Fight for life

PHOTO: Wendy L. Zeller
A radiation machine sits in the Hershey Medical Center where it treats many cancer patients each day.

By JENNIFER NEJMAN
Collegian Staff Writer

A little girl carried a doll under her arm to her cancer treatment at the Hershey Medical Center. Both the girl and doll were hooked up to an intravenous unit.

The little girl was delighted that the doll could accompany her, said Dr. John Neely, chief pediatric oncologist at the Hershey Medical Center.

Cloth dolls are one way doctors and nurses help their young patients understand what will be done to their bodies to cure their illness. The dolls range in height from baby size to child size.

"Some kids don't quite understand where their kidneys are or where their stomachs are," said Janiece Crovella, child life specialist in the hematology and oncology outpatient clinic. The outpatient clinic is an area where children can undergo chemotherapy and other treatments during the day and then go home at night.

Anatomically correct dolls allow nurses to foreshadow for children what cancer treatment is to come.

"When we work with the dolls, we can be exact where they will end up with a boo-boo and where a bandage will go," Crovella said. "If we can go through each step of what's going to happen to them, they are less frightened."

Play leads to understanding, Neely said. "We even get (the children) masks and gloves so they look like they're in surgery," he said.

In addition to dolls, doctors and nurses use more sophisticated techniques to ease the pain.

Treatment methods

Treatment for cancer patients can be difficult, and side effects may result from the method applied to stop the cancerous growth. Cancer is a term used to describe diseases when abnormal cells grow out of control, according to the National Institutes of Health and National Cancer Institute Internet site.

Two forms of treatment are radiation and chemotherapy. Radiation, Neely said, is intended to stop cells that are dividing, and is stronger than chemotherapy. Neely explained its effect as more like a sledgehammer with high-intensity energy that disrupts cells and is aimed directly at tumors.

For toddlers, staying still for half a minute while the radiation is applied can be terrifying, he said. "I think one of the most difficult things about radiation for the little kids," Neely said, "is to lie still in the same position every day."

Chemotherapy is the use of drugs to halt cancer.

"The theory behind chemotherapy is that the cancer is growing and the rest of the body isn't," Neely said. "Most times the body can withstand the effects of chemotherapy."

However, parts of the body that are still growing, such as hair, blood and the lining of the bowel, may be affected once high doses of chemotherapy are pumped into the body, Neely said.

Side effects that are caused by pumping high doses of chemotherapy into the body, such as nausea, are not as harsh as they used to be due to new drugs.

Mediport

To ease needle fears and make the process less terrifying for cancer patients, doctors at the medical center use a device called Mediport to insert needles for blood work.

When children come in for treatment, they continuously receive needle sticks, Neely said. To help the needle insertion process go a little quicker, a Mediport -- a metal or plastic disk the size of a quarter -- is inserted under the child's skin, usually on the chest.

Then, the next time a patient needs blood work, doctors and nurses won't have to look for the child's veins, and the needle slips in and out quickly in-to the chest skin, which is not as sensitive.

The disk stays in the child during daily activities, Neely said. "Kids can shower, swim, play baseball -- it's not visible," he said.

EMLA Cream

Nurses, and sometimes parents, apply EMLA Cream to the child's ports -- the skin areas where the needle will enter. The white cream that Crovella said employees at the clinic call the "magic cream" or "marshmallow" numbs the area so inserting the needle is less painful.

"Now these kids get poked and prodded and won't even feel it," said Moye Stauffer, registered nurse at the outpatient clinic.

EMLA Cream has been used on patients at the clinic for about four years to speed up the needle insertion.

Spinal Taps

Spinal taps -- when a needle is inserted between two vertebrae to draw out the fluid for testing -- can be an uncomfortable process, but doctors and nurses at the medical center use conscious sedation so the patients do not remember the procedure.

Conscious sedation is a process in which patients are given drugs that put them in a subconscious state, Stauffer said. The process is similar to the nitrous oxide gas a patient receives in the dentist's office, she said. Patients awaken when the spinal tap has been completed, and most usually do not remember what happened.

Since she started working at the medical center eight years ago, Stauffer said the new treatments and drugs have improved treatment and recovery time. New medicines designed to eliminate nausea in chemotherapy patients also have helped kids feel better during the treatments, she said.

"With the (technology) of new medicines," she said, "kids are feeling better, kids are out sooner and they can be more like kids."