Mahran Agil, 30, used to work in a perfume shop. In his spare time, he loved buying, breeding and selling pigeons.

Then the uprising against Colonel Muammar Gaddafi began and he was catapulted into a bloody civil war.

“Gaddafi was killing the people of my country. I had to fight for them,” he says, sitting in a wheelchair in a large light rehabilitation room at Charing Cross Hospital in west London.

Soon he was fighting alongside friends and strangers in the battle for Tripoli, armed with a double-barrelled hunting rifle.

On 20 August, the day the capital fell to rebel forces, he was shot three times in his legs. One bullet exploded in his lower right leg, shattering the bones.

“In the first five minutes I felt nothing. After that I fell down,” he says.

He was taken to to a field hospital where he was given nothing but a cast and some painkillers.

Then at a military hospital, steel work was fitted to his lower leg before he was moved to Tunisia and then to Britain, after the UK government agreed to provide up to 50 places at specialist hospitals for Libyans needing surgery, prosthetic limbs and rehabilitation.

The request came from the new Libyan government, which is also footing the bill.

But by the time he arrived in Britain, the surgeons thought it was too late to save his lower leg.

“He’d had a severe injury to the bones to the leg but he’d also lost a lot of soft tissues all the way down to and including his ankle joint,” says plastic surgeon Professor Jagdeep Nanchahal of Imperial College Healthcare Trust.

“It was also clear he had deep infection because you could smell the bacteria.”

An amputation was recommended.

“He was disappointed,” says Professor Nanchahal. “He had come to us expecting reconstruction and had gone though multiple surgeries in other countries with that view, so it took him a little while to get his head around that.”

‘V’ sign

On 20 October, the day Colonel Gaddafi was captured and killed, Mahran’s lower right leg was amputated.

An X-ray showing the broken bones in Mahran Agil's leg before amputation

All infected tissue was removed and the bones were amputated at a point where they could provide a good lever for a new prosthetic leg and allow ample room for the prosthesis.

Muscle and tissue was then wrapped over the stump to provide ample padding.

“Once he made the decision that he was going to have an amputation it’s all gone swimmingly well,” says Professor Nanchahal.

“In just over a week he was in a gym doing upper body work, he was on a prosthesis within a couple of weeks and now he’s about four weeks after the procedure and he’s actually walking pretty well.

“Mahran’s been extraordinary because as other Libyans have come to this centre he’s engaged with them and cheered them up.

“A lot of them are pretty unhappy. They’re in a foreign country, they don’t understand the language. These are fit young people who suddenly feel that their lives have been taken away from them.”

Mahran himself appears a little uncomfortable with the attention. But he is keen to stress he has no regrets.

“When I left home and I went to fight I was expecting even to die, so all options were there,” he says. “This is a fate and destiny I received from God, so I’ve accepted this.”

The interview over, he raises his hand to make a “V” sign, then asks to be filmed with the nursing and medical staff who are helping him through his recovery.

Moffitt Cancer Center surgeon Doug Letson has an enemy.

It’s the number 448.

That’s how many American children learn they have bone cancer each year, then face painful treatments, the risk of limb amputation and possible death.

It doesn’t matter that those children account for just 4 percent of the 11,210 annual pediatric cancer cases added each year or that they’re just a blip in the nearly 1.6 million new cancer cases that will be diagnosed in 2011.

Letson is drawn to them, especially the youngest patients, the ones the medical establishment usually says should have a cancerous arm or leg amputated instead of trying to save it.

Though endoprosthesis surgery — inserting a prosthetic under the skin — regularly is used to salvage the limbs of adult bone-cancer patients, the prevailing wisdom is that the risks are too great for a growing child.

“If you’re 16 we can save your leg, and if you’re 14 we’ve got to cut it off,” Letson said of the established standards. “It just doesn’t make any sense to me.”

Letson and Moffitt’s Sarcoma Program are openly challenging that position. In the past 18 years, they have implanted expandable chrome and titanium prosthetics into 50 young cancer patients.

It’s unpopular, difficult and expensive, but Letson said it leaves kids with little more than a scar to remember their cancer.

“We want to not only cure them of their cancer but make them more functional,” he said of the procedure, which he does in cooperation with All Children’s Hospital or Shriner’s Hospital for Children — Tampa. “We’re forgetting about the most important population we have: these children. Why can’t we do this in these children?”

The team’s first mission is helping a child survive. But like medical professionals in other rare, high-risk and high-cost fields, they push financial and scientific boundaries to offer children a normal life.

* * * * *

Children such as Katie Karp, who competed in a school track meet the day before a searing pain started shooting through her leg. The 12-year-old Windermere girl thought it was a sprain.

Instead, an MRI found a tumor on her thigh bone. Within days, Katie was undergoing chemotherapy and was scheduled to have her thigh bone replaced with an experimental limb created in the United Kingdom.

That was 10 months ago. Letson implanted the prosthesis, an expandable bone designed to grow with a powerful magnet that pulls and twists the limb, eliminating the need for repeated surgeries.

