Saturday, July 9, 2011

Kids and Cancer

Posted by Jenna at Saturday, July 09, 2011

I'm not sure where the summer went! Rotations will be starting in 3 weeks and I'm excited but definitely nervous. For those of you that don't know me, I'm Jenna. I'm originally from Upstate NY and did 3 years of undergrad at the University at Buffalo before coming to UofM. My passion is pediatrics and has been pretty much since I walked into the doors of CCLittle 3 years ago. Some may find pediatric pharmacy practice scary, after all, much of what's done is a 'best guess' since there aren't many pediatric clinical trials. But, I love it and I love helping adorable kiddos!

I spent my summer working on a variety of projects, all of which are peds related: my PharmD project with NICU (neonatal intensive care unit) pharmacist Dr. Mehta, restructuring the pediatrics elective with the Peds ID (infectious disease) and Peds Surgery pharmacists Dr. Klein & Dr. Blackmer respectively, a case report with the PICU (pediatric intensive care unit) pharmacist Dr. Beckman, and an article for the PPAG (pediatric pharmacy advocacy group) KidsMeds website. If you haven't learned already, pharmacy (and medicine, in general) is full of acronyms!

I would definitely recommend identifying faculty that have similar interests to your own (if you know what you're interested in). Get to know them and let them know you have an interest, many times they would love to have you help out with their writing projects. This is a great way to spruce up your CV and establish good relationships for letters of recommendation and future networking!

I unfortunately did not get my first choice rotation, the Peds Hem/Onc rotation with Dr. Erika Howle, so I decided to set up an experience for myself. I met Erika in March, when I attended the PPAG Conference in Memphis, TN and I felt comfortable asking to shadow her for a week. I'm thinking that this is where I'd like to end up practicing but with such an emotionally charged area, I wanted to have some experience first before identifying this as my passion in residency or job interviews. Like peds in general, peds hem/onc scares a lot of people and most people's reaction to my interest in it is 'How can you (emotionally) do that?' or 'How are you going to deal with kids dying?' or 'That's going to be so sad.'

To be perfectly honest, I'm not positive that I can emotionally deal with a baby, child, or teen dying, especially from cancer, so that's something I need to find out. But the reason I see myself practicing here is because you can learn so much from these kids. They are so resilient and have the best attitudes about life. They're getting potions of toxic medications and yet they still find the strength to run around and play like 'normal' kids. There is something to be learned from each child you encounter and often times that lesson is: you have it good, stop complaining and live your life to the fullest! For every sad, heart-wrenching story there are several joyful stories to help buffer it. I'm sure that experiencing losing my first patient, especially my first pediatric patient, will be incredibly difficult and is something that I'm not looking forward to, but it is something I'll need to learn to handle regardless of whether I end up in peds hem/onc. In the end, you're helping patients, and whether that means a cure or making them comfortable, you're doing everything within your power - and that's all you can do.

(The above was written before a week of shadowing in Peds Hem/Onc)

It was a somber day on the unit, having lost a teen AML (acute myeloid leukemia) patient late last week. Everyone on the peds hem/onc team seemed to be pretty shaken by his passing, which happened sooner than expected. He was diagnosed in February and had been admitted since then. He seemed like a complete sweetheart, who had incredible faith and optimism despite his poor prognosis.

There are currently 7 patients on the unit (the average is ~12), 4 of which unfortunately don't have a great long-term prognosis. The patients ranged in age from 20 months to 20 years old and included: ovarian cancer, pre-B cell ALL (acute lymphoblastic leukemia), osteosarcoma with lung metastases, AT/RT (atypical teratoid/rhabdoid tumor), high risk neuroblastoma, and sickle cell disease.

The majority of pediatric oncology patients are placed on a COG (children's oncology group) protocol. The treatment names consist of a combination of letters & numbers such as ANBL0532, AOST0331, and AALL0232. The second, third, and fourth letters let you know what type of cancer you're treating, so the example protocols are for NBL (neuroblastoma), OST (osteosarcoma), and ALL. The peds hem/onc group has a handful of CPG's (clinical practice guidelines) that are good resources for students, interns, & residents to use for the treatment of chemotherapy-induced adverse effects. They include guides such as the treatment of: N/V (nausea/vomiting), TLS (tumor lysis syndrome), neutropenic fever, and different chemo toxicities as well as a guide to infection prophylaxis (for PCP - Pneumocystis jiroveci (carinii) pneumonia- and bacterial, fungal, or viral infections).

I think that's enough for one post - stay tuned for an explanation & treatment of some of the acronyms used in this post!


Valener L. Perry said...

Excellent article with insight Ms. Bognaski on pediatrics. Keep your blogs coming as all need to consider your well thought out commentary regarding your future with children. All my best, Asst Dean Perry

Jenna said...

Thank you Dean Perry! Peace :-)