Palliative care as a true art form

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How do you ease the pain from an ailment amidst lost words? How can you serve the afflicted when lines start to blur? When the foundation of communication begins to crumble, what will be the pillar health-care professionals can lean on to support patients afflicted with dementia during their final days?

The practice of medicine is both highly analytical and evidence based in nature. However, it is considered a “practice” because at the highest level, it resembles a musician navigating an instrument. It resembles art. Between lab values, imaging techniques and treatment options, the nuances for individualized patient care so often become threatened.

Dementia, a non-malignant terminal illness, involves the progressive cognitive and social decline in those afflicted. Though there is no cure, dementia is commonly met in the setting of end-of-life care. During this final stage of life, the importance of comfort via symptomatic management and communication usually is a priority in patient care. But what about the care of a patient suffering from dementia? While communication serves as the vehicle to deliver care at a high level, medical professionals are suddenly met with a roadblock. And there … behind the pieces of shattered communication and a dampened map of ethical guidelines, health-care providers are at a standstill.

It’s 4:37 a.m. You receive a text message from the overnight nurse at a care facility regarding a current seizure. After lorazepam is ordered and administered, Mr. H, a quick-witted 76-year-old, stabilizes. Phenobarbital 15mg SC qhs was also added to prevent future similar events. You exhale a sigh of relief.

Mr. H. has been admitted to the floor 36 hours earlier after having a seizure while playing poker with colleagues. Since he became your patient, he’s shared many stories from professional and family life with you, along with as many jokes as he could fit in between. However, over the course of the next seven days, Mr. H. would develop aspiration pneumonia, progressing to ventilator dependency and, ultimately, multi-organ failure with rapid cognitive decline.

What strategies and tools would you use to maximize the well-being of your patient during his decline? How would you bridge the gap of understanding between the patient’s family and health-care team to provide the standard of care that all patients are owed?

To give Mr. H. the type of care he would have wanted, upon his hospital admission, he should have been questioned about his understanding of illness along with the goals of care of the medical team. The patient should have been informed that it is imperative to adhere to the medical regimen implemented by his team along with the risks of not doing so. In the event disease-related complications arose, advanced directives should have been documented to avoid any unnecessary measures.

It is important to note, that with each change in status of the patient’s health status, the goal of treatment must be reassessed. The patient or surrogate decision-maker’s understanding of these goals is paramount in maintaining the patient’s autonomy. It is often said that effective communication is the bedrock of a healthy relationship. This is true regardless of type of relationship.

This is why I and Megan Vierhout wrote Integrated End of Life Care in Dementia: A Comprehensive Guide, a book targeted at providing a much-needed road map to navigate the many challenges involved in end-of-life care for individuals with dementia. Ultimately, our aim is to provide a compass for both health-care professionals and the families of those affected by the progressive effects of dementia. We provide practical advice on optimizing communication with individuals with dementia while taking their cognitive limitations, preferences and needs into account.

I invite you to explore the unpredictable terrain of end-of-life care for patients with dementia. Together, we can pave a smoother, sturdier path toward the practice of medicine as a true art form.

This article is republished from healthydebate under a Creative Commons license. Read the original article.

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  • The Seven-Day Sleep Prescription – by Dr. Aric Prather

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    You probably already know about sleep hygiene. So, what does this book have to offer?

    Dr. Aric Prather offers seven days’ worth of adjustments, practices to take up, from when you get up in the morning to when you lay your head down at night.

    Some you’ll surely be familiar with, like avoiding blue light and social media at night.

    Others, you might not be familiar with, like scheduling 15 minutes for worrying in the daytime. The rationale for this one is that when you find yourself inclined to worry at a time that will keep you awake, you’ll know that you can put off such thoughts to your scheduled “worrying time”. That they’ll be addressed then, and that you can thus sleep soundly meanwhile.

    Where the book really comes into its own is in such things as discussing how to not just manage sleep debt, but how to actually use it in your favour.

    Nor does Dr. Prather shy away from the truths of our world… That the world these days is not built for us to sleep well. That there are so many other priorities; to get our work done, to succeed and achieve, to pay bills, to support our kids and partners. That so many of these things make plenty of sense in the moment, but catch up with us eventually.

    Bottom line: what this book aims to give is a genuinely sustainable approach to sleeping—controlling what we can, and working with what we can’t. If you’d like to have a better relationship with sleep, this book is an excellent choice.

    Click here to check out the Seven-Day Sleep Prescription, and improve yours!

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  • How To Nap Like A Pro (No More “Sleep Hangovers”!)

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    How To Be An Expert Nap-Artist

    There’s a lot of science to say that napping can bring us health benefits—but mistiming it can just make us more tired. So, how to get some refreshing shut-eye, without ending up with a case of the midday melatonin blues?

