Friday, October 28, 2016

Optional Rotation: Child and Adolescent Bipolar Spectrum Services

The field of genetics/genomics is currently one of the fastest growing in science.  Every day, new variations in the human genome are discovered and their potential effects on the body are delineated.  Some mutations and changes have easily understood effects that accompany them, while others are do not have such clear cut answers.  One area that has been captivating scientists for years is the genetics of mental health.  There has been significant research conducted concerning this field of study, and while some results have been promising, such as that of a recent team that discovered singlenucleotide polymorphisms (SNP) more common among individuals with schizophrenia , scientists have largely not found any consistent clinically significant genetic changes that contribute to an individual’s mental health.

Last fall, we had the pleasure of having Dr. Jehannine Austin, president of the National Society of Genetic Counselors (NSGC), talk about her experiences running the first ever genetic counseling clinic specifically targeting patients with psychiatric disorders.  Although genetic testing is not available for these patients, Jehannine and her colleagues were able to speak to them about the multifactorial nature of their disorders, how both genetic and environmental factors were tied to their presentation.  Listening to Jehannine talk about how these services she and her team provided peaked my interest in potentially being a future resource and a genetic counselor who would value the opportunity to counsel patients on mental health disorders.  This was one of the reasons why I chose to pursue an optional rotation at the Child and Adolescent Bipolar Spectrum Services (or CABS clinic.)  The clinic services youths with bipolar disorder, following their treatment, providing therapy services, coordinating other aspects of care such as school services, following up with inpatient treatments, and offering clinical research opportunities for those who qualify.  I went in with the hope that I would leave the rotation with a better understanding of pediatric psychiatric disorders, as well as the treatment and management options that follow after diagnosis.

The CABS clinic was gracious enough to allow Brooke Hornak, Michelle Morrow (who also share the same interest as I do) and me to join their team for a month.  The experience I had there was absolutely incredible, and although I was only there for a small portion of time, I feel that through my observations I was able to learn much about the intricacies of medical psychiatric care. During my rotation, I was able to observe intake sessions and medication and treatment follow-ups.  During intake sessions, new patients were seen during two different appointments.  During the first session, patients were asked a series of very detailed interview questions by a therapist or social worker that helped to determine the child’s experience with mood changes and overall mental health.  Questions were also asked regarding past medical, developmental, educational, and social history, and any reports of trauma or abuse.  The second session involves a review of the information, and is followed by a discussion with one of the psychiatrists about whether or not the individual meets any mental health diagnosis criteria.  If the psychiatrist believes that they do have bipolar disorder, the patient then has the opportunity to continue care through the CABS clinic or through another psychiatric care facility.  These intake sessions were extremely interesting to observe.  The questions often resulted in very difficult answers.  Many children as young as 3 or 4 presented with a past history of trauma, and had significant psychiatric symptoms as well.  However, all of the clinicians were extremely kind, patient, and thorough with the patients and families, and by watching them I truly feel that I learned important skills in terms of counseling individuals with seriously negative psychosocial events in their pasts.

I also had the opportunity to observe the psychiatrists as they followed up with their patients about treatment and their progress.  During these sessions, it was very apparent how much the child’s bipolar disorder could affect the entire family.  Many parents and siblings became visibly emotional, and felt tired and even helpless.  However, once again, the clinicians at the CABS clinic expertly addressed these concerns and worries head on, which was inspiring to watch.  As a genetic counseling student, one of our roles that we consistently learn about, is that our field has a focus on tending to the whole patient, not simply addressing only their medical diagnosis and treatment, but the psychosocial issues that may come with it.  Being able to observe these sessions showed to me how truly important it is to care for the mental health of the entire family as well, so that the family could function well for the good of the patient.

My time at the CABS clinic was exciting and inspiring to me.  Watching and learning from individuals who have mastered a plethora of psychosocial skills was incredibly valuable to me during my clinical rotations.  Seeing children and families affected by bipolar disorder, and the strength and resilience they showed during treatment, pushed me further to pursue a genetic counseling position that would directly help individuals with a history of bipolar disorder or other mental health disorders.  I know that my fellow students and I greatly enjoyed our learning experience, and I can only hope that future genetic counseling students can utilize the CABS optional rotation and learn from the wonderful team and families there.