Now 13, Katie is matter-of-fact about the monthly sessions that lengthen her leg about 1 centimeter at a time.

Katie Karp, 13, had her left knee and thigh bone replaced with a prosthesis that can be adjusted as she grows. Photo: Kate Caldwell

“So this is really cool because it’s painless,” she said. “You might be a little sore afterward because it’s like growing pains, but I never have them.”

Katie and her mother know that without the experimental surgery, activities such as horseback riding would be impossible. They’re also grateful they found the alternative treatment; they have watched two friends lose limbs to osteosarcoma in the past few months.

“Every child deserves to have as many options as possible,” Leslie Karp said.

The U.S. Food and Drug Administration this summer approved the femur salvage procedure, which Letson said can cost $20,000 to $30,000 per child. It took 15 years, but the approval is a significant step in persuading the medical community to change its standards, he said.

* * * * *

The operating room sometimes is the first place Letson meets a patient. But relationships grow, as do the children he treats. He has danced at weddings and attended graduations of patients who were as young as 4 when he operated on them.

He has also said goodbye. The five-year survival rate of children with osteosarcoma and a similar condition called Ewing’s sarcoma is 65 percent to 70 percent, the American Cancer Society reports. Children with amputated limbs or an endoprosthesis face almost identical odds of survival.

But health care decisions regularly rely on hard numbers, not heartwarming stories, and a prosthesis is expensive.

Insurance company officials, whom Letson said traditionally look for front-end savings, can be reluctant to endorse an expensive prosthetic that doesn’t have a lifetime warranty.

“They’re like tires on your car,” Letson said of the devices. “Kids wear them out. They break them, just like anything else.”

So he has fought the critics with data. He and other advocates published studies calculating the long-term costs of expandable limbs.

They projected a patient’s need for replacements and care up to age 60, and found amputation ends up costing insurance companies more.

* * * * *

Nine months ago, Josalyn Kaldenberg went from being the best rope climber in Woodward, Iowa, to pediatric cancer patient. Osteosarcoma had invaded her right upper arm, and doctors believed amputation was the 8-year-old’s best chance for survival.

Her mother, Heidi Kaldenberg, scoured the Internet for alternatives. Upper-arm prosthetics had been created for children in the United Kingdom, but not for those in the United States. Then she found Letson’s name and saw that he had done similar experimental procedures. She shared what she learned with her daughter’s oncologist.

Five days before the scheduled amputation, Letson said he would be able to do the surgery. Josalyn traveled 1,400 miles to undergo the surgery at Tampa’s Shriner’s Hospital. It was the first time an American surgeon replaced a child’s entire upper-arm bone with the expandable prosthesis.

Josalyn is back in Iowa, using her right arm to decorate coloring books with her brothers and sisters. Her final chemotherapy treatment is scheduled for next week.Her mother said instinct led her to look for alternatives to amputation, but it took medical professionals willing to wade through bureaucratic logistics to make the pioneering procedure a reality.

“It’s the difference of life and death for Josalyn,” Kaldenberg said. “In her case … she might not have an arm right now had they not gone and fought through the red tape.”

* * * * *

The financial and scientific battles pediatric bone cancer advocates face is one tiny conflict in the nation’s gargantuan health care system. But it’s an example of the challenges doctors and patients will encounter in a future demanding dramatic cuts and changes to medical care.

Letson worries about a business and economic environment caught up in making sure medical care returns the “biggest bang for the buck.” When you’re talking with a patient, the only return on investment that matters is a person’s life, he said.

“We have to figure out ways to reduce this surging medical cost, but where?” he asked. “It shouldn’t be on the patient care side. We have to find new and better ways to reduce costs.”

Pediatric patients are not the ones most at risk in the political battles, Letson said. He also can see the establishment questioning the financial value of endoprosthetics in older patients. Treatment decisions should be made using evidence, not speculation, he said.

Once a week at Moffitt, Letson conducts rounds with medical students pursuing surgery. They review a group of cases, and he challenges the students to think smarter than those who performed the procedure.

Letson says he has a similar internal inquiry each time he sees one of the children he has operated on in the past 18 years. How much is he limping? How big is her scar?

He’s never satisfied with the answers. And he hopes he’s not the only one who feels that way.

“We’ve got a long ways to go,” he said. “We can do a lot better.”

Sgt. Shaun Tichenor, 32, a graduate of Staples-Motley High School, is currently rehabilitating at Walter Reed Hospital in Washington, D.C., after stepping on an improvised explosive device last spring in Afghanistan and undergoing a leg amputation in June.

Sgt. Shaun Tichenor, a Staples-Motley High School graduate who lost a limb as the result of the explosion of an improvised explosive device in Afghanistan, is currently rehabilitating at Walter Reed Hospital in Washington.

It was the early morning of April 23, at the conclusion of an overnight patrol near Kandahar, when the U.S. Army soldier stepped on an IED, triggering an explosion that shattered his right heel and damaged his ankle. That explosion set into motion a series of medical transfers and procedures. He was helicoptered to Kandahar Air Field Hospital where surgery was done on his leg.  He then went to Bagram Air Base and later Landstuhl in West Germany before being transferred to Fort Bragg in North Carolina

At Fort Bragg Tichenor faced a choice. He could have keep his leg and have limited mobility or approve an amputation and with the help of a prosthesis, have a more active life. He and his wife, Mixas Rivera Tichenor, decided in favor of the amputation and on June 3 his foot was amputated about six inches below the knee.

