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Paediatrics

CHILDHOOD CANCER A 360° PERSPECTIVE

By | Oncology, Paediatrics | No Comments

CHILDHOOD CANCER A 360° PERSPECTIVE

With guest speakers

Dr Shankar

CLIC Sargent representative

Lucy Northrop – childhood cancer survior

 

‘CHILDHOOD CANCER A 360° PERSPECTIVE’ proved to be another popular, and inspiring Medsoc Monday. Childhood cancer is a tragic but often treatable phenomenon that affects many families in the UK. Currently, over 3,600 children are diagnosed with cancer in the UK each year. The most common forms of cancer in childhood are leukaemia, lymphoma, brain tumours and sarcomas.   Research into treatment is happening all of the time and as a result success rates and cure are an ever-increasing trend. Fifty years ago, three quarters of children diagnosed with cancer died; now two thirds survive. Although diagnosis is undoubtedly the biggest challenge many families will ever face, some childhood cancers hold a reassuring cure rate of up to 99% for example in Retinoblastoma – a tumour of the eye. Despite this, families and individuals require significant support from medical professionals and charities in order to overcome the challenge.

Our event looked to collaborate the experiences and expertise of many different individuals involved in the presentation, diagnosis, investigation, treatment and long term effects of childhood cancer diagnosis.

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We commenced with a thorough, detailed account of the varying forms of childhood cancers, death rates, common signs and symptoms and potential treatment options. This was in the form of a lecture from experienced Dr Shankar, a consultant paediatric oncologist from UCLH. He provided us with many impressive statistics on how treatments are becoming increasingly effective and included some excellent graphical evidence. Dr Shankar also demonstrated the aggressive nature of childhood cancers and also the side-effect heavy nature of the impressive but invasive treatments. He emphasised some sobering life-long repercussions of a childhood cancer diagnosis that can often be forgotten about in the excitement of cure.

Next, we were lucky enough to host a social worker from CLIC sargent the childhood cancer charity we were supporting. Working at UCH this speaker was able to impart information about the great opportunities CLIC provides to patients and families across the UK following their diagnosis. We discussed the 4 main ways in which CLIC help – financially, clinically, practically and emotionally. It was fascinating to hear how simple initiatives such as providing rooms for patients and families to stay (such as the ‘Patient Hotel’ opposite Macmillan Cancer Centre, Huntley Street) can make such a huge difference. They are comfortable, safe places for families to stay free of the stresses of travel and expense of renting a room in central London. The CLIC representatives also take time to get to know the patients and their individual requirements. Having somebody to contact and turn to at any time is invaluable to many families. With limited time, we were only able to hear a snippet of how the charity helps – it was fantastic to get an insight into what a great cause the evening supported.

Finally, we were privileged to hear first-hand how it felt to be diagnosed and treated for childhood cancer with the support from CLIC. Lucy was an absolute inspiration in sharing her own experience of osteosarcoma diagnosis in her wrist a few years ago. Her incredibly well-written memoir outlined the multiple hurdles she and her family had to overcome following diagnosis. Lucy underwent difficult chemotherapy, multiple complications including many admissions to hospital with infections and an even more troubling course of radiotherapy and wrist fusion surgery. She admitted would have been lost without support from the hospital professionals and CLIC.Untitled2 She had a very close relationship with her CLIC representative who she describes as keeping them going. When treatment was not working as well as hoped and her mother became increasingly frustrated and began to lose hope in the treatment plan CLIC were able to patiently step in and explain the plan and sympathise with troubles. She describes how the charity were also supportive practically providing advice, accommodation and best of all a friendly face to talk to when things got too tough. Sadly, Lucy lost two friends she met in hospital to cancer. It was having somebody to talk this through with that helped her stay positive herself and maintain the strength to go out with friends to celebrate the end of chemotherapy. Lucy is now back at work and thrilled to have had the all clear from her cancer. She is aware that there will be complications later in life, not least, limited movement in the affected wrist. She astonished the audience with her determination and positivity.

Speaking to Lucy and her father, Edgar, afterwards, it was humbling to learn how much pressure the experience had really placed on the family. Against the odds, they remain optimistic, grateful and keen to spread work of their experience to thank charities such as CLIC and also help other children facing such a tough diagnosis. We are glad we were able to create a stage to express these amazing experiences and would like to say a huge thank-you to everyone who attended. We raised £38.46 and a lot of awareness for an excellent charity that works alongside families challenged by cancer all across the UK including locally at University College London Hospital.

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Our 1st event was a hit!

By | Paediatrics, Psychiatry | No Comments

 

MONDAY 3RD NOVEMBER: A PAEDSOC + PSYCHSOC JOINT EVENT

A record turn-out of MedSoc members, homemade cakes, bottomless wine glasses and a fantastic professional husband and wife team made for a magnificent MedSoc Monday event.   Last week, the UCL Harrie Massey Lecture Theatre was taken over by a host of enthusiastic medical students of all ages and stages in training.  The speakers – Dr Rory Conn a child and adolescent psychiatrist and Dr Chloe Bulwer, a paediatrician both currently working at ICH and Great Ormond Street provided an inspiring and engaging discussion of the overlap between the two specialties. Four cases were discussed.