    First, why do we want to nap?

    Well, maybe we’re just tired, but there are specific benefits even if we’re not. For example:

    What can go wrong?

    There are two main things that can go wrong, physiologically speaking:

    1. We can overdo it, and not sleep well at night
    2. We can awake groggy and confused and tired

    The first is self-explanatory—it messes with the circadian rhythm. For this reason, we should not sleep more than 90 minutes during the day. If that seems like a lot, and maybe you’ve heard that we shouldn’t sleep more than half an hour, there is science here, so read on…

    The second is a matter of sleep cycles. Our brain naturally organizes our sleep into multiples of 20-minute segments, with a slight break of a few minutes between each. Consequently, naps should be:

    • 25ish minutes
    • 40–45 minutes
    • 90ish minutes

    If you wake up mid-cycle—for example, because your alarm went off, or someone disturbed you, or even because you needed to pee, you will be groggy, disoriented, and exhausted.

    For this reason, a nap of one hour (a common choice, since people like “round” numbers) is a recipe for disaster, and will only work if you take 15 minutes to fall asleep. In which case, it’d really be a nap of 45 minutes, made up of two 20-minute sleep cycles.

    Some interruptions are better/worse than others

    If you’re in light or REM sleep, a disruption will leave you not very refreshed, but not wiped out either. And as a bonus, if you’re interrupted during a REM cycle, you’re more likely to remember your dreams.

    If you’re in deep sleep, a disruption will leave you with what feels like an incredible hangover, minus the headache, and you’ll be far more tired than you were before you started the nap.

    The best way to nap

    Taking these factors into account, one of the “safest” ways to nap is to set your alarm for the top end of the time-bracket above the one you actually want to nap for (e.g., if you want to nap for 25ish minutes, set your alarm for 45).

    Unless you’re very sleep-deprived, you’ll probably wake up briefly after 20–25 minutes of sleep. This may seem like nearer 30 minutes, if it took you some minutes to fall asleep!

    If you don’t wake up then, or otherwise fail to get up, your alarm will catch you later at what will hopefully be between your next sleep cycles, or at the very least not right in the middle of one.

    When you wake up from a nap before your alarm, get up. This is not the time for “5 more minutes” because “5 more minutes” will never, ever, be refreshing.

    Rest well!

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  • Beetroot vs Carrot – Which is Healthier?

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    Our Verdict

    When comparing beetroot to carrot, we picked the carrot.

    Why?

    It was close! And beetroot does have its advantages, but we say carrot wins on balance.

    In terms of macros, these two root vegetables are close to identical, down to both having 9.57g carbs per 100g, and 2.8g fiber per 100g. Technically, beetroot has a smidgen more protein, but nobody’s eating these for their tiny protein content.

    When it comes to vitamins, it’s not close and the margins are mostly huge: carrots have a lot more of vitamins A, B1, B2, B3, B5, B6, C, E, K, and choline, while beetroot has more vitamin B9.

    In the category of minerals, superficially it swings the other way, but the margins this time are small. Nevertheless, beetroot has more copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while carrots have more calcium.

    This would make things, on balance, a tie: equal on macros, carrots win on vitamins, beetroot wins on minerals.

    But because of the relative margins of difference, carrots win the day, because they’re almost as good as beetroot on those minerals, whereas beetroot doesn’t come close to carrot on the vitamins.

    Want to learn more?

    You might like to read:

    From Apples to Bees, and high-fructose C’s: Which Sugars Are Healthier, And Which Are Just The Same?

    Take care!

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  • How To Reduce Chronic Stress

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    Sunday Stress-Buster

    First, an important distinction:

    • Acute stress (for example, when stepping out of your comfort zone, engaging in competition, or otherwise focusing on something that requires your full attention for best performance) is generally a good thing. It helps you do you your best. It’s sometimes been called “eustress”, “good stress”.
    • Chronic stress (for example, when snowed under at work and you do not love it, when dealing with a serious illness, and/or faced with financial problems) is unequivocally a bad thing. Our body is simply not made to handle that much cortisol (the stress hormone) all the time.

    Know the dangers of too much cortisol

    We covered this as a main feature last month: Lower Your Cortisol! (Here’s Why & How)

    …but it bears mentioning again and for those who’ve joined us since then:

    A little spike of cortisol now and again can be helpful. Having it spiking all the time, or even a perpetual background low-to-moderate level, can be ruinous to the health in so many ways.

    The good news is, the physiological impact of stress on the body (which ranges from face-and-stomach fat deposits, to rapid aging), can be reversed—even the biological aging!

