Saturday, April 17, 2010

By David Rogers Daily News Staff Writer

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Palm Beach Daily News photographer Jeffrey Langlois followed Georgia resident Wyatt Gray for
four months as the 11-year-old underwent limb-lengthening surgery followed by months of
physical rehabilitation at St. Mary’s Medical Center and the Rehabilitation Center for Children and
Adults. This is the first half of a two-part feature.

In his young life, 11-year-old Wyatt Gray has managed to keep up with his peers pretty well. For
four years, he’s played football at Sawnee Elementary in Cumming, Ga. The Alpharetta, Ga.,
resident also plays baseball and enjoys a game of pingpong at home.

But as he’s grown, his left leg hasn’t kept pace. He’s had to wear a lift in his shoe to
compensate. Because his left foot is angled inward, he doesn’t land solidly on the heel when he
moves. The difference in length between his legs is only going to increase if nothing is done. He
was born with Streeter syndrome. While his mother was pregnant with Wyatt, a band of
amniotic membrane encircled his left leg below the knee. Surgery eight weeks after his birth
removed the band, but it still reduced the circulation and nerve function in the area below the

Last year, Wyatt spotted a news story about orthopedic surgeon Dr. Dror Paley. He alerted his
mom. With Wyatt understanding what he might face, Cindi Gray and her husband Bill, a
commercial flooring salesman, decided Cindi would suspend her career as a post-surgical critical
care nurse for several weeks and take their middle child to the Paley Advanced Limb Lengthening
Institute at St. Mary’s Medical Center in West Palm Beach.

Their journey began Dec. 3 with a car ride down the Florida coast. The next day, Wyatt and
Cindi had their first face-to-face consultation with Paley.

Wyatt, pale and nervous, listened as Paley explained the options: The surgeon can lengthen
Wyatt’s left leg so it matches his right leg; he can stunt the growth of the right leg; or he can
amputate the left leg and give Wyatt a prosthesis. Wyatt wants the first option, though it will
leave him in pain and require months of intense physical therapy.

Settling in at Quantum House, on the grounds of St. Mary’s, Cindi and Wyatt have just days to
ponder what is about to happen and how it will change Wyatt’s life.

On the morning of Dec. 7, Cindi kisses her son as Paley prepares to operate. A pioneer of
techniques that correct limb deformities, Paley cuts into Wyatt’s left leg. He uses a wire saw
called a Gigli saw to cut through the bone.

He installs a metal support structure called a fixator on Wyatt’s leg. The device keeps the bone
stabilized, but as importantly, will be used across the next three months to stretch the bone as
it attempts to close the gap. The fixator will help realign Wyatt’s leg.

It will be a painful process.

A few days after surgery, Wyatt is recuperating in a room at St. Mary’s.

He winces as a nurse cleans incision sites around the fixator.

Asked whether the surgery was worth it, he shakes his head no.

It hurts, he says.

Cindi Gray is accustomed to seeing the difficult time patients have following an operation. But
this is different. “There’s nothing worse than seeing your child in pain. You feel empathy for your
patients, but he’s got this thing on his leg for six months or however long it’s going to be,” she

The surgery was just the first step. To get his left leg longer, Wyatt will have to endure more
than three months of physical therapy in the Palm Beaches.

The quest to get his legs to match is only beginning.

Direct link to this story
Dror Paley, MD, FRCSC
Wyatt’s journey: Boy braves limb-lengthening surgery

By David Rogers Daily News Staff Writer

Eleven-year-old Wyatt Gray was not sure a few days after his Dec. 7 surgery if his quest to get a
longer left leg was worth it.

When he was born, doctors discovered string-like amniotic bands had wrapped around his lower
leg in utero, reducing the circulation of blood. That band was removed while he was an infant, but
it stunted the growth of his left leg and left him with a misaligned foot.

On Dec. 3, Cindi Gray, a post-operative critical care nurse, put her career on hold, said goodbye to
her husband Bill, their two other children, Zane, 13, and Willow, 6, and mapped a course from
Alpharetta, Ga., to West Palm Beach.

