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CA - in Kids

It's devastating, it's disastrous, it's heart-breaking, it's just saddening - when you talk about ALL, AML, CML, Lymphoma, Retinoblastoma, Neuroblastoma, Germinoma, Rhabdomyosarcoma, Osteosarcoma, etc - in children.

The good news is, it is a curable disease, the child can be cured of their diseases with the appropriate treatment and care.

The bad news is, the process of going through the treatment is disastrous, and the oncology emergencies situation such as Tumour Lysis Syndrome, hyperleukocytosis, anterior mediastinal syndrome, SVC syndrome & CVL sepsis is not uncommon. The common side effects from chemotherapy or even antifungal drugs that patient will be on includes nausea & vomiting, febrile neutropenia, bone marrow suppression, mucositis, hypertension, hyperglycemia / DKA, and tubulopathies causing electrolyte imbalance.

These are not that uncommon, judging on the amount of Blood C+S being done, and the number of patient came in for febrile neutropenia.

Worse still is when i witness child underging RT. I've seen RT in adults when i'm doing attachment in NCI, now i'm seeing 2 years old kid going through that, felt sooooo pity for them!

Yeah, i'm in paeds oncology ward for 2 weeks now, as a houseman, ranked the lower-most among doctors in the ward. So, i'm not treating or directly involve in the management of the patient, i'm just there in the ward, doing all the miscellaneous job including tracing results, running to the main lab (finally i counted officially that it took me only 5 minutes to walk from Institute Paediatric to the Main Lab with a super fast walking speed), getting the results ready so chemo drugs can be started, filling up forms for either blood transfusion or laboratory tests, calling (plus being scolded) the PDN MO to request for blood products, diluting drugs, clerking new cases, calling patients that didn't turn out for the appointment, escorting patient to certain procedure - just to administer sedation drugs in case they did not sleep during the procedure, writing the discharge summary, assisting MOs in the procedures, and putting in results forms to patient's folder. If lucky, get to do chemoport insertion and removal, administer chemo drugs and do the book for patient.

LP and BMA is a norm there, FBP and CSF result is the essential indicator there, Blood C+S result is super important, as well as the blood counts cause it determine the patient is suitable for the next cycle of the chemo drug, oh not to forgot the TDM level as it determine whether to increase hyperhydration or the percentage use for the next cycle of chemo drugs, esp MTX.

I'm talking alien i know.

One more thing, i felt sad for newly diagnose case, one is the bright student in school but turn out to have AML, another one is a cheerful girl, the final diagnosis is ALL, pre-B, officially registered in the ward on the last few days i was there.

So that's about my life there. After 2 months of work, still very new and fresh i know, I realize it's not so easy to please everyone, and we got to act very fast and think really quick. And most of the time, praying is very important, seriously!

Going back to general paeds ward next week, felt stress, but i got to move on, striving through God's grace.

Till then.


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