Seamless care from Monterey to Palo Alto saves baby with brain cyst

Karina Barger and her husband David Goldman noticed something unusual with their 2-month-old son Bobby. He was consistently looking to the left and couldn’t bring his eyes to look straight ahead. Barger felt a “little embarrassed” to be calling for a doctor’s appointment about what could be a minor symptom, but the couple felt something might be seriously wrong with their son.

Todd Dwelle, MD, Bobby’s pediatrician at the Pediatric Group of Monterey — part of the Stanford Medicine Children’s Health care network — saw them an hour or two after they called the office. At the appointment, Dr. Dwelle picked up Bobby, turned him in a circle and noticed his eyes weren’t tracking the room.

“It was not normal eye movement,” says Dr. Dwelle, who placed a call with a local neurologist and went through Bobby’s symptoms with Bobby in the room. They decided that Bobby needed to be seen immediately. Dr. Dwelle called the Pediatric Emergency Department at Stanford Health Care to let them know that the family was on the way.

“I have four kids,” says Barger. “I’m a working mom, and I’m a teacher. I’ve seen it all. It takes a lot for me to bring my kid to the doctor’s office.” Barger felt that Dr. Dwelle was sensitive to the urgency of the moment and the family’s need for clear, compassionate guidance. “He said, ‘You need to get in your car and drive directly to Stanford. Do not go home.’ I think he knew I needed him to say it to me just like that to take it seriously.”

The family drove straight to the emergency department. When they arrived, a nurse and doctor were waiting for them. “The fact that Dr. Dwelle was able to call ahead so that they were waiting for us when we got there was very reassuring. They knew we were coming, and they knew exactly what to expect when we walked through the door.” After an initial exam, Bobby was admitted to Lucile Packard Children’s Hospital Stanford, where an MRI was conducted, revealing an arachnoid cyst in Bobby’s brain. The cyst was positioned on his pituitary gland, which had been putting pressure on his optic nerve.

Before his retirement, Dr. Michael Edwards from the pediatric neurosurgery team performed the surgery to drain the cyst. “Dr. Edwards was absolutely, unbelievably amazing,” says Barger. Bobby’s parents were thrilled to learn that his tumor was benign, but they also understood how serious his risk had been. The pressure the cyst was putting on Bobby’s pituitary gland could have caused his breathing to stop, and — had they waited even a few days longer for Bobby to be seen — he could have lost his sight.

Even though he was on vacation, Dr. Dwelle, frequently called the intensive care unit to check in on Bobby as he recovered. The family was soon given clearance to return home.

Dr. Dwelle says that the close relationship between the Stanford Medicine Children’s Health, Pediatric Group of Monterey and Lucile Packard Children’s Hospital Stanford ensured seamless communication between all of the specialists involved. He added that this close affiliation also provided convenience for the family. “Bobby and his parents didn’t have to drive up to Stanford for frequent check-ups because of the local presence here,” says Dwelle.

Barger feels that one of the reasons Bobby’s outcome has been so successful is the coordination between Dr. Dwelle and the entire Stanford Medicine Children’s Health network of specialists. “He knew the system well enough to send us to Packard Children’s, where we’d get the exact care Bobby needed.” She added that the coordination of services within the network made it much easier for her family to endure and recover successfully from a difficult situation.

Dwelle also finds the fluid communication between his practice and the Stanford Medicine Children’s Health network and the ability to ask questions in real time to be huge assets. “The ability to quickly run things by Stanford specialists in real time helps us as pediatricians deliver that specialty level of care to more people in our community.”

Bobby has made a full recovery and is a healthy 13-month-old baby with only a thin scar around his head from the surgery. He’s walking and talking, and instead of just looking left, he’s looking around in every direction.

Barger says the family has been “incredibly happy” with the whole Stanford Medicine Children’s Health network. “It’s nice that it’s just been this one system we’ve been able to stay within. And not just any system, but the best system in the world. It couldn’t have possibly ended any better for our family.”