Correction: Hospice-Defibrillator story
The Associated Press
Thursday, March 18, 2010; 3:20 PM
WASHINGTON -- In a story March 15 about hospices being slow to turn off patients' defibrillators, The Associated Press reported erroneously the proportion that had a way to identify implant recipients. The study found 20 percent had a method to do so, not one in 20.
The story was pretty lengthy. Quite obvious that a correction did not receive much space.
On Feb. 2, we learned that my husband of 43 years had Stage 4 lung cancer. There was no asking “Why me?” Richard knew very well why. He’d been a pack-a-day smoker for 50 years. Although he quit for good more than 15 years ago, it was far too late. After a few weeks of encroaching weakness and coughing, a PET scan showed that cancer was ravaging his body, taking up residence in both lungs (along with emphysema), in his spine, his adrenal glands and his brain. It was inoperable and incurable. He was looking at weeks or months of remaining life, maybe a year at most.
Long before this diagnosis, we had discussed and written down our wishes if either of us faced such a dismal prognosis. At nearly 77, Richard felt he had already cheated the grim reaper despite his long addiction to nicotine. He wanted nothing to do with drastic therapies that might grant him a few extra months at the expense of his comfort and his ability to do what needed doing before he died.
His choice — affirmed by the doctors we consulted — was for palliative treatments aimed at minimizing his pain and maximizing his function. As his health care proxy, I had long ago agreed to such a plan. Our sons and daughters-in-law knew him far too well to try to persuade him otherwise.
Treatment and Comfort
For his comfort and our convenience, we stayed with local doctors at our local hospital, New York Methodist, an affiliate of Weill Cornell Medical College. I was extraordinarily impressed with the intelligence and sensitivity of the doctors we saw: our primary care physician, whose specialty is geriatrics; the pulmonologist, who made the diagnosis and provided a pretty clear picture of what was ahead; an oncologist, who strongly recommended palliative radiation (which could, if Richard wanted it, be followed by gentle chemotherapy); a radiation oncologist, who explained how radiation could help control pain; and a neurologist, who periodically assessed his physical limitations.
We were warned of two potentially disastrous complications. Richard was already suffering from severe sciatica attributed to the spinal tumors, and we learned that these could cause permanent paralysis if they impinged on the spinal cord. The brain lesions could bleed and cause a hemorrhagic stroke. And his balance, which we realized in hindsight had been declining for months, was also at great risk from lesions in the pons, near the top of the brainstem.
And so he began three weeks of radiation to his lower spine and whole brain. For a week, though the city was blanketed by snow and his balance was iffy, he was able to walk himself with a cane to and from the hospital for treatments. But 10 days from the start of radiation, he awoke unable to walk, and the oncologist said he had to get to the hospital without delay.
The paramedics who responded to the 911 call were amazingly gentle and reassuring. A magnetic resonance imaging test of the spine and brain revealed no tumor to explain this handicap, prompting a probable diagnosis of swelling caused by the cancer, the radiation or both.
And so began a two-week hospital stay marked by increasing pain (and increasing doses of narcotics to control it), extreme weakness and constipation caused by the narcotics. Richard thought there was no point in continuing treatment; he’d never get any better or leave the hospital alive. His doctors thought otherwise and urged him to continue the radiation, along with medications to counter the swelling and constipation.
My goal, my hope, was that he would live just three more weeks and be well enough on March 26 to attend a musical celebration of his life’s work as a lyricist, at which friends and family from far and wide could say goodbye.
On the sixth morning of his hospitalization, his bowel congestion finally relieved, he awoke pain-free and cheerful and announced, half joking, “Today, I almost feel like living.” I began to breathe normally again, no small thanks to the capable and conscientious oncology nurses and nurse technicians, whose cheerful demeanor seemed able to inspire a will to live in a corpse.
A Final Journey
But this was to be only a brief reprieve. After two weeks of radiation, it became obvious that the treatments were only adding to his misery, not relieving it — every touch, every movement seemed to hurt him — and he was no longer able to get out of bed. Encouraged by my sons and their wives, who saw no point in prolonging his agony, I reluctantly abandoned my March 26 goal and arranged for hospice care.
