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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Pasteurization: What It Does And Doesn’t Do
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Pasteurization’s Effect On Risks & Nutrients
In Wednesday’s newsletter, we asked you for your health-related opinions of raw (cow’s) milk, and got the above-depicted, below-described, set of responses:
- About 47% said “raw milk is dangerous to consume, whereas pasteurization makes it safer”
- About 31% said “raw milk is a good source of vital nutrients which pasteurization would destroy”
- About 14% said “both raw milk and pasteurized milk are equally unhealthy”
- About 9% said “both raw milk and pasteurized milk are equally healthy”
Quite polarizing! So, what does the science say?
“Raw milk is dangerous to consume, whereas pasteurization makes it safer: True or False?”
True! Coincidentally, the 47% who voted for this are mirrored by the 47% of the general US population in a similar poll, deciding between the options of whether raw milk is less safe to drink (47%), just as safe to drink (15%), safer to drink (9%), or not sure (30%):
Public Fails to Appreciate Risk of Consuming Raw Milk, Survey Finds
As for what those risks are, by the way, unpasteurized dairy products are estimated to cause 840x more illness and 45x more hospitalizations than pasteurized products.
This is because unpasteurized milk can (and often does) contain E. coli, Listeria, Salmonella, Cryptosporidium, and other such unpleasantries, which pasteurization kills.
Source for both of the above claims:
(we know the title sounds vague, but all this information is easily visible in the abstract, specifically, the first two paragraphs)
Raw milk is a good source of vital nutrients which pasteurization would destroy: True or False?
False! Whether it’s a “good” source can be debated depending on other factors (e.g., if we considered milk’s inflammatory qualities against its positive nutritional content), but it’s undeniably a rich source. However, pasteurization doesn’t destroy or damage those nutrients.
Incidentally, in the same survey we linked up top, 16% of the general US public believed that pasteurization destroys nutrients, while 41% were not sure (and 43% knew that it doesn’t).
Note: for our confidence here, we are skipping over studies published by, for example, dairy farming lobbies and so forth. Those do agree, by the way, but nevertheless we like sources to be as unbiased as possible. The FDA, which is not completely unbiased, has produced a good list of references for this, about half of which we would consider biased, and half unbiased; the clue is generally in the journal names. For example, Food Chemistry and the Journal of Food Science and Journal of Nutrition are probably less biased than the International Dairy Association and the Journal of Dairy Science:
FDA | Raw Milk Misconceptions and the Danger of Raw Milk Consumption
this page covers a lot of other myths too, more than we have room to “bust” here, but it’s very interesting reading and we recommend to check it out!
Notably, we also weren’t able to find any refutation by counterexample on PubMed, with the very slight exception that some studies sometimes found that in the case of milks that were of low quality, pasteurization can reduce the vitamin E content while increasing the vitamin A content. For most milks however, no significant change was found, and in all cases we looked at, B-vitamins were comparable and vitamin D, popularly touted as a benefit of cow’s milk, is actually added later in any case. And, importantly, because this is a common argument, no change in lipid profiles appears to be findable either.
In science, when something has been well-studied and there aren’t clear refutations by counterexample, and the weight of evidence is clearly very much tipped into one camp, that usually means that camp has it right.
Milk generally is good/bad for the health: True or False?
True or False, depending on what we want to look at. It’s definitely not good for inflammation, but the whole it seems to be cancer-neutral and only increases heart disease risk very slightly:
- Keep Inflammation At Bay ← short version is milk is bad, fermented milk products are fine in moderation
- Is Dairy Scary? ← short version is that milk is neither good nor terrible; fermented dairy products however are health-positive in numerous ways when consumed in moderation
You may be wondering…
…how this goes for the safety of dairy products when it comes to the bird flu currently affecting dairy cows, so:
Take care!
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How To April Fool Yourself Into Having A Nutrient-Dense Diet!