The couple are the parents of three children, Janae, Shaun Jr., and Alejandro.

Tichenor is undergoing physical and occupational therapy after receiving a new prosthesis on July 6.

“I just got my prothesis about a week and half ago and I’m already walking pretty good with it,” he said. “My physical therapist said I’ll be walking pretty good in about a month, without a crutch, and I’ll be running in four or five months.”

From the outset, he told his therapists he was serious about the rehabilitation.

“I don’t want to slack,” he said. “I want to be pushed. I’m not here to waste time. I’m here to get better and get back to my (infantry) unit.”

Whether Tichenor is able achieve his No. 1 goal — to return to his unit — will depend on what turns out to be the “end state” of his rehabilitation. Should his physical condition prevent him from rejoining his unit, Tichenor would like to continue in the Army as an instructor in basic training or as a liaison to Wounded Warriors.

“My main goal is to stay in the infantry,” he said, “get back in the fight.”

He credited his positive attitude to his work ethic and to his family.

“I’ve got three kids that look up to me,” he said.

Virginia Tichenor Staley of Pine River, Tichenor’s mother, who is also an Army veteran, said her son is third generation Army person. His grandfather, RIchard L. Tichenor, also served in the U.S. Army. She said in an email the Wounded Warrior program was helpful when she traveled to the East Coast to visit her son and the Family Assistance Group with the Beyond the Yellow Ribbon Organization in the Brainerd area has also offered assistance to her.

Tichenor said his family lived in the Brainerd area during his school years.

While recuperating at Walter Reed, Tichenor said he had the opportunity to meet former talk show host Montel Williams, Jon Stewart of the “Daily Show” and President Barack Obama.

“I shook his hand and talked about football for about five minutes,” he recalled of his meeting witht he president.

His injury, he said, gave him a deeper understanding of the determination of wounded service members and the importance of family.

“It really opened my eyes,” he said of the soldiers. “They have the same attitude I do. I don’t see very many with a bad attitude.

Also, he credited his wife and family for being the backbone to his recovery efforts.

“If I didn’t have my wife and kids, I don’t think it would be going as good,” he said. “My wife kicked me in the butt sometimes.”

Hunter Bork did not just win the high jump title at the Paralympic Games on June 16-19 in Miramar, Fla., he also set an American record in the event.

On Monday morning in a text from Dakota Wesleyan track and field coach Pat Belling, Bork found out his winning mark of 4-feet, 10.25-inches was also the new American record.

“Honestly, I got the text (Monday) morning and I was like ‘huh, that’s pretty sweet,’ ” said Bork in an interview with The Daily Republic. “I didn’t expect it.”

Bork, who finished his sophomore year at DWU, was 18 when he had his left leg amputated after he was diagnosed with osteosarcoma — a cancerous bone tumor.

Bork is still able to compete in track and field, though, as he uses a special running prosthesis. He competes for the DWU track and field team.

At the Paralympics — which is open to all male and female athletes with amputation or limb losses, athletes with physical disabilities such as dwarfism, blindness, spinal cord injuries, wheelchair use and cerebral palsy — Bork not only won the high jump competition, but he finished third in the long jump and seventh in the 100-meter dash.

Bork said he had no idea that he broke the record in the high jump, or even what the record was before the event started.

“Honestly, I didn’t think about it,” he said. “The only thing I went down to Florida for was to compete and do my best. I wasn’t looking at any record.”

The Paralympics ended Bork’s training for the summer. Even though he won an event at the Paralympics, he was told he was not accepted to the Para Pan American Games, which are held every four years. The Para Pan American Games will be held in Guadalajara, Mexico, from Nov. 14-20.

“I was not accepted to that,” Bork said. “The person said, hopefully, in the next couple of years if I get more involved and stuff, I could be.”

With his competitions over for the summer, Bork is spending time with his friends before he starts training again when DWU starts its fall semester.

“I haven’t had a lot of time to hang out with my friends since I was training and traveling,” he said. “School is already around the corner … I am assuming when school starts, I will start training again.”

The 26-year-old, a Serbian living in Austria known only as Milo, was severely injured in the collision in which he also hurt his leg and shoulder.

He was in his home country on holiday in 2001 when he smashed into a lamppost and although his leg fully recovered, his forearm and hand did not.

Ten years later he has gone under the surgeons knife and he will have a bionic hand fitted to his stump in several weeks time.

Prosthetic: Milo is measured up using his bionic hand prior to the operation

The new hand will be controlled by nerve signals in his arm and the amputation, performed by Viennese surgeon Professor Oskar Aszmann, is only the second voluntary one to have taken place.

‘The operation will change my life,’ he told BBC News.

‘I live 10 years with this hand and it cannot be (made) better. The only way is to cut this down and I get a new arm.’

