When a young patient investigated ways to make her biweekly blood draws less painful, she discovered a Mayo Clinic presentation and staff at Mayo who were more than happy to help her, even though she was a patient elsewhere.

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For an entire month, Ryan Black felt like she was living with chronic altitude sickness.

"My symptoms included heaving breathing, anxiety problems, tiredness and the biggest one, a fast heart rate," she says. "I'd be sitting down, and my heart rate would jump up to around 170 beats per minute very quickly."

At that point, Ryan's mother, Nicole Paradise Black, M.D., a pediatrician at University of Florida Health Shands Children's Hospital in Gainesville, Florida, knew Ryan was suffering from something that wasn't going to go away on its own.

"We took her in and after some testing, she was diagnosed with Graves' disease," Dr. Paradise Black says.

For Ryan, being diagnosed with an immune system disorder that results in the overproduction of thyroid hormones, or hyperthyroidism, wasn't the hardest part. The frequent blood draws that followed her diagnosis required much more emotional strength.

"I had to get blood draws every week to every two weeks immediately after finding out I had Graves' disease," she says. "The anxiety and the build-up to the needle stick was the hardest part."

Taking steps to ease pain

Ryan's phlebotomist, Constance McMillian, sensed her anxiety.

"I think Constance could tell that I was nervous, so she started talking with me and my dad throughout every blood draw," Ryan says. "That really helped calm me down because you build trust with those who help you when things are difficult."

During one blood draw, Constance began telling Ryan about the lack of pain-reducing resources she had access to at her draw station. "It was sad to think that other people might be having worse experiences than me at the blood draw station because they don't have the equipment to make that process better," Ryan says.

Ryan could have left it at that. Instead, she took it upon herself to do something about it.

"We talked about it at home, and I said, 'There are different ways you can help children,'" Dr. Paradise Black says. "And she said, 'I'd love to just be able to get more supplies for the draw stations. Toys for distraction, things like that.'"

That, of course, would require money. "I asked her if she really wanted to take this to the next level, and she said, 'Yes, that's what I want to do to help them,'" Dr. Paradise Black says. "So I told her, 'Then we need to do a fundraiser.'"

Getting help from Mayo Clinic

Before they started fundraising, however, Dr. Paradise Black and Ryan took their idea to the child life specialists and phlebotomy staff at University of Florida Health who would be affected by their work.

"We engaged our child life specialists and our phlebotomy team and department, and we ultimately decided we'd do a formal proposal and bring it to them, because what Ryan wanted to do was going to require additional work and training for them," Dr. Paradise Black says. "We wanted to make it feasible for them."

When Ryan and her mom sat down to start writing their proposal, they began by searching online for "child-friendly blood draws." One of the first results was a presentation by Darci Block, Ph.D., a clinical chemist at Mayo Clinic in Rochester, and Katy Bos, a Pediatric and Adolescent Medicine nurse manager at Mayo Clinic.

"It was all right there in the presentation. It really helped educate Ryan on the different things that can be done to make blood draws better and easier for kids."

Nicole Paradise Black, M.D.

That presentation, "Solutions to Reduce Pediatric Phlebotomy Pain and Improve the Overall Healthcare Experience," was given during Mayo Clinic Laboratories' 2017 Phlebotomy Conference, where Bos and Dr. Block discussed the importance of using pain interventions during pediatric blood draws.

The presentation also offered ways to overcome barriers to implementing, consistently offering, and using pain interventions for pediatric patients undergoing phlebotomy.

"It was all right there in the presentation," Dr. Paradise black says. "It really helped educate Ryan on the different things that can be done to make blood draws better and easier for kids.

Connecting to identify solutions

As Ryan began writing her own presentation, she realized she was borrowing heavily from Dr. Block and Katy Bos. "She didn't think that was right, so that's when we reached out to Dr. Block," Dr. Paradise Black says.

Dr. Block couldn't have been happier to help.

"I'm both humbled and surprised that Ryan not only found our presentation but that it was so useful to her," Dr. Block says. "I'm just very pleased to have contributed to something that could help others."

With what she's learned from Bos and Dr. Block, Ryan is on track to making that happen.

"Dr. Block has given us very helpful information and citations to further our presentation," Ryan says. "Her work has given our work something to build off of. She taught me a lot of things that I was previously unaware of and made the development of our project a lot easier. She has also been very accessible with answering our questions."

Specifically, Ryan says that Dr. Block has helped her identify the different types of topical creams that can be administered to numb areas of the skin during blood draws.

"I'm both humbled and surprised that Ryan not only found our presentation but that it was so useful to her. I'm just very pleased to have contributed to something that could help others."

Darci Block, Ph.D.

"Before looking through her presentation, my mom and I didn't know that there was more than one cream that can be used," Ryan says. "It was very helpful to learn there is more than one solution."

Ryan and her mom presented their ideas for implementing additional pain-reducing resources at blood draw stations to the director of laboratory services at University of Florida Health. "We're also working on ways to measure the effects of our project and have had four pediatric residents from UF Health join our project team to help with education and training materials," Ryan says.

It's a big step forward in Ryan's work to make blood draws easier — and less painful — for others like her.

"I know that everyone will most likely have to get their blood drawn at some point in their life," she says. "I also know that experience can be very tough, and I want to make it easier for as many people as I can. It's one thing to want to help someone because you see their pain. It's another to want to help because you know their pain."

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