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OneThousandOne represents the amount of time, verbally, that it takes to count to one second. In this one second of time, a great thing happened at The Nebraska Medical Center. In fact, several great things probably happened. A patient was cured, a researcher found the missing link, a nurse treated an injury, a doctor comforted a family or maybe a child just smiled.
MOMENTS IN MEDICINE at THE NEBRASKA MEDICAL CENTER
Fall | Winter 2012

Above and Beyond

Sam Hubka knows that the best things in life aren’t handed to you. And when you want something really badly, you have to give 110 percent to get it — whether it’s winning a football game, a wrestling match or a battle with cancer.

A senior in high school and an all-around athlete, Sam Hubka dreamed of playing football in college. Determined to make that happen, he gave 110 percent both in his studies and on the field. When his teammates would walk off the field after a grueling two to three-hour football practice, Sam would linger longer to run more hills.

Sam Hubka
Sam Hubka during a football game for Lincoln Southeast High School during the fall of his senior year in 2007.

His hard work paid off. When Nebraska Wesleyan College recruited him to play football for the Prairie Wolves, everything seemed to be falling into place. But that’s where Sam’s future took a new and uncertain turn.

During his last semester, Sam had to put everything on hold when he was diagnosed with a rare bone cancer in his left tibia called osteosarcoma that occurs in about 1,000 people in this country each year.

Several years ago, many teens with this cancer would have lost their limb. But doctors at The Nebraska Medical Center were able to save Sam’s leg and his life using some of the most advanced cancer treatment and prosthetic devices available today.

With a twinkle in his eyes and a grin on his face, today Sam doesn’t talk about what he can’t do, but what he can. He goes to school like normal students his age, he hangs out with friends and he’s replaced his love for football with sports like golf, frisbee disc golf and bicycling. That’s all amazing stuff considering the fact that a large section of his tibia is now gone and replaced with a metal endoprosthesis.

Family members say that it’s Sam’s positive attitude, determination and the expert care he received at The Nebraska Medical Center that helped Sam and his family get through one of the most difficult years of his life.

Sam was a senior at Lincoln Southeast High School in Lincoln, Neb., when he noticed that his knee had become swollen and painful. It was wrestling season and Sam was anxious to play out his senior year. The trainer thought he must have developed tendinitis and advised him to sit out until it got better. Sam rested it, iced it and underwent physical therapy.

Wresting season turned into baseball season and still Sam’s knee had not improved. In fact, it appeared to have gotten worse. There was a constant throbbing and achiness.

Sam underwent an MRI at a Lincoln hospital, which showed some sort of irregularity. Probably a sports injury that had become infected, Sam was told. The doctors in Lincoln sent Sam to Sean McGarry, MD, an orthopedic oncology specialist at The Nebraska Medical Center for a second opinion. Dr. McGarry performed a bone biopsy to get a definitive diagnosis.

Sean McGarry, MD
Dr. McGarry
Dr. McGarry is the only orthopaedic oncologist in Omaha who specializes in malignant and benign tumors of the bone and soft tissue in children and adults.

The results weren’t what Sam or his parents expected. Sam was told that he had osteosarcoma, a cancer of the bone that sometimes has a genetic link, but in more than 99.5 percent of cases it has no known cause. “I was very surprised,” says Sam. “But everything happened so quickly that I guess I didn’t really have time to react, nor did I have a full understanding of what it all meant.”

His diagnosis was March 28, 2008. Sam’s treatment included a total of 32 weeks of chemotherapy, 16 weeks before the surgery and 16 weeks after. He started inpatient chemotherapy on April 2, spending Monday through Friday in the hospital and going home on weekends. His regimen included three weeks on and two weeks off. “I was pretty sick at times,” recalls Sam. “But it was manageable. My brother, mother or father were there with me all of the time to give me support so that helped a lot.”

Sam endured a difficult regimen, but still he managed to stay positive. “My goal was to play college football,” notes Sam. “That was probably the biggest thing on my mind. If everything went well and I could get better, there was still a chance I could play.”

So Sam took that 110 percent work ethic that he had on the field and brought it to his hospital room. “Fighting something like this at 17 years old and watching his destiny change so quickly and abruptly was very difficult,” says his mother, Linda Hubka. “He knew that pouting, feeling sorry for himself or being depressed would do no good, so he skipped all these steps and just handled it like a soldier. And that infectious smile was there almost all of the time.”

“Sam showed so much resilience through all of this,” agrees his father, Rich Hubka. “He was always the calm one, the leader. He would say, ‘We can do this.’ Hearing him say those words made it easier for all of us.”

Knowing they had the best doctor for the treatment brought reassurance to the entire family. Dr. McGarry is the only orthopaedic oncologist in Omaha who specializes in malignant and benign tumors of the bone and soft tissue in children and adults. Dr. McGarry joined the staff at The Nebraska Medical Center in 2005 and is an assistant professor in the Department of Orthopaedic Surgery and Rehabilitation at the University of Nebraska Medical Center (UNMC). He received his medical degree from Creighton University Medical School, completed a surgery internship and orthopaedic surgery fellowship at the University of Colorado Health Sciences Center in Denver. He went on to complete a fellowship at the University of Florida Shands Hospital in Gainesville, Fla., in orthopaedic oncology.

“Because these conditions are not very common, it’s very important to see a specialist who sees these conditions exclusively, as this provides the volume and experience needed to provide the right diagnosis and the right treatment.”
Sean Mcgarry, MD

Bone and soft tissue tumors are not very common with about 10,000 total occurring in the United States each year. Benign conditions (such as bone cysts in children) and lipomas (fatty soft tissue tumors in adults) are much more common than malignant tumors and are easier to treat. In children, benign tumors are often diagnosed after some sort of trauma such as a sprained ankle and a radiograph is obtained to rule out a fracture. But these often go away by adulthood.

