Elephant Leg

The Challenge of
‘Elephant Leg’
By Yang Ching-jung
Translated by Anny Huang
Edited by Margaret Hsieu
He was wearing a sari skirt made from the soft
fabric that is characteristic of South Asian cultures.
His steps were uneven, but the smile on his face
shined bright like the sun. That was the first impression
Kannanyason Sababathy left on the people who
greeted him in the terminal of Chiang Kai-shek
International Airport.
If these people had not already known about his
medical condition, nobody would have guessed that
underneath the sari skirt, this Indian-Malaysian man’s
right leg was deformed, resembling the enormous leg
of an elephant. His leg had been tormented by the “
elephant leg” disease for 15 years.
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A l l o f h i s d o c t o r s c o n c l u d e d t h a t
amputation was the only solution. However,
the team of doctors in Hualien Tzu Chi Medical
Center accomplished an impossible task. They
sculpted his enormous leg, which was long
plagued by spreading tumor, back to its original
slenderness.
Kannanyason has seven siblings. Though
growing up in a big family, he had always been
loved by everyone throughout his childhood.
He had a happy, optimistic personality. Later
in his grown-up years, he worked at a wellcompensated
job in a Japanese company based
in Malaysia. He did not drink, smoke, or
gamble. He lived a good and healthy lifestyle.
Kannanyason thought back on his life, “
I even had a girlfriend that I was already
planning on marrying. Everything in life was
so good, so happy.”
From heaven to hell
In 1989, Kannanyason had a car accident.
The local hospital promptly operated on him to
repair his femur fractures and ligament injuries,
using a cast to stabilize his right leg. He was
recovering well for awhile, but one day after
he was discharged, he slipped and fell in the
bathroom. The same bone that was broken from
the car accident fractured again.
This time the doctors had to use nails and
pins to stabilize his thigh. After the nails and
pins were removed, his entire right leg started
to swell. Fluid had seeped out from the wound,
making a foul smell. His perfect life shattered
into pieces. He lost his job, health, and even his
fiancé. Suddenly, it was as if he had fallen from
heaven to hell.
Kannanyason did not know what he had
ever done to deserve such suffering. He fell
into despair and even attempted suicide. It
was his family’s tears and his mother’s love
that kept him alive. They started to seek other
doctors’ help with the hope of finding a cure.
The swollen leg became often inflamed as
the weather changed, causing Kannanyason
to have frequent fevers. For long he had been
tormented by the pain in his leg. He endured
the pain and dragged the deformed leg to see
many doctors. The only answer he got was
amputation.
Kannanyason did not want to lose his leg.
He even traveled to as far as India to seek for a
cure, but was still disappointed with the same
answer. Although every doctor offered different
explanations, Kannanyason had never given up
on his leg. Even when his mother assured him
that he would be all right after amputation, he
still would not give up on his leg.
Secondary Lymphatic Edema is caused by blockage in the lymphatic
system, resulting in engorgement of certain parts of the body. There
are several etiologies for lymphatic blockage, including parasitic
infection, surgery, radiation therapy, malignant tumor, etc.
Medicine With Humanity Vol. 3 January 2006 39

Dr. Lee Chun-ta measures Kannanyason’s right calve.
Contact with Tzu Chi
He lived and endured the pain for 15
years. Finally one day, a friend suggested
Kannanyason to give “Tzu Chi” a try. “
Tzu Chi? What is Tzu Chi?” he said. His
friend explained that Tzu Chi is a Taiwanbased
Chinese Buddhist charity foundation.
Kannanyason was doubtful. “Is that possible?
Why would Chinese people ever help an Indian
man?” he asked. His friend encouraged him
and said, “We’ll see when we give them a try.”
I n S e p t e m b e r o f 2 0 0 3 , a d o u b t f u l
Kannanyason and his mother visited Tzu
Chi , s Malaysia Klang Chapter. As soon as
they entered the chapter, a Tzu Chi volunteer
noticed that pus and blood were coming out of
his leg, leaving a bloody trail on the floor of the
meditation hall.
The volunteers took him to the nearby Tzu
Chi Klang Free Clinic for immediate treatment.
As soon as he uncovered his dressings, the
nurse was surprised to see his leg swollen
like an elephant’s leg. A strange odor was
noticeable.
Kannanyason remembered how much he
was touched when several nurses immediately
came to treat his wound. He also remembered
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Medicine With Humanity Vol. 3 January 2006