Francine Russo put it succinctly in her excellent new book, “They’re Your Parents, Too!” (Bantam, 2010): “The real challenge in making decisions about life-extending treatment is how much we can focus on what our dying parent needs rather than our own anguish. This is the ultimate test of emotional separation.”
And so the next day, I got in the ambulance with my husband for his transfer to Calvary Hospital, a lovely, peaceful hospice whose Brooklyn campus is at Lutheran Medical Center. The hospice physician reviewed his pain medications and immediately suggested changing to a continuous morphine drip, which greatly relieved his discomfort and my gnawing distress over watching him suffer. Nothing more to worry about, no more decisions to make.
Three days later, it was apparent to all that the end was near. He had stopped eating, no longer uttered a word and slept almost all the time. Knowing that hearing is the last sense to go, we continued to talk to him, saying how much we loved him, reading the many incredible letters and e-mail messages sent by family and friends, and wishing him a peaceful end.
Posted By - Julie Wolfe - Updated On: 3/17/2010 8:31:54 AM
DECATUR, Ga.--"Failure is not an option. We'll crawl across that finish line if we have to," Andy Jenkins said. His wife nods in agreement.
Megan and Andy Jenkins say they're not real runners. Meagan's older brother, Ron, was. "He won awards and set cross-country records in high school and everything," Meagan said. "We called him Teflon Ron, because nothing seemed to stick to him. He always came through in the end."
When Ron was diagnosed with Leukemia, he went through radiation, stem cell treatment, and bone marrow transplant. "It was just like, bam, after he had that transplant, he was so good. He looked good, he was exercising. He went on vacation with us," Meagan remembered.
It looked like he had slipped through the fierce grasp of cancer. But then, something stuck to Teflon Ron. In a way, it was the cure that killed him.
"The radiation and all of the medication, it destroyed his liver," Megan said. "That's why we're so committed to raising money for research. We have all of these treatments. I mean, there are a lot of treatments out there, but it was the treatments that killed him in the end. So, that's why we need to come up with better things."
Ron died in September 2009. "It was really hard," Andy said. "It was heart-breaking to see Meag living with that void in her life."
One month later, Meagan stumbled upon team in training. "When you lose someone to something like Leukemia, you feel completely helpless and there's nothing you can do, and I just needed something."Team in Training was kicking off their spring season, gathering a group to run the ING Georgia Marathon. TNT raises money for the Leukemia and Lymphoma Society by completing endurance events.
"We didn't really know what we were getting ourselves into," Megan said with a laugh. The couple had rarely run more than a few miles before.
For the last six months, side by side, Meagan and Andy trained. They ran through the physical pain and through their still-fresh grief.
"You just take a deep breath and take each day as it comes," Andy said. "We realized very quickly that running was going to help fill part of that void."
This Sunday, they will stand at the start line of the ING Georgia Marathon. Ron's final words will push them to the finish. "He looked at my mom, my sister, his wife, and I and he said, 'I'm not giving up.'"
"We know our knees are going to be burning, our feet are going to be really sore. More painful than they've ever been before. But that will be almost an honor to carry that pain through the finish line," Andy said.
Leave your good luck comments for Andy and Meagan in the comments section below.
Pain Relief Often Delayed for Cancer Patients
Referrals to palliative care programs come too late, survey finds
Story Tools
TUESDAY, March 16 (HealthDay News) -- Palliative care services, which help people who are seriously ill relieve symptoms such as pain, are now found at most U.S. cancer centers, but many programs don't interact with patients until it's too late, study findings show.
Dr. David Hui, of the University of Texas M.D. Anderson Cancer Center in Houston, and his colleagues surveyed 71 U.S. National Cancer Institute-designated cancer centers and randomly surveyed 71 other cancer centers. They received responses from 71 percent of 142 executives and 82 percent of 120 program leaders.
The researchers also found that the NCI cancer centers were more likely to have palliative care programs and physicians. A report on the survey was published in the March 17 issue of the Journal of the American Medical Association.
"Palliative care outpatient clinics, inpatient consultation teams, palliative care units and hospices all play an integral role providing symptom control, psychosocial support and transition of care for patients with cancer and their families along the cancer care continuum," the study authors wrote. "Based on this understanding, multiple national and international organizations support early incorporation of palliative care into oncology practice."
