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.
"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."
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.
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."
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