Wyatt James Dunbar has just awoken from his nap. His eyes are sleepy but ready for action.
They dart around the living room, to the decorated Christmas tree, and settle on the strangers with camera and notebook. He smiles, jams his fingers into his mouth, and squirms around when he's placed on the rug for some "tummy time."
He's your basic adorable 7-month-old, straight out of central casting for the Gerber baby. When his mother, Ashley, takes him to the store, invariably an old lady will stop and gawk and make cutesy noises. "They'll say, 'He has such a perfect face.'"
If Dad Jeff is along, however, he'll start in with the whole story. He'll take out his iPhone and show a photo of Wyatt when he was just born. What the inquisitors see first confuses, then mystifies them. What is ... that? Is that his twin brother, nestled next to him? No, that's Wyatt. The thing next to him is attached to him, and it's larger than his head.
"I carry the photo to remind me how lucky we are he made it through that," Jeff says.
When Wyatt was in his mother's uterus, a tumor began growing inside Wyatt's neck. When it was first discovered, about 21 weeks into his 40-week gestational period, the tumor was about the size of a golf ball. But it kept growing, and the closer Wyatt's due date got, the faster it grew. There was no way to know whether he would survive, and if he did, whether he might have a permanent disability.
"What I wanted to do was crawl up in a ball and cry," Ashley said. "But I knew I couldn't do that. ... I knew I was meant to be his mother, whether that was 50 years, or the nine months I got to carry him."
Wyatt was born May 16 at UCI Medical Center, an event engineered by a small army of physicians, nurses and technicians. UCI handles many of these kinds of challenging deliveries, but that didn't make Wyatt's case any easier. His birth was months in the planning, requiring painstaking coordination and precise skill.
What's in there?
The thing growing in Wyatt is called a teratoma, a mass of tissue most commonly found on a woman's ovaries. When it grows in the neck it's called a cervical teratoma.
Teratomas can be composed of a wide variety of tissue types, which is why doctors have found odd things inside them. They've found bone, cartilage, brain cells and even hair and teeth. Remember the movie "My Big Fat Greek Wedding"? When Aunt Voula told the guests about the "twin" with the spinal column that was growing in the lump on her neck? That was probably a teratoma.
Wyatt's mass was mostly liquid, which is why it grew so quickly: Something in there just started secreting fluid. But its location presented problems: It was concentrated on the left side of his neck, and there are many delicate structures there. It pushed upward enough that his jawbone was moved around. Then the worry was that it had compressed his windpipe, and that he would suffocate during delivery, before his airway had been secured.
Babies in the womb breathe through their mothers, with oxygenated blood delivered through the placenta and into the umbilical cord. When Ashley and Jeff were referred to UCI, doctors put together a dream team of specialists to hash out a plan.
Jeff and Ashley, both 26, also were there, and they had done their homework, doctors say. They stayed calm, and were equal partners in the planning.
"This couple in particular stands out," said Dr. Manuel Porto, an obstetrician at UCI who specializes in high-risk pregnancies. "For a couple that was on the young side, they kept a very even keel. They asked incredibly poignant and appropriate questions. ... They were a pleasure to work with from the get-go."
How it went down
The delivery was scheduled four weeks before Wyatt's due date. That's because the team needed to be assembled far ahead of time. Also, if Ashley had gone into labor on her own, the risk to both her and the baby would have been much greater. When Ashley was wheeled into the operating room, more than 20 people were already there ? one crew tending to the mother and another devoted to the baby. "I'll never forget the energy in that room," she said. "It was like game day."
The last thing Ashley remembered before she went under general anesthesia was someone saying, "We can fit three between the legs." It's not a sentence most women want to ever hear.
First off, Porto inserted a needle and drew out 500 cubic centimeters (16.9 ounces, larger than a Grande drink at Starbucks) of the fluid from the tumor. That shrunk it considerably, but it was still massive.
