My 1st Chapter Meeting and Nervous System Tumors

I have to say, I enjoyed this educational dinner far more than the last. I’m not sure if it was because I had nowhere to go but up after my previous experience? The two meetings did share some similarly awkward attributes: Again, no one asked my name, but they did ask what school I went to. As pretty much the only person under 40 there (again) I suppose it was kind of obvious I was a student. At least they were friendly enough to apologize for how alienating their conversation was, even though they never introduced themselves. There was a moment I could have enacted a guerilla style self-introduction, but this time I let it pass. I personally enjoyed being a fly on the wall. 

A couple of the nurses were talking about how they’ve had patients who put quarters in their shoes to increase their weight. Apparently this is a common practice for patients with anorexia nervosa. However, in the case being spoken of, the patient tried to increase their weight so that they could receive more CHEMO! I certainly joined them in their astonishment. I could only guess that the patient thought that by getting more chemo it would work better? Good reminder on the importance of fully educating patients as to how their chemo works and why they receive the dosage they do!

I was amazed by the casual and easy manner in which the chapter president lead the meeting. As a current chapter president of the National Student Nurses’ Association who is required to use Robert’s Rules of Order  to conduct meetings, I had to admire her ability to shoot from the hip. Have you ever watched C Span? They use Robert’s Rules of Order there too, need I say more. I think if I were at a hearing of that nature I would go rogue and just start filibustering out of sheer boredom. Anyway…

Madame President simply called upon her board members to speak on different topics and they would pop up out of the audience like whack-a-moles, brushing crumbs off their mouths and looking slightly confused. All in all they got the job done. It was a good reminder for my type A personality that even if things appear completely disorganized, the ultimate goal can still be achieved….my fellow type A-ers will share my amazement.

The speaker was excellent, and provided an info packed presentation about neurological cancers. 

~Here are some of the highlights:~

Keep in mind neuro cancers refer to both brain AND spinal chord cancers

Meningiomas= Most common type (30-40%) of brain cancer

Glioblastomas= Most common (20%) malignant brain tumor

Two types of Brain Tumor= Primary (start in brain) and Secondary (mets from other organ ex. Breast)

Malignancy happens in degrees, so it is untrue to say that you had the “good” kind of cancer necessarily. The speaker (Meg Schwartz, APN) noted that patients will be bewildered when years later the tumor they thought wasn’t malignant crops back up in the same location and presents as malignant.

Case Study

52 YO Caucasian c/o difficulty coordinating feet while running that progressed to right sided hemiparesis. 5 years prior had a negative MRI during a work-up for transient vision loss, DX as TIA. Pt underwent brain biopsy, pathology interpreted as anaplastic astrocytoma, WHO grade III. Pt ultimately received whole brain radiation w/ concurrent temozolomide followed by nine cycles of adjuvant temozolomide. Pt developed a gliomatosis cerebri progression of tumor and attempted three other chemo regimens before passing away in hospice care. From Dx to death: 17 months.

Benign can=dangerous: Any tumor in the brain can become deadly if it grows to the point where it crowds out healthy brain tissue.