 - Emily Massiello, Class of 2017

Friday, October 14, 2016

Optional Rotation: UPMC Hereditary GI Tumor Program

Upon entering the program, I had a strong interest in cancer genetics and wanted to take every opportunity to expand my knowledge in this area. For my optional rotation, I chose to spend three weeks with two wonderful genetic counselors in the UPMC Hereditary GI Tumor Program at Shadyside Hospital. Patients are referred to the clinic for a variety of suspected hereditary cancer predispositions. This may be due to a personal diagnosis or a family history of polyps or gastrointestinal cancers. During my rotation, I was able to see patients whom we counseled regarding Lynch syndrome, Cowden syndrome, and familial pancreatic cancer – all of which I had not yet had the opportunity to see as part of my rotations.

Before coming into this optional rotation, I had completed two general cancer rotations, so I had a solid understanding of how a general cancer genetic counseling session went. I was comfortable counseling patients regarding Hereditary Breast and Ovarian Cancer, and I was familiar with ordering gene panels for patients. I was able to take these skills and continue to build on them - addressing psychosocial issues in session, learning the nuances of cancer counseling, and crafting my own counseling style. Most importantly to me, I became intimately familiar with the numerous hereditary colon cancer syndrome criteria and guidelines that had initially felt overwhelming when I learned about them in class.

Another terrific experience I gained during this rotation was observing the same surveillance procedures I had discussed as management recommendations with patients throughout my rotations. Individuals at an increased risk for colon cancer and polyps have more frequent colonoscopies than the general population. Some of the cancer predispositions confer an increased risk for gastric, small bowel, and pancreatic cancer. The first two can be screened for with upper endoscopy and pancreatic cancer surveillance can include endoscopic ultrasound. Having observed these procedures, I feel that I can speak about them more confidently when describing them to the patients.

As a MS Genetic Counseling/MPH Public Health Genetics dual degree student, I felt that this rotation was extremely valuable as it gave me the chance to learn more about Lynch syndrome, which is one of the CDC’s Tier 1 conditions. The information that I learned in clinic has allowed me to participate more fully in my Public Health classes, especially those in which these Tier 1 conditions are discussed, which in turn allows me to help educate my peers who do not have a genetic background. The education of other healthcare providers and policy makers is going to be part of the multifaceted role I have as a practicing genetic counselor, which makes the education of my peers a valuable learning experience.

I am very grateful that I had this rotation experience. I think it was a perfect one for me as it allowed me to gain more experience in cancer genetic counseling sessions, get the opportunity to interact with patients with a variety of syndromes not seen as frequently in the general cancer rotations, and acquire knowledge that dovetailed with my Public Health classes.

- Emily Griffenkranz, Class of 2017

Saturday, October 1, 2016

NSGC's Annual Education Conference 2016 Reflections

The 2016 was the Class of 2017's first full Annual Education Conference. Between the breakout education session, exhibition booths, ever growing job board, and overall atmosphere of excitement, it is nearly impossible to pick what was the most valuable or favorite moment. Below are are few of the many great experiences our students had.

It was amazing and energizing to see the wide variety of specialties and expertise of our profession presented in one place. - Kavitha Kolla

I really enjoyed the alumni dinner. I was able to get great input about jobs in some of the different areas that I'm considering. Plus it was lovely to meet others who attended the program. - Emily Griffenkranz

I enjoyed hearing about the latest research in psychiatric genetics and neurogenetics.  I’m looking forward to growth and additional job opportunities in these fields! - Michelle Morrow

I really enjoyed the Exhibition booths because I liked collected resources about specific diseases and learning about services and support groups for patients - Emily Massiello

I loved Matt Might’s talk about how he used social media to aid in the diagnosis of his son’s rare disease. It meant a lot to see one parent advocate as much as he could for his child and in that process establish connection between advocacy groups, researchers, and families. - Sam Wesoly

My favorite part of NSGC was Dr. Belinda Fu’s presentation. I loved how she exposed herself to show the importance of being mindful when talking to patients. She led an engaging talk I know will be able to utilize in my practice. - Brooke Hornak 

I found both future and current presidential speeches inspiring and took away a beautiful message to stay true to yourself while also always pushing yourself to be more - Anna Zakas

There were so many great talks at NSGC, but there was just no way to attend all of them. However, by dividing up session with classmates and meeting up later to discuss them, I don't feel like I missed out on anything and I had an opportunity to both learn and teach my classmates. - Christine Munro

It was so wonderful to see how much the profession has grown and how many opportunities are available to us. You really can take genetic counseling in so many different directions. It was also really great to network, especially with all of our successful alumni - Leslie Walsh

The most valuable thing to me was realizing how much I have learned from the program and rotations. Sitting through the lectures and sessions I felt like I had a good idea if the topics and issues discussed. - Sara Blankenship

I loved seeing so many genetic counselors in one spot. It was wonderful to meet future colleagues and build professional relationships. - Bryony Lynch