The hand can ‘pinch and grasp’ in response to signals sent by the brain that would have powered movement in his real hand and it was manufactured by German prosthetics company Otto Bock.

Prof Aszmann said: ‘Milo is now 26 years old and he wants to go on with his life. To biologically reconstruct a hand for him would be a never-ending story and in the end he would still have a non-functional hand.

‘It is in the patient’s interest to provide him with a solution he can live with properly and successfully and so I have no problem with cutting off his hand.’

After his accident his leg healed but his right shoulder suffered from what is known as a ‘brachial plexus’ leaving his right arm paralysed.

Prof Aszmann took nerve tissue from his leg and managed to restore arm movement, but his hand remained unusable.

More muscle and nerve tissue was put into his forearm but while this failed to work it did boost brain signals to his forearm making it possible for him to use a bionic arm.

Milo decided to have the prosthetic arm fitted after using a similar to his dysfunctional hand so that he could see what it was like to have a bionic arm.

He found it so helpful that he opted for the rare procedure.

It was only last year that an Austrian called Patrick became the first patient in the world to decide to have his hand amputated.

The 24-year-old lost the use of his left hand after he was electrocuted three years before. He said he was delighted to experience movement in his new limb moments after it was fitted.

Patrick can now open a bottle quickly and tie his own shoelace with his current prosthesis, which has two sensors fitted over nerves within the lower arm.

However, he is now testing a new hand from Otto Bock that has six sensors giving improved motor function.

Read more: http://www.dailymail.co.uk/health/article-1388581/Man-CHOOSES-hand-cut-saying-bionic-one.html#ixzz1MmlSeND1

One week away from losing his leg to cancer, 6-year-old Tom became the youngest patient to have pioneering bone replacement surgery. In total, he has undergone 48 operations – and defied doctors’ predictions that he would never be a dad.

Tom McKenzie is every inch the successful man. A happily married 30-year-old from Linton, he runs a thriving recruitment business and has two beautiful children. But getting to this point has been a battle.

When he was just 6 years old, Tom had surgery to save his leg from amputation; since then he’s had a total of 48 operations, meaning much of his life has been spent in hospital.

“Even now my dad says to me ‘if we’d have known that you were going to have to have so many, I’m not sure we’d have still gone through with the original operation’,” says Tom. “But you can’t live your life on ifs, buts, maybes. You just live with what you’ve got, and adapt.”

The story begins when Tom was 5. Skidding around on icy leaves with his friends one day, he fell badly, breaking his left leg. After six weeks in traction it seemed to heal, but six months later Tom’s mum Patricia spotted a bruise above his knee, and then noticed he was dragging his leg when he walked.

He was sent for a scan at Addenbrooke’s, where doctors broke the worst possible news: Tom had Ewing’s sarcoma, a form of bone cancer, and a tumour was growing in his leg.

“I had to have chemotherapy, but to be honest there’s only parts I can remember; I think your consciousness blocks a lot of your memory out,” says Tom. “But it’s strange, I still can’t have Robinson’s orange squash; they’d break the anti-sickness tablets up and put them in it, and even now the smell and taste of it reminds me, and makes me feel ill.”

After 18 months of intensive chemo, the tumour seemed to have disappeared, but Tom’s parents were told that the only way of being sure was to amputate his leg: “and obviously they were devastated”, says Tom.

By chance, Patricia came across a newspaper article about someone in a similar situation: they’d been saved from amputation by having an artificial bone inserted.

It seemed to be the answer to their prayers, and they contacted the Royal Orthopaedic Hospital in Birmingham, where the operation had been done.

“I was just under a week away from having my amputation when we were booked in. They hadn’t done a bone replacement on anyone so young before; the person they’d done it on before was in their 20s,” says Tom. “I was only 6.”

During an all-day operation, Tom’s femur was removed, and replaced with an aluminium prosthesis. It was a complete success.

“The first thing I remember was getting out of the bed, and it was like I’d stepped on the moon; my legs were just stuck to the ground because the bone felt so heavy,” he says. “I couldn’t, just couldn’t walk. I had to learn again, like being taught from a baby.”

It was, he says, a frightening experience: “Even now I sometimes have memories in nightmares of what happened during that time.

“But fortunately it was a great hospital; there was a real family-type atmosphere, and that really helps the healing process.”

Tom undergoing chemotherapy and learning to walk again following his first operation

As he grew, Tom had to have many more operations; every six months ball bearings would be inserted into the prosthesis to lengthen it. But problems like infections and dislocations all meant additional surgery, and each time he had to learn to walk from scratch.

“Inevitably I was bullied at school, mainly because I didn’t have any hair when I was having chemotherapy, and then because I couldn’t walk properly. You do get called names, but I didn’t really feel anything, to be honest,” he grins. “Everybody gets called names.”

Did he ever feel sorry for himself? “I suppose I did, but there’s always someone else worse off – you’d turn round and see someone who had had their leg amputated.”

