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		Diagnosis
		Side Effects of Treatment
		Catheters
		Surgery
		Radiotherapy
		Blood Counts and Transfusions
		Scans
		Bone Marrow Transplants
		Finishing the Treatment
		Relapse

Diagnosis

Lumbar Punctures are undertaken for diagnostic purposes and to give treatment into the cerebrospinal fluid (CSF). This is the fluid that surrounds the brain and spinal cord. In some illnesses there may be cancerous or leukaemic cells in this fluid. It was also shown many years ago that some malignant diseases, in particular leukaemia, remained hidden in the CSF and if special treatment to kill these cells was not given, the disease might regrow from there. Therefore, many treatment protocols include regular lumbar punctures (and sometimes also radiation). Lumbar punctures are not much more painful than an intravenous injection, but they cause a lot of anxiety in both the patients and the parents. A needle is inserted in the back, between 2 vertebrae (bones in the back) and fluid is tapped quite easily.

Bone marrow aspirations and biopsies are usually done at the time of diagnosis of many malignant diseases and from time to time during the treatment, to ensure that the patient is free of disease in the marrow. This procedure is somewhat painful, but the principle pain is during the suction of the marrow from inside the bone. A needle is inserted into the hip bone at the back in order to get to the marrow.

To alleviate the pain, fear and anxiety, a number of measures are available:

1. Time the procedures with a general anaesthetic when possible. This is often not practicable. 
2. Sedation for the procedure. This usually involves the child taking a tablet then having an intramuscular injection to achieve a calm, sleeping state, but not as deeply asleep as with general anaesthetic. This is effective in many patients but some children keep waking up. Even if half awake, the child does not usually remember the procedure that has been undertaken. 
3. Explaining the procedures. With older and co-operative children, we spend some time explaining the procedures and give them details of everything that is to be done. When appropriate we also demonstrate with the use of a small doll as a model. We then allow the patient the opportunity to play with the doll and do the procedures on it. We explain the importance of the child remaining still during the procedure and we also offer a prize/gift to the child if he/she has been still during the procedure. 
4. Local anaesthetic cream - a cream applied painlessly over the area of skin where the procedure will be done on the patient. If necessary, we also inject local anaesthetic for extra pain reduction. 

For many older children and adolescents the most suitable method of sedation is the use of nitrous oxide (laughing gas). Again adequate preparation and explanations are important to obtain co-operation during what are new and sometimes scary experiences.

Chemotherapy is one of the most important parts of a patient's treatment. This can be given either by mouth or by intramuscular (deep into the skin) injection. Some of the medications can also be given intravenously and must not be allowed to leak otherwise serious burns to the skin and underlying tissue can occur. For this reason it is important that the child be very still for an injection.

After a while the children become used to having their intravenous treatment and they do not remain anxious about this. We do attempt to have experienced people giving the injections but we also need understanding and co-operation in instances where the procedures have to be repeated. This is for the patient's benefit and despite the distress it needs to be done.

We have available three video cassettes that describe the procedures. One is a parent's attitude, the other is a young child's attitude and the third is an older child's view. We also have a relaxation cassette tape for parents if they themselves feel anxious about the procedures and need some help.

We are always very happy to spend time with a child and his/her parents and to explain the procedures any number of times in order to allay their fears and worries. Parents and children are welcome to come to the procedures unit in the Day Only Unit and we would be happy to give explanations and assistance as required.
 

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