As a competitive swimmer for Terre Haute’s North Vigo High School, sophomore Sam McCarter trains a minimum of three hours a day, hoping to chisel seconds off his best time. That’s not unusual for an athlete with the ambition of winning events and competing beyond high school. But in McCarter’s case, those workouts are more challenging than they are for most athletes.
That’s because of a bone cancer diagnosis he received at age 7 and the lofty goals he has set for himself since. “When patients present with osteosarcoma as children or teens, there’s usually a biopsy and then a combination of fairly harsh chemotherapy, followed by surgery to remove the mass,” says Dan Wurtz, MD, an orthopedic surgeon at Riley Hospital for Children, Indiana University Health, specializing in orthopedic oncology for patients with bone or soft tissue tumors.
Two factors made the surgical part of McCarter’s treatment more difficult: 1) He still had a lot of growing to do, and 2) the location of the mass involved the middle and upper portions of his femur. To address McCarter’s condition, Wurtz needed to remove the upper two-thirds of the femur. Beyond that, he wanted to offer a solution that would let McCarter keep a functional limb.
At the time, such a diagnosis might have easily led to amputation. Instead, Wurtz suggested an alternative that had just been approved by the FDA. “We replaced his hip at the ball and socket and attached a device down the shaft of his femur to new device anchored to his bone, which would allow bone to grow onto it as Sam matured,” Wurtz says.
The surface of the device was intentionally rough to encourage bone growth, which would eventually replace the removed section of the femur. Rather than using a replacement alternative with cemented components that might fail over a lifetime, Wurtz thought Sam’s age merited a new biologic solution that offered potentially better long-term results.
After a painful nine-month recovery, including three months of chemotherapy, Sam was better, but suffered from nerve sensitivity in the affected leg. Wurtz suggested swimming to desensitize the leg and strengthen his body. At first, being in the pool was frightening. “I started with swim lessons and eventually got good enough that my instructor recommended I join the swim team,” says McCarter. By the time he was in middle school, he was competing and winning.
“I think I’ve done pretty well, considering the fact that I only have half the kicking capacity of able-bodied swimmers and I have to rely on my upper body to make up the difference,” McCarter says. “Like every other kid in the world, I wanted to excel at something and get the trophies.”
With that kind of competitive zeal, McCarter’s routine soon added unexpected wear and tear on his hip joint. “He was becoming overactive in the very sport I advised him to pursue to avoid stressing the device and causing it to wear out sooner,” Wurtz says.
After a few short years of serious athletic training, McCarter had metal grinding on bone. Walking and swimming were painful.
Wurtz first addressed McCarter’s pain by smoothing the surface of the hip implant to reduce friction. Later, he replaced the femoral head. With each surgery, McCarter’s left leg was slightly lengthened to help equalize the difference in leg length. Finally, it was necessary to replace the hip socket in 2011.
Today McCarter competes in the 500-yard freestyle, 100-yard backstroke and 100-yard breast stroke for North Vigo High School’s swim team. After the 2013-2014 season ends, he will reach for another goal—a shot at The 2016 Paralympic Games. McCarter needs to squeeze in two world competitions each year between now and 2016 to get there, and his times must meet certain standards. Since the Indiana State High School Athletic Association doesn’t permit competition in Paralympic events during Indiana’s high school season, that’s not as easy as it sounds.
“I still have a way to go, but I feel like it’s very achievable,” says McCarter. As a kid whose vocabulary has never included the word “can’t”, his mother says he has the motivation to work through challenges. “Sam has a way of pushing everyone around him and bringing out the best in people,” says Mary McCarter. “He pushes me to be strong and become a better person, and he even has me swimming for fitness now.”
Having his world turned upside down by cancer at an early age has offered an apparent trade-off for McCarter. In exchange for the soccer and baseball he missed and the suffering he endured, he has acquired two characteristics that are essential for success in any pursuit: determination and hard work. “I’ve had to struggle to overcome pain and learn to walk and ride a bike again,” McCarter says. “I feel like you have to look at the big picture and try harder, even when you’re just inching toward a goal. If you keep working harder and harder, eventually you’ll reach it.”
This summer, McCarter hopes to complete a boundary water trip with Venturing Scouts—a trip that was postponed while he recovered from his last surgery. He is also working on an Eagle Scout project that may eventually help a city park get accessible playground equipment for children with disabilities. His thoughts are also focused on starting college, where he hopes to study engineering and participate in collegiate swimming.
Meanwhile, Wurtz says he finds inspiration in seeing what Sam has accomplished. “Some patients would have just gone to the pool, but Sam took it to a whole new level by becoming a competitive swimmer,” says Wurtz. “When you look at his case and the location of his tumor, it wasn’t that long ago that treatment might have gone down the path of amputation. Thankfully, we’re not just finding ways to remove tumors in young kids like Sam, but we’re saving their limbs, keeping them functionally active and maintaining some reasonable growth.”