Archives for September 2014

Palliative Defined

Palliative Defined

‘Palliative’ (p`alle `aytiv) or ‘Palliate’ (p`allee `ayt): the relief of physical, emotional, psychosocial and spiritual symptoms with or without cure of the medical condition. Simply put, palliative care seeks to assist you in living the best day you can live, every day.

Unfortunately, for many people, it is synonymous with hospice and, therefore, death. Whether speaking to patients, families or other health care providers, the reaction to the word ‘palliative’ is often the same: hands up, step back, shake head and an emphatic, “no-no, it’s not time for THAT.”

Consider for a moment that palliative care (relief of symptoms whether or not the underlying condition can be cured) has become a medical specialty, just as cardiology, neurology, nephrology and many others are. Palliative care has taken the concept of holistic symptom relief, combined it with a team approach and is focused on the prevention and relief of suffering while supporting the best quality of life for patients (and loved ones) facing a serious illness.

Unlike hospice, palliative care does not require a terminal prognosis. Palliative care seeks to provide the physical, emotional, psychosocial and spiritual care that is often needed throughout the course of a serious illness, diagnosis to conclusion. Palliative care can and should be utilized while receiving aggressive treatment to prolong life, as well as to ease the symptoms of dying.

Studies have shown that people who receive palliative care can live longer, with greater quality of life than those who do not receive palliative care. Before you step back, shake your head and say “it’s not time for THAT,” ask yourself why you wouldn’t deserve the very best YOU-based care that WE can provide.

Opioid-Induced Constipation

Opioid-Induced Constipation

Opioids are effective pain relievers, but commonly cause changes in your bowel habits.  Why does this happen?  These medications increase the amount of time it takes stool to move through the gastrointestinal system.   They are also able to partially paralyze the stomach so that food remains in the stomach for a longer period of time.  Additionally, opioids reduce digestive secretions and decrease the urge to pass stool.  Often, laxatives and/or stool softeners are prescribed/recommended at the same time as the pain killers.

How can you prevent this from happening?  You can make changes in your lifestyle by:

  • Increasing your dietary fiber (whole grain breads/cereal, fruits, vegetables, nuts, and seeds)
  • Increasing decaffeinated fluid intake to at least 8 cups/day
  • Increasing exercise or physical activity (15-30 minutes/day)
  • Increasing time and privacy for toileting

What options are available for treating constipation if lifestyle changes are not possible or effective?

  • Colace (docusate sodium) 100mg 1-2 capsules once or twice daily
  • Miralax (polyethylene glycol) 17 GM (1 capful) once or twice daily
  • Milk of Magnesia (MOM or Magnesium Hydroxide) 30 ml once daily
  • Senokot 1-2 tablets once or twice daily

Always contact your healthcare provider’s office if you have not had a bowel movement in 3 days.  Occasionally, rectal interventions are recommended if the above measures are not effective.  Rectal interventions are as follows:

  • Suppositories
  • Enemas
  • Rectal irrigation
  • Manual evacuation

Cancer Communication

Cancer Communication

The goal of good health care communication is to build a trusting relationship between the patient and the health care team. A trusting relationship allows for sharing of information and defining of patient expectations. 

Cancer is a life-threatening illness. When diagnosed with cancer patients feel fear and anxiety about prognosis and treatments. A general sense of loss of control occurs for nearly all patients. Open communication with the patient and provider fosters many positive results:

 -More informed patients

-Patient’s expectations clearly defined to the health care team

-Patients more satisfied with care

-Patients and families with more control of medical decision making

-Better able to make the change from active treatment to palliative care

Patients and their families should define their expectations for communication to and with the physician. This allows the provider to tailor communication to that family’s and patient’s needs. Some patients and families want a lot of detailed information. Others want less detail. The need for information may change as the patient moves through diagnosis and treatment. There will be key times when information will need to be discussed in detail. These key decision times include:

 -When the patient is first diagnosed

-Anytime new decisions about treatment need to be made

-After treatment, when discussing how well it worked

-Whenever the goal of care changes

-When discussions about advance directives, such as a living will, need to occur 

Cancer is an overwhelming diagnosis. Patient-provider communication, for multiple reasons outlined above and more, is the basis for quality cancer care and cancer outcomes.