Meet Out Survivors: Coulter Hnatt

Coulter Hnatt, like many preschool boys, has favorite superheroes. Exuberant and playful, he roots for his good guys to win. It is no surprise that Coulter’s experience at the Proton Therapy Center can be summed up like a comic book headline: Beam versus Rock.

Rock—this story’s bad guy—is the name Coulter gave to the tumor in his brain, and good guy Beam is what Coulter calls the proton radiation beam that MD Anderson physicians used to defeat Rock.

Doctors in College Station, Texas, discovered Rock, an ependymoma, in mid-May 2012 after becoming ill on a family trip.  Coulter underwent CAT scan and MRI testing—the results of which showed a brain tumor. He was immediately sent to a children’s hospital in Houston for surgery the following morning.

As he was taken back into the operating room, Coulter looked at his parents and said, “Let’s get this Rock out of here!”

Knowing Coulter would require radiation treatment after surgery, the Hnatts were concerned about the possibility of cognitive impairment that can develop as a result of radiation. Anxious to find other options, they began online research and discovered proton therapy.

“Once we learned about proton therapy, we talked with our physicians, read online testimonials, and received feedback from family and friends,” his mother Courtney said. “It was clear that the MD Anderson Proton Therapy Center was the best option for Coulter.”

Coulter’s maternal grandmother, MacKay, said the benefits of proton therapy for a child like Coulter made the decision to come to MD Anderson easy: “His tumor was right on the brainstem which controls everything in life; to be able to control the radiation to the point you can with proton is incredible.”

“Coulter’s tumor location was an important factor in considering what treatment option would be best for him,” said Coulter’s physician, David Grosshans, M.D., Ph.D., and assistant professor in the department of radiation oncology. “We wanted to limit unnecessary radiation dose to other areas of the brain thereby allowing for normal development and growth. Proton therapy allows us to do that.”

Courtney and Coulter moved temporarily to a Houston apartment near the Texas Medical Center. Dad Michael anchored their home in College Station with their 18-month-old daughter, Audrey. Grandmother and Grandfather, MacKay and Bill, were able to accompany Courtney and Coulter to Houston and became a major part of the in-person support system. Courtney, expecting the couple’s third child, had entered her third trimester.

“Since College Station is relatively close to Houston we were able to spend some weekends at home in College Station with the whole family. That was a huge help in feeling normal during his treatment. Coulter was even able to go swimming!”

On June 13 Coulter began his daily proton treatments, Monday through Friday, for 7 weeks. Kelly Wagner, child life specialist at the center, played an integral role helping young Coulter feel more comfortable during treatment.

Using a medical play doll named Alex, Kelly taught Coulter about the proton therapy process so he knew what to expect. Kelly and Alex walked Coulter through the steps, including how to wear the treatment mask that aligned Coulter’s head perfectly in place for Beam to do its good work.  

Active and sports-minded, Coulter had never shown interest in playing with dolls. He loved Alex so much, though, that his treatment team made him his very own medical play doll, which he also named Alex.

The bond that formed between Kelly and the Hnatt family, especially Coulter, was powerful. “She became like part of the family,” said MacKay. “When treatment ended, Coulter said he was going to miss Kelly so much.”

Throughout his treatment Coulter remained an active, playful little boy, running through the waiting room to the toys in the children’s play room each morning. Courtney said that his side effects from treatment were minimal.

“It was remarkable,” she noted. “Very little hair loss, a little nausea but no vomiting and minor fatigue.”

MacKay and Courtney took Coulter on frequent explorations after his morning treatments, including the Houston Zoo, the Aquarium, museums, Space Center Houston, and even the beach on Galveston Island.

Coulter wasn’t the only one who had a pleasant experience at the proton center. Michael and Courtney did as well.

“There is so much care and love from the staff,” Courtney said. “Everyone knows your name; it’s just very personalized.”

On July 31, Coulter completed proton therapy and hit the gong in celebration. Looking back on their experience at the Proton Therapy Center, Courtney said, “I couldn’t fathom complaining about anything because everything was so wonderful.”

In the end, Beam defeated Rock and Coulter is back home in College Station being an active, growing big brother.