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These nutrient-dense foods pack such a punch you only need a bit added to your meal…
- “Have 5 servings of fruit per day”—popular wisdom in the West
- “Have 7 servings of fruit per day!”—generally held as the norm in Japan
- “Have these 12 things that are mostly fruit & veg & nuts each day”—Dr. Greger’s Daily Dozen
- “Does the pickle that comes with a burger count?”—an indication of how much many people struggle.
For what it’s worth: pickles are a good source of some minerals (and some healthy gut bacteria too), but are generally too high in sodium to be healthy for most people beyond in the most modest moderation.
But! It can be a lot easier, and without sitting down to a salad buffet every day!
Here are some sneaky tips:
(call it our nod to April Fool’s Day, because tricking yourself into eating more healthily is a top-tier prank)
Beyond soups and smoothies
Soups and smoothies are great, because we can take a lot of nutrients that way without actually oing much eating. And if we’ve a want or need to hide something, blending it does a fine job. However, we’re confident you already know how to make soups and smoothies. So…
Sauces are another excellent place to put nutrients—and as a bonus, homemade sauces will mean skipping on the store-bought sauces whose ingredients all-too-often look something like “sugar, water, spirit vinegar, glucose-fructose syrup, modified maize starch, maltodextrin, salt…”
Top things to use as a main base ingredient in sauces:
- Tomato purée—so much lycopene, and great vitamins too! Modest flavour, but obviously only sensible for what you intend to be a tomato-based sauce. Use it to make anything from marinara sauce to ketchup, sweet-and-sour to smoky barbecue.
- Lentils/beans—if unsure, red lentils or haricot beans have a very mild taste, and edamame beans are almost not-there, flavor-wise. But cooked and blended smooth, these are high-protein, iron-rich, flavonoid-heavy, and a good source of fiber too. Can be used as the base of so many savory creamy sauces!
- Corn—that yellow color? It’s all the lutein. Home-made creamed corn goes great as a dipping sauce! Added spices optional.
Vegetables that punch above their weight
Sometimes, you might not want to eat much veg, but a small edible side-dish could be appealing, or even a generous garnish. In those cases, if you choose wisely, you can have a lot of nutrients in a tiny portion. Here are some that have an absurd nutrient-to-size ratio:
Cacao nibs—one for the dessert-lovers here, but can also garnish a frothy coffee, your morning overnight oats, or if we’re honest, can also just be snacked on! And they keep for ages. Botanically technically a fruit, but we’re going to throw it in here. As for health qualities? Where to begin…
They:
- are full of antioxidants and fight inflammation
- boost immune health
- help control blood sugar levels
- improve vascular function and heart health
- and even fight cancer, which is a many-headed beast, but for example:
…which is starting to look like a pattern, isn’t it? It’s good against cancer.
Brussels sprouts—if your knee-jerk reaction here wasn’t one of great appeal, then consider: these are delicious if done right.
Buy them fresh, not frozen (nothing nutritionally wrong with frozen if you like them—we’re just doing the extra-level tastiness here). Wash them and peel them, then cut twice from the top to almost-the-bottom, to quarter them in a way that they still stay in one piece. Rub them (or if you’re going easier on the fats, spray them) with a little olive oil, a tiny touch of lemon juice, and sprinkle a little cracked black pepper. Sautée them. We know people will advise roasting, which is also great, but try the sautée approach, and thank us later.
Four sprouts is already a sufficient daily serving of cruciferous vegetables, and provides so many health benefits, with not just a stack of vitamins and minerals, but also have anti-cancer properties, are great for your heart in multiple ways, and reduce inflammation too. They’re literally one of the healthiest foods out there and you only need a tiny portion to benefit.
Kale—Don’t like the taste/texture? That’s OK, read on… No surprises here, but it’s crammed with vitamins and minerals.
- If you don’t care for the bitter taste, cooking it (such as by steaming it) takes that away.