However, the researchers found that "palliative care patients were referred too late in the disease trajectory, a marker of limited access and integration."
"Although most cancer centers now have a palliative care program, significant gaps and delays in the delivery of care remain," Hui's team concluded.
More information
The Center to Advance Palliative Care has more on palliative care.
-- Randy Dotinga
SOURCE: JAMA/Archives journals, news release, March 16, 2010
Copyright © 2010 HealthDay. All rights reserved.
Jun 17 2008
Not Treating – A Neglected Option
One of the criticisms of modern medicine is that doctors prescribe too many pills. That’s true. Patients and doctors sometimes get caught up in a mutual misunderstanding. The patient assumes that he needs a prescription, and the doctor assumes that the patient wants a prescription. But sometimes patients don’t either need or want a prescription.
I’ll use myself as an illustration. I get occasional episodes of funny, blurry spots in my visual field that gradually expand to a sparkling zigzag pattern and go away after 20 minutes. They are typical scintillating scotomas, the aura that precedes some migraines. I am lucky because I never get the headache. My doctor said we could try to prevent my symptoms with the same medications we use to prevent migraine, but there was no need to treat them from a medical standpoint. Nothing bad would happen if we didn’t treat. I told her I didn’t want them treated. They are a minor annoyance; I can carry on with my normal activities, even reading, throughout the episodes, and I have no desire to take pills with potential side effects and with the cost and the hassle of remembering when to take them.
If it had been a typical patient and a typical doctor, the sequence of events might have been very different. The patient might have been more frightened by the strange phenomenon than I was. (I thought the weird tricks my brain could play on me were fascinating and fun to watch, not scary.) The patient might have desperately wanted those threatening symptoms to go away without understanding how insignificant and non-threatening they really were. The doctor might have assumed the patient wanted them to go away. The pills might have been offered and accepted with little thought.
A woman goes to her doctor complaining of nausea and vomiting. She wants to get something to stop it. She finds out she is pregnant, and it’s only morning sickness. Her whole attitude changes; now she is happy to put up with the symptoms. She wouldn’t want to take anything that might harm her baby.
When a patient goes to a doctor, he doesn’t necessarily want treatment. He really wants answers to these questions:
What is causing my symptoms?
Is it serious?
How long is it likely to last?
How can it be treated?He may ask about the side effects of treatment.
He is less likely to ask one other crucial question: what would happen if we didn’t treat at all?Here’s a scenario that plays out in doctor’s offices thousands of times every day: a patient has cold symptoms. Maybe he’s afraid it might be something more serious than a cold, like a sinus infection or pneumonia. Maybe he thinks the doctor can cure his cold with antibiotics or some other new remedy. The doctor examines him and reassures him that it’s only a cold. He knows there is no treatment that will make the cold go away any faster, but since the patient has gone to all the trouble to come in for an appointment, the doctor feels a little embarrassed about telling him it’s trivial and sending him away with nothing. He gives him a decongestant and some Tylenol. He knows they won’t do a thing to affect the course of the cold but hopes they may help relieve some of the symptoms. He has the feeling that in this social interaction he is expected to give the patient a token, in this case a prescription. The patient has the same feeling: that he ought to get something to take home. Both the doctor and the patient think the doctor ought to “do” something. (These are not the bad doctors; the bad ones prescribe antibiotics or homeopathy or something equally nonsensical.)
What if every doctor explained that there was no effective treatment, that the symptoms would subside in a week with or without pills, and that symptomatic treatment wouldn’t help much and carried a small risk of side effects? The patient would then have the chance to say, “I want something to take even if it’s no better than placebo” or “I don’t really need to take anything. I just wanted to be sure it wasn’t something serious.”
When a patient has a high LDL cholesterol and other risk factors for heart disease, especially if he has already had one heart attack, some doctors assume they should prescribe statins, and patients assume they should take them. The reality is that most patients who take statins will probably not benefit from them. Instead of a knee-jerk grab for the prescription pad, a thoughtful doctor could look up the NNT (number needed to treat) and NNH (number needed to harm) and tell the patient something like “For your particular risk group, 84 patients need to take statins to prevent one death from heart attack, and of those 84 patients, 3 will have serious but not life-threatening side effects.” (I’m just making up these numbers.) Some patients will think “I might be that one patient whose life is saved” and will want the pills. Others will opt not to treat, thinking they are more likely to be one of the ones with side effects and/or no benefit.
