in her wheelchair, could pass through the stadium easily.
Eleanor's extended family, friends, parishioners at West Side Presbyterian, community members, the local hair salon, and fellow Girl Scouts sustained the Hahns with gifts of cards, home-cooked meals, free scalp washings, prayer shawls, leaf-raking, house-cleaning, and gifts. Perhaps most touching was the fundraiser Eleanor's best friend, Katie, organized over the Internet to purchase a wig for Eleanor.
"Our family, friends, and faith kept us going; we had to keep believing that Eleanor would be fine," recalls Mrs. Hahn. "The first month was horrible because we didn't know what for sure was going to happen, but we felt reassured to know that Dr. Wittig, Dr. Harris, and the entire TCI team followed a structured protocol of treatment that saved her arm and her life. They took care of us in so many ways."
By the end of June, Eleanor had regained some weight and could enjoy eating solid food again. She was strong enough to enjoy a trip to The Shops at Riverside in Hackensack. She was cleared to attend West Side Presbyterian Church's yearly youth retreat at Henlopen State Park in Delaware, where she supervised a group of sixth-grade girls.
Looking Ahead to the Future
Finally, on July 8, Eleanor underwent her 18th - and final - chemotherapy. It was day for celebration at the Hahns. Eleanor's continued care includes the weekly interferon injections, physical therapy to regain the functioning of her arm, and regular follow-up visits with her doctors.
"The treatment we used for Eleanor killed the tumor and eradicated all signs of disease," says Dr. Wittig. "We were able to save her arm and shoulder and keep the cancer from spreading elsewhere in her body. I expect her to do well in the years ahead."
Eleanor says she is looking forward to experiencing a "normal" year as a high school junior, to celebrating her 16th birthday, and enjoying time with her family and friends.
"I'm working on finishing the requirements needed to earn my Girl Scouts Gold Award with a project that will benefit teens at TCI,"she says. "I plan to rejoin my senior high choir at church, explore colleges, learn to drive, and go back to babysitting. I won't be able to play soccer for another year, but I will be at the games cheering on my team."