Reoccurrence is normal

One specific symptom of a primary brain tumor (as headaches can be the symptom of many things) are positional headaches in which laying down actually makes the headache worse.

~~~~~~~~

Unlike my last ONS dinner, I couldn’t find the pluck to try to secure a life raft in a sea of cronies. There were a few other student members and I thought about asking them to join Student Nurses Against Cancer  since their presence signaled they were possibly like minded to myself. After working all day, studying for a final, and battling rush hour traffic to get there, I didn’t have the energy to network uphill.

The next meeting is in May. Maybe if I’m just around long enough someone will start talking to me? I believe that’s called the mere-exposure effect . I’ll keep you posted. Who knows? It just may work!

5 Easy Steps To Start Your Own Chapter of Student Nurses Against Cancer

Starting a chapter of Student Nurses Against Cancer (SNAC) can be a great way to share information and socialize with other students who want to specialize in oncology, as well as help your community. But how do you go about it?

1. Make Sure You Understand What SNAC Is  SNAC is a student lead organization for nursing students who intend to specialize in oncology. It can also be extended to nursing students who do not plan to specialize but are passionate about preventing cancer and raising money for research. The structure of SNAC is intended to be as informal as possible to allow each chapter the freedom to express their creativity and drive. However, each chapter should have three basic things in common: Education, Fundraising, and Volunteering.

Education could include (but is definitely not limited to) having special speakers at chapter meetings, doing cancer prevention education on campus, or giving educational talks in the community.

Fundraising could include on campus events or chapter participation in larger events such as Race for the Cure.

Volunteering should be as hands on as possible. Contact a local cancer center and see what needs they have for volunteers. 

These are a few suggestions but you are only limited to your imagination!

2. Assess the Interest  Your group may start small, but that’s ok. You could start by word of mouth or emails to your classmates. Most online course shells have an option to send an email to everyone in your class, so that’s the unofficial way to go about it. You could also contact your Student Services rep and get permission to send an Eblast to your entire student body. You may come across some red tape on that one. Right now you are in the assessing stage, so focus on that.

3. Find a Faculty Advisor  Now that you have several students who are interested and have collected their contact info, you need to find a professor who is wiling to advise you. A good place to start is asking a professor who you have already taken a class from. Before involving other students, you will meet with this professor to figure out logistics such as how often meetings will be etc.

4. Get Administration on Board  Now that you have a faculty advisor and can demonstrate student interest, you can approach the administration through your Student Services representative to have the chapter recognized by the school. This will make things easier in terms of meeting/promoting at the school, as well as the slight possibility you may get a budget from the school. As I said this is slight, but it could make a big difference when you are fundraising to have some money for supplies etc. There is also the option of doing the chapter unofficially in which case you can ignore steps three and four and just meet wherever you want.

5. Notify/Organize  Email SNAC at studentnursesagainstcancer@gmail.com to let them know you are forming a chapter. Include the name of your school, when the chapter was established, and the name and contacts of your members. As new members are added, their contact info should be submitted. Once you get the green light from your school, you can have your first meeting. Use the contacts you gathered before and encourage those students to spread the word to their fellow classmates. You can elect leaders or keep the format open. Then you can decide meeting times and what specific activities the chapter would like to do. Connect with SNAC on Facebook for daily updates and to ask any questions.

Good luck!

Why Hospitals Can’t Take Integrative Medicine Seriously Yet

Yesterday when I finished completing my LinkedIn account, I was prompted that one of my connections was a part of the Society For Oncology Massage group. Since I am a member of the actual society itself, I clicked on it, interested to see what great things were being shared...

To my dismay I found a conversation facilitated by the administrator of the group that was based on a false premise. Namely that it is unsafe to use deep pressure during manual treatment of chemo-induced peripheral neuropathy to the plantar surface of the feet due to *DVT/PE risk. What was her basis for this bold claim? Her “12 years of experience” as a massage therapist as well as “asking the oncologists and physical therapists she works with”. She went on to say in a later post that “physicians don’t always know” the safe parameters for massage and cancer patients. EXACTLY, care to cite some actual sources?

Later I was on Facebook and saw there was a new post on the Society For Integrative Oncology page. Interested, I clicked. A person posted a question about which essential oils people were using in their practice, to which someone replied that all essential oils were unsafe in the hospital setting because of “contact dermatitis”. Most of the time contact dermatitis wouldn't even be an issue because usually essential oils in the clinical setting are inhaled rather than directly applied. Sigh.

As a massage therapist working in a cancer center, I was frustrated that no one seemed to take me seriously. I commonly felt I was treated as if I had no clinical expertise whatsoever by the staff, who humored my presence more than welcomed it. Nurses would frequently ask (in front of patients) if I would also give the patient a pedicure along with their plantar CIPN treatment. As a nursing student, I can now understand why. Without an evidence-based practice, you cannot make quantifiable statements, which doesn’t leave you a lot to hang your hat on in terms of interventions. At the time I didn’t understand the importance of sharing the evidence with my fellow hospital staff. There actually IS a growing abundance of clinical research on integrative medicine and cancer patients, but one must understand the need to use it (or for that matter be able to fully comprehend a peer reviewed journal).

