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HEALTH CARE TEAM AT CHILTON MEMORIAL DONATES SERVICES TO CHILD FROM DOMINICAN REPUBLICReleased: 06/27/2003
It’s 7:30 a.m. on a relatively quiet Saturday in Pompton Plains, an upscale suburb in northern New Jersey. Most of the residents are sleeping in.
Healing the Children Coordinator Rena Tolsma matches up resources with children in need. The organization’s staff members tapped hand and wrist specialist Dr. Ambrose for several previous cases, and were grateful he was receptive to donating his surgical skills once more. Dr. Ambrose will remove the tumor from the boy’s wrist. He invited pediatric orthopedic surgeon Ron Snyder to perform the knee surgery, so Enyer, age four, could have both operations done simultaneously. Chilton Memorial Hospital’s administration donated the operating room. Already the room is abuzz with the skillful work of anesthesiologist Kwon Kim, MD, who is contributing his professional services, as well, and with the work of a registered operating room nurse and two surgical technicians. The staff are positioning Enyer on the table and preparing instruments and equipment for the operation.
Enyer suffers from multiple osteochondromas, a hereditary condition that causes enlarging tumors that look like bone spurs to form along his joints. Before the operation, Enyer was able to walk, and could use his arms, but had trouble kneeling because of the tumor that juts out from his knee. Without today’s surgery, the bone tumors on Enyer’s wrist and knee would grow as he grows, while his bones would grow abnormally, and be shorter than normal, twisted and deformed. Already, Enyer’s left arm is 28 percent shorter than his right art because a tumor on his left wrist damaged bone growth. Eventually, he might be unable to run, and have difficulty walking and using his hands. “We are doing this so Enyer can retain mobility of his limbs and to reduce his pain, but there are cosmetic considerations, too,” Dr. Snyder explained. “Enyer isn’t quite school age, but soon will be. Growths this size would be easily noticed,” he said, alluding to the questions and teasing he believes Enyer might be subjected to otherwise. “Within just a few days of surgery, Enyer should be one active four-year-old again – minus these tumors.” The doctors confer and decide surgery on Enyer’s knee will be done first. Dr. Snyder carefully makes an incision along the upper end of Enyer’s leg to expose the growth on the boy’s knee. He exchanges his scalpel for a metal chisel, and deftly begins whittling away at the area where the bone spur connects near the knee – a process that will take nearly an hour. Although a complication from surgery on knee tumors is that the growth plate can be damaged, in this case, all goes well, and bone growth actually is expected to improve now that the tumor is gone. Dr. Kim, who has been monitoring Enyer’s vital signs at every stage, adjusts the dials controlling the anesthetic Enyer is receiving. He announces that all is well after the surgery on the knee. He assessed Enyer for other risks prior to surgery, and he knows it is now Dr. Ambrose’s turn to tackle the difficult surgery on the delicate bones of Enyer’s wrist. Dr. Ambrose is highly skilled and so affable that his statements put everyone at ease. It’s little wonder he was the first physician at Chilton Memorial to win the hospital’s coveted Service Star Award that recognizes those employees and others affiliated with the hospital for performing above and beyond their duties on a routine basis. Now that Dr. Snyder’s surgery on Enyer’s knee is complete, Dr. Ambrose confidently makes an extensive incision that is half the length of Enyer’s left forearm. He has little choice. If the physical therapy students who study under his guidance at the University Medical/Dental School of New Jersey were here, he would explain that if he made a smaller incision, he would probably not be able to see where the tumor presses against the normal tissue and nerves. The large incision is necessary to avoid accidentally severing a nerve or one of the tendons that controls movement to Enyer’s fingers. With magnification, Dr. Ambrose exposes the tendons in Enyer’s left arm, freeing them from the tumor, which he says is the largest tumor of its type that he has ever seen. A major nerve is closely attached to the tumor, and it requires intense dissection to free it without damage. Progress is slow, but steady. Once the tumor is severed from the bone and the remainder of the bone spur is shaved down, it is time to reconstruct the muscle and transfer it back to where it belongs, but Dr. Ambrose and Dr. Snyder first move Enyer’s wrist to test its range of motion. The results please them. Before surgery, Enyer could not rotate his hand to turn his palms up or down. Now, his wrist has almost full motion. Dr. Ambrose is also convinced that Enyer’s left arm will grow correctly now that the tumor will not shunt its growth. “The benefit of doing surgery at such a young age is that the body is likely to compensate and normal bone growth will catch up to some extent,” Dr. Ambrose explains. Finally, the skin is sutured. One cast is placed on Enyer’s leg below the knee, and a second one is placed from his wrist to his shoulder to protect his bones. It is now time to share the good news with Enyer’s host family. “Doing an operation like this is an immensely rewarding experience,” Dr. Ambrose said about volunteering his services today. “Here is someone who really needs care, but can’t get it any other way in his own country. Many children in third world countries have difficult lives, but it would be overwhelming to have a condition like this, too. Enyer may need additional surgery in the future to remove other tumors, but this was the right time to do this surgery because at this age most of these growth problems can correct themselves.” Enyer’s host parents, Ron and Sue Troast of Midland Park, have been patiently waiting just outside the operating room for hours. Enyer is the fourth child needing medical attention that the Troasts have opened their home to and hosted. Ron Troast, an optician, traveled to Enyer’s home country, the Dominican Republic, six times with Healing the Children to provide eye exams and glasses to residents. Sue Troast became involved with the organization when her brother-in-law showed her a photo of one of the children needing medical help. “That’s all it took for me to agree to add a sixth child to our household,” she said. The doctors tell the Troasts the surgery has been successful. The Troasts will relay the good news to Enyer’s mother in the Dominican Republic by phone to relieve her anxiety, as well. Enyer will recover and be pampered by the nurses on the pediatrics unit at Chilton Memorial, then will be released the next day to the care of the Troasts who generously will care for him until he undergoes physical therapy and his casts are removed and he can return to the Dominican Republic. Sue Troast admits communication with Enyer was initially problematic when he arrived a week before his surgery, as neither she nor her husband speak Spanish, and Enyer didn’t speak English, but she says they frequently get their meanings across by pointing to objects. Communication is simplified when the youngest of the five Troast children is home from school, as she is completing her fifth year of Spanish and has mastered the language well. Otherwise, when Sue Troast is alone with Enyer, she occasionally looks up a word or phrase in a Spanish dictionary and recites it, but from Enyer’s giggling, she suspects she must have mispronounced it. Once she repeated a phrase only to have him squeal delightedly, and then blurt out the word in English. In just a week, Enyer has learned several words in English, and can be heard counting and singing in English to the music of the “Jungle Book” video that he never tires of watching. The staff at Healing the Children have told the Troasts that by the time Enyer leaves the United States, he most likely will communicate in English. It’s apparent the experience has been an enriching one for the physicians and the Troasts. “We do it primarily because it’s a Christian thing to do,” Sue Troast explains about what motivated her to take in four children needing medical care from Healing the Children over the years. “And look at what my five children have learned from the experience – they’ve learned compassion and sacrifice, and they’ve learned to appreciate all that they have here.” Everyone is pleased Enyer’s prognosis for recovery is good. The disappointing news is that his tumors may regrow or that new ones may start. When Sue Troast was rocking Enyer in her arms, just days before his surgery, she noticed that other tumors can be felt developing along his rib cage and shoulder blade. Although Enyer will fly home to the Dominican Republic in July, he will most likely need to return to the United States for more surgery in a few years. The really good news is that the Troasts, Dr. Ambrose, Dr. Snyder, and the surgical team at Chilton Memorial say they’ll be waiting for him. Chilton Memorial Hospital is a fully accredited, 256-bed, acute-care, community hospital located at 97 West Parkway in Pompton Plains. Its many services include the Chilton Cancer Center, the Comprehensive Breast Center, a Cardiac Catheterization/Angiography Suite, a family-centered obstetrics program featuring home-like labor/delivery/recovery rooms, a state-of-the-art Emergency Department, and a bariatrics weight loss surgery program. For more information on Chilton Memorial's facilities and services, please visit www.chiltonmemorial.org. PHOTO CAPTION 1: Orthopedic Surgeon Lawrence Ambrose, MD, from Wayne, was one of three Chilton Memorial physicians to donate his professional services to remove developmental tumors from the wrist and knee of a four-year-old child from the Dominican Republic. Shown here just three weeks after surgery are Enyer, as the cast that protected his wrist is removed, while his host parent, Sue Troast from Midland Park, looks on. PHOTO CAPTION 2 Four-year-old Enyer, a child from the Dominican Republic whose wrist and knee tumors were removed by Orthopedic Surgeons Lawrence Ambrose, MD, (far right) and Ron Snyder, MD, (not pictured), was all smiles after the cast from his arm was removed. Sue and Ron Troast from Midland Park (behind Enyer) served as Enyer’s host parents, donating their time to care for him before, during and after and his surgery. Dr. Ambrose, Dr. Snyder, and Anesthesiologist Kwon Kim, MD, all donated their professional services to remove tumors from Enyer’s wrist and knee that stunted proper bone growth and eventually would have prevented Enyer from running, walking, and using his left arm. Chilton Memorial Hospital also generously donated its operating room and nursing staff for Enyer’s surgery and recovery.
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Dr. Larry Ambrose, MD, and Dr. Ron Synder, MD, could be resting too, but they aren’t. The two are scrubbing their arms vigorously on their day off at the deep stainless steel sinks near the operating rooms of Chilton Memorial Hospital. The orthopedic surgeons have donated their time and their expertise to remove baseball-sized growths from the left knee and left wrist of Enyer, a child who traveled from the Dominican Republic with a worker from the mid-Atlantic chapter of Healing the Children, a network that arranges medical care for children that need it, whether it is in the United States or abroad.
Not surprisingly, Enyer is oblivious to the action. He doesn’t see the heart monitor, EKG machine or the intravenous bags that drip an antibiotic and a solution that combines salt, sugar and electrolytes into his arm. Dr. Kim administered general anesthetic medications so Enyer will sleep comfortably while the surgery progresses for more than three hours.