The UCI team had agreed the best course was a complicated procedure called an EXIT, which stands for ex utero intrapartum therapy. It's essentially two operations at once: First the baby ? in this case, Wyatt and his giant tumor ? is brought out using a standard Caesarian section, an incision in the belly and into the woman's uterus.
What happened next was critical: Since Wyatt's airway was blocked by the tumor, they had to keep him breathing through the umbilical cord until his trachea could be opened up. In a normal birth, you want the mother to push, contracting the uterine muscles to shut off the supply of blood to the placenta as the baby comes out.
"We want to keep the fetal circulation through the placenta to the mother intact and as vibrant as possible until the airway is secured," Porto said.
Porto brought out just the head and an arm, so a monitor could be attached to Wyatt's tiny finger. Basically, he was still a fetus, being nourished by his mother, even though he was outside her body. Then the pediatric head and neck surgeon in the room, Dr. Gurpreet Ahuja, went to work. He quickly found the trachea, and a breathing tube was inserted.
Even with a massive tumor attached to him, Wyatt was safe for now. He weighed 5 pounds, 13 ounces, but the tumor, despite the drainage, weighed an estimated 1.1 pounds.
Tumor removed
Ashley and Jeff couldn't hold their son right away. He was under heavy sedation for two weeks. The tumor still had to be cut off.
The doctors could have done so right away, but they decided to wait to study the thing. They found that his left carotid artery was stretched around the tumor. "Multiple nerves were intimately related," Ahuja said, including the most critical, the facial nerve. An angiogram was conducted, providing a vascular roadmap of Wyatt's head and neck.
In an operation that lasted more than five hours, Ahuja and a colleague, Dr. William B. Armstrong, removed the tumor. "I'm pretty confident we got it all out. You can never be 100 percent certain of that, but we're pretty certain," Ahuja said.
On June 27, after six weeks in the hospital, Wyatt went home with his parents. It was Ashley's birthday.
Life at home
Wyatt has overcome some developmental problems. At first, his head craned to the right, the result of being displaced by the tumor for months. But he's been doing stretching and other exercises with an occupational therapist, which has helped. Also at first, he couldn't handle breast milk, even from a bottle. But now he's breast-feeding.
"He's almost right on track of where a baby should be," Ashley says.
One of his vocal chords was distended by the growth, leaving him with a raspy "smoker-man" voice, his mother said. But when he cries out, it sounds more normal. "He's definitely got some pipes," Jeff says.
Awhile after Wyatt woke up, his sister, Delaney, came into the living room, bleary-eyed. She's the one who came up with the name Wyatt, the hero of her favorite PBS Kids show, "Super Why!" She thought of it as they rode the giant Mickey Ferris wheel at Disney's California Adventure, back when her parents had just learned of their unborn child's condition. "We were trying to take our minds off how scared we were," Ashley says.
She and Jeff are confident and hopeful. They live with her parents, Jackie and Ron, in Fountain Valley, and it can get tough sometimes, especially since Ron, 50, has been battling Stage IV colon cancer. Ashley's sister Lindsay James-Wong has a 15-month-old daughter, Mackenzie, who was born with a serious heart ailment, as well as a disorder that left her arms shorter than normal.
How much adversity can one family take? Yet they know how lucky they are.
Case in point: Jeff works as a special-education aide at Westminster High School, but he also works at an Apple store. Just after they found out Ashley was pregnant, Jeff was offered a full-time job at the store. He already had health insurance as a part-timer, but the full-time gig allowed him to upgrade to a better PPO plan.
Jeff reads aloud his total medical bills, for Ashley's and Wyatt's care: 1 million, 235,000 dollars. The vast majority of it paid by the insurance company.
Last year, at Christmas, the Dunbars told their family they were expecting the child that would become Wyatt. This year, the house was filled with family again, and again they're celebrating.
"There's nothing about this that didn't have a divine feeling to it," Jeff says.
Contact the writer: lhall@ocregister.com or 714-796-2221
Source: http://www.ocregister.com/articles/wyatt-381756-ashley-tumor.html
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