living your best to the end

Organ and Tissue Donation: a learning experience

Donna Renzetti (left, standing) Vice President, Corporate Services and Chief Financial Officer at West Park Healthcare Centre came in on a Saturday to make sure there were plenty of chairs at the ready for the Trillium Gift of Life Network (TGLN) presentation on organ and tissue donation and transplant. She needn’t have worried: the gathering group were all wheelchair bound – or rather, wheelchair liberated (depending on your point of view) with the range of wheelchairs equivalent to a high-end car collection, complete with customization. I’m a public member on West Park Healthcare Center’s Palliative and Supportive Steering Committee, and am always up for attending education sessions that can increase my knowledge and understanding of end of life concerns and issues for their residents. Donation is not just for the able-bodied These good folks, for whom day to day living is their first priority, were interested in learning about organ and tissue donation. Their home is the complex continuing care section of West Park Health Center and many live with terminal degenerative conditions like Lou Gehrig disease (ALS) , Lung Disease (COPD), stroke, traumatic brain injury. Restricted and diminished though these West Park residents may appear to me – it’s clear they know exactly with whom they want to sit and are affectionate and caring with one another – communicating by various means. This is a substantially different crowd than the week prior, when I’d attended an Ontario Hospital Association conference on Ethics and Legalities in End of Life, where TGLN also made a presentation, encouraging discussion, decisions and making wishes known. That group, from various healthcare organizations, heard:...

Dialysis and End Stage Kidney (Renal) Disease – ESRD

End of life planning for those with specific chronic conditions:  Topic – Kidney Failure “End-of-Life Care planning (aka: Palliative Care or Advanced Illness Management) is essential for kidney failure patients.” Dr Robert Bear, Nephrologist, Blogger, Tweeter and Author Dr Robert Bear, whom I met via twitter (@RobertAllenBear) educates me on end of life decisions faced by those with end stage kidney disease – also called kidney failure. “While many frail and elderly patients with kidney failure will not choose dialysis treatment, for those that do the annual death rate on dialysis is 15-20%; and, overall, about 20% of long-term dialysis patients will ultimately decide to withdraw from it. “ As Dr Bear reminds me: “60 years ago, doctors would give mostly comfort care to those with end stage renal disease (ESRD) These days, specialists who provide that kind of care are in short supply” Today, for those with ESRD, comfort seems less emphasized than dialysis, now an option, thanks to medical advancements. It wasn’t until I saw ‘Gayla’s Goodbye’ and heard first-hand why she decided not start dialysis, that I began to understand its impact on life: ”My mother had kidney failure (ESRD) and went on Dialysis. She got more and more exhausted from those trips to the clinic. They took up so much of her life. It’s not for me.” Gayla subsequently died peacefully at home. Dr. Bear describes dying of ESRD as ‘typically a painless death’: “As the poison levels rise she would’ve spent more time sleeping. Essentially, she would have ‘slept away’. [blogger’s note: isn’t that how we all want to go?] “If patients are in...

Dr Paula Rochon: Medications and the Elderly

Dr Paula Rochon, Geriatrician,Vice-President Research–Women’s College Research Institute; Adjunct Scientist Kunin-Lunenfeld Applied Research Unit I heard Dr Paula Rochon speak to a small but extremely attentive group of senior seniors. The topic: Medications and the elderly. Rochon is a Geriatrician by training, and her research focus and passion is medication. My take-away: don’t underestimate the impact of medications – the time and effort and challenges required to take ‘em, and the potential effect on other functions. I spoke with Dr. Rochon afterwards, and she clued me in to specific issues related to medications and aging, and a message to pass along to fellow females: Women have to be particularly diligent because so much medication research is done with men. Here’s what I learned: Even if your parent’s been taking the same medication(s) forever, it’s still a good idea to get them reviewed every 4 -6 months. Why? Because aging bodies may not need as much of any one medication. Ask if all medications are necessary, or if any medications can be eliminated If new medication is prescribed, find out what it’s for, if it’s replacing something else, and how it’ll interact with other medications food and drink. Much as weight plays a huge role in how much medication infants are given, as an aging body shrinks, they may not need as much medication. Know your parents weight and height Many medications, or combination of medications can cause confusion, which can lead to a mess o problems: confusion, losing balance and falling, misplacing glasses, dentures, and often –are you ready for this: misdiagnosis of dementia or early Alzheimers. Many pills...

Dr James Downar: death is as precious as life

He seems far too young to be dedicated to minimizing suffering at life’s end, but that is, indeed, Dr Downar’s mission. His three specialties are inter-related: critical care, ethics and palliative care. Palliative care changes the focus from cure to comfort. This sensibility doesn’t fit with the military language often used in healthcare situations: battling, fighting, giving up, winning, losing. Dr Downar’s take puts that tough language into ‘life’s end’ perspective: “In healthcare, you’re always fighting. At life’s end, what your fighting for changes and what one person means by fighter is different than for another. The goal is to determine what you’re fighting for.” When people are asked about Cardiopulmonary Resuscitation (CPR), they often answer without understanding what is involved, and what the consequences may be. CPR can cause pain and suffering, and studies show that the survival rate after CPR in the hospital is very low. “When the heart stops, it’s usually not a random event. For 95 per cent of the population, death is a predictable event caused by a chronic and incurable disease.” Dying has become a foreign concept for many boomers “An unanticipated consequence of modern medicine is that many adults have never seen someone die. It’s not like previous generations where the dying were attended to at home. As a result, we have trouble accepting death, and we may request therapies that will fix a small problem but actually worsen the quality of life for a dying person.  We need to be comfortable with the idea of improving care by NOT trying to ‘cure’ some problems, such as a pneumonia in a person with...

BestEndings Chat: end-of-life discussion video’d

Inaugural BestEndings Chat topic: Why is it so hard to talk about dying.   Insights, Revelations. Confessions and Spirited Debate amongst 6 friends from diverse backgrounds. Together, we represented Hindu, Athiest, Christian, North American Catholic, Mexican Catholic and Muslim. Left to right: Mike, Sudhir, Ruth, Kathy, Colleen, Gina, Majid Mike Houlahan, Healthcare Executive; Sudhir and Ruth Handa, Businessman, Colleen Young, plain language writer and founder of Canada’s national tweet chat for healthcare and social media: #hcsmca, Gina Camacho Ibarra and Majid web developers, BestEndings. The video will be uploaded soon, but in advance – a taste of what’s to come (funny bits saved for the video) Mike: I’m involved in healthcare, I’m engaged with BestEndings and still – when my father had a health scare, I was too scared to talk to him. Sudhir: I guess because of my upbringing, I am not afraid of dying – I just want to be fully prepared. Ruth: I don’t think you can say any one religion offers more comfort than another. Gina: In Mexico, we celebrate death: we visit our relatives and have Day of the Dead. Majid: I love talking to you every day: it’s a great opportunity to talk about living – that’s really what you’re talking about. Colleen: So often, when someone is ‘going’ you want to do something. My mother’s given me something to do in the event she can’t speak: she’s asked me to read to her. I feel very comforted by...

Cardiopulmonary resuscitation (CPR) in elderly: low survival

Study of In-Hospital Cardiopulmonary Resuscitation (CPR) in the Elderly : Cardiopulmonary resuscitation (CPR) evolved from a specific intervention applied in limited clinical situations to the default response to cardiac arrest in or out of the hospital, an evolution accompanied by a dramatic decline in survival rates after CPR.1-3 The largest study to date, which included 14,720 CPR events from the National Registry of CardioPulmonary Resuscitation, showed that 17% of patients survived to discharge.9 Associations between age and survival after CPR remain unclear, with conflicting results from previous studies.6,10,11 Black race may be associated with lower survival after in-hospital or out-of-hospital CPR and may be associated with delayed defibrillation.12-14 Subsequently, innovations allowing rapid out-of-hospital CPR resulted in improved outcomes in the out-of-hospital setting.4,5 However, it is unclear whether advances in CPR or in care after cardiac arrest have improved outcomes after in-hospital arrest. Full article New England Journal of...