Neither course is unreasonable; the choice depends on things like the patient’s philosophy, his degree of optimism, his fear of death, and his willingness to take risks. One way to look at it is that statistically a group of people on statins will live longer than a group not on statins, so the doctor should offer them to the group. Another way to look at it is that if 84 patients chose not to take the pills, one would have guessed wrong and would have a heart attack and the other 83 would have guessed right. (Of course, the situation is really a bit more complicated, because statins may have good or bad effects on other parts of the body besides the heart, and there are other things to consider like cost and interactions with other medications the patient might be taking and the patient’s ability or willingness to work on reducing other risk factors.)
In my article on “Reading the Medical Literature with a Critical Eye” I discussed an article about t-PA treatment for stroke. “The bottom line is that one in eight patients is helped at three months, one in 17 is harmed, and although the randomized trial showed no increase in mortality, there has been a documented increase in death rates in patients who have received t-PA therapy outside of research trials.” There is room for disagreement, but many people would agree that not treating is the better option.
Early stage prostate cancer is another real dilemma. It may be slow-growing, and the patient may die of other causes before the prostate cancer can kill him. Should you try to eradicate the cancer with surgery or radiation, with a significant chance of complications like impotence? Or is conservative management reasonable (surveillance, watching for a rise in his PSA levels)?
Are your knee joints kaput? Joint replacement surgery is an option. Medical treatment with drugs like NSAIDS or narcotics is an option. Non-treatment is an option too – maybe you would rather give up sports, avoid stairs, and accommodate your lifestyle to your limitations.
Another personal example: when I had a breast biopsy, I chose local anesthesia because I thought it was safer than general anesthesia. The anesthesiologist agreed, but said he would use IV sedation along with it. I asked him why. He said to control my anxiety. I told him I wasn’t anxious and didn’t want it. We negotiated, and finally he agreed not to give me a sedative before the surgery and I agreed that he could give it at any time during the procedure if he thought I seemed anxious or my BP rose too high to suit him. It was probably the first time in his career that he had omitted routine IV sedation for a procedure like this. All went well; I wasn’t anxious, we chatted throughout the surgery, and my time in the recovery room was minimized.
IV sedation is a good idea for the average patient, but not every patient needs or wants it, and it’s nice to have the option of no treatment. My anesthesiologist would never have even considered that possibility if I hadn’t spoken up.
Of course, non-treatment is not always a reasonable option. If a patient has severe diabetes and doesn’t get insulin, he will die. I’m not talking about those cases. But even in those cases, the principle of autonomy gives the patient a choice. Every surgeon has had an occasional patient who refuses life-saving surgery with the full understanding that it means he will die. If the patient is mentally competent, he has the legal right to refuse any treatment.
Think of the many self-limiting minor illnesses where non-treatment IS a reasonable option. Things like colds, common backaches, headaches, earaches, sore throats, gastroenteritis… many of the most common reasons for doctor visits. If the doctor rules out a serious condition, there is no need to take pills for symptoms that are expected to subside on their own. The patient may prefer to try simple comfort measures at home. I’m rather fond of the old remedy for a cold that says to go to bed, put your hat on the bedpost, and drink whiskey until you can’t see the hat. That’s a joke; but seriously, “tincture of time” is a treatment with no side effects: it’s the safest and cheapest remedy of all.
I have had lots of patients tell me “It doesn’t really bother me that much. Now that I know it’s nothing serious I’m happy to put up with it. I don’t need to take anything.”
So this is a plea to doctors and patients alike: when you’re considering treatment options, keep non-treatment on that list of things to consider. Let’s destroy the myth that the doctor always has to “do” something.
24 Responses to “Not Treating – A Neglected Option”
Great post. Non-treatment is always an option and the patient has the right to decide. I also tell my patients to let their families in on their decisions. This avoids problems in the future.
In my own very limited experience, anaesthesiologists are the hardest to negotiate with. Bummer — I have a (literally) dangerously high pain tolerance but don’t tolerate anaesthesia at all well. If I’d had my druthers, my appendectomy would have been under local, just like the c-sections that delivered all of my kids.