Case one – constipation in a 7 year old boy with an anxious mother.  Key points of interest included the impact of missing school at this age, and the distinction between functional and medical causes of constipation.  Defaecating can undeniably become a psychological challenge particularly when previous fissures lead to an association with discomfort or pain of with parental obsession or despair when toilet training causes sensitisation to an essential daily task.  This case also highlighted, however, that paediatricians can deal with some psychological issues themselves. Interventions such as star charts, laxatives, exercise and normalising of toileting behaviour are possible without psychiatric input.

Case two – ‘fitting’ for a psychiatrist – explored the fascinating case of a young child having what appeared to be seizures. The child would frequently fall to the floor with no prior warning. These unexpected attacks would happen utterly randomly, whilst the child was mid-sentence or, even, whilst on the stairs. Interestingly, though, the child never sustained any injuries during these ‘seizures’ and would recover relatively quickly. It was these factors, combined with the impact upon the child’s life who was now frequently missing school, which led to the transfer of the case to the psychiatry team. After several meetings it transpired that the child had been feeling severely anxious about his transition to high school. Whilst this move was still 18 months away the child was feeling the pressure. Having aired these anxieties and learnt to deal with them the child’s ‘seizures’ stopped and he was able to return to a less stressful school life. Having touched upon the topic of seizures the case then allowed us to explore the varied nomenclature of seizures and the proposed stigma behind the label ‘pseudo-seizure.’

Case three – highlighted the importance of family trees in both paediatrics and psychiatry.  A lot of medical problems can be traced back directly, or indirectly, to other family health issues.  This strategy of showing natural linkage can help children to engage in and understand more the ‘why me?’ aspect of coping with a medical condition at a young age.  This case described a 15 year old girl with type 1 diabetes.  Her mother and sister, unusually, also had the condition and managed to keep their blood sugars under good control.  The 15 year old however had poor control with medically unexplained hypoglycaemic attacks and seizures.  Finding additional used insulin on the girl’s person prompted some handover from paediatrics to psychiatry.  Was this girl purposefully injecting insulin as an attempt at weight control, self-harm or attention seeking?  Although paediatricians are essential to ensure good management of this chronic condition, this would be imposssible without compliance from the patient.  Psychiatrics therefore become indispensible in investigating a patient’s coping mechanisms and attitude towards their diagnosis alongside illiciting a complete psychiatric history and management plan. Drs Conn and Bulwer discussed the difficulties of helping this girl who denied inflicting any problems on herself and the possibility or dissociative amnesia or genuine lack of awareness of her actions.  The case also highlighted the importance of family meetings and rapid response to potentially life-threatening scenarios.

Case four – raised some questions about handover into adult services.  In Australia, there are specialist psychiatrists for the age range 16-25 due to the complex and clear psychological challenges and changes at this time.  Potentially a very influential sub-specialty as 1 in 4 adolescents will attempt self-harm of some sort and, at this age, suicide, particularly male, is the commonest cause of death.  We discussed a 20 year old gentleman with an expansive pituitary tumour.  He was treated with Cabergoline, a commonly used dopamine agonist in Parkinson’s disease.  This massively reduced his production of prolactin and along with hormone treatment the boy completed puberty and reached his full height potential.  Physically, the endocrinologists were very pleased with this treatment response and, with the tumour location and spread, felt that surgery or radiotherapy were not desirable management options.  The paediatricians faced a new challenge when the boy experienced extreme, unanticipated side effects of the Cabergoline and decided to ask the psychiatrists for help.  The boy was experiencing what he perceived to be undesirable and uncharacteristic sexual impulses.  It is well-documented that some Parkinson’s patients can become impulsive with treatment for example beginning to gamble and shop excessively.  The boy was becoming distressed by his ‘need’ to masturbate, impulse to watch porn and potential attraction to males around him.  In this case, as the medication had to be continued, psychological input was essential to ensure that this highly functioning university student could keep the impulses under control so as not to jeopardize his social life, education or even future employment.  A hard balance to make but a nice example of multi-disciplinary teams weighing up the cost and benefit of a particular treatment ensuring the psychological impact is minimised.

With anonymous questions literally pulled from a hat between case studies we were able to facilitate discussion of taboo and difficult topics students may not have wished to have shouted out themselves.  These included how to pursue an interest in Psychiatry when faced by the stigma against the specialty from other professionals and even parents, which specialty creates the best dinner party stories and the variation in on-call rotas and responsibilities (don’t chose paediatrics if you want to sleep at weekends!).  Audience participation was relaxed and general atmosphere one of enthusiasm and enjoyment.  As psychsoc and paedsoc presidents we were thrilled to see so much interest in the two specialities and honoured to have such a generous and honest perspective from a couple of highly-experienced professionals.

 

To more events!

Signing off,

Elspeth and Rosie