There, at the Paley Advanced Limb Lengthening Institute at St. Mary’s Medical Center, orthopedic
surgeon Dr. Dror Paley cut into the lower half of Wyatt’s left leg, sawed the bones apart and
installed a metal-framed fixator to stabilize and lengthen the leg.

The fixator has a set of pins. Wyatt learned he would be using a wrench to make minute rotations
every day. The incremental turns ever so slightly widened the gap between the bones in his lower
leg and continued the process of realigning his foot.

Just a day after surgery, Wyatt began what would become four months of physical therapy. What
hurt the most was stretching and moving his leg. His muscles would spasm time and again as they
moved and healed. “It would do it in the lower thigh and the calf,” he said.

“It was at least an 8,” Wyatt said, when asked to rate the pain on a scale of 1 to 10.

Physical therapists at St. Mary’s and at the Rehabilitation Center for Children and Adults in West
Palm Beach each worked with him for an hour each day, five days a week.

The muscle spasms occur because, as the bone is growing about a millimeter a day, soft tissue is
dragged along, said Fran Guardo, director of the Paley Institute’s rehabilitation department. “The
muscle at one point reaches the end of its length, then it goes into a protective spasm,” Guardo
said. Therapists worked to minimize spasms by applying hot packs to prepare the muscles for
movement and using electrical stimulation for pain relief, she said. Valium is given to some children
to alleviate the pain, and therapists also use distractions such as video games to keep patients’
minds off the pain. “The stretching we have to do is painful,” Guardo said.

Watching Wyatt struggle wasn’t easy, his mother said.

“You hear the other children crying and you see the wheels in Wyatt’s mind turning, saying, ‘How
am I going to be able to do it?’ ” Cindi Gray recalled.

She scheduled the therapy early in the day, so Wyatt had less time to think about the process.”I
felt like I was constantly bribing him when we had to do it later,” Gray explained.

As the weeks continued, Wyatt became stronger. He started encouraging other children going
through the same process. And his ability to empathize with children facing more difficult medical
challenges grew, his mother said.

At the Rehabilitation Center, physical therapy assistant Rich Sylvester helped Wyatt stretch in the
water. She would do soft-tissue mobilization, a type of massage, to reduce the spasms in Wyatt’s
calf muscles. Wyatt progressed from using a walker to being able to walk without one, Sylvester
said. “He did have some tough days. He had some pain, but he got through it,” Sylvester said.
“He was very positive.”

Guardo agreed. “He actually did extremely well. He was such a trooper,” the physical therapist said.

Wyatt encourages many of Paley’s other young patients, some of whom Wyatt lived with at
Quantum House.

“They called me the mayor of Quantum House, because I would meet and greet everyone at the
front door,” he said.

Wyatt’s physical therapy was set to wrap in late February, but was extended into early April,
because he wasn’t able to lengthen his leg as quickly as some patients can. “His skin was so
tight,” Cindi Gray said. “He was starting to take a lot of pain medication.”

The two were able to return home on April 3.

She praised Paley. “He’s an amazing man,” Gray said.”He’s given my son a chance to be as close
to normal as he can be. Life is hard enough for kids growing up right now,” she said.

Sylvester, the physical therapy assistant, agrees. “These are parents that were told (elsewhere)
they’d have to amputate these kids’ legs. From a parent’s point of view, it’s miraculous,” Sylvester

On Monday, Wyatt attended classes at Sawnee Elementary for the first time since November.

He wore shorts because of the fixator, a device that seems to fascinate his friends. “They all
freaked out,” he said. “They asked a bunch of question: Does it hurt? Do those pins go through
your bones? How much does it weigh?’ ”

Wyatt will likely have the fixator removed in June or July. Then, he’ll have to take it easy for
another month before returning to activities that place his full weight on the leg.

He’s looking forward to rejoining the football team. “I’ll be tackling,” he said.

Wyatt’s not sure how it’s going to feel to be able to walk again without a lift in his shoe.

“It’s going to be good, I guess.”

The process was long and difficult, but it had more than one reward.

“It was really painful, but I got to meet a lot of magnificent people that I will always keep in touch
with and talk to,” he said.

Direct link to this story
Wyatt’s journey, Part 2:
Physical therapy requires perseverance