Knees? Run in the family [1]. My orthopod (bless him) has informed me that one will require replacement — someday. In the meantime, exercise is working as well for me as for my brothers and at least two of theirs are worse.
Your point about the “informed healthcare consumer” is so well worth repeating that I would suggest it should be part of the regular high-school curriculum; it would fit in so well with other existing health topics that I don’t think it would actually displace anything.
[1] Sorry ’bout that.
Thank you Harriet for a heck of a rational post. I absolutely agree.
But Harriet, what about Saint John’s Wort?
But Harriet, what about Saint John’s Wort?
There’s research showing that duct tape works.
Good article, thanks.
I was just wondering though: Let’s say Joe goes to the doctor with a headache, runny nose, nasal congestion and body aches.
Doctor tells him it’s the flu (and for purposes of discussion it is).
Joe, not satisfied with being told to go home, rest and get plenty of fluids goes to the local sCAM clinic/store/hole-in-the-wall and buys a couple boxes of homeopathic sugar pills. Joe takes the pills and in 3-4 days is feeling much better, and so ascribes his ‘cure’ to homeopathy. Would spending time telling Joe about the flu, and about how there’s no cure for it but time be advisable ?
(this assumes Joe is otherwise healthy and not in a high-risk group)Personally, I also get those visual symptoms, but unfortunately they domean a migraine is coming.
Oddly, I have never asked my doctor for any special drugs for this, as I only get one about 1-2 times per year.Addendum:
I looked up migraines on google, found the mayo clinic website section on it, and they list sCAM treatments available
Migraine: Complementary and Alternative medicine
The Mayo Clinic just lost 1000 respect points with me.Excellent essay! After a few years of practice, when I stopped being so afraid of clients, I started telling them when I thought the best choice was to do nothing, and I was amazed at how many of them really liked that option. Sure, if things to progress then some will be mad you didn’t do something right away, but most seem happy with your honest opinion. I was surprised, though, at how often the nurses seemed suspicious of my not offering treatments they had seen other docs offer, and it takes a while for them to get to know me before they stop wondering if maybe I’m just lazy.
Pec wrote: Thank you Harriet for a heck of a rational post.
_______Yes, it is so rare that Harriet writes rationally! *Sarcasm off*
[...] blog to watch! Posted on June 19, 2008 by adiemusfree If this post is anything to go by, and from the ones I’ve read, it is, then dipping in and out of [...]
Dr. Hall, is there a way to send you a private message?
In my field (pain medicine) I routinely offer the option of no treatment, as by the time people come to see me they have often reached a working arrangement with their chronic symptoms which demands a good reason to change. For many chronic stable problems, reversion to the natural history is a safe but sometimes difficult to choose option. Its a good topic to bring up..
DLC: There is a difference between “listing” *CAM* treatments and “recommending” them. Since your link did not work, I Googled this page. It is a consumer education page that simply mentions commonly used treatments and the state of science surrounding them. For example, their sole comment on chiropractic is: “There are no scientifically valid studies that prove that chiropractice or other spinal-manipulation treatments are effective in the treatment of migraine.” However, they acknowledge that biofeedback can reduce migraine pain, and that there is “some scientific evidence” that feverfew may prevent migraines. Those statements are true, DLC. If you do not want to use those modalities, that’s your prerogative; but please don’t condemn Mayo for giving people straight facts about things they have already probably heard of elsewhere.
The worried well are responsible for over 1/3 of office visits to primary care in my unscientific estimation. My colleagues think it’s even higher.
Imagine how many pounds of hydrochlorothiazide we could provide to impoverished hypertensives with the resources wasted on these visits.
But that would be logical. Applying logic to the American health care system will give you scintillating scotomatas followed by a pounding unilateral headache. Don’t go to the ER though – its to busy being the US national health care system to help you.
The worried well are responsible for over 1/3 of office visits to primary care in my unscientific estimation. My colleagues think it’s even higher.
Imagine how many pounds of hydrochlorothiazide we could provide to impoverished hypertensives with the resources wasted on these visits.
You can’t have it both ways. If patients only come to be seen when they have spurting arterial wounds but “don’t want to bother you over something minor” you won’t see the man with a case of “indigestion” or his wife who is “acting funny.” (Says //me, whose father died of an MI that he didn’t think was serious enough to interrupt a fishing trip.)