Kannanyason gets his right leg back
to normal after three surgeries, without
amputation.
had often gotten from other people.
N e a r t h e e n d o f 2 0 0 4 ,
Kannanyason received a phone call
from Tzu Chi’s Malaysia Malacca
Chapter, informing him that he could
go to Taiwan for medical treatment.
Although he was very happy to hear
that, he took it lightly. He told Tzu
Chi volunteers that if the doctors
in Taiwan also concluded that
amputation is the only cure, he would
come back to Malaysia immediately.
Alternative to amputation
the hospitality of the nurses. When they heard
that his mother was hungry, they even brought
hot food for her.
Since that day, the volunteers at Tzu Chi
Klang Free Clinic picked him up from his
home and took him to the free clinic for weekly
medical treatment. After a while, every time
when he stepped into the free clinic, everyone
including other patients would greet him like
greeting a good friend. At the free clinic, he
was no longer haunted by the strange stares he
Kannanyason’s insisting on no
amputation was a big challenge
that tested the skills of the medical
team in Taiwan. The medical team
consisted of doctors in plastic
surgery, orthopedics, anesthesia,
rehabilitation, nuclear medicine,
nutrition, nursing, and volunteers.
In a meeting before Kannanyason
’s arrival in Taiwan, plastic surgeon Dr. Lee
Chun-ta indicated in a presentation that
although he had seen other cases of secondary
lymphatic edema in the past, he had never seen
a tumor this big.
Dr. Chang Yao-jen, vice president of
Hualien Tzu Chi Medical Center, said that after
all the doctors in Malaysia and the specialists
in Taiwan carefully evaluated the case,
amputation was still their recommendation.
Knowing that it was against Kannanyason’s
Medicine With Humanity Vol. 3 January 2006 41

wish, they decided to do everything to save his
leg.
The doctors researched every medical
journal and publication, only to discover that
Kannanyason’s case was not only rare, but
it was also extremely difficult to treat. They
could not find an alternative to amputation.
After many discussions and evaluations, the
medical team decided to accept this impossible
mission and invited Kannanyason to Taiwan
for treatment.
Suffering going to be over
When Kannanyason first arrived in Taiwan,
he told everyone happily that his suffering
was finally going to be over. Even though
Kannanyason talked positively on the outside,
inside his heart, he thought it probably was
another futile trip.
However, as soon as he walked into Hualien
Tzu Chi Medical Center, he bowed in front of
the wall painting of Buddha healing a patient.
At that moment, his hope rekindled. The
thought that this was going to be a successful
treatment flashed through his mind.
In order to ensure the success of this
operation, the doctors must have a good
understanding of the possible side-effects
of removing giant tumors on the patient’s
circulation and metabolism. To estimate the
size of the tumor, Dr. Chen Ing-ho, a well-
Puerto Rico American volunteers Mr. and Mrs. Santiago come to cheer Kannanyason up. He wondered how could they
volunteer for Tzu Chi if they don’t speak Chinese.
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Medicine With Humanity Vol. 3 January 2006

To ease Kannanyason and his mother’s anxiety of coming surgery, hospital volunteers cooked their favorite curry rice
for them.
known orthopedic surgeon, used a technique
mentioned in the ancient Chinese tale of Tsao
Chung weighing the elephant.
He asked the head nurse to find a
large barrel with a wide opening that is
approximately the height of Kannanyason’
s knee. The barrel’s opening should be big
enough for Kannanyason to place his entire
right foot in it. Using the volume of water
displaced by Kannanyason’s right and left
calves in the water-filled barrel and calculating
the difference, Dr. Chen would be able to
tell how much more his right leg weighed
compared to the healthy left leg.
Dr. Chen patiently counted every ladle of
water, measuring the left leg first and then the
right leg. He estimated that right leg weighed
22 kilograms more than the left, which was
equivalent to the weight of a five-year-old
child.
According to Dr. Lee, Kannanyason’s
height was 178 cm. Before the operation, he
weighed 135 kilograms. The size of his left
thigh was 61 cm and his right thigh was 78 cm.
The circumference of his left calf was only 45
cm, but his right calf was 105 cm. His right calf
was twice as thick as the left calf.
Since Kannanyason first arrived in Hualien
on Dec. 23, 2004, the doctors conducted a
series of tests to confirm that the lymphatic
Medicine With Humanity Vol. 3 January 2006 43

