Solving Medical Mysteries
HealthReach, Spring-Summer 2013 | Page 6
There are few more frustrating words for a patient to hear — and a doctor to say — than, “We don’t know what’s wrong.” As the only musculoskeletal oncologist in Northern Virginia, and one of only about 100 such specialists practicing nationwide, Felasfa M. Wodajo, MD sees conditions that are rare to most physicians, but commonplace for him. His specialty is treating bone and soft tissue cancers (sarcomas), but many times patients suspected of having a sarcoma have something else wrong with them. By the time patients come to see Dr. Wodajo, they usually have seen many doctors and been through a battery of tests with abnormal findings and inconclusive results — patients like Jaime and Robert.
Jaime Riggleman, 36, woke up suddenly one morning with severe pain in her left hip. Four months later, after seeing several doctors in Winchester near her home, physical therapy and inconclusive tests, including two MRI scans and a CT scan, she was diagnosed with bursitis. “I remember the doctor telling me, ‘You’ll just have to live with it,’” Jaime says.
Still in extreme pain, Jaime sought another opinion from a specialist in sports medicine and orthopedics. That doctor suspected a tumor and referred her to Dr. Wodajo.
“I was scared to death, thinking I had cancer,” said the young mother of two, “when Dr. Wodajo walked into the exam room and said, ‘You don’t have a tumor or bursitis.’ Then he explained about myositis ossificans. I had bone growing in the muscle of my hip. It was bigger than a golf ball.” Myositis ossificans is an unusual and poorly understood condition where muscle turns into bone. The bone solidifies, causing pain with every movement. After a biopsy confirmed Dr. Wodajo’s diagnosis, he scheduled Jaime for surgery.
“We needed to remove the bony growth. Otherwise, Jaime would still have been in pain,” Dr. Wodajo explains. The drawback of surgery with this condition is that it can restart the process of muscle turning to bone. To reduce the risk of recurrence, Jaime was given a single dose of radiation immediately after surgery.
Jaime’s procedure was performed on an outpatient basis and she was able to return to her home the same day. “A week later,” Jaime recalls, “I went to my follow-up visit. I was walking slowly, but I had no limp.” She is now back to previous activities and happily pain free.
Jaime said she was so “fed up with doctors” before her appointment with Dr. Wodajo that she nearly cancelled it. “I had lost hope, thinking no one would ever figure this out. Dr. Wodajo knew what was wrong within five minutes and said, ‘We’ll fix it.’”
Robert is a bicycle commuter, riding 14 miles each way from his home in Maryland to downtown DC. One winter morning, he spun out on a patch of ice, landing on his side and punching his wallet into his hip, with his bike landing on top of him. There was a huge bruise and swelling, but little pain, and he didn’t think he needed to see a doctor.
Several months went by and then he noticed new swelling at the point of impact. His doctor suspected a sarcoma because the mass felt hard and had grown rapidly. Robert had an MRI, but the results were inconclusive.
“There was clearly something there, but my doctor didn’t know what it was,” Robert said. “It just looked like a big mass. But he was a very smart doctor and referred me to Dr. Wodajo.”
When he arrived at Dr. Wodajo’s office, Robert said,“I was contemplating my own death or at least the thought of major surgery.” Robert explained his injury. Dr. Wodajo did an exam and reviewed his scans.
“I knew immediately it was a Morel-Lavallée lesion,” Dr. Wodajo said. It’s a not-uncommon complication after a bike or motorcycle accident when the person slides across the ground with shearing force. The fascia covering the muscles can split and fill up with blood, which never goes away. Sometimes these masses can be around for months, even years, causing pain. The treatment is a simple surgery to remove one of the two layers of fascia and the blood product goes away.
Within a week after surgery, Robert had relief from the swelling. And, he says, he learned some valuable lessons: Don’t ride a bicycle on ice, empty your pockets before riding, go to the doctor if you get a severe bruising injury, and go to doctors who know the experts.