GVHD

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    I took care of my first ever oncology pt the other day. I am a NICU and a peds Cardiac ICU nurse. This patient was in my cardiac ICU because pt was an "old" congenital heart (though I think pt would have been better off in PICU). Pt is in their twenties and is on third relapse of CML and s/p a bone marrow transplant. Pt wound up with severe GVHD. As someone who has never experienced this before I am just wondering what the outcomes are of this. It's been about 3 months since the transplant. Pt is in renal and liver failure, getting photopharesis and hemodialysis...and of course has multiple other issues going on. Is there a potential light at the end of the tunnel? Pt is so sick in a way I have not quite ever experienced and I have nothing to compare to. For some reason this situation just makes me sadder than the infants who hang out on ECMO with their chests open for weeks on end.

    Would love to hear your stories.

    Also kudos to you nurses who take care of these patients everyday. I used to think I wanted to do peds oncology...but really don't think I would be able to anymore.
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    Unfortunately, I have no good GVHD stories. In fact, all the patients I've seen who get allogenic stem cell transplants have ended up dying from GVHD. I shudder when I hear that my patients are going for allo SCTs because it typically means they won't be around much longer.
    ShantheRN likes this.
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    Thanks for your input. Sadly this patient did die just this past week, what a miserable last few months of life though.
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    I agree with SoldierNurse, unfortunately. It seems like my onc pts are doing okay till we "fix" them with BMT If it doesn't outright kill them, the quality of life afterwards makes you wonder if it's even worth it. They just seem to....linger. It's awful.
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    I must agree. I used to work on a BMT unit. I much preferred the autologous transplants because the patients getting allogeneic transplants would get SO SICK and when they got GVHD it was an awful way to die. On a side note, we were told that a "little GVHD" was good because it had an anti-tumor effect. Unfortunately, many patients had more than a little.
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    PLF2323: I've heard the same thing about having a "little GVHD". I understand the anti-cancer mechanism it represents, but like you said, a very small handful of patients only ever have "a little GVHD". I was told this by a doc who was enthusiastically telling her interns about GVHD outside the room of my patient, whose GI tract, skin and liver was involved in her particular case of GVHD. I was a little offended because the doc was making it sound as though "a little GVHD" wasn't a big deal, particularly to the patient. I wanted to ask the doc if she'd like to sample "a little GVHD" and then give the lecture to her interns.
    CarryThatWeight likes this.
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    There's no fixing severe GVHD. It sounds like your patient isn't going to recover unfortunately. GVHD is terrible.
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    Hey SoldierNurse22,
    I was just wondering how difficult it is to get a position in oncology in the army (or navy)? And do you live on base? How is your schedule? I'm going into my senior year of nursing school and have been looking into nursing in the armed forces. I had no idea oncology was even an option, but I think I would be really interested in it... I'm trying to get onc for my practicum, so I'll see how that goes! Let me know if you can answer any of my questions.. Thanks

    and umcRN, I agree w/ u... Kudos to all the oncology nurses out there! When I was younger my grandmother went through chemotherapy and died of lung cancer... She loved her nurses and they were very compassionate. They're an inspiration
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    Hey Amistad,
    Unfortunately, getting into the military nowadays is difficult on its own. Getting into oncology, at least at my facility, is even harder (they seem to think we're overstaffed). Because I'm single, I am not able to live on this particular base (Walter Reed Bethesda only has housing for enlistees). My schedule has seen better days, but that changes with the leadership (I work 7 days in every 2-week period; I will be on call for an additional 2 days per pay period starting next schedule). I don't mean to sound so negative. I do enjoy my job (most of the time), but it does get difficult after a while. We've recently had a string of unexpected deaths on the floor, and that never helps.
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    I forgot I had this post but wanted to thank you all for the replies. Think I will stick with cardiac & nicu kiddos for now


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