    Read: Biological age is increased by stress and restored upon recovery ← this study is so hot-of-the-press that it was published literally two days ago

    Focus on what you can control

    A lot of things that cause you stress may be outside of your control. Focus on what is within your control. Oftentimes, we are so preoccupied with the stress, that we employ coping strategies that don’t actually deal with the problem.

    That’s a maladaptive response to an evolutionary quirk—our bodies haven’t caught up with modern life, and on an evolutionary scale, are still priming us to deal with sabre-toothed tigers, not financial disputes, for example.

    But, how to deal with the body’s “wrong” response?

    First, deal with the tiger. There isn’t one, but your body doesn’t know that. Do some vigorous exercise, or if that’s not your thing, tense up your muscles strongly for a few seconds and then relax them, doing each part of your body. This is called progressive relaxation, and how it works is basically tricking your body into thinking you successfully fled the tiger, or fought the tiger and won.

    Next, examine what the actual problem is, that’s causing you stress. You’re probably heavily emotionally attached to the problem, or else it wouldn’t be stressing you. So, imagine what advice you would give to help a friend deal with the same problem, and then do that.

    Better yet: enlist an actual friend (or partner, family member, etc) to help you. We are evolved to live in a community, engaged in mutual support. That’s how we do well; that’s how we thrive best.

    By dealing with the problem—or sometimes even just having support and/or something like a plan—your stress will evaporate soon enough.

    The power of “…and then what?”

    Sometimes, things are entirely out of your control. Sometimes, bad things are entirely possible; perhaps even probable. Sometimes, they’re so bad, that it’s difficult to avoid stressing about the possible outcomes.

    If something seems entirely out of your control and/or inevitable, ask yourself:

    “…and then what?”

    Writer’s storytime: when I was a teenager, sometimes I would go out without a coat, and my mother would ask, pointedly, “But what will you do if it rains?!”

    I’d reply “I’ll get wet, of course”

    This attitude can go just the same for much more serious outcomes, up to and including death.

    So when you find yourself stressing about some possible bad outcome, ask yourself, “…and then what?”.

    • What if this is cancer? Well, it might be. And then what? You might seek cancer treatment.
    • What if I can’t get treatment, or it doesn’t work? Well, you might die. And then what?

    In Dialectic Behavior Therapy (DBT), this is called “radical acceptance” and acknowledges bad possible/probable/known outcomes, allows one to explore the feelings, and come up with a plan for managing the situation, or even just coming to terms with the fact that sometimes, suffering is inevitable and is part of the human condition.

    It’ll still be bad—but you won’t have added extra suffering in the form of stress.

    Breathe.

    Don’t underestimate the power of relaxed deep breathing to calm the rest of your body, including your brain.

    Also: we’ve shared this before, a few months ago, but this 8 minute soundscape was developed by sound technicians working with a team of psychologists and neurologists. It’s been clinically tested, and found to have a much more relaxing effect(in objective measures of lowering heart rate and lowering cortisol levels, as well as in subjective self-reports) than merely “relaxing music”.

    Try it and see for yourself:

    !

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  • Does Ginseng Increase Testosterone Levels?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    ❓ Q&A With 10almonds Subscribers!

    Q: You talked about spearmint as reducing testosterone levels, what about ginseng for increasing them?

    A: Hormones are complicated and often it’s not a simple matter of higher or lower levels! It can also be a matter of…

    • how your body converts one thing into another
    • how your body responds (or not) to something according to how the relevant hormone’s receptors are doing
    • …and whether there’s anything else blocking those receptors.

    All this to say: spearmint categorically is an anti-androgen, but the mechanism of action remains uncertain.

    Panax ginseng, meanwhile, is one of the most well-established mysteries in herbal medicine.

    Paradoxically, it seems to improve both male and female hormonal regulation, despite being more commonly associated with the former.

    But it also…

    Bottom line: Panax ginseng is popularly taken to improve natural hormone function, a task at which it appears to excel.

    Scientists are still working out exactly how it does the many things it appears to do.

    Progress has been made, and it clearly is science rather than witchcraft, but there are still far more unanswered questions than resolved ones!

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  • Vitamin C (Drinkable) vs Vitamin C (Chewable) – Which is Healthier?

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    Our Verdict

    When comparing vitamin C (drinkable) to vitamin C (chewable), we picked the drinkable.

    Why?

    First let’s look at what’s more or less the same in each:

    • The usable vitamin C content is comparable
    • The bioavailability is comparable
    • The additives to hold it together are comparable

    So what’s the difference?

    With the drinkable, you also drink a glass of water

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    Are You Wasting Your Vitamins? Maybe, But You Don’t Have To

    If you’d like to get some of the drinkable vitamin C, here’s an example product on Amazon

    Enjoy!

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