Kenzies Gift Parent Pack

K e n z i e ’ s G i f t D i a r y Supporting you and your family

Turn your face towards the sun and the shadows fall behind you.

Kenzie’s Gift was founded in 2008 by Nic Russell in memory of her 3 year old daughter Kenzie.

The story of Kenzie’s Gift is not one of miracles. It is one of the gutsy determination, tenacity and love of an amazing and beautiful little girl, Kenzie.

Kenzie was only two years old when she was diagnosed with cancer and sadly died on the 29th of December 2005. Through this tragedy came the hope for families that is Kenzie’s Gift.

Our purpose is to support the emotional well-being and mental health of children, young people and their families affected by cancer, serious illness or bereavement.

We achieve this through the provision of one on one therapy with registered mental health professionals, the delivery of printed cancer and grief packs for children, and an extensive online information resource.

We receive no government funding. All this is made possible by wonderful supporters, donors, grants, philanthropists and fundraising initiatives, ensuring the Gift keeps on giving to those who need it.

Please accept this Gift from us now.

It comes with love and hope for your future.

Kenzie’s Gift PO Box 13224 Tauranga 3141 Email: hello@kenziesgift.com Website: www.kenziesgift.com First published 2011 ©Kenzie’s Gift

Name: Home: Work: Mobile: Email:

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K e n z i e ’ s G i f t D i a r y g u a r d i a n s o f t h e c h i l d r e n w i t h

h o p e

It is devastating to be told your child has cancer. These words take you and your family into a situation you hoped would never happen. It is an overwhelming and difficult place to be.

Kenzie’s Gift is here to help you, your child and family cope with some resources we hope you will find useful.

This Diary, used in combination with the Kenzie’s Gift Information Book, can accompany you throughout this challenging time as a supportive resource. It will help you keep track of appointments and record information about your child’s medical history, diagnosis an treatments.

There are places for you to write down questions for your child’s medical team, not e down treatment side effects and store business cards and other items. Getting to know all of the people who will be involved with your child’s care can be quite a challenge and the Diary has a section for recording their contact details too.

The information in the Diary will be helpful not only to you but to the medical team caring for your child. Most of the sections can be completed by you and your team could help fill in some too.

Kenzie’s Gift Diary

About Kenzie’s Gift

A b o u t

K e n z i e ’ s

G i f t

“I commend Kenzie’s Gift … as an investment in the future of our children, our families and whanau” (Nigel Latta, Ambassador for Kenzie’s Gift) Kenzie’s Gift supports the emotional well-being and mental health of children, young people and their families affected by cancer. We achieve this through the provision of one on one therapy with registered mental health professionals, the delivery of printed cancer packs for children, and an extensive online information resource. The support programmes aim to reduce the distress, improve quality of life and assist with the management of anxiety, fear, grief, loss and anger.

Our programmes and resources are based on the latest evidence and ‘best practice' research and we continually update our online and printed resources to reflect this. Our lead health professional is registered Child and Youth Psychotherapist Lorna Wood. She advises on the development of our programmes and resources for families.

We receive no government funding. All this is made possible by wonderful supporters, donors, grants, philanthropists and fundraising initiatives, ensuring the Gift keeps on giving to those who need it.

Please accept this Gift from us now. It comes with love and hope for your future.

Best, Nic Russell and The Kenzie’s Gift Board.

Visit: www.kenziesgift.com Get in touch: hello@kenziesgift.com

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K e n z i e ’ s G i f t D i a r y g u a r d i a n s o f t h e c h i l d r e n w i t h

Contents Details for you and your child Contacts Appointments Test Results Treatments Dates to remember Medical Expenses Notes Plastic file holders

Contents

h o p e

How this Diary can help you Information can help us to understand what is happening now and in the immediate future. Knowing who to call if you need help, advice or more information is important too and having all of this at your fingertips and reduce stress.

This Diary prompts you to: Write down information about your child’s diagnosis and treatment Note questions for the medical team Record contact information for those involved with your child’s care File business cards and items Note appointment times Record treatment side effects …. and more.

Have a look through and see what the Diary can offer.

