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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8 Signs Of Iodine Deficiency You Might Not Expect
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Health Coach Kait (BSc Nutrition & Exercise) is a certified health and nutrition coach, and today she’s here to talk about iodine—which is important for many of our body functions, from thyroid hormone production to metabolic regulation to heart rate management, as well as more superficial-but-important-too things like our skin and hair.
Kait’s hitlist
Here’s what she recommends we look out for:
- Swollen neck: even a slightly swollen neck might indicate low iodine levels (this is because that’s where the thyroid glands are)
- Hair loss: iodine is needed for healthy hair growth, so a deficiency can lead to hair loss / thinning hair
- Dry and flaky skin: with iodine’s role in our homeostatic system not being covered, our skin can dry out as a result
- Feeling cold all the time: because of iodine’s temperature-regulating activities
- Slow heart rate: A metabolic slump due to iodine deficiency can slow down the heart rate, leading to fatigue and weakness (and worse, if it persists)
- Brain fog: trouble focusing can be a symptom of the same metabolic slump
- Fatigue: this is again more or less the same thing, but she said eight signs, so we’re giving you the eight!
- Irregular period (if you normally have such, of course): because iodine affects reproductive hormones too, an imbalance can disrupt menstrual cycles.
For more on each of these, as well as how to get more iodine in your diet, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Further reading
You might also like to read:
- A Fresh Take On Hypothyroidism
- Foods For Managing Hypothyroidism (incl. Hashimoto’s)
- Eat To Beat Hyperthyroidism!
Take care!
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Chromium Picolinate For Blood Sugar Control & Weight Loss
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First, a quick disambiguation:
- chromium found in food, trivalent chromium of various kinds, is safe (in the quantities usually consumed) and is sometimes considered an essential mineral, sometimes considered unnecessary but beneficial. It’s hard to know for sure, since it’s in a lot of foods (naturally, like many trace elements)
- chromium found in pollution, hexavalent chromium (so: twice as many cationic bonds, if this writer’s chemistry serves her correctly) is poisonous.
We’re going to be writing about the food kind, which is also possible to take as a supplement.
In this case, supplementing vs getting from food is quite a big difference, by the way, since (unlike for a lot of things, which are often the other way around) the bioavailability of chromium from food is very low (around 2.5%), whereas chromium picolinate, one of the most commonly-used supplement forms, boasts higher bioavailability.
Does it work for blood sugars?
Yes, it does! At least, it does in the case of people with type 2 diabetes. Rather than bombard you with many individual studies, here’s a systematic review and meta-analysis of 22 criteria-meeting randomized clinical trials that found:
❝The available evidence suggests favourable effects of chromium supplementation on glycaemic control in patients with diabetes.
Chromium monosupplement may additionally improve triglycerides and HDL-C levels.❞
Type 1 diabetes does not have anything like the same weight of evidence, and indeed,
we couldn’t find a single human study. It was beneficial for mice with artificially-induced T1D, thoughwait no, we have an update! We found literally a single human study:Chromium picolinate supplementation for diabetes mellitus
Literally, as in: it’s a case study of one person, and the results were a modest reduction in Hb A1c levels after 3 months of 600μg daily; the researchers concluded that ❝chromium picolinate continues to fall squarely within the scope of “alternative medicine,” with both unproven benefits and unknown risks❞.
As for people without diabetes, it may reduce the risk of diabetes:
Risk of Type 2 Diabetes Is Lower in US Adults Taking Chromium-Containing Supplements
However! This was an observational study, and correlation ≠ causation.
Furthermore, they said:
❝Over one-half the adult US population consumes nutritional supplements, and over one-quarter consumes supplemental chromium. The odds of having T2D were lower in those who, in the previous 30 d, had consumed supplements containing chromium❞
That “over one-quarter consumes supplemental chromium” brought our attention to the fact that this is not talking about specifically chromium “monosupplements” (definitely not quarter of the adult population take those), but rather, “multivitamin and mineral” supplements that also contain a tiny amount (often under 50μg) of chromium.
In other words, this ruins the data and honestly the benefit could have been from anything in the “multivitamin and mineral” supplement, or indeed, could just be “the kind of person who takes supplements is the kind of person who lives a lifestyle that is less conducive to becoming diabetic”.
Does it work for weight loss?
We’re running out of space here, so we’ll be brief:
No.
There are many papers that have concluded this, but here are two:
Chromium picolinate supplementation for overweight or obese adults
and
Is it safe?
Science’s current best answer is “we don’t know; it hasn’t been tested enough; we haven’t even established the tolerable upper limit, which is usually step 1 of establishing safety”.
Nor is there an estimated average requirement (if indeed there even is a requirement, which question is also not as yet answered conclusively by science), and science falls back to “here’s an average of what people consume in their diet, so that’s probably safe, we guess”.
(that average was reckoned as 25μg/day for young women and 25μg/day for young men, by the way; older ages not as yet reckoned)
You can read about this sorry state of affairs here.
Want to try some?
Notwithstanding the above lack of data for safety, it does have benefits for blood sugars, so if that’s a gamble you’re willing to make, then here’s an example product on Amazon.
