June 23, 2013

Pro Golfer with History of Leukemia and ENT Emergencies

The New York Times published a story about pro golfer Laura Kueny who was diagnosed with acute lymphocytic leukemia at 3 years of age and the harrowing experiences she had to go through to beat the cancer.

It certainly brought back memories when I was a resident at Duke University and was filled with dread whenever I got consulted to evaluate a sick child with leukemia undergoing treatment.

It is breathtaking just how sick such children are... what in a normal child is not considered an ENT emergency like strep throat, tonsillitis, sinusitis, and ear infections, are now considered an emergency. Such common childhood infections can literally kill a child undergoing chemotherapy and/or bone marrow transplant. With cancer treatment, these kids have no immune system and significantly reduced ability to clot due to platelet loss.

Being poked and prodded is a given... but there's also the ENT endoscopies and surgeries that often need to be performed to either save a life or to just figure out what germ is causing an infection so the appropriate powerful antibiotic can be given.

Making a hole in the eardrum as well as nasal endoscopies are routinely performed in order to culture the pus present.

Tonsillectomy surgery can be a particularly harrowing experience for an ENT surgeon as it can be literally life-saving and life-ending all at the same time. A bad tonsillitis can overwhelm what little immune system these children have in spite of antibiotics and emergency tonsillectomy may need to be performed to help the child recover from a potentially lethal infection... BUT... performing this type of surgery when platelet counts may be non-existent can also result in life-threatening blood loss. In the end, the child remains intubated after surgery while getting IV platelet infusions, and the entire oral cavity packed with gauze to provide direct pressure to manually stop bleeding for a few days. Once the gauze packing is removed and no bleeding is seen, extubation can proceed.

Sinus surgery for persistent sinusitis can also result in a nosebleed that just will not stop bleeding thereby requiring prolonged nasal packing.

And is it worth it in the end?

Yes... for what used to be a death sentence has now become one of the more curable cancers.

Golfer Leaves Hospital as a Survivor, Returns as a Winner. New York Times 6/22/13
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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