NOTES:

I nf or m a tion

about

you

a nd

you r

You & your child

ch ild

Emergency contact Your details

First name: Last name:

Title:

Home:

First name:

Work:

Last name:

Mobile:

Address: Home: Work: Mobile: Email:

Emergency contact First name: Last name: Home: Work: Mobile:

Health Insurance, Family Doctor (GP) and NHI Number Doctor Name of Family Doctor Address Work Mobile Email

Health Insurance Name of company Type of cover Policy Number

NHI Number Public Hospital Number

Your child

School Principal

Name

Name

Nickname

Contact Phone Email

Teachers

Your child’s school

Name

Subject

School your child attends:

Name

Subject

Name

Name

Subject

Address Contact phone Email

Dean or counsellor at your child’s school Name Contact Phone Email

My child’s medical history Condition

Treatment

Date

My child’s immunisation history For

Date

Hospital/Clinic

Doctor

My child’s allergies Allergy to

Treatment

Allergy to

Treatment

NOTES:

Information about the medical team and your supporters

In this section you can record the names, contact details and areas of responsibility for the members of the medical team caring for your child.

You may also want to note down the details of other people you meet in hospital, for example other parents whose children are affected by cancer and contact information for friends providing support.

Medical Team & Support

The Medical Team Name Area of care Work

Name

Home

Area of care

Mobile

Work

Email

Home

Address

Mobile Email Address

The Medical Team Name Area of care Work

Name

Home

Area of care

Mobile

Work

Email

Home

Address

Mobile Email Address

The Medical Team Name Area of care Work

Name

Home

Area of care

Mobile

Work

Email

Home

Address

Mobile Email Address

The Medical Team Name Area of care Work

Name

Home

Area of care

Mobile

Work

Email

Home

Address

Mobile Email Address

The Medical Team Name Area of care Work

Name

Home

Area of care

Mobile

Work

Email

Home

Address

Mobile Email Address

The Medical Team Name Area of care Work

Name

Home

Area of care

Mobile

Work

Email

Home

Address

Mobile Email Address

The Medical Team Name Area of care Work

Name

Home

Area of care

Mobile

Work

Email

Home

Address

Mobile Email Address

The Medical Team Name Area of care Work

Name

Home

Area of care

Mobile

Work

Email

Home

Address

Mobile Email Address

Friends and supporters Name Home Work Mobile

Name

Email

Home

Address

Work Mobile Email Address

Friends and supporters Name Home Work Mobile

Name

Email

Home

Address

Work Mobile Email Address

A p p o i n t m e n t s

Appointments

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Appointments Date of appointment Questions and discussion items

Test results/information

With

Pathology results It may be easier to have your surgeon complete the details for you on this page.

Date of surgery Type of surgery Type of cancer Grade of cancer Location of tumour Size of tumour Other information

NOTES:

T e s t

Test Results

R e s u l t s

Test results Date

Test

Specialist

Result

Test results Date

Test

Specialist

Result

Test results Date

Test

Specialist

Result

Test results Date

Test

Specialist

Result

Test results Date

Test

Specialist

Result

Test results Date

Test

Specialist

Result

Test results Date

Test

Specialist

Result

Test results Date

Test

Specialist

Result

Test results Date

Test

Specialist

Result

Test results Date

Test

Specialist

Result

Test results Date

Test

Specialist

Result

Test results Date

Test

Specialist

Result

T r e a t m e n t s

Treatments

S u r g e r y

Surgery

Surgery Noting the details of the surgical team is a good idea, in case you need to contact them afterwards.

Contact Name

After Hours Date of surgery Type of surgery Name of Surgeon Name of Anaesthetist Name of Nurse (if applicable) Hospital where surgery took place

Surgery Notes Date

Notes

Surgery Notes Date

Notes

Surgery Notes Date

Notes

Surgery Notes Date

Notes

Surgery Notes Date

Notes

C h e m o t h e r a p y

Chemotherapy

Chemotherapy In this section you can record contact details for those people who will be administering the chemotherapy treatment and some particulars about the treatment plan. It is a good idea to note side effects your child experiences too, because this information can help your medical team to adjust the treatment, if needed.

Name of Oncologist

After Hours Name of Oncology Nurse

After Hours Hospital/clinic where treatment will be given Contact number Address

Chemotherapy Date treatment commenced Date treatment completed Number of treatments planned Number of treatments received Name of chemotherapy drugs received Anticipated side effects

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

Chemotherapy Notes Treatment date Chemotherapy drugs and other medications received Side effects Questions/concerns for the medical team

R a d i o t h e r a p y

Radiotherapy

Radiotherapy In this section you can record contact details for those people who will be administering the radiotherapy treatment and some particulars about the treatment plan. Making note of any side effects your child experiences can be helpful for your medical team too.

