Making Difficult Decisions: Palliative Care vs Aggressive Treatment of Cancer

The following article is from the Washington Post, April 30/12.  It is by a woman diagnosed with aggressive breast cancer, describing her experiences and reasons for choosing to not have aggressive treatment of the cancer.

It is similar to another article included on this website Acceptance: when to say stop (Waging Peace in the War on Cancer). Both articles offer a perspective for patients and their families when deciding whether to focus on a primary goal of comfort or cure in the face of an incurable disease.

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Goal Focused Care: How To Choose The Most Appropriate Healthcare While In Hospital

Planning for the future is something many do everyday.  Healthcare is no different. Every patient has the right to participate when deciding what kind of medical care is appropriate for them. This information is being offered to help patients and families in hospital clarify healthcare related goals and make important decisions about medical treatment.

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Treatment Dilemmas in Dementia: When Can You Say Stop?

Many families have told me that dementia is a diagnosis worse than cancer.  

An excellent article published in the New York Times on June 20, 2010, [ see the link below *], and written by Katy Butler [the patient’s daughter], describes eloquently what living with dementia can be like for many families. She summarizes the problems caregivers deal with, the effects on the family, and the ethical choices they sometimes face when confronted with the dilemma of “what is the right thing to do”.

 

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Are Seniors Overmedicated?

Although seniors constitute 13% of the population, they consume 30% of all prescription drugs, prompting many seniors and their families to ask, “Why all these pills?”  I’ve seen patients taking as many as 20 different prescription and OTC (over-the-counter) medications.  Are all these drugs really necessary, or, could they be causing more harm than good? The following facts suggest that we should be concerned about this high consumption of medications:

 

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Ketamine Protocol for In-Hospital Use

Purpose: Treatment of opioid-resistant pain and of opioid-induced neurotoxicity.

What is Ketamine: It is a “dissociative anesthetic” (the mind is ‘dissociated’ from the body and pain), meaning a patient ‘appears to remain awake’ but is actually unconscious and feels no pain when given full anesthetic doses.  With sub-anesthetic doses, pain/agitation are reduced without ‘loss of awareness/consciousness’.   It is particularly beneficial for neuropathic pain and opioid-resistant or difficult pain syndromes; and, as an adjuvant agent, can reduce the amount of narcotic required.
Physiological Effects to be expected (uncommon w/ sub-anesthetic doses):  tachycardia, increased secretions, diplopia, myoclonus, increased BP [occasionally hypotension].

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