After first surgery, Kannanyason takes
his first steps with a big smile on his
face and said: ”My foot is so light!”
edema in his right leg was indeed caused by the
lymphatic obstruction induced by the surgery
performed for the car accident. From MRI
(Magnetic Resonance Imaging) scan, they
concluded that the “elephant leg” was caused
by complete blockage of the right leg lymphatic
system, causing lymphatic fluid leakage from
the capillaries. Dr. Lee indicated that such
severe case of lymphatic edema was very rare
in the world.
Due to complete lymphatic blockage, the
surgeons were unable to use microvascular
techniques to divert the lymphatic circulation
into the veins. The fact that Kannanyason was
still able to drive and walk normally indicated
that the neurological functions in his right leg
was normal. Therefore, the doctors decided to
completely remove the tissues and skin of the
lymphatic tumor, followed by a skin graft.
Furthermore, due to Kannanyason’s diabetic
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history, the doctors decided to perform the
surgery in two phases. The first phase is to
remove the giant tumor, and the second phase
is to reconstruct the entire right leg, as well as
removing the area of lymphatic blockage.
Surgery lasts 10 hours
The first phase of surgery was performed
on Dec. 31. The entire surgery took 10 hours.
Because the tumor was filled with lymph, with
the first incision, lymphatic fluid and blood
flowed out profusely. They transfused him with
5,000 cc of blood product. The tumor removed
consisted mostly of fat and lymphatic tissue,
weighing 12 kilograms, with a thickness of 7
cm, width of 40cm, and girth of 65 cm.
Initially they estimated that the surgery
could be completed in four hours, but because
Kannanyason’s calf was thick and stiff, the
doctors were not able to control the blood flow
using pressure bandages. The duration of the
surgery extended to 10 hours.
For the right calf skin graft, two-thirds of
the skin was taken from the tumor, and the rest
from the left leg. The tumor even spread to his
toes. Dr. Chang indicated, “The specialists ,
initial recommendation was to amputate the
toes, but we were able to keep all the toes after
great care and treatment following the surgery.”
After the surgery, the head surgeon Dr.
Lee Chun-ta and anesthesiologist Dr. Shyr
Ming-hwang walked out of the surgery room
and informed Kannanyason’s mother, who
was waiting anxiously, that the surgery was
successful. Upon hearing this good news,
Kannanayson’s mother embraced Dr. Lee with
great excitement. She even got down on one
knee and kissed the hands of Dr. Lee and Dr.
Shyr. It was her way of expressing her utmost
gratitude and respect for them.
Because the surface area of right calf was
too big, two-thirds of the skin was taken from
the healthier part of the tumor. However,
because the tumor was colonized by bacteria,
despite antiseptic measures and antibiotic
therapy, the graft still became infected.
Following the surgery, Kannanyson was febrile
for several days.
After the fever defervesced, Kannanyason
finally got out of the bed and took his first steps.
With a big smile on his face, he said, “My foot
is so light! It feels like a cotton rod that is ready
to fly!”
After Kannanayson’s condition stabilized,
he was no longer getting fevers from the
infection. The second phase of surgery was
performed on Jan. 20, 2005. The doctors
removed the leg lymph nodes and treated the
infection in his right calf. The total duration of
There are three treatment options for lymphatic blockage:
In mild or moderate cases, lymphatic blockage can be removed
by microvascular surgery techniques.The lymphatic edema can be
completely resected, and then skin graft may be performed.In cases
where knee or ankle joints have lost their functions and have become
stiffened, amputation may need to be performed.
Medicine With Humanity Vol. 3 January 2006 45

the second surgery was five
hours. Blood transfusion
was not necessary this time.
The removed lymph nodes
weighed one kilogram.
The followed-up surgery
w a s o n F e b . 1 7 . T h e y
removed the excessive
tissue growth from the right
leg, and replaced it with skin
taken from the right and left
legs, a total length of 1,210
cm. The subsequent skin
condition was good.
Able to wear pants
again
After three surgeries
a n d t h r e e m o n t h s o f
rehabilitation, a farewell
party was organized for
Kannanyason’s discharge.
He finally was able to wear
pants, which he had been
longing to do for 15 years.
K a n n a n y a s o n t o l d
everyone with a less than
fluent Chinese, “Thanks to
Master Cheng Yen, thanks
to the doctors, thanks to the
Finally he can wear pants, which he had been longing for 15 years.
nurses, thanks to the volunteers for giving me a him a new life. His mother also stood up to
brand new leg.” The size of his right calf was give a speech, but she was already in tears and
reduced from 105 cm when he first entered the could hardly speak.
hospital to 45 cm at the end of his hospital stay. “Kannanyason’s trip to Taiwan signifies
Kannanyason said he was very grateful to a surgery that accomplished two impossible
Hualien hospital’s doctors for removing the tasks,” said Dr. Chang Yao-jen, who proudly
suffering that had lasted 15 years and for giving shared the experience. “One was to prove
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Before Kannanyason’s leaving the hospital, resident volunteer Ms. Yen sends him a pair of new sandals, blessing him
to walk on the bodhisattva path.
Kannanyason’s initial presumption wrong
that ‘Chinese people would never help an
Indian man.’ The second was to prove that ‘no
amputation’ was possible. We are so happy that
the medical team in Hualien hospital was able
to accomplish this impossible mission with all
the good wishes from Tzu Chi members all
over the world.”
Regarding treating the wound after leaving
the hospital, Dr. Lee reminded Kannanayason
that although the wound was recovering
well, the newly transplanted skin was still
very fragile. Within half a year, some of the
transplanted skins may possibly peel off.
Kannanyason must avoid cuts or injuries to the
new skin. If he ever gets hurt, he must go back
to Tzu Chi’s Malaysia Klang Free Clinic to
seek immediately medical treatment.
A relatively simple bone fracture operation
tragically turned into a foul-smelling, pusforming
tumor, tormenting Kannanyason for 15
years, whose strength and determination shined
through.
The medical team in Hualien hospital took
three months to turn Kannanyason’s wish into
a dream come true. His legs are now light and
agile. It was a continuous effort of Tzu Chi
volunteers, from Malaysia to Taiwan, then
back to Malaysia again. For the medical team,
they were only fulfilling their duties. But to
Kannanyason, it was a new chance to live
again.
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