living your best to the end

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: 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 hospice care, troublesome...

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...
End of life decisions and next Tuesday’s food.

End of life decisions and next Tuesday’s food.

Dr Rebecca Sudore: changing focus from planning end of life to preparing for end of life decisions An Associate Professor In-Residence in the Division of Geriatrics at University of San Francisco, the impossibly young Dr Sudore is dedicated to helping vulnerable older adults and their families make informed medical decisions, especially for advance care planning and at the end-of-life Dr Sudore, at a University of Toronto Bioethics Speakers series, used this question to illustrate the impossibility of meaningful planning for life’s end: ‘Do you know what you’re going to eat next Tuesday? The answer: ‘it depends’. And so it is in planning for what’s essentially the unknowable in the end of life journey. Dr Sudore’s research recognizes the possibility of not everyone agreeing and focuses on preparing for decision-making. Seemingly simple questions, says she, open the floodgates. Is there anyone you’d trust to make medical decisions? Do they know? What have you talked about with them? 50%-76% will be unable to make our own end of life medical decisions The importance of conversations with the surrogate can’t be emphasized enough. Even so,having spoken to dozens of surrogates as part of her research, the findings are distressing and revealing: Many surrogates don’t want the role. Sudore thinks it of paramount importance to ask the question of patients: Are you ok with your surrogate making ‘in the minute’ decisions? Giving your surrogate permission to override or change your wishes – putting flexibility or leeway right into your Advance Directives – can make the difference between a surrogate adjusting to loss or suffering from Post Traumatic Stress Disorder. Dr Sudore gives, as an...

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...