Growing up in hospital became a part of life for Tom. He had lessons at his bedside, and made close friends with fellow patients who were going through the same thing. And Tom admits that, in his younger days, he assumed he’d eventually die there: “A couple of my really close friends died, so I thought well, the end of this is that I’m not going to come out.”

And when Tom was 14, that almost happened. “I’d just had an operation, and when I came home I said I wanted to do my SATs,” he recalls. “l got to the school hall and had my leg up on a chair, and it felt like I kept getting cramp, but 100 times worse than cramp, with pains shooting up and down my leg.”

Tom couldn’t finish the exam and went home in agony. “I was in the bath for hours, because it was the only thing that would calm it down. The local doctors said that it was just because of the operation, but I knew something wasn’t right.”

It wasn’t. Tom had deep vein thrombosis, and it was spreading fast. Eventually he was rushed to hospital “and they said it could’ve been fatal if we’d left it another 24 hours. So I had to have another operation for that”.

The surgery continued, with Tom eventually having a hip replacement. Each time he’d bravely grin and bear it, but one day it all became too much.

“I must’ve been about 16 or 17. I had an operation, and I was about to go home, but the wound wasn’t healing.”

An X-ray showing the prosthesis in Tom's leg

When pus started oozing from his leg, Tom realised it had become infected: “They put me on strong antibiotics, and then they had to take the bone out, clean it, and put it back in again, wrapped in antibiotics to dissolve within the leg to try and kill off anything that was in there.

“That was the worst time that I’ve ever had. I’d gone through all of these operations, and then all of a sudden the leg could’ve gone anyway because of the infection. The doctor came in and said ‘Look Tom, I’m not sure how long we can carry on doing this’.”

Tom had to spend three dark months in hospital: “I just wanted it over, either way. I was being sick every day because of the antibiotics, I was dizzy all the time, and I was missing out on so much – back home all my friends were learning to drive.

“I remember saying to my dad: ‘I just don’t want it any more’. There was no light at the end of the tunnel; all I could see was either amputation or me never getting out.”

But although amputation may have seemed like a good option, Tom could never have had a false leg: “They would have to have amputated to the top of the hip, so there was nothing to attach it to,” he explains. “I’d have had just one leg and been on crutches or in a wheelchair the whole time.”

Fortunately Tom made a full recovery, but not long after he faced another setback when blood tests revealed that, because of the damage done by the chemotherapy, he only had a 10 per cent chance of having children.

“I was devastated, absolutely devastated,” he says.

He needn’t have worried: his girlfriend Becky – now his wife – fell pregnant soon after they’d started seeing each other. “It was totally by accident, but it’s the best thing that ever happened,” grins Tom, who’s dad to Rosie, 8, and Charlie, 5.

It’s now been five years since Tom had an operation, but his problems are ongoing. Seven years ago surgeons tried to insert a bigger prosthesis but failed to get through the scar tissue. “They said it was like cement,” he says.

Because of this, Tom’s left leg is six centimetres shorter than his right, meaning that he suffers from chronic back pain and has to take strong painkillers every day.

Tom has defied the odds and now runs a thriving recruitment business and had two children

But for Tom the worse part isn’t the pain, it’s the fact that he can’t do certain things with Charlie, like playing football: “I can only watch him kick a ball about in the garden, and that’s really hard. He loves football – he must’ve broken about four vases in the house! But I’m always really proud watching him play.”

Today, Tom – who’s terrified of heights – is doing a tandem skydive to raise money for a new playroom at the hospital where he spent so much of his childhood.

“I just wanted to give something back,” he says. “I wouldn’t have got through it if it hadn’t been for Birmingham; it was a home from home. And even now I go back twice a year for check-ups and intensive physiotherapy to strengthen the leg.”

And Tom says he can’t thank the hospital enough for what they’ve done for him. “I feel like I’m the positive side of it all,” he explains. “I do face problems daily: I can’t stand up for long, I can’t help Becky much in the house, and I have to grit my teeth when I walk to work. But I’ve got my own business, I’m married, I’ve got two kids – this is what can happen if you can battle through it.

“I never really sat there and said why me?” he adds. “I’m not going to live for yesterday and what could have happened, I look to tomorrow and what can happen.”

Tom is hoping to raise £2,500 for a new playroom at the Royal Birmingham Orthopaedic hospital. Do donate, visit www.justgiving.com/tmckenzie.

John Tartaglio on his way to completing the New York Marathon

On Sunday, November 1st, after starting at 6 AM (just before the sun rose over the Verazanno Bridge), twenty-two-year-old John Tartaglio became the first complete double leg amputee to finish a marathon. John completed the 26.2 miles in 15 hours and 59 minutes, running on a custom designed carbon fiber running prosthesis built by A Step Ahead Prosthetics. John started hours before the elite runners and thousands of others and finished at Tavern on the Green in Central Park just before 10 pm while the other 42,000 runners had finished and were home resting their sore muscles. John was supported during the long day through the streets of New York by his parents, his coach Dave Balsley, P.T. and Amy Palmiero-Winters, director of Team A Step Ahead.

http://site.mawebcenters.com/astepaheadllc/newsletter_november_2009.html

(Thanks to Steve McNeice for sending us this article)

My husband Simon has got used to me forgetting our wedding anniversary, so it was fabulous when, last year, my mother offered to have the children for a few days so we could celebrate. We booked into my favourite spa hotel in Hampshire.