Name of Radiation Oncologist

After Hours Name of Radiation Technician

After Hours Hospital/clinic where treatment will be given Contact number Address

Radiotherapy Date treatment commenced Date treatment completed Number of treatments planned Number of treatments received Radiation dose received Body areas treated Anticipated side effects

Radiotherapy Notes Treatment date

Notes

Radiotherapy Notes Treatment date

Notes

Radiotherapy Notes Treatment date

Notes

Radiotherapy Notes Treatment date

Notes

Radiotherapy Notes Treatment date

Notes

Radiotherapy Notes Treatment date

Notes

Radiotherapy Notes Treatment date

Notes

Radiotherapy Notes Treatment date

Notes

B o n e

M a r r o w

T r a n s p l a n t

Bone Marrow Transplant

Bone Marrow Transplant Name of Specialist

After Hours Name of Nurse

After Hours Hospital/clinic where treatment will be given Contact number Address

Bone Marrow Transplant Treatment date Type of transplant Notes

Bone Marrow Transplant Notes Notes

Bone Marrow Transplant Notes Notes

Bone Marrow Transplant Notes Notes

Bone Marrow Transplant Notes Notes

C o m p l e m e n t a r y

Complementary Therapy

T h e r a p y

Complementary Therapy Some complementary therapies may benefit your child’s health and wellbeing while receiving conventional medical treatments like chemotherapy and radiotherapy.

Popular therapies like gentle massage and reiki can help to relax your child and alleviate some of the side effects associated with medical treatments. Vitamin supplements and other herbal remedies may also be beneficial.

It is very important to check with your medical team before administering any complementary therapies to ensure these choices will not affect the medical treatments your child is receiving.

Date

Therapy

Notes

Complementary Therapy Date

Therapy

Notes

Complementary Therapy Date

Therapy

Notes

Complementary Therapy Date

Therapy

Notes

Complementary Therapy Date

Therapy

Notes

Complementary Therapy Date

Therapy

Notes

O t h e r

Other

Other In this section you can record details of other support or assistance you or your child may receive, for example, play therapy sessions, counselling (for you or your child), and teaching sessions in hospital.

Date

Therapy

Notes

Other Date

Therapy

Notes

Other Date

Therapy

Notes

Other Date

Therapy

Notes

Other Date

Therapy

Notes

Other Date

Therapy

Notes

D a t e s

t o

r e m e m b e r

Dates

Dates to remember Date

What to remember

Dates to remember Date

What to remember

Dates to remember Date

What to remember

Dates to remember Date

What to remember

Me d ical

Ex p e nses

In this section you can record medical expenses and claims made to your insurance company too.

Medical Expenses

Medical Expenses Date

Provider Services/ Treatment

Referred by

Treatment

Amount charged

Date of insurance claim

Date of insurance payment

Amount of payment

Amount paid by me

Medical Expenses Date

Provider Services/ Treatment

Referred by

Treatment

Amount charged

Date of insurance claim

Date of insurance payment

Amount of payment

Amount paid by me

Medical Expenses Date

Provider Services/ Treatment

Referred by

Treatment

Amount charged

Date of insurance claim

Date of insurance payment

Amount of payment

Amount paid by me

Medical Expenses Date

Provider Services/ Treatment

Referred by

Treatment

Amount charged

Date of insurance claim

Date of insurance payment

Amount of payment

Amount paid by me

Medical Expenses Date

Provider Services/ Treatment

Referred by

Treatment

Amount charged

Date of insurance claim

Date of insurance payment

Amount of payment

Amount paid by me

Medical Expenses Notes Notes

Medical Expenses Notes Notes

Medical Expenses Notes Notes

Medical Expenses Notes Notes

Medical Expenses Notes Notes

Note s

Notes

NOTES:

NOTES:

NOTES:

NOTES:

NOTES:

NOTES:

NOTES:

NOTES:

NOTES:

NOTES:

Ho ld e r s

You can store business cards and other loose items here.

Holders

We gratefully acknowledge the following organisations and individuals for their generous support of the Kenzie’s Gift Journey Kit The Estate of Sir Ernest Hyam Davis Benefitz - Designed by Karen McKinlay & Lee Darby The Kiwanis NZ-SP District Foundation Trust Nigel Latta - Clinical Psychologist & Kenzie’s Gift Ambassador Mike McCrystal - Oncologist & Kenzie’s Gift Trustee Lorna Wood - Child and Youth Psychotherapist Lara Mulgrew - Child and Youth Psychotherapist