A Conversation with Dr. Lastrapes

Recently, Lisa talked with Dr. Kelly Lastrapes, Assistant Professor of Hematology, Oncology and Palliative Care at Children's Hospital of Richmond at VCU. Kelly received her undergraduate degree from William and Mary, and her medical degree from VCU/MCV School of Medicine. She completed residencies at Children's Hospital of New Orleans (LSU), and her fellowships in oncology and palliative care at VCU. As a native Richmonder, Dr. Lastrapes is happy to be back in her hometown with her family.
Lisa: Dr. Lastrapes, you are currently conducting some interesting research. Can you tell us a little about it?
Dr. Lastrapes: I am very interested in a medical condition called Delirium, which is a global brain dysfunction that is caused by having an underlying medical illness (like cancer). I am trying to understand who is most at risk to get Delirium, what are the long term effects of Delirium, and how we can best treat Delirium in pediatric patients. 

Lisa: What are some of the symptoms of Delirium?
Dr. Lastrapes: Hallucinations, paranoia, and agitation are common symptoms. They are related to the underlying disease, medications, and an abnormal environment (e.g. a hospital room or ICU), including disrupted sleep cycles. There are neuro-cognitive implications for patients with Delirium, with potential long-term effects. 

Lisa: I understand that there is some new research relating to adult Delirium, but that there is very little information on Delirium in the pediatric population. What are you currently studying?
Dr. Lastrapes: I'm doing a retrospective review of pediatric oncology patients over the past 10 years to determine whether they might have had Delirium that was not previously identified. I hope to use this information to help identify possible risk factors and to be able to look prospectively for potential interventions. If we are able to diagnose Delirium in our patients, then there are ways they can be treated to alleviate the symptoms or the condition altogether. For example, patients can be taught to utilize modifications when they are in the hospital for extended periods of time such as keeping the shades up during the day (to keep the sleep/wake cycle on track), keeping familiar objects and people nearby, and using re-orientation techniques (having a clock with the date and time on the wall). In some instances, a brief treatment course with anti-psychotic drugs can be helpful as well.
Lisa: What is your long-term goal for this research?  
Dr. Lastrapes: I want to increase awareness of this debilitating disease to promote early diagnosis and treatment. I'm excited because CHoR has developed a Delirium Task Force in Pediatrics. We are getting ready to begin universal screening for Delirium in the Pediatric ICU. 

Lisa: In addition to conducting research into Delirium and serving as a clinician to pediatric hematology/oncology patients, you spend quite a bit of your time focused on Palliative Care. 
Dr. Lastrapes: Yes, I am really excited about our expanding supportive care team. When most people hear the term “palliative,” they think “end of life.” It's much more than that. We focus on symptom management and helping pediatric patients manage their illness by utilizing goals of care to improve patients' quality of life. I am working to help referring physicians and patient families understand that we are a care partner during the treatment of a life-threatening or complex medical condition. We are not simply a support system for a hospice patient.

Lisa: What do you like to do for fun and/or what is your favorite thing about Richmond?
Dr. Lastrapes: I love spending my free time with my family at Forest Hill Park (especially at the Farmer's Market). I am a former singer/dancer/thespian and love that my daughter has become quite the dancer and actress (in three short years).