13 years, 82 surgeries: One battle with HPV and The Birmingham News By and The Birmingham News The Birmingham News
on March 29, 2009 at 12:40 PM, updated February 15, 2010 at 2:46 PM

Dr. Brian J. Wiatrak, a pediatric otolaryngologist at Children's Hospital, looks down the throat of Dayton Danner for growths that clog the 13-year-old's airway. The growths are caused by human papillomavirus and must be removed about every six weeks. Otherwise, Dayton would suffocate.

Fighting for life is a way of life for 13-year-old Dayton Danner. Since age 2, he's been undergoing operation af­ter operation, needle stick after needle stick, anesthesia after anes­thesia, only to repeat the process a few weeks later.

He had his 82nd surgery Wednesday -- his second this year, following a Feb. 11 operation.

Dayton is on the front lines in the war against human papillomavi­rus, HPV. When he was born, or shortly thereafter, he was infected with HPV type 11.

The bug colonized Dayton's air­way, causing persistent, non-can­cerous but suffocating growths. He goes to Children's Hospital about every six weeks to have the growths cut out by Dr. Brian J. Wiatrak, a leading authority on Dayton's dis­ease -- recurrent respiratory papil­lomatosis, RRP.

The condition is rare, but the virus that causes it isn't. Over the past 25 years, scien­tists have learned that HPV in­fections are as common as colds and responsible for a va­riety of health problems. There are more than 120 types of HPV, and everybody carries at least a few. Many are harm­­less, but others can be life threatening.

Some are sexually trans­mitted, but these viruses are so infectious that they can be transmitted through casual touch, too, given the right cir­cumstance. Studies show that 75 percent of U.S. adults have contracted a genital HPV in­fection by age 50. The most obvious and dan­gerous infections strike women. When left untreated, HPV infections of the cervix can evolve into cancer. That's why more than 50 million U.S. women undergo Pap tests an­nually.

HPV can also cause cancers of the penis, anus, skin, throat, neck, tongue, tonsils, lungs and larynx. The virus can strike wherever our bodies come in contact with the world -- our skin externally and mucosal tissue internally.

Worldwide, HPV kills about 1,200 men and women every day, primarily through can­cers. In the United States, HPV rivals its distant relative HIV in running up billions of dollars a year in medical costs, according to one recent study.

A new vaccine, Gardasil, prevents genital HPV infec­tions. But it's expensive, con­troversial and given only to women and girls. Researchers at the University of Alabama at Birmingham are working on better vaccines and searching for new treatments despera­tely needed for patients like Dayton.

Tara Parr, a registered nurse at Children's Hospital, pulls a catheter from Dayton's arm. He says that he's had so many needle sticks that they don't bother him anymore, but his face tells a different story.

Dayton's day Dayton has been in Child­ren's Hospital so often that surgery is actually a pleasant experience for him, says his mother, Kara Smith of Home­wood. He gets the same nurse, same doctor and same operat­ing team. He loves them, and they love him.

"This is like his favorite day of the month," she said. "He gets doted on, one-on-one."

Outside Dayton's room, Wiatrak looks weary when told the boy is enjoying him­self. "That's sad," he says.

Medicine, even when given with spoonfuls of sugar, is a poor substitute for a normal childhood.

There are other problems, too. The hallmark of Dayton's disease is a permanent hoarseness, making him barely audible. Schoolmates started calling him "Froggy," and his mom pulled him out of class and started home­schooling because of the emo­tional pain the nickname in­flicted.

"Until middle school it's been fine," Smith said. "Now, he's starting to get picked on."

Breathless surgery
The actual surgery is quick and efficient but a little alarm­ing to watch, since it involves actually stopping Dayton's breathing for about three min­utes at a time. Doctors satu­rate Dayton's body with pure oxygen and shut down his breathing while Wiatrak in­serts scopes and special in­struments to buzz away air­way growths.

Using this "apnea" tech­nique, a monitor beeps away, as an anesthesiologist watches a gauge to determine when Dayton has depleted his oxy­gen and needs another load. Beeps get closer and change pitch when it's time.

"He's got a lot of good pul­monary reserve," Wiatrak said. "That lets us go for a long time."

After about three minutes, Wiatrak removes his tools from Dayton's throat, and a tube is inserted to pump oxy­gen.

When Wiatrak goes back in, he uses a combination camera and magnifier to examine Dayton's windpipe and spot growths. Most of them are around Dayton's vocal cords, thus the reason for Dayton's hoarseness.

"That's the larynx, and that's a papilloma bulging right there," Wiatrak says as he uses a tiny instrument that both cuts and vacuums away the growth.

When done, he uses a long needle to inject a vaccine, normally used to prevent measles and mumps in child­ren, around Dayton's larynx. It's an experimental treatment that sometimes triggers an im­mune response that helps keep HPV at bay. It works on some patients; it doesn't on others. Doctors aren't sure why.

There's not much research on RRP because there just aren't enough patients, Wia­trak said. He practices with two other pediatric ear, nose and throat specialists, and be­tween them they have 25 pa­tients with the condition. Na­tionwide, there are about 14,000 child and adult RRP patients.

There's no cure for RRP, but much of it could be prevented if everybody were inoculated, Wiatrak said. Gardisil, a vac­cine approved by the FDA in 2006, protects against HPV types 6, 11, 16 and 18. In addi­tion to RRP, these types cause most genital warts and most cervical cancer. The vaccine could cut RRP cases, since doctors believe babies pick the virus up from their moth­ers.

"I think everyone should get vaccinated," Wiatrak said. "But who's going to pay for it? I don't have answers to any of that stuff."

Dayton has a pretty good chance of living a long life. Of­ten, RRP symptoms improve after a child goes through pu­berty. Then, operations may be required only once or twice a year.

But it doesn't always go that way.

HPV casualty
Micah Harper was diag­nosed with RRP when he was 2 and endured 103 operations before he died at age 19, two years ago.

"He was a great kid," said his mother, Susan Harper of Hoover. "My son had no ene­mies. Everybody loved Micah -- guys, girls, teachers. He was a gift from God to me."

Micah was being prepared for his 104th surgery at Child­ren's Hospital when a nurse noticed he was running a high fever. An X-ray showed he had pneumonia. The operation was canceled, and Micah was sent home with antibiotics.

"That Friday morning I heard him knocking on the wall because he could not speak very well," Harper said. "He looked at me straight in the face and said, 'Mother, I can't breathe.' And he dropped over dead."

A combination of RRP and pneumonia killed him, she said. "He didn't have a chance."

Micah's entire operating room team from Children's Hospital showed up at his fu­neral, Harper recalled.

"You don't see much of that," she said. "They loved him. This was his operating family."

HPV Dayton Danner surgery