- If you don’t care for the texture, baking it with a little sprayed-on olive oil changes that completely (and is how “kale chips” are made).
- If you don’t care for either? Do the “kale chips” thing mentioned above, but do it on a lower heat for longer—dry it out, basically. Then either blend it in a food processor, or by hand with a pestle and mortar (it turns to powder very easily, so this won’t be hard work), and you now have a very nutrient-dense powder that tastes of very little. While fries are not a health food, an example here is that you can literally dust fries with it and they won’t taste any different but you got a bunch of vitamins and minerals added from a whole food source.
- If going for the above approach, do it in batch and make yourself a jar of it to keep handy with your seasonings collection!
Bell peppers—Working hard to justify their high prices in the grocery store, these are very high in vitamins, especially rich in carotenoids, including lutein, and as a bonus, they’re also full of antioxidants. So, slice some and throw them at whatever else you’re cooking, and you’ve added a lot of nutrients for negligible effort.
Garlic—once you’ve done the paperwork, garlic not only makes bland meals delicious, but is also a treasure trove of micronutrients. It has a stack of vitamins and minerals, and also contains allicin. If you’ve not heard of that one, it’s the compound in garlic that is so good for blood pressure and heart health. See for example:
- Lipid-lowering effects of time-released garlic
- Garlic extract lowers blood pressure in patients with hypertension
- Garlic extract reduces blood pressure in hypertensives
If an apple a day keeps the doctor away, just imagine what a bulb of garlic can do (come on, we can’t be the only ones who measure garlic by the bulb instead of by the clove, right?)!
But in seriousness: measure garlic with your heart—have lots or a little, per your preference. The whole point here is that even a little of these superfoods can make a huge difference to your health!
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Behind Book Recommendations
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It’s Q&A Day!
Each Thursday, we respond to subscriber questions and requests! If it’s something small, we’ll answer it directly; if it’s something bigger, we’ll do a main feature in a follow-up day instead!
So, no question/request to big or small; they’ll just get sorted accordingly
Remember, you can always hit reply to any of our emails, or use the handy feedback widget at the bottom. We always look forward to hearing from you!
Q: What’s the process behind the books you recommend? You seem to have a limitless stream of recommendations
We do our best!
The books we recommend are books that…
- are on Amazon—it makes things tidy, consistent, and accessible. And if you end up buying one of the books, we get a small affiliate commission*.
- we have read—we would say “obviously”, but you might be surprised how many people write about books without having read them.
- pertain in at least large part to health and/or productivity.
- are written by humans—bookish people (and especially Kindle Unlimited users) may have noticed lately that there are a lot of low quality AI-written books flooding the market, sometimes with paid 5-star reviews to bolster them. It’s frustrating, but we can tell the difference and screen those out.
- are of a certain level of quality. They don’t have to be “top 5 desert-island books”, because well, there’s one every day and the days keep coming. But they do have to genuinely deliver the value that we describe, and merit a sincere recommendation.
- are varied—we try to not give a run of “samey” books one after another. We will sometimes review a book that covers a topic another previously-reviewed book did, but it must have something about it that makes it different. It may be a different angle or a different writing style, but it needs something to set it apart.
*this is from Amazon and isn’t product-specific, so this is not affecting our choice of what books to review at all—just that they will be books that are available on Amazon.
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Natto, Taurine + Black Pepper, And Other Game-Changers
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Loved the info on nuts; of course I always eat pecans, which didn’t make the list of healthy nuts!❞
Dear subscriber, pardon the paraphrase of your comment—somehow it got deleted and now exists only in this writer’s memory. However, to address it:
Pecans are great too! We can’t include everything in every article (indeed, we got another feedback the same day saying the article was too long), but we love when you come to us with stuff for us to look at and write about (seriously, writer here: the more you ask, the easier it makes my job), so let’s talk pecans for a moment:
Pecans would have been number six on our list if we’d have written more!
Like many nuts, they’ve an abundance of healthy fats, fiber, vitamins, and minerals.