Barring perfect diagnostic skills in every member of the general public, you will have either Type I or Type II errors. That being so do you prefer to see people who are well but concerned about something that might be an early sign of something serious, or do you prefer that they stay home with what could have been treatable if caught earlier?
>>You can’t have it both ways. If patients only come to be seen when they have spurting arterial wounds but “don’t want to bother you over something minor” you won’t see the man with a case of “indigestion” or his wife who is “acting funny.” <<
Please, you are smarter than that.
The point is NOT that it is not perfect (everyone who makes an appointment has a serious problem) but the current ratio creates an incredible amount of waste. We are NOT helpless when it comes to improving the utilization of resources.
The medico-industrial complex has done a great job of terrifying the public into useless testing and inefficient use of resources. Doctors are willing participants in the process – and in fact are incented to see as many patients and perform as many procedures as possible.
If you give a doctor a patient ….
He’s gonna want to do a test
and if you let him do a test
the test is going to come back with a trivial abnormality
and if there is a trivial abnormality,
he’s gonna want to do a test ….
Actually I am surprised that you have time to answer this post.
Don’t you know that the gurgling in your stomach could be due to a tumor of your duodenum that is partially blocking stomach outflow? When’s the last time you had an unproven triple ultrasound screening? I don’t like the way you look – I am going to have to suggest a PURE scan to check the calcium in you heart arteries – can’t ever be too safe, now can we? You know the protein level on your chem 21 is a little bit high, we better repeat that and do an electrophoresis ….Jenny – make sure Mr Overshoot has an appointment in 6 weeks to go over everything we order today ….
What the hell is a PURE scan?
Google is your friend: http://www.bizjournals.com/stlouis/stories/2004/05/10/focus1.html
Oh. I know it as the Calcium score by EBT. Haven’t used it yet. Where would we be without the worried well? Frequently it’s a waste of time explaining to them that they don’t need those tests. They’ll find another doctor who will take them seriously. OTOH there is the saying “If you don’t do a test that’s not indicated, how will you ever make the diagnosis?”
Ah yes, the St. Louis Business Journal, where else would we learn medicine; our friend?
As a layperson, I think the hardest thing is knowing when something is serious and treatable. Like I suddenly have black spots moving in my visual field. It is Saturday night and I have a 4 hour drive alone starting early Sunday morning. I live in a rural area and remember a friend telling the story of her retina becoming detached when she was driving alone a long way from home, but I don’t remember the details if I ever heard them. Do I go to the ER? I didn’t. I hit the road and got to the doctor when I got home, but my decision was not based on knowledge and I was worried driving.
In my experience taking care of myself, loved ones and pets, if I’m dealing with an MD or DVM who I know well, I can phone and get the required information to make an informed decision. But in today’s legal climate that is impossible if the doctor doesn’t know you well.
rjstan – well said, reasonable and actionable patient information can be difficult to find. I certainly sympathize with doctors that don’t want to give advice over the phone in the current legal climate.
I hope that everything came out okay for you. Did you end up with a CT scan of the head? Followed by an MRI? And a neurology consultation? told to follow up with ophthamology? Or did your physician pursue watchful waiting?
I was referring to even simpler cases – colds for instance. Mild non-chronic musculoskeletal pain. Mild anxiety. Mild insomnia.
Then we can talk about the diseases that the pharmaceutical companies have created, advertised and legitimized in order to sell a drug that didn’t have a disease to start with or had a disease with a narrow definition that the drug company was able to widen with expanded ‘off label’ prescribing.
Medicalization: “To medicalize the human condition is to apply a diagnostic label to various unpleasant or undesirable feelings or behaviors that are not distinctly abnormal but that fall within a gray area not readily distinguishable from the range of experiences that are often inescapable aspects of the fate of being human.” Paul Chodoff, M.D.
Grapmag,
Are you referring to restless legs syndrome by chance?Wonderful post, but still exhibiting the bias inherent in conventional medicine. If it’s not a phama developed and promoted product it can’t be effective and shouldn’t be recommended. One example for the flu is Sambucol, over the counter, developed by an eminent Israeli virologist in the 90’s, patented based on the elderberry, and shown is several RCT’s to reduce flu symptoms by 4 days with no side effects.
