Upper respiratory infections aren鈥檛 uncommon during winters in Waco, Ky., but Caroline Cain had a lot of them.
Caroline鈥檚 distress was enough to warrant chest X-rays to rule out pneumonia. While her imaging showed no signs of a bacterial infection, there was something else. A small mass in Caroline鈥檚 mediastinum 鈥 the area between the lungs 鈥 was noticeably larger compared with X-rays from previous years. Her family pediatrician referred them to a pulmonologist 鈥 a doctor who specializes in respiratory issues 鈥 who delivered even more concerning news.
鈥淭hey said, 鈥楾his doesn鈥檛 look like a pulmonary etiology,鈥欌 said Elizabeth Cain, Caroline鈥檚 mother.
Instead, they told Elizabeth, the family needed to see a cancer specialist.
鈥淢y world felt like it had shattered at that point.鈥
Discovering a tumor
A tumor had been growing inside of Caroline for three years. That much was known before the family met鈥, who works in the 鈥痑迟鈥 (KCH). Harrington, a children鈥檚 cancer specialist, ordered the labs and additional imaging that helped confirm the nature of the tumor.
A biopsy eventually led to diagnosis of a ganglioneuroma, a rare tumor of the fibers in the autonomic nervous system. Ganglioneuromas, sometimes called ganglioma, tend to occur most in young women and girls, but, fortunately, are rarely cancerous.
鈥淐aroline鈥檚 presentation was typical in that it was found incidentally and had been present for years,鈥 Harrington said. 鈥淭hese benign tumors don鈥檛 usually cause symptoms.鈥
An MRI鈥痵howed the tumor originated from the lower area of her spine and was getting closer to Caroline鈥檚 renal arteries, which provide oxygen to the kidneys.鈥
Elizabeth, a registered nurse, and Caroline鈥檚 father, Chad, did their due diligence and decided鈥, the pediatric surgeon with whom the family had been in conversations at KCH, would perform the necessary surgery.鈥
鈥淚 mean, there was just really no choice in my mind,鈥 Elizabeth said. 鈥淚 just felt comfortable at UK, and that鈥檚 where I wanted to be with my child.鈥
Caroline, who was 6 years old at the time, latched on quickly to 鈥淒r. Eric,鈥 and continues to ask about him now that she has recovered. She was as invested in her care at UK as her parents.
鈥淐aroline is an energetic, sweet and thoughtful girl,鈥 Rellinger said. 鈥淪he asked a lot of questions that reflect her natural curiosity towards medicine. Caroline has been steadfast throughout her course of treatment, and her strength and trust in our team was inspiring.鈥
An advanced surgical option
After many conversations, Caroline鈥檚 family and her care team at KCH landed on thoracoscopic surgery as the best way to remove her tumor and provide the best outcome.
Thoracoscopic surgery, or video-assisted thoracic surgery, is a minimally invasive alternative to open-chest procedures. A surgeon makes small incisions in a patient鈥檚 chest wall and uses a thin tube with an attached camera 鈥 a thoracoscope 鈥 to visualize the chest cavity through one of the incisions. The surgeon then operates by guiding instruments through the other small incisions.
Thoracoscopy has been performed at KCH for more than a decade, but its use in the removal of ganglioneuroma and similar tumors is just gaining popularity. KCH sees about two or three patients with ganglioneuroma each year, and Rellinger previously had great success using thoracoscopy to remove them. However, the location of Caroline鈥檚 tumor 鈥 extending above and below the diaphragm 鈥 presented a bigger challenge.鈥
Typically, he said, tumors like Caroline鈥檚 require a more invasive approach. Rellinger prepared Caroline and her family for a worst-case scenario. If the original plan didn鈥檛 pan out, she would end up with a large incision from her armpit to her abdomen, leading to a longer hospital stay and a large scar she鈥檇 carry for life. A more invasive surgery would also heighten Caroline鈥檚 risk for future issues related to the chest wall, like scoliosis.
鈥淜nowing the risks and benefits, I felt strongly that trying a minimally invasive approach was what I would want for one of my own children,鈥 Rellinger said.
鈥業t鈥檚 going to be OK, Mommy鈥
Caroline was a rock leading up to her surgery.
鈥淪he didn鈥檛 really have a care in the world,鈥 Elizabeth said. 鈥淪he kept telling me, 鈥業t鈥檚 going to be OK, Mommy.鈥 We had a prayer bear that some people from our church bought her, and prayer cloths and a rosary. She never really showed any fear. It was pretty amazing.鈥
Elizabeth鈥檚 emotions, on the other hand, ran high, especially on the day of surgery. The reassurance she got from Caroline鈥檚 care team helped steady her.
鈥淭he head of anesthesiology came in the morning of her surgery and sat down with me as a mother,鈥 Elizabeth said of . 鈥淵ou don鈥檛 see that out of every health care provider. She had tears in her eyes, I had tears in my eyes. She sat there with me, as a mom, just for a moment in time. I still have a picture of her and Caroline sitting on the bed, so happy together.鈥濃
Hall admired the family鈥檚 bravery throughout a terrifying time, and is proud to have played a crucial role in their care, medically and emotionally.
"As a parent, I take the responsibility of anesthetizing someone's child very seriously and treat them how I would want my own child treated,鈥 Hall said. 鈥淭he last thing I tell babies and children before they go to sleep is 鈥業 love you,鈥 and I absolutely mean it. The moment I stop falling in love with every child I care for, I need to find a new career. But I don't see that ever happening.鈥
Plan A worked: Rellinger was able to resect Caroline鈥檚 tumor 鈥 about four inches long, or the width of a typical smartphone 鈥 through the less-invasive procedure, allowing for a speedier recovery and decreased risk of infection.鈥
During her short hospital stay, Caroline found joy in the people who cared for her. In addition to 鈥淒r. Eric鈥 and others involved with her surgery, she loved chatting up the nurses who visited her. One, a travel nurse named Maddie, had a name badge colored like a cow that she still talks about.
鈥淐aroline loves鈥楾wilight,鈥 and her nurses actually decorated her door with鈥楾wilight鈥欌痵tuff,鈥 Elizabeth said. 鈥淎nd they gave her a card when she was being discharged. They took time to do stuff like that.鈥
While she had about as smooth and enjoyable a hospital experience as a kid can have, Caroline was excited to return home to her dogs, cats and cattle. She has an affinity for gymnastics and cheerleading and now gets to take to the mat with a couple of tiny scars and a carefree spirit.鈥
Her follow-up imaging has shown no signs of the tumor coming back or complications from her surgery 鈥 a procedure that will continue to offer hope for kids just like her.
鈥淢y goal each day is to try to make the greatest impact that I can to advance the care of children here in the Commonwealth and beyond,鈥 Rellinger said.鈥
鈥淪ome days that involves operating,鈥 he said. 鈥淪ome days that entails performing research. And other days, it is focused on inspiring groups 鈥 to build clinical programs to advance what our health care system has to offer for the children and families we are privileged to care for.鈥