They’re particularly good for zinc, which is vital for immune function, healing (including normal recovery after normal exercise), and DNA synthesis (so: anti-aging).
Pecans are also great for reducing LDL (“bad” cholesterol) and triglycerides (which are also bad for heart health); check it out:
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Cashew Nuts vs Coconut – Which is Healthier?
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Our Verdict
When comparing cashew nuts to coconut, we picked the cashews.
Why?
It can be argued this isn’t a fair comparison, as coconuts aren’t true nuts, but it’s at the very least a useful comparison, because they have very similar (often the same) culinary uses, so deciding between one or the other is something people will often do.
In terms of macros, cashews have 6x the protein and more than 2x the fiber, as well as slightly more fat (but the fats are healthy, as are those of coconut, by the way) and 2x the carbs. Depending on what you’re looking for, this head-to-head could come out differently, but we say it’s a win for cashews.
You may be wondering: if cashews have more of all those things, what are coconuts made of? And the answer is that coconuts have 8x the water (and yes, this is counting the coconut meat only, not including the milk inside). Of course, if you get dessicated coconut, then it won’t have that, but we’re comparing fresh to fresh.
In the category of vitamins, cashews have a lot more of vitamins B1, B2, B3, B5, B6, E, and K. Meanwhile, coconut has more vitamin C, but it’s not a lot. An easy win for cashews here.
When it comes to minerals, cashews have rather more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. On the other hand, coconut has more sodium. Another easy win for cashews.
Cashews also have the lower glycemic index.
All in all, cashews win the day.
Want to learn more?
You might like to read:
Take care!
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Alzheimer’s: The Bad News And The Good
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Dr. Devi’s Spectrum of Hope
This is Dr. Gayatri Devi. She’s a neurologist, board-certified in neurology, pain medicine, psychiatry, brain injury medicine, and behavioral neurology.
She’s also a Clinical Professor of Neurology, and Director of Long Island Alzheimer’s Disease Center, Fellow of the American Academy of Neurology, and we could continue all day with her qualifications, awards and achievements but then we’d run out of space. Suffice it to say, she knows her stuff.
Especially when it comes to the optimal treatment of stroke, cognitive loss, and pain.
In her own words:
❝Helping folks live their best lives—by diagnosing and managing complex neurologic disorders—that’s my job. Few things are more fulfilling! For nearly thirty years, my focus has been on brain health, concussions, Alzheimer’s and other dementias, menopause related memory loss, and pain.❞
Alzheimer’s is more common than you might think
According to Dr. Devi,
❝97% of patients with mild Alzheimer’s disease don’t even get diagnosed in their internist offices, and half of patients with moderate Alzheimer’s don’t get diagnosed.
What that means is that the percentage of people that we think about when we think about Alzheimer’s—the people in the nursing home—that’s a very, very small fraction of the entirety of the people who have the condition❞
As for what she would consider the real figures, she puts it nearer 1 in 10 adults aged 65 and older.
Source: Neurologist dispels myths about Alzheimer’s disease
Her most critical advice? Reallocate your worry.
A lot of people understandably worry about a genetic predisposition to Alzheimer’s, especially if an older relative died that way.
See also: Alzheimer’s, Genes, & You
However, Dr. Devi points out that under 5% of Alzheimer’s cases are from genetics, and the majority of Alzheimer’s cases can be prevented be lifestyle interventions.
See also: Reduce Your Alzheimer’s Risk
Lastly, she wants us to skip the stigma
Outside of her clinical practice and academic work, this is one of the biggest things she works on, reducing the stigma attached to Alzheimer’s both publicly and professionally:
Alzheimer’s Disease in Physicians: Assessing Professional Competence and Tempering Stigma
Want more from Dr. Devi?
You might enjoy this interview:
Click Here If The Embedded Video Doesn’t Load Automatically!
And here’s her book:
Enjoy!
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