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Caroline's Story

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Practice Makes Perfect

Excellence doesn't happen overnight.  It takes practice, practice and more practice.  Just ask 14-year-old Caroline Utt and WakeMed pediatric surgeon Dr. Duncan Phillips.  At first glance, you may think these two have nothing in common.

But when you look at how much they practice to achieve excellence, you realize it's "game on" for these two every day.

Caroline is a very well-rounded young lady.  She is a member of the National Junior Honor Society who also enjoys volunteering her time with her mother through the National Charity League.  In addition to schoolwork and serving her community, you will also find Caroline doing typical teenager things like having her nails done with friends and going to the movies. 

On top of all that, Caroline has a passion -- one that she feeds almost daily with practice.  Caroline is passionate about tennis.  Fueled by her desire to be like her big sister and to spend time with her dad, Caroline took up tennis at age 6.  By age 8, she was in her first tournament.  Since then, her tennis achievements have been plentiful.

  • Ranked among the top 5 in the state in her previous age groups (10 and under and 12 and under)
  • Ranked as high as 67th in the nation (12 and under)
  • Qualified to participate in USTA Zonal team tennis by playing on one of the South Region Zonal teams.  Other teams in this particular competition are from Florida, the Caribbean, Mid-Atlantic (Md/Del/PA/NJ).   

"We are most proud of Caroline's reputation as one of the fairest, most well-behaved players on the court," said Paul Utt, Caroline's father.  "Many parents have commented to us that they have told their children to emulate Caroline's demeanor and sportsmanship she displays on the court.  I believe Caroline takes pride in her balanced outlook toward the game enjoying success on and off the court with her peers." 

But Caroline had a small problem - about the size of an orange, in fact.  When Caroline was 3 years old, she was at a restaurant with her family.  As many 3-year-olds do, she fell while playing in the restaurant booth.  When she fell, Caroline struck the upper inside part of her left arm. 

A lump began to form, and, as it continued to grow, Melissa, Caroline's mother became worried.  After treatment for cat scratch fever had no impact on the growth, the Utts consulted a surgeon.  The lump under her arm turned out to be an acquired lymphangioma. 

A lymphangioma can occur when a collection of blood vessels and lymph vessels clump together or over grow.  They can be present at birth or they can occur later as a result of an injury.  In Caroline's case, that injury occurred when she fell in the restaurant at age 3.  Lymphangiomas are very rare and can be difficult to treat.  The Utts soon found this out.  The first surgeon they visited aspirated the lymphangioma, but it quickly returned. 

At age 5, Caroline had the lymphangioma surgically removed.  But, as she and her parents soon learned, lymphangiomas can be tricky.  Because the surgeon did not get all of the lymphangioma during the surgery, it quickly grew back again.

Because lymphangiomas are noncancerous growths and Caroline was not experiencing any pain, the Utts made the decision to postpone any additional lymphangioma treatment until new technology and expertise became available.

For the next seven years, Caroline continued to hone her tennis skills, practicing almost daily and finding time to hit with her dad each week.  At age 10, she earned a No. 1 state ranking among girls in her age group, and at age 12 she earned a No. 3 state ranking.

It was when Caroline entered her teens that permanent removal of the lymphangioma became a priority.  Though slow growing, the lump could eventually become painful, more difficult to remove and interfere with her ability to play competitive tennis.  And for an eighth grader looking forward to high school, the lump under her arm made Caroline feel self conscious.

A trip to pediatrician Dr. Thomas Bodenstine with her son actually led Melissa to seek out pediatric surgeon Dr. Duncan Phillips.  "I mentioned Caroline's lymphangioma to Dr. Bodenstine, and he said 'Melissa, you will love Dr. Phillips.  I really think a lot of him.'"

The advancements in technology and expertise that the Utts were looking for came in the form of magnetic resonance imaging (MRI) and Dr. Phillips, who, they would soon learn, was quite practiced in the surgical removal of lymphangiomas like Caroline's.

Before seeing Dr. Phillips, Caroline was scheduled for an MRI - something the other surgeons she went to earlier in her life could not do because of her young age. Then she went for a consultation with Dr. Phillips at WakeMed Children's

Caroline, her parents and even Dr. Phillips were surprised to learn that, as the MRI revealed, the lymphangioma was actually the size of an orange - much larger than they could ascertain from the smaller lump under her arm.  Dr. Phillips talked to Caroline about the lymphangioma and his plan to remove it.  "He spoke to me, not my parents," said Caroline about her visit with Dr. Phillips. 

Melissa added that he provided her with some medical journal articles about lymphangioma treatment and removal to help her understand why the earlier procedures didn't work and why the procedure he planned to perform would likely be successful.  Because lymphangiomas are rare, the surgical removal of them is even rarer. 

Fortunately for Caroline, Dr. Phillips has a good amount of practice with lymphangioma removal.  In comparison to some pediatric surgeons who may see just a few lymphangiomas throughout their entire career, Dr. Phillips performs approximately five lymphangioma procedures a year. 

With Caroline's MRI results as his "roadmap" and 15 years of practice under his belt, Dr. Phillips was able to safely and completely remove the lymphangioma.  Surgical precision proved to be a necessity because Caroline's lymphangioma was situated close to the ulnar and other nerves.  One slip would have meant no more competitive tennis for Caroline.

Caroline went home the same day she had the procedure.  Less than two months after her surgery, Caroline and her 16-year-old partner took the women's doubles title in a local tournament.  At age 14, Caroline often plays played in the 16-year-old age group.

Caroline's goals related to tennis also ring true as words of wisdom we can all live by:  "I want to take it as far as I can go and be as good as I can be." 

Keep practicing, Caroline.  You are clearly on the road to excellence.


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