From a pediatrician’s perspective: Dr. Nadine Hess diagnoses RB
For the first time in her twelve years as a paediatrician, Dr. Nadine Hess, a paediatrician in Hamburg-Eppendorf, diagnosed a retinoblastoma last year.
In little Isabel, who was just five months old at the time.
“I immediately suspected that it could be a RB,” recalls Dr. Hess in an interview with KAKS.
Naturally, we wanted to know more about the indications of a tumor and the further circumstances for clarification:
KAKS: How did you notice Isabel’s illness?
Nadine Hess: Well, actually from a distance, not with the naked eye, but with an ophthalmoscope.
The child’s left eye looked kind of cloudy.
As if there was a veil of mist in it.
That’s when I thought: it’s an RB.
KAKS: What was the situation in which you had this suspicion?
NH: An everyday one.
The mother came to my practice with her child.
For the U5 examination.
So it was really a completely normal situation.
Isabel was five months old, a super girl.
Everything seemed to be in perfect order.
And it was.
Until, at the end of the examination, I asked the mother to take the child on her lap and sit down a few meters away from me.
Just like I always do.
Because I wanted to use the ophthalmoscope to complete the U5 with the early childhood eye examination.
And then I saw this veil in one eye very clearly.
KAKS: Did you immediately know how to proceed?
NH: Yes.
I did two things straight away: firstly, I made an appointment at the eye clinic at Eppendorf University Hospital.
For the very next day.
I didn’t want to lose any time.
And I told Isabel’s mother that I wanted to have an abnormality checked as soon as possible.
The visual axis in the child’s eye was still developing, of course, and it was important to act quickly.
I didn’t express my specific suspicions to the mother.
I wanted to spare her hours of uncertainty and fear in case I was wrong.
At that point, I don’t think the mother was too worried.
KAKS: Did you get the appointment at the UKE quickly?
NH: Yes.
I was asked directly: Do you think it’s an RB?
KAKS: Do you remember the moment when it became clear that the specialists had confirmed your diagnosis – barely 24 hours later?
NH: Of course.
“Oh God, that poor child”, that was my first thought.
But then I remembered what I had learned during my studies.
With RB, the affected child has a good chance of recovery.
Further assessment and treatment then took place in Essen.
At the national reference center for retinoblastomas.
KAKS: What was the conversation with the parents like when the diagnosis was finally made?
NH: The father came to my practice alone, actually just to pick up the necessary papers for further treatment in Essen.
The conversation was naturally very emotional.
At first he was still calm; as men are.
I told him how sorry I was.
And I hoped that he and especially his wife would forgive me for not confronting them immediately with my suspicions.
He began to cry.
Bitterly.
A moment I will certainly not forget.
I remember taking him in my arms.
KAKS: Isabel has bilateral RB – and this was only finally diagnosed at the hospital.
Diagnosed early enough to save the child’s eyesight and life.
How important is the so-called fluoroscopy test according to Brückner against this background?
NH: In a word: important.
KAKS: Is it part of the standard program?
And what do you do in your practice?
NH: For almost a year now, the Brückner test has indeed been mandatory in the children’s guideline for the U examinations four to seven.
This applies to all pediatric practices in Germany.
Irrespective of this, I carry out this early detection of all kinds of visual disorders in children from the U3 examination until the child is four years old.
KAKS: The Children’s Eye Cancer Foundation is naturally delighted that its efforts to standardize early childhood eye examinations have been so successful.
Our focus continues to be on the white pupil, which can be an indication of a disease, a retinoblastoma.
Do you make parents aware of the white pupil phenomenon in your practice?
NH: Honestly?
No. You don’t tell the parents exactly what you’re looking for.
Unless the parents want to know in detail.
But once again: the mandatory early eye examination is a super important step in the child’s preventive medical check-up.
It was the only way that Isabel’s retinoblastoma could be detected early and treated quickly.
I’m glad about that.
And also that she is still my only RB patient today.
Nadine Hess, born in Aachen, studied human medicine in Düsseldorf, Duisburg-Essen and Bochum.
She completed her specialist training in Essen, Switzerland and Datteln.
She has been a pediatrician in private practice in Hamburg-Eppendorf for three years.
Together with Dr. Nicolaus Lingens, she looks after around 1800 children and young people.
Around 70 to 100 young patients a day.
An immense responsibility.
KAKS also wanted to find out more about this.
In a “hail of questions”, we asked Dr. Hess to keep her yes or no answers spontaneous and her reasons brief:
KAKS: Have you ever regretted specializing in pediatrics and adolescent medicine?
NH: Yes.
Because it’s an exciting, enjoyable, but also energy-sapping job that leaves little room for a good work-life balance.
KAKS: Have you already reached your limits in practice?
NH: Yes.
Sleepless nights in which I wonder whether
I have done something right are part of it.
Because everyday practice is often nothing more than a snapshot in time, in which I have perhaps three to four minutes to correctly assess a child.
KAKS: As a pediatrician, is it right to involve the parents in everything?
NH: Yes.
KAKS: Can the relationship with a family be too emotional?
NH: Yes.
You have to be very careful.
Z. For example, when treating children from your close circle of friends.
I would prefer not to treat them.
You always run the risk of losing objectivity.
KAKS: Do you remember one family in particular?
NH: Yes.
Isabel and her family.
She was a seriously ill child.
My first RB patient.
You don’t forget that.
Just like two other cancer patients who are currently very close to my heart.
And just a few weeks ago, we had an unusual, life-threatening situation that I will never forget.
A family came to my practice with their baby for a U3 examination.
When the child suddenly collapsed and had to be resuscitated.
KAKS: Is distance part of the “job”?
NH: Yes.
But nobody explains how to do it.
You have to figure it out all by yourself.
KAKS: Is pediatric and adolescent medicine different today than it was ten years ago?
NH: Yes.
Parents want to take less responsibility.
Today, the child sneezes three times and some parents come to my practice to make sure it’s nothing serious.
The willingness to tolerate a normal infection is often no longer very pronounced.
Parents today are often overly concerned and demanding.
This attitude is also changing the practice of pediatric medicine.
In addition, the pressure on parents, who often both work and are constantly absent from work, is also great.
When I was little, my mother was often at home and there was no employer pushing for me to come back to work quickly.
KAKS: Is it permissible not to tell parents the whole truth?
NH: Yes.
If you’re not 100 percent sure.
KAKS: Is expensive medicine the best?
NH (laughs): Nah.
KAKS: This raises the question: What is the best medicine?
NH: One that comes with patience, affection and love.