It was just what we needed – for me, a break from live 24-hour news presenting and, for Simon, from the intensity of running his architecture practice. A few weeks later, I found out I was pregnant.

I was 44 and already had three beautiful children – Sophie was 11, Joseph nine, and flame-haired Tom just six. News of a fourth came as a complete shock.

In fact, after the positive pregnancy test, I could hardly speak and had to ask Sophie to break the news to her dad. She called him at work. ‘Daddy, are you sitting down? Mummy’s pregnant again.’

The first scan at 12 weeks went smoothly and we were overjoyed. Relatives congratulated us and my girlfriends spluttered the foam off their cappuccinos in disbelief.

The weeks went by and we became more used to the idea of a new baby. But the atmosphere at our 20-week scan was different. There was a problem, the sonographer said.

Our baby had club foot, or talipes, where the feet grow in the wrong direction. One foot was definitely affected – the other was folded and tucked underneath his bottom so we didn’t know about that one for sure. I sobbed all the way home.

We blamed ourselves for having a baby in our 40s, although we know now that age is not a determining factor. Talipes is just one of the many conditions babies can be born with, like blindness or deafness. In fact, club foot is the most common birth defect – affecting one in 10,000 newborn babies. Intellectually, you take that in but deep inside you feel you must be to blame.

My colleagues at Sky News were ultra-supportive. In fact, one of the executive producers had already had a baby with club foot and we met him and his wife with their son one sunny morning in Hyde Park. We watched their boy skip from slide to swing and felt very relieved seeing his ease of movement.

Another friend had two children born with the condition and when we saw their little feet carry them happily down the street we began to relax. We learned that Byron, Dudley Moore and Steven Gerrard had been born with club foot. We started to feel less anxious.

Then, by chance, I saw a television documentary that featured the work of an amazing orthopaedic surgeon, Dr Steve Mannion, who works in Malawi, in one of the poorest parts of Africa, treating babies born with club foot.

There, the social consequences of leaving it untreated can be horrific as, without the ability to earn, some children are abandoned by their parents.

Known as the ‘Crocodile Dundee’ of orthopaedic surgery, Dr Mannion had learned of a little-known treatment pioneered in the US more than 30 years ago known as the Ponseti Method.

In the traditional surgical treatment of club foot, tight tendons and ligaments in the foot are cut and ‘released’ on the operating table and bones are pinned into place.

But Dr Ignacio Ponseti argued that this painful surgery yielded poor results and could lead to arthritis in later life. So he developed a radical new treatment, where babies’ feet are straightened by manipulation, a series of plaster casts and, later, special boots and bars to keep bones growing in the right direction.

In fact, the Ponseti Method, forced on Dr Mannion by the shortage of money and doctors in Malawi, had produced amazing results. It gave us great hope to learn that it was now being adopted as a new standard treatment for talipes babies in the UK. (Sadly, Dr Ponseti himself died recently.)

Steps, the UK talipes charity, estimates 80 per cent of children like James are now treated with this method.

The months rolled by, and at work the camera crew had to be ever more inventive with angles so that viewers would not miss the headlines while marvelling at my gigantic bump. James Edward Paul Middlehurst was born two days before Christmas last year. He is a beautiful, smiling little boy, with the most amazing dark eyes.

We were just about prepared for a year of club-foot treatment when we were dealt another devastating blow. As well as the club foot in his right leg, James’s left leg, which had been tucked up underneath his bottom, hadn’t grown properly, and never would.

He had a short thighbone (a condition called proximal femoral focal deficiency, or PFFD), no kneecap and was missing one of the two bones of the lower leg (known as fibular hemimelia). The remaining bone was bowed and too short and his foot was sticking out at right angles to his lower leg. This was a one-in-100,000 deformity and it was a totally useless limb. As a result, as James grows, this leg will not grow with him.

I fell into the arms of a nurse as I left the consulting room. I was desolate and felt myself crumple in front of her.

‘This is life,’ she said, with kindness and understanding. Those three words have stayed with me. In one instant she seemed to say: ‘It is not your fault, face up to this and accept it. And you are not the only one.’

I have seen her since and thanked her for that moment of support. She was right there when I needed her and yet she was just doing her job.

As the hours at the hospital passed, we realised our little man might not even be able to walk. It was even more critical that his ‘good’ leg – the right one with the club foot – was treated expertly. This would be his primary leg – the left one would have to be reconstructed, including the removal of his foot, in order for him to wear a prosthesis.

We were distraught. I remember seeing my husband with his forehead against the hospital consulting room wall trying to take it all in. Nothing prepares you for hearing doctors talk about amputating your six-day-old baby’s foot.

We had to take James for an X-ray. Our tears fell down on his bright red tummy as we held him on the X-ray table. An entry in my diary for that day simply reads: ‘The worst day of my life.’

