Month: March 2009

Care of the Dying Patient and Their Family

Dr. PK Sachan, Professor and Head of the Department of Surgery, HIHT, Dehradun, India

  Friday, February 24^th, 4:00pm, HIHT

 There are new challenges to the oncology team.  How do we care for the terminally ill patient and best use palliative care versus the familiar curative care approach. 

 These challenges include:

1.     Medicalization of death—people rushing to the hospital and having unrealistic expectations for those terminally ill.

2.     Hospitals are run like a business—noisy, no place to discuss and reflect on these deeper issues surrounding dying.

3.     Lack of awareness and lack of education of staff—newly trained staff lack training in palliative medicine, management skills are poor

4.     Poor symptom control of pain—under or over control of pain symptoms, not dealing with side effects of management.

5.     Changing trajectory of disease—better health care giving rise to improved long term survival and how to handle the problems that arise.

6.     Difficult to give an accurate prognosis

7.     Communication gap between staff, patients and other disciplines in speaking among each other.

8.     Lack of planning due to poor information given and received from families and patients.

9.     Death is considered a taboo—

(Int J Clin Pract 2009.  63 (3):508-515.)

 

Planning the care of the terminally ill patient is important.  Discuss the prognosis properly.  Don’t make predictions.  Meet with others in the team who are the seniors for more information.  Don’t be extreme, nor overly optimistic.  Look at the statistics for each problem.  Explain these statistics and course of the disease to the family so they can make a good decision.  Explain the events that will happen and the best form of timely treatment.

 

There are barriers that inhibit advanced care planning.  Does the doctor lack curiosity—is the doctor more concerned with only diagnosis and medical/surgical treatment.  Has the doctor learned about the patient’s hopes, likes and dislikes and general life that has been lived and now will be ending?  How to best support this patient?  Does the doctor emphasize curing the disease or helping to heal the patient who has a terminal disease?  How does the doctor inform the children?  If the parent is dying, find out who in the family/village that is closest to this child.  What are the cultural and religious considerations of the patient and the family?

 

There are many considerations to palliative care:  relieve pain and symptoms, consider that dying is normal, do not hasten or delay the process, utilize proper support and integrate other services, use a team approach to coordinate and manage the program properly.

 

Patients want relief of their suffering.  Try to optimize their physical comfort, maintain proper management and prepare for their death.

 

There are multiple problems and systems that must be managed: Insomnia, fatigue, psychological problems, respiratory problems, bleeding and GI disorders

 

Consider sources of distress that come from the family and finances.  Be attentive to spiritual concerns and prepare for the final days (patient/family comfort and staff support).  Prepare to deal with grief and bereavement of all concerned.

A Wonderful Success

International Conference on Meditation for Pain Management

More than 100 people from around the world were welcomed to the peaceful, colorful, flower-perfumed campus of Swami Rama Sadhaka Grama, Rishikesh, for the groundbreaking Conference on Meditation for Pain Management. The beautiful setting belied the serious topic of pain and its management. Findings were presented from the most up to date advances in scientific knowledge combined with insights and wisdom of ancient traditions. The five day event, 24th – 28th February 2009, shed new light on the physical, mental emotional and spiritual nature of pain and stress.

 

Swami Veda Bharati, disciple of Swami Rama of the Himalayas, graced the participants with his presence during guided meditations and lectures. His compassion, love and humor permeated the atmosphere of the meditation hall. He spoke from his personal experience of dealing with chronic pain, shared the results of his own experimentations and framed all within the context of a spiritual philosophy of pain management through meditation. In his words, “Let not body conditions become mind conditions.” Meditation works on the self-regulating mechanisms inside us to prevent pain. Suffering due to pain is a result of our emotions. It is we who choose to enjoy or to suffer; we choose our emotion about the fact of pain. Swamiji emphasized the purpose of meditation is to strengthen the energy field of the mind and to increase the capacity of the mind to remain neutral towards pleasant or painful events around us. This is reflected in the concept of “dhrti” or steadfastness. To treat pain, dissolve the negative emotion and open the blockages caused by tension. Through this process we create a new “lifestyle” for our mind.

 

The rest of the jam-packed schedule included 37 sessions varying in style between lectures, demonstrations, practicums and discussions. The multinational speakers, leading researchers and practitioners in their fields, included doctors, scientists, researchers and senior teachers of the Himalayan Yoga Tradition. Dr. S.B. Mishra, Vice-Chancellor Dev Sanskrit University, gave the inaugural address. He spoke about the philosophy of his University which to develop culture, commitment and character in its students as well as competency skills. The Conference theme address was given by Dr. John Clarke who inaugurated the Combined Therapy Program at the Himalayan Institute under the guidance of Swami Rama. He defined the goal of combined therapy as an integration of medical science with self awareness to facilitate changes in lifestyle, and thereby enhance the effectiveness of medical treatment.

Sessions included papers on brain research and scientific studies of the effects of yoga practices such as the 61 points relaxation, relaxation and the breath, and various meditation techniques. Participants learned about complementary therapies which have much to offer in the treatment of pain such as the five elements approach, yoga mudras, homeopathy, ayurveda and panchakarma. Several sessions explored the use of biofeedback for pain control and stress reduction. Clinical practitioners discussed their use of an integrative therapy approach in diverse applications such as managing neurological disabilities in children, low back pain, anxiety in dental patients, patients with cancer, and care of the dying patient and family Practical sessions included joints and glands as taught by Swami Rama, hatha yoga for osteoarthritis and low back pain, use of mantra, diaphragmatic breathing, the sweeping breath, yoga nidra and contemplative walking.

Conference participants were graciously welcomed by Dr. Kathy McKeehan and Mr. Vijay Dhasmana, Vice-Chancellor HIHT University, to the impressive campus of the Himalayan Institute Hospital Trust for a delightful, informative and inspiring day. In addition to hearing from the medical staff, many of whom were personally trained by Swami Rama, participants were treated to a delicious picnic in the park and were able to visit Swami Rama Centre. Other sessions were held at Seema Dental College and Hospital, facilitated by Dr. Anirudh G. Pratap Singh, Director. Seema Dental College is a next door neighbor to SRSG and was a co-sponsor of the Conference as was HIHT Hospital and University.

Two of the Conference evenings were devoted to world class cultural events. Jyoti Shrivastava offered an inspired evening of classical Indian dance in the Odissis style. The evening of Kirtan highlighted the talents of guests and residents of the Ashram including world renowned violinist Alexandre Jablukov, a masterful storyteller, an exquisite dancer, and the chanting of traditional bhajans led by the Gurukulum students.

A vote of thanks to Conference Chairs, Dr. Susan Gould-Fogerite, Dr. Veena Maitra, Mr. Vijay Dhasmana and Dr. John Clarke. For summary reports of all sessions, please visit www.ahymsin.org/main and look under the “news and dates” menu. The entire Conference was professionally videotaped and also audio recorded for future broadcasts. A book of the proceedings and other additional material is planned.

As one participant noted about the Conference, “It has motivated me for my lifetime. I want to learn meditation, become a teacher and serve the community.” One of the goals of the conference was help attendees recognize their own pain and stress-related symptoms and learn new tools to manage them in order to better serve themselves and the world. By this and other measures, the Conference was a wonderful success.