The basis of most “integrative” modalities-such as massage, essential oils, Reiki etc- is unfortunately very loosey goosey, and is often taught by oral tradition. Rarely is a truly clinical approach used for these modalities, aside from in the research setting. This becomes a problem when the “experts” in our field can’t AGREE, and may or may not be using a scientifically sound logic as the basis for their practice.

Is manual treatment safe for cancer patients? Are essential oils appropriate for hospital use? If we can’t get our story straight, I don’t blame the world of allopathic medicine for having a hard time letting us practice in hospitals to our fullest potential. I think this is unfortunate, because the research is there for us to use, and our patients could benefit from us doing so. I sincerely hope things will improve in the future, and I am personally committed to backing all my CAM treatments with peer reviewed research.

* Due to diminished sensory perception, one actual risk of deep manual treatment to the feet of a CIPN sufferer could be at risk of superficial tissue injury. No studies have been done on the subject, nor have any findings of this been reported in any research on manual CIPN therapy.

Quick NCBI Resources for commonly used CAM treatments:

Integrative Medicine 

Manual CIPN Treatment 

Massage 

Acupuncture 

Reiki 

Guided Imagery 

You could save a patient's life: BRCA1 & BRCA2 testing

 I do not in any way claim to be an expert on genetic testing for cancer. I would just like to share some basic information on an important test that can be done for breast and ovarian cancer. It is crucial to approach a genetic instrument like this with sensitivity and judiciousness.

Although currently there is no standard criteria to determine if BRCA1& BRCA2 testing should be done, genetic factors should be used to determine whether testing is appropriate. The crucial determinant is a presence of family history, as well as other genetic factors.

Risks include (but are not limited to):

Two first degree relatives diagnosed with breast cancer, one of which was under 50 YO; one first degree relative with bilateral breast cancer.

In the case of a person of Ashkenazi Jewish decent, one first degree relative with breast or ovarian cancer, or two second degree relatives on the same side with breast or ovarian cancer.

It should be noted that these and other factors, as well as a positive result for the presence of a BRCA1 or BRCA2 does not necessarily mean that breast or ovarian cancer is an inevitability. The test speaks only to the risk for developing cancer. Knowledge about the presence of the mutation is important not only to the patient themselves, but also future generations of their family.

When recommending BRCA1/2 testing, be sure to advise patients to check their insurance coverage as it can vary widely. A combination of tests may be done, starting with a blood draw. Since the blood is sent away to a lab to be analyzed, it is also good to let the patient know there may be a wait of a few weeks or more for the results.

For more details

If there is anyone who has anything to add, please feel free to comment!

Top 5 Reasons to Join the Oncology Nursing Society as a Student Nurse

No, I'm not being paid to say this! :-)

1. Advanced knowledge- The Clinical Journal of Oncology Nursing (free w/ membership) and educational talks provide all the up to date information about what is happening in the world of oncology. This puts you way ahead of other nursing students because oncology is rarely focused on in school in a detailed way. Plus, the information is geared specifically to nursing practice because they assume you’re already a nurse. It’s kind of like getting to peak at the answers before you have to take a test!

2. Real world information- Ask questions to veteran oncology nurses. You may have to be persistent (see previous post) but I guarantee you will have more usable information than if you would’ve tried your luck with Google and message boards (trust me, I’ve already scoured the interweb).

3. Free money and food!!- Yes, this is real! There’s no guarantee that being a member will get you an ONS Foundation scholarship, but it certainly can’t hurt! If you are a poor college student like me, then you can fully appreciate the free food that you get at the educational dinners!

4. Digital updates- Along with the clinical journal which contains the most current research available on a wide array of topics, ONS also sends out weekly emails with training offerings and quick online articles containing new information on important topics. Online classes are also offered for CEUs.

5. The greater good- Nursing organizations like ONS are so important to our (future) profession. It is the sharing of expertise and research that make us empowered as nurses rather than powerless in the face of bureaucracy. ANA (American Nurses Association) is also a very important lobbying group for nurse and patient rights, and they offer an online student membership for free.


For more ways to keep up to date with oncology information and connect with other future oncology nurses, like Student Nurses Against Cancer on Facebook!

ONS Educational Dinner: Lessons in Awkwardness

I joined the Oncology Nursing Society as a student member…which I highly recommend any students-or oncology nurses for that matter-do immediately for reasons I may elaborate on in a later post….and then I got it…the email that would moderately change the course of an evening of my life: “Come learn about PNH (paroxysmal nocturnal hemoglobinuria) on such and such night". Sold.

Nearing my 30’s I have now cultivated the ability to do what was once unthinkable-walk alone into a room full of people I don’t know and see what happens. Many people avoid this at all costs, even into later adulthood, and I can’t say that I blame them. It’s about as comfortable as getting my teeth cleaned but I strangely enjoy it as an enthusiast of (totally unqualified) social anthropology.

So I walked into the door toward which all the tables full of unfriendly faces were aimed and had seconds to select a seat. I noted a woman sitting alone in the back and pondered joining her, but felt the pressure of a one on one interaction could be too much if things went south. I played it safe and asked to join two middle-aged women sitting at their own table. “No? This seat was not taken?” This was a promising start….

