1. Infection Control / Microbiology

Microbiological problems of the patients, are always discussed with one of the senior Microbiology Specialists as the need arises, and then, the following Monday, during Grand Rounds the first hour is dedicated to a review of the weekly problems and their outcomes, and any new cases which may have arisen.

2. Imaging

In weekly Radiology Rounds, the week's imaging results are reviewed with an expert, highly experienced Professor of Radiology.  We have regularly scheduled conferences with a specialist in Nuclear Medicine, reviewing the scans of the patients as they progress through therapy.

3. Pathology

We have a particularly close ongoing relationship with the Pathology Department, whose outstanding hematopathologist, Dr. Gail Amir, has trained with Prof. Elaine Jaffe of the National Institutes of Health. The basis for successful therapy is the initial critical step of providing the specific diagnostic classification of the hematological disease and Dr. Amir has superior diagnostic ability. In our weekly conferences, Dr. Amir demonstrates the specimens and reviews the many intricate processes which were performed in the laboratory to arrive at each precise diagnosis.

4. Cytogenetics

We also have a monthly conference with the cytogeneticists, who perform a vital diagnostic service for our patients who are diagnosed as having leukemia or lymphoma.

5. Social Medicine / Epidemiology

An ongoing interchange with the Department of Social Medicine allows for us to critically evaluate the outcome of our patients' care.

6. Bone Marrow Transplantation

We have an extremely close relationship with the Bone Marrow Transplantation Department, and one of their Senior Physicians attends our weekly Thursday Staff Meeting to provide consultations on their recommendations regarding a patient's need for this type of therapy.

7. Blood Banking

We have the invaluable ongoing contribution of the staff of our outstanding Blood Bank who participate in our weekly rounds and in our clinics. A high caliber blood bank is absolutely essential for treating all hematological disease.  We are proud to say that the Hadassah Ein Kerem Blood Bank has set standards of safe administration of blood products which are being followed throughout the country. Furthermore, a large portion of our blood products are prepared here at Hadassah in our Donor Center, thus saving crucial transit time in case of an emergency need for blood products, as in cases of sudden bleeding. 

There are a number of other diagnostic and therapeutic medical specialty services which are all readily available for the patients who need them. These are departments which have had close working relationships with us and provide invaluable immediate assistance for the particular individuals who require such expertise. Among them are:

- Neuro-oncologists, who provide expert evaluation of neurological complications of hemato-oncological disease;

- Oncologists, who provide radiation as an adjuvant treatment when needed;

- Pain Consultation experts, who are anesthesiologists who are specifically trained in pain relief, using all medical modalities as may be necessary to assuage pain. These include the use of a variety of medications (oral, transdermal, intravenous) or using such methods as specific, directed nerve blocks for localized pain.

We also have available the most expert consultations from all the medical subspecialties as are needed for our patients (Cardiology, Pulmonary Medicine, Gastroenterology, etc). These may be necessary in an emergency or to resolve a chronic problem.

Social Work Services

Social work services are extremely helpful to the patients and their families, who may be faced with devastating illness. Our social worker is highly experienced, as well as sympathetic and knowledgeable. She can help with providing information, referrals for help in the home, and many other types of suggestions which help the patients and their families cope with the illness facing them. The social worker can be reached through the department telephone or through the department of social services. Besides the concrete type of services, which are very helpful, she is an experienced therapist and can help the patients and their families cope with their disease.

Psychological Services

Our department treats all types of hematological disease, both benign and malignant, and some of the diseases are either chronic or ultimately fatal. All such illnesses can have their emotional toll on the patient and their families. The patient may become depressed, develop sleep disorders, or marital dysfunction may develop after diagnosis. Various studies have shown that over 50% of patients develop a clinically apparent level of anxiety and/or depression which worsens as the disease progresses.

These psychosocial problems require the help of a trained professional, as their therapy lies beyond the scope of the physician's duties and training. Therefore, for the past 5 years, our department has employed a psychologist for this purpose.

Dr. Liliana Libof is the psychologist on our Department. Her task is to evaluate and treat the psychosocial and behavioral aspects of the patient's therapy. She follows the patient throughout their medical treatment, during the various stages of the illness, from the initial shock of the diagnosis, throughout the treatment phase, and even after recovery, or chronicity sets in.

Our psychologists have been trained in specific treatment interventions which have been found to be effective in these types of situation. As such, the psychologist's intervention markedly improves the quality of life of the severely ill patients, allowing them to cope better with their illness. Complete care can not ignore the psychosocial aspects of the patient's illness.

The scope of the psychologist is broad, encompassing evaluation of patients in the inpatient department, the Day Care, and the Clinic. Each setting has its own specific problems which the patient requires help in overcoming. The psychologist may be needed as a resource for referral for help in the home, or may deal with deeply rooted psychological issues, such as overcoming the stigma of transferring the patient to a hospice, or other facility, when the family can not care for the patient at home. Many other crises need to be met as the patient's condition changes (for the better or for worse).

Most useful are the psychologist's contributions to the Staff Meetings. The psychologist may enlighten the staff as to a psychosocial problem of which they had been unaware. The psychologist can also be quite helpful in providing the staff with approaches that avoid confrontations with patients and/or family members who may have been problematic (due to depression, poor communication, etc).

In conclusion, psychosocial intervention is an integral part of or multidisciplinary approach to patients with hematological diseases. This service is available to all, and requires only that the patient and/or family request it.

Dietician

Maintaining proper nutrition is of great importance for our patients. Consultation with a specially trained dietician is therefore available.

For patients undergoing chemotherapy for periods of several months to a year, weight loss and loss of appetite may present a severe problem. Not only is weight loss physically debilitating, causing loss of the body's protein mass, but it causes emotional distress which can be highly debilitating as well. Nutritional problems in patients with malignancies can be caused either by the disease itself (such as in cases where the tumor affects the mouth or other portions of the gastrointestinal tract) or it can result from treatment, such as chemotherapy or radiation which can decrease appetite or cause, even temporarily, more severe symptoms which interfere with food intake.

Recognizing the importance of maintaining proper nutrition, we have available registered dieticians on a consultative basis for our department. We have a regularly  assigned dietician who is available to all those who require this service. The dietician evaluates the patient with a complete nutritional assessment. Then she works closely with the physicians and the nurses to manage nutritional complications of the individual patient's disease. When supplements are recommended, she works closely with each patient to meet their particular needs, in view of the particular disease and the disability it may be causing.