Note: the dosage per capsule there (800μg) is half of the low end of the dose that was implicated in the serious kidney condition caused in this case study (1200–2400μg), so if you are going to try it, we strongly recommend not taking more than one per day.
Take care!
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4 Critical Things Female Runners Should Know
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When it comes to keeping up performance in the face of menopause, Shona Hendricks has advice:
Don’t let menopause run you down
- Prioritize recovery! Overtraining without adequate recovery just leads to decreased performance in the long term, and remember, you may not recover as quickly as you used to. If you’re still achey from your previous run, give it another day, or at least make it a lighter run.
- Slow down in easy and long runs! This isn’t “taking the easy way out”; it will improve your overall performance, reducing muscle damage, allowing for quicker recovery and ultimately better fitness gains.
- Focus on nutrition! And that means carbs too. A lot of people fighting menopausal weight gain reduce their intake of food, but without sufficient energy availability, you will not be able to run well. In particular, carbohydrates are vital for energy. Consume them sensibly and with fiber and proteins and fats rather than alone, but do consume them.
- Incorporate strength training! Your run is not “leg day” by itself. Furthermore, do whole-body strength training, to prevent injuries and improve overall performance. A strong core is particularly important.
For more on each of these (and some bonus comments about mobility training for runners), enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
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I Will Make You Passionate About Exercise – by Bevan Eyles
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What this isn’t: a “just do it!” motivational pep-talk.
What this is:a compassionate and thoughtful approach to help non-exercisers become regular exercisers, by looking at the real life factors of what holds people back (learning from his own early failures as a coach, by paying attention now to things he inadvertently neglected back then), both in the material/practical and in the psychological/emotional.
Further, he gives a 10-step method, for those who would like to be walked through it by the hand, making the transition to exercising regularly (and as a leisure habit, rather than as a chore) as frictionless as possible.
The style is friendly and energetic, and very easy-reading throughout.
Bottom line: if you are someone who finds exercising to be a chore, this book can definitely help you “get from here to there” in terms of finding joy in it, and finding exercise even easier than not exercising. Yes, really.
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Pulse – by Jenny Chandler
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Beans, chickpeas, and lentils are well-established super-healthy foods, but they’re often not a lot of people’s favorite. And why? Usually because of unhappy associations with boring dishes that can barely be called dishes.
This book raises the bar for pulses of various kinds, and not only provides recipes (180 of them) but also guidelines on principles, tips and tricks, what works and what doesn’t, what makes things better or worse, perfect partners, sprouting, and more.
The recipes themselves are not all vegan, nor even all vegetarian, but the beans are the star throughout. For those who are vegan or vegetarian, it’s easy to make substitutions, not least of all because the author is generous with “try this instead of that” and “consider also” suggestions, to help us tailor each dish to our personal preferences, and even the desired vibe of a given meal.
The dishes are neither overly simplistic (it’s not a student survival cookbook, by any means) nor overly complicated; rather, enough is done to make each dish invitingly tasty, and nothing extraneous or pretentious is added for the sake of being fancy. This is about delicious home cooking, nothing more nor less.
If the book has a weakness, it’s that visual learners will feel the absence of pictures for many recipes. But, the text is clear, the instructions are easy to follow, and a photo for each dish would probably have doubled the cost of the book, at least, while halving the number of recipes.
Bottom line: if you’d like to get more beans and other pulses in your diet, but are unsure how to make it exciting, this is an excellent option.
Click here to check out Pulse, and expand your kitchen repertoire!
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Overcome Front-Of-Hip Pain
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Dr. Alyssa Kuhn, physiotherapist, demonstrates how:
One, two, three…
One kind of pain affects a lot of related things: hip pain has an impact on everything that’s connected to the pelvis, which is basically the rest of the body, but especially the spine itself. For this reason, it’s critical to keep it in as good condition as possible.
Two primary causes of hip stiffness and pain:
- Anterior pelvic tilt due to posture, weight distribution, or pain. This tightens the front muscles and weakens the back muscles.
- Prolonged sitting, which tightens the hip muscles due to inactivity.
Three exercises are recommended by Dr. Kuhn to relieve pain and stiffness:
- Bridge exercise:
- Lie on a firm surface with your knees bent.
- Push through your feet, engage your hamstrings, and flatten your lower back.
- Hold for 3–5 seconds, relax, and repeat (10–20 reps).
- Wall exercise with arms:
- Stand with your lower back against the wall, feet a step away.
- Tilt your hips backwards, keeping your lower back in contact with the wall.
- Alternate lifting one arm at a time while maintaining back contact with the wall (10–20 reps).
- Wall exercise with legs:
- Same stance as the previous exercise but wider now.
- Lift one heel at a time while keeping your hips stable and your back against the wall.
- Practice for 30–60 seconds, maintaining good form.
As ever, consistency is key for long-term relief. Dr. Kuhn recommends doing these regularly, especially before any expected periods of prolonged sitting (e.g. at desk, or driving, etc). And of course, do try to reduce, or at least break up, those sitting marathons if you can.
For more on all of this plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
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