…but that’s about as promising as it got for the rest of the night. They never bothered to introduce themselves and continued to have their own private conversation for the next 20 minutes. This was not the veteran-nurses-taking-me-under-their wing experience I had envisioned while listening to the hits of the 80’s and 90’s on the drive over. Perhaps the saying isn’t true-Nurses don’t eat their young, they just ignore them until they die of starvation…or maybe something slightly less intense. Although technically the image of eating your own young is way worse. Just sayin.

I drew the line when *Ricki got there.  Three  people ignoring me? I had my limits. So I piped up and said, “It looks like you all know each other. I haven’t introduced myself yet, I’m Wendy. I’m a student member.” Without any attempt to hide their disinterest they each FINALLY rattled off their names. Victory! I was in!...and then they returned to their own private conversation. DAMN IT! I now had two choices:

1. I could allow myself to become a food ghost- a shadowy figure whose presence was only known when a plate needed to be passed.

2. I could interject myself into the conversation and attempt to forcibly take the information I assumed they would be eager to share about oncology nursing.

Like I said, I’m nearly 30, and I surely didn’t drive downtown in rush hour to hear about how they “never carry cash anymore”…I chose the latter.

So then I just started interjecting myself into the conversation by loudly offering up details that should’ve already been discovered through normal, polite conversation. It was small talk Tourrete’s, but oddly wasn’t any more awkward than what had already been transpiring.

I found out a lot that way. I found out (ok, overheard) that it’s better to work at a hospital because smaller cancer centers and doctors offices often close. I found out it’s better to spend a couple years on Med/Surg than to go straight into pure oncology work because you will see all those same issues in combination with cancer, so you need to be familiar with those as well. They debunked advice another nurse had given me about getting my phlebotomy certification before working with cancer patients-“You will learn that on the floor working in Med/Surg doing IVs all day” was the consensus. I learned that there was a chapter of ONS specific to my city which was a separate entity from the national organization. Noting that all of them lived and worked in the city but none of them were active in the chapter they described, a light finally dawned on me. I had accidentally sat with the “just here for dinner” table! Ohh it made so much sense!

The speaker was very informative and I was excited to be learning things that would apply in my future work with cancer patients. I felt privileged to be getting this advanced knowledge now, before even entering into clinicals. I felt happy that I could understand a majority of what was being said. I felt very grateful for the free food I was given.  In fact, feeling a pleasant high from the two free desserts I had just eaten, I tried to push my luck and asked one of the nurses if she would consider letting me shadow her for a day. I knew it was a very long shot considering she didn’t even care to know who the hell was sitting next to her. No dice.

All in all, it was a very awkward evening, but I came away with a full belly and a lot more knowledge. Now if only I could find a way to sense who can hold a conversation from across the room. Working on it!

*Names were changed, you know, just in case

You didn't ask, but I'll tell you about myself anyway

My name is Wendy and I am a licensed massage therapist and full time nursing student pursuing my bachelor’s of nursing degree. Why endure the widely known tortures of nursing school? Simple: I want to become a nurse who helps cancer patients.

How did I get from massage to nursing? Before I was a nursing student, I was a massage therapist for ten years. Very early in my career, a dear friend was diagnosed with breast cancer. Her doctor recommended massage for symptom relief, and so she asked me. This struck terror in my heart. At the time I went to massage school our book had one paragraph about cancer patients that made it seem like touching them would be tantamount to personally delivering cancer throughout their body. I always pictured it as dislodging little chunks of tumor that would float down the blood stream causing metastases the whole way through. This reflected the lack of research that had been done on the subject. Intuitively, I knew that if I significantly decreased my pressure and stayed attune to my client, I could provide safe and effective relief. Of course I still felt superstitious about it, so I pursued training in outpatient oncology massage.

Many years later the research finally caught up to what I had instinctively known-massage for cancer patients can not only be safe but beneficial! I’ve never read a study that said massage could cure cancer, so that is definitely not what I’m saying. BUT research has confirmed massage can do some very amazing things for cancer patients: Decrease pain, increase sleep, increase gastrointestinal motility, decrease the amount of pain medications needed, decrease stress (which is directly linked to immune system efficacy). Advanced techniques applied by a certified practitioner (such as myself) can also reduce scar tissue, reduce lymphedema, improve range of motion, and even reduce the symptoms related to chemo-induced peripheral neuropathy (study on effects is currently in progress)!

After receiving my clinical oncology massage certification from William Beaumont Hospital in Royal Oak, Michigan I worked in an outpatient cancer center for two years and I loved every minute of it. Although homeopathic treatments such as massage are slowly transitioning from “alternative” to “complimentary”, so much work still needs to be done to get oncology patients the evidence based and open minded treatment that could completely change their experience. When I realized I could do more for cancer patients from within as a nurse, as opposed to from without as a massage therapist, I enrolled in nursing school.

This blog is for all nursing students, particularly for those who want to focus on oncology as a specialty.

This blog is for all nurses, particularly those who want to share their knowledge to help others.

This blog is for all people affected by cancer, particularly those who are seeking a safe place to learn and share their experiences.

This blog is for all people, particularly those who are black sheep seeking thoughts about health that unabashedly question the status quo.

P.S. Full disclosure: I love (parentheses), CAPS, run on sentences, and having way too many opinions- Enjoy!