Although it still hasn't been a year since a rare cancerous tumor prompted the amputation of her right leg, spunky Nicole M. has kept pace with her fellow students at Woodlawn Elementary School, in the classroom as well as on the soccer field. And, as she improves her agility, the young knee disarticulation amputee also has visions of learning to rollerblade and possibly returning to dance and gymnastics.

Most of Nicole's swift rehabilitation is directly due to her upbeat spirit and the love and support showered on her by family - including her four-year-old brother Bryan, plus friends, and most everyone who has crossed her path. Helping her get back into action so quickly has been a combination of advanced prosthetic care and an intensive regimen of physical therapy. The result is a bright and bouncy third-grader who sees no meaningful limitations to her life - now or in the future.

"Nicole was born with a relatively rare form of cancer. We were told that only 200 cases of it have been documented worldwide," explained Julia M.

"A problem was apparent at her birth; the calf of her right leg was bulging and at least one and a half times bigger than the other leg. When she was seven days old, she had a series of tests - ultra-sound and an MRI - and the diagnosis was something called an AV malformation. It means the arteries and veins in that leg had formed improperly," her mom continued.

Since physicians had ruled out a tumor at that point, it was decided not to biopsy the mass in Nicole's leg because of the possibility of uncontrollable bleeding, Julia recalled. When the swelling increased, a vascular surgeon suggested the baby wear a compression stocking; the bulge disappeared after that.

"Nicole developed normally for seven years - crawling and walking on schedule. She has always been a very active little girl who loves sports. And she was also involved in dance and gymnastics," Julia noted.

A highlight for Nicole was playing on the Northwest Soccer Club's Dragons team which is coached by her dad, Mike M. In the fall of 1999, when her right leg began hurting, she blamed it on her ankle that'd been twisted in gym. But the pain intensified.

"It affected her ability to play soccer. We tried physical therapy, but nothing worked. By then she was in extreme pain and taking Tylenol with codeine around the clock," Mrs. M. remembered.

"We sent her to an orthopedic surgeon who reported that the pain was due to a sarcoma - a tumor in her calf. It had wrapped itself around a nerve bundle at the top of her leg and it was affecting the nerves in her foot."

Once the tumor was confirmed, events began to move quickly. The family took Nicole to University Hospital in Iowa City; a biopsy shortly after Christmas confirmed that she had infantile fibrosarcoma. She'd been born with the tumor; there had never been an AV malformation. In less than two weeks, though, intensive chemotherapy relieved her pain and shrunk the tumor dramatically. Nicole bounced back, wearing hats to school to cover her hair loss.

Despite their daughter's swift response to chemotherapy, Mike and Julia knew that surgery was inevitable. The decision they agonized over, however, was whether to have their child's leg amputated - the safer course - or opt for just tumor removal to try to save her leg, a choice that would risk a potential spread of the cancer.

In early March, the couple went to Rochester's Mayo Clinic for further tests and a second opinion. There, even though suspicious spots on an x-ray of Nicole's lungs turned out to be a false alarm, the scare was sufficient to prompt them to choose the safer route of amputation. Surgery was scheduled for March 10th, 2000, in Iowa City.

"At first when the doctor told her she needed an amputation, she didn't understand what he meant. I had to say, 'They're going to cut your leg off.' It was terrible for all of us," Julia said softly.

"But it was one of those moments when Nicole was stronger than we were. She said, 'Don't worry, you'll still have us two kids.' I couldn't believe a child so young could be so brave and understanding," her mother continued.

In the weeks that followed, Nicole rebounded, using crutches and a walker. Her spirits also picked up with the prospect of a spring soccer season. Though she couldn't yet play, she signed up and helped cheer on the team from the bench.

Another factor that boosted her enthusiasm was selecting a signature design for her new prosthetic socket. Rod Cheney, CPO, and Prosthetist Andy Besser, her practitioners at American Prosthetics & Orthotics, suggested laminating cartoon characters to the socket. She was delighted.

"Rod went out of his way to find something Nicole would like. She picked out a bright blue socket with Rugrats on it - her favorite cartoon. I thought, 'Oh, my goodness - it's so noticeable.' I'd have chosen something very unobtrusive....hiding it. But she loves it," Julia laughed.

"People actually walk up to her and say, 'I like your leg!' I think that's much more positive than trying to hide the fact she wears a prosthesis."

Nicole also is thrilled that she wears the same knee component as Rudy Garcia-Tolson, 12, a bilateral above knee amputee who has won scores of medals for swimming and competed in several California triathlons along with actor/comedian Robin Williams.

The custom-designed and fabricated prosthesis consists of a narrow ML ischial containment socket secured by supracondylar suspension, noted Andy Besser. It features a high-performance, polycentric linkage Century XXII knee, with an Otto Bock dynamic energy foot. By the time fall arrived, Nicole had mastered her leg sufficiently to suit up with her soccer team and also try out for basketball, a sport she hadn't played before. Some private physical therapy lessons by Jenny White, PT and an above knee amputee who trains new amputees to run, have also boosted Nicole's confidence on the playing field.

Mike and Julia are as pleased with their daughter's athletics as they are with her academic performance.

"Although she missed 54 days of school last year, she was still able to advance with her class. And she's been able to continue doing well," her proud mom reported.

"One of her Christmas presents was a scooter, so she's anxious to try that out. And Jenny White promised to give her more lessons so that she'll be able to try rollerblading."

So if you're strolling down the sidewalk in Des Moines this spring, keep an eye out for a bright blue blur decorated with Rugrats. It just could be Nicole M., one of American Prosthetics & Orthotics' favorite patients!

Winter 2001 index