Why isn’t every MD aware of this inexpensive, safe, widely available and reasonably well studied treatment?
Because it’s sold in the health food store and not at CVS or not sold as a prescription? Because it’s not hawked by the drug rep, or mentioned at medical conferences or advertised in medical journals?
That’s one of my problems with this site. The assumption that no medicine not developed by a mainstream pharma should be given consideration, or that if it’s not in the mainstream there’s no science behind it.
oderb,
Saying that we don’t recommend products just because they are not pharma developed and promoted is a vile calumny. I have 3 criteria for recommending a product: (1) is there good evidence that it’s effective, (2) is there good evidence that it’s safe, and (3) is there a reliable source that is pure and can be trusted to contain the amount of active ingredient stated on the label. If an herbal remedy met those criteria, I would recommend it; if a pharmaceutical didn’t meet those criteria, I wouldn’t recommend it.
I was only able to find one abstract of a clinical Sambucol study from 1995, and it didn’t say how many subjects there were, and it was published in an alternative medicine journal, so I didn’t find the evidence very convincing. You say there are several RCTs – perhaps you could give us the references. Are they good studies? Do they pass Bausell’s 4-point checklist? (See http://www.sciencebasedmedicine.org/?p=4)
The Natural Medicines Comprehensive Database tries to review all the published literature and it only lists one study, and it rates elderberry as “possibly safe” and “possibly effective” – it doesn’t even rate their “probably effective” rating, much less an “effective” rating. The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach by Ernst et al does not even list elderberry or Sambucol.
And since most cases of influenza resolve without treatment, the option of not treating with Sambucol OR pharmaceuticals is worth considering.
Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 Advance Care Planning Ribbon - NHPCO and Caring Connections are asking you to help raise awareness about the importance of advance care planning by wearing the white It’s About How You LIVE ribbon – or a simple white ribbon of your own. Wearing the ribbon is particularly important on March 31 to honor the 5 year anniversary of Terri Schiavo’s death to focus national attention on the importance of talking about healthcare decisions before a crisis. The awareness ribbon also calls attention to the upcoming annual National Healthcare Decisions Day (NHDD) on April 16. (For more information about NHDD, visit www.nhdd.org).
The white awareness ribbon reflects the message of peace long associated with the white dove and the It’s About How You LIVE campaign encourages people to:
Learn about options for end-of-life care
Implement plans to ensure your wishes are honored
Voice decisions to family, friends and health care providers
Engage others in conversations about the importance of advance care planning
You can order the Advance Care Planning Awareness Ribbon from NHPCO’s Marketplace or create your own cloth ribbon to wear or give to others.
Read more about the Advance Care Planning Awareness Ribbon campaign in NHPCO's press release from March 16, 2010.
Here are some suggestions of how you can use the ribbon as a community outreach tool:
Share white ribbons with your staff, volunteers, and people in your community and encourage them to wear them on March 31, April 16 or any time they want to help promote advance care planning.
Talk to your community partners – faith communities, businesses, referral sources – about distributing ribbons and other advance care planning resources.
Offer to do conduct presentations on advance care planning in your community.
A local business or individual contributor may be interested in supporting your awareness campaign efforts by purchasing the ribbon pins or printing the engagement cards for your organization. Offer to put their logo or message of support on the backside of the engagement card. You may also add a message of your own on the reverse side of the engagement card!
Engagement Cards – explaining the awareness ribbon and the LIVE message are available for downloading. Print them on cardstock or similar paper stock, then attach the awareness ribbon pin or a simple white ribbon of your own. Distribute to staff, volunteers, and throughout your community. The cards are available in three formats:
four cards on a page [PDF]
eight cards on a page [PDF]
Awareness Ribbon Flyer - use this 8 ½” by 11” flyer on bulletin boards in your office, local library, grocery store, faith community…anywhere a public interest notice might be found.
Let local media and other audiences know about your local efforts that are part of this national outreach campaign.
For more Advance Care Planning resources including brochures click here.
For more information and other community outreach resources, please visit www.caringinfo.org/Community
Fifth Anniversary of Terri Schiavo's Death:
Wear a White Ribbon to Raise Awareness of Advance Care Planning
Olbermann: 'Life panels' invaluable for Americans
Keith Olbermann shares some of the details of his personal experience dealing with difficult medical decisions for his ill father and the importance of talking with loved ones about end-of-life care and the value to Americans of including "life panels" in any health reform solution.