It was Christmas and the kitchen was filled with presents and congratulations cards. A beautiful bouquet of flowers arrived from everyone at Sky News and calls were coming from work as colleagues read their internal mailshots announcing the arrival.

My parents were full of love for James. Mum told me: ‘I knew this one would be special.’ Dad held him closer than he had held any of the others when they were babies.

My close friend Jacquie Beltrao, sports presenter at Sky News, brought round a huge home-made chocolate cake and chilled champagne, which we shared as we talked.

Another close friend, a neighbour who has watched all my children grow, held me in her arms one evening when I wasn’t so strong and told me what an amazing child James would be in a family such as ours.

We all headed north for New Year. In fact, I think we’d have fallen apart if it hadn’t been for my husband’s two brothers and their wives. They talked to us, fed us (we would not have eaten otherwise) and listened to us. They gradually put us back together again.

The worst of it was (and it feels so odd to remember this now) we weren’t thrilled to bits with James. It was as if the joy of a newborn baby had been snatched from us. But they showed us how to be delighted with our little son. As we left, I tried to thank Simon’s older brother. He just smiled at me saying: ‘That’s what families are for.’ I’ll never forget it.

Back in London, scans showed James’s hips were forming well. We began to dare to hope that he would be able to walk. At Chelsea and Westminster Hospital, orthopaedic surgeon Alison Hulme began treating James’s club foot.

She came across as a disarming mix of an incredibly skilled professional and a favourite auntie. She took us through James’s treatment plan over the coming years with medical straightforwardness, saying his club foot leg would be treated using the Ponseti Method and the other leg would be ‘managed prosthetically’.

She did not shy away from telling us exactly what to expect, while also sweeping James up in her arms and cooing adoringly at him.

Denise Watson, James’s physiotherapist and Ponseti practitioner, was just as dotty about him.

‘He’s so gorgeous. Come to Auntie Denise,’ she would say, before whisking him off for a new plaster cast. She and her expert team began ‘training’ his club foot-affected leg to grow in the right direction. His first cast was fitted when he was less than a month old and was changed once a week until he was six months old.

Bath times were a challenge as we weren’t meant to get the plaster casts wet and James loves kicking and splashing in the water. But we found a way of waterproofing the casts and got on with it.

Crawling has also been surprisingly good. Denise predicted that with one short leg he might only crawl in circles (I think she was joking) but I’m proud to report James crawls, at speed, wherever he wants to.

He’s now 11 months old and his club-foot leg is a Ponseti success story. The plaster casts are history and he just wears a splint during the day to keep the bones growing in the right direction.

One night recently at bath time, he took all his weight on his newly treated leg, looked up at me and smiled triumphantly. As he beamed from ear to ear, I knew this determined little baby was also determined to walk.

Our next hurdle is the reconstruction of his left leg and the amputation of his left foot. That’s scheduled for this Tuesday and we know it will be tough.

As we prepare for it, his leg is being slowly stretched with physio to make a straighter limb. The operation will create a ‘stump’ (or ‘lever’ as they like to call it) at his ankle and his prosthetic leg will be fitted next month.

Just like his casts, those will be changed as he grows. We know that as soon as he gets his new false leg, his Ponseti-treated leg will be the most important part of taking those magical first few steps. The doctors are not sure how often the prosthetic will need to be changed, but perhaps every six months or so.

It’s been quite a journey and I’ve been back at work since June. Colleagues at Sky News have been wonderful. And we have learned masses from our children.

Joseph stood up in class and told his friends that his little brother would soon have a ‘cool bionic leg’ and announced that if there was a fancy-dress party, James would definitely win as a pirate, the only contestant genuinely wearing a false leg.

Tom thinks that if James’s leg means he can’t be a striker at football, he can be a goalie. And Sophie said to me: ‘Mummy, James’s disability makes me love him more because I think he needs us more.’

Little James Middlehurst may have had an uncertain start to his life but with expert NHS treatment – not to mention the devotion of his siblings and love from us – we know he’ll go a long way. We now know he will walk and run and live a full life.

We also know he won’t be playing for Manchester United. But there’s nothing stopping him from being an architect like his daddy or a newsreader like his mummy.

James with Paula and the Middlehurst family

Interview by Vincent Graff

• Dr Steve Mannion’s charity, at www.feetfirstworldwide.com

Being a stork is hard work. Not only do you have to collect enough frogs and other delicacies to keep you going during the day, but you also have to fly to Africa and back once a year — and deliver babies to new parents the world over. What’s a bird to do if it gets injured?

Dietmar, a stork in the German state of Saxony, was confronted recently with exactly this problem. In August, Dietmar arrived in a bird reserve located between Dresden and Leipzig suffering from a broken leg. The sanctuary staff did everything they could to help Dietmar, but in the end the limb had to be amputated. However it has now been replaced with a carbon prosthesis.

Regular Physical Therapy

Andrea Kirsten, who works at the preserve, speculated in the tabloid Bild that Dietmar may have flown into a high tension wire. The artificial leg, which was funded by donations, cost over €1,000 ($1,500) and is protected from mud and dirt with a baby sock.

While Dietmar’s wings have been clipped so that he can’t leave the sanctuary — he likely couldn’t survive in the wild — the stork receives regular physical therapy. His meals, which consist of thawed-out frozen baby chickens, are delivered directly to his beak.

Dietmar will now have to spend the rest of his life in his new home. But Kirsten is doing her best to make his life tolerable. According to Bild, she plans to build him a nest in the hopes of attracting a mate next spring.

It’s Raining Amputees

_uacct = “UA-1237182-6″;urchinTracker();

Motala, the 48 year old elephant, joyfully throws dirt after being fitted with her prosthetic leg

We knew the day of Robo Dumbo would come, we just didn’t know it would come so soon. Actually, we couldn’t be happier for Motala. After losing her foot to a landmine a decade ago while working in a Thai logging camp, the 48-year-old elephant has been fitted with a special prosthesis. Reports this week say she took a stroll, tossed some dust with her trunk, and is doing great.

The Associated Press quotes Soraida Salwala, secretary general of the Friends of the Asian Elephant, saying: “It has gone very well—she has walked around twice. She has not put her whole weight on it yet but she’s OK.”

Motala being fitted with her prosthetic leg

After a number of years without a front left foot, Motala was given a temporary prosthetic meant to strengthen and prepare her for the permanent device she received last week. The injury happened while working in a Thai logging camp near the Burmese (Myanmar) border. She stepped on one of the many landmines that remain from violent conflicts in the area. The initial amputation, which took place shortly thereafter, required such large quantities of anesthetic drugs that is was recorded in the 2000 Guinness Book of World Records. A good photo chronology of Motola can be found here.

André Picard

(From Monday’s Globe and Mail Last updated on Monday, Aug. 10, 2009 03:09AM EDT)

Imagine for a moment that you have a cancerous tumour eating away at the bone and muscle in your leg. You can choose to amputate the leg or undergo surgery that removes the cancer and leaves the limb intact.

It seems like a no-brainer.

But surprising new Canadian research, published in the medical journal Cancer, says that amputees often have better outcomes.

Patients with a group of cancers known as bone and soft tissue sarcomas who opt to have a limb removed report better movement, less emotional trauma, better sexual functioning and fewer side effects than those who undergo limb-sparing surgery.

“Amputation is often seen as the failure option by surgeons,” said Ronald Barr, a professor in the departments of pediatrics, pathology and medicine at McMaster University in Hamilton, and co-author of the study.

“But patients don’t always see outcomes the same way as providers,” he said. “What matters to them is quality of life.”

Dr. Barr said the research – which is a compilation and analysis of a number of small studies – is not an indictment of the work of surgical oncologists but rather a reminder that “they don’t need to undertake these operations just because they can – the needs of the patient have to come first.”

Soft tissue sarcomas are cancers that develop from cells in the soft, supporting tissues of the body. Almost half occur in limbs – especially the legs.

Amputation is pretty straightforward solution: The part of the limb where there is cancerous tumour is removed.

Limb-sparing surgery is more complex: It involves cutting away the bone affected by the tumour and replacing it with another, either taken from a cadaver or from the patient themselves.

The study found that patients undergoing limb-saving surgery suffer far more postoperative infections, they take longer to recover and rehabilitate and often have more limitations in their movements than amputees.

Adela Janczak, a 24-year-old from Binbrook, Ont., knows these issues all too well.

Adela Janczak who had endured about 22 operations since Ewings Sarcoma, a rare cancer of the bone, was discovered when she was 6.

At 6, she was diagnosed with Ewing’s sarcoma, a rare form of cancer, in her right leg. Surgeons removed her right femur and replaced it with a bone from a donor, but her body rejected it.

A second limb-saving surgery was performed. Surgeons removed the fibula from her healthy left leg and used it to construct a femur for her right leg, a complex 16-hour operation.

Ms. Janczak spent months in a body cast and several more months with her right leg encased in a metal contraption that stretched the bone to lengthen it. She also suffered a number of severe postoperative infections, often requiring surgery.

There were 22 surgeries in all but she has been in remission from cancer since 1991.

She said that amputation was definitely considered as an option but “personally, I didn’t want to do the prosthesis thing.”

“I’m covered in scars and pinholes but it’s my leg and it’s beautiful.”

Ms. Janczak said she recognizes that limb-sparing surgery is not perfect. Her right leg is shorter than her left and she cannot bend her leg at the knee, which means she has mobility limitations. “With a fake leg, I might be able to run or play hockey.”

But the key is that the pros and cons of amputation and limb-sparing surgery were always explained to her and “all the decisions were up to me,” Ms. Janczak said.

Dr. Barr said that is the essential message he hopes practitioners will take from the research, that patients have a right to make choices that are right for them.

Dr. Jay Wunder, a surgical oncologist at Mount Sinai Hospital in Toronto and co-author of the paper, said there is also more research to be done in the area to understand how these complex decisions are made.

“Future studies that include function, health-related quality of life, economics, and stratification of patients by age will be useful contributions to decision-making … by patients, health care providers and administrators,” Dr. Wunder said.