Bone cancers affect about 2,000 people each year in the United States. The most common types include osteosarcoma, which is more prevalent in teenagers; chondrosarcoma, which occurs most frequently in adults 40 to 60 years old; and Ewing’s, which occurs in the teen years and 20s.

Osteosarcoma, the type of cancer Sam had, most commonly develops above and below the knee and in the shoulder bones. Dr. McGarry says he sees about eight to 10 cases of osteosarcoma in Nebraska each year and about 20 cases of bone cancer as a whole. Each case is very unique in terms of how aggressive it is and how quickly it spreads. Teenagers typically complain of pain at night that increases with intensity as it progresses and eventually doesn’t go away. It may or may not appear as a bump. In about 20 to 25 percent of cases, the cancer spreads through the bloodstream to the lungs. The five-year survival rate for this cancer is 65 to 70 percent. Once teens reach the five-year mark, they are considered cured. Very few will experience a relapse after five years, notes Dr. McGarry.

“Because these conditions are not very common, it’s very important to see a specialist who sees these conditions exclusively, as this provides the volume and experience needed to provide the right diagnosis and the right treatment,” says Dr. McGarry. “The average pediatrician or ER doctor might only see these kinds of conditions about once or twice in a career.”

Patients who are referred to Dr. McGarry will typically undergo diagnostic testing that includes X-rays followed by an MRI of the tumor, a bone scan and a CT scan of the lungs. If cancer is suspected, a biopsy will follow. If cancer is confirmed, a patient will undergo three months of chemotherapy followed by more X-rays, and then an MRI of the tumor and a CT scan of the lungs to restage the tumor.

Surgery is often a complex procedure that involves removing the tumor and replacing the bone with metal replacements and donated bone. This is followed by another six to eight months of chemotherapy.

“Forty years ago, it was common to amputate the leg for a patient with one of these conditions,” says Dr. McGarry. “But advancements in chemotherapy, as well as the metal reconstructions called endoprosthetics that replace the affected bone, have improved greatly. These have resulted in fewer complications and better outcomes.”

The metal endoprosthesis is placed inside the body and tendons are reattached to the device. The surface is comprised of a gritty texture which helps bone cells grow into it.

“These are difficult surgeries,” says Dr. McGarry. “I typically spend hours studying the anatomy of the area in an MRI to determine exactly where my incisions are going to be, making sure that I will avoid cutting into critical nerves and trying to preserve as much muscle as possible while making sure all of the tumor is removed.”

The tumor had grown larger than expected in Sam’s case, requiring Dr. McGarry to remove about five inches of bone from the tibia below the knee. Sam also lost some of his muscle in the process.

The surgery took more than 10 hours. “When Dr. McGarry came out of surgery, he looked exhausted,” says Rich. “But he still took the time to talk to our family about the surgery. Throughout the entire process, Dr. McGarry was always so calming, reassuring and positive. After he would leave the room I would tell myself, ‘We are going to get through this. It’s going to be okay.’”

The complexity and gravity of the surgery ended Sam’s chances at playing football. Those words were crushing. “That’s the only time I saw Sam break down and cry,” recalls his brother, Max.

But Sam didn’t have time to dwell on it. Shortly after surgery, he began another 16 weeks of inpatient chemotherapy. Still healing from surgery and knowing that his life had definitely taken a different course, this time was harder. But Linda says he continued to battle through it with the same positive attitude and perseverance he applied to sports and the rest of his life. “He had a matter-of-fact attitude about it,” she says. “His attitude was, ‘If you act sick, you’ll be sick. I’m going to try to get through this feeling as good as I can.’”

He passed the time, often with the company of Max, playing video games, watching TV and having water gun fights. With regular visits by his mother, father and other family members, Sam was rarely alone. He developed a close relationship with his nurses and they learned to read his needs. “I became really close to all of my doctors and nurses,” says Sam. “They really took the time to get to know me.”

Sam Hubka and family
Sam Hubka, with his mother, Linda, and brother, Max

Sam says he has grown especially close to Dr. McGarry. “He was very direct and realistic and at the same time, very calming,” says Sam. “You knew he had everything under control and that helped me feel more confident. I knew I was in good hands. I never felt like he was out of his element.”

The hospital staff was also very accommodating, says Linda. The hour-long trips from Lincoln to Omaha and back took its toll on the family. When possible, Sam was allowed to have some of his chemotherapy treatments performed at a Lincoln hospital to ease the strain on family.

Sam managed to finish his last semester of high school from his hospital bed and attended graduation with the rest of his classmates during a break in his chemotherapy treatments. His last and final chemotherapy treatment ended on Dec. 29, 2008 — nine months after his initial diagnosis. Sam remembers watching the Nebraska versus Clemson football game in the Gator Bowl on New Year’s Day with his brother and friend. Nebraska beat Clemson 26 to 21. “It was a good omen,” notes Sam. “And it was such a good feeling to be with my brother watching the game and doing something normal.”

Anxious to get on with his life, Sam didn’t waste any time and enrolled at Southeast Community College during the second semester. By January of the next year, he transferred to the University of Nebraska at Lincoln.

Life is beginning to feel normal again. Sam is finishing his last year of college with a degree in graphic design and is looking to the future.

It’s been four-and-one-half years since his surgery and Dr. McGarry says his sixth sense tells him that Sam has a bright future. “He’s done absolutely awesome,” he says. “If I had to put up a billboard, he’d be my poster boy.”

“Sam came through this with a tremendous will to move forward and change his life,” notes Rich.

And he’s doing it the only way he knows how: by giving it 110 percent.

Next article in the Fall | Winter 2012 issue of One Thousand And One:
Bariatric Program: The Lighter Side of Life