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Fixit: Hospice is specialized care for dying
More from Karen Youso
Q What is "hospice"? What does it do and does it cost money?
A Hospice is a specialized form of care for individuals in the last stages of terminal illness. Rooted in the centuries-old tradition of preparing gifts for those embarking on a long journey, hospice care provides physical, emotional and spiritual support for dying individuals and their families. It's appropriate for people of any age or religious faith and with any terminal illness.
Think of hospice as care that:
• emphasizes the quality of life in the remaining days, weeks or months of a person's life.
• focuses on the person, not the disease, and also cares for the family.
• provides relief from the physical, emotional and spiritual pain that often accompanies a terminal illness.
Specially trained professionals and volunteers provide hospice service, often to individuals in their homes. But hospice care is also provided in assisted-living programs, nursing homes and other long-term residences. The needs of the patient and family determine the type and frequency of services.
A hospice team includes a doctor, nurse, social worker, spiritual caregiver and sometimes home health aides, therapists and volunteers. The patient's personal physician can work with the team. However, at the core of the hospice team and the center of all decision-making, is the patient and the family.
In most cases, there is no cost to patients for hospice services. It's paid for by insurance, Medicare, Medical Assistance and MinnesotaCare.
For more information, visit: www.hospicemn.org, or call 651-659-0423, toll-free 1-800-214-9597.
FROM MICHELE FEDDERLY, DIRECTOR, HOSPICE MINNESOTA
No pressure problemQ We moved into a 60-year-old house and found that the water pressure is lower than we like. What can be done about it?
A The small-diameter pipes (less than 1 inch) of years ago do not meet water needs today. In addition, galvanized or lead pipes in older plumbing can build up deposits over time that further restrict flow.
The solution is to replace the piping with today's standard 1-inch copper piping. That can be expensive, but it's the only real solution. Acid solutions sometimes are used to clear old pipes of sediment, but this method is often unsuccessful and can result in leaks.
Also, check that the water meter hasn't become clogged or that the city isn't working on any water lines in your area.
For those looking at homes, remember to check the water pressure before buying. Turn on taps at the highest and lowest points in the house and see whether there's plenty of pressure. Also, check that the house has copper pipes and are of the appropriate diameter. If not, you'll want to figure the cost of updating the plumbing into your bid.
Minnesota potatoesQ Where can I buy Minnesota-grown potatoes?
A Try your grocery store. Just because a bag doesn't say "Minnesota grown" doesn't mean the potatoes aren't from Minnesota. Potatoes packaged as "grown in the USA" actually contain Minnesota potatoes, typically from the Red River Valley. Depending when different crops are ready, they can be a mix of Minnesota, Wisconsin or Iowa potatoes. However, if the bag says Idaho, then you're buying Idaho potatoes.
Minnesota Grocers Association
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ARTICLES / General / The Healing Power of Music/ Other Articles
The Healing Power of Music
by Steve Toll and Linda BarehamWhat better �medicine� than a �treatment� that has only positive side effects and �therapy� that is actually enjoyable? That is the �miracle of music� when applied with intention. Music is shown to have the ability to help organize the brain; especially vital to those who are afflicted with Alzheimer�s.
Usually after twenty minutes of music, there are observable effects, such as singing, foot tapping, and clapping. Studies have shown that the results of a musical therapy session last for several hours afterward. Positive results include elevated mood, increased socialization and appetite and reduction in agitation. These benefits are attributed to the stimulation the brain receives during a music therapy session, a sort of �cognitive workout� inspiring us to coin the phrase, �What exercise is to the body, music is to the brain.� The power of music often inspires physical movement and can be used in combination to encourage gentle exercise.
As speech, writing and traditional forms of communication are compromised, music provides an alternative means of maintaining a connection, thereby helping to normalize interaction between caregiver and patient. Music used therapeutically creates an environment where the patient can be nurtured and cared for in a way that is safe, gentle and appropriate. Music is central to maintaining human bonds when those with dementia have lost the ability to initiate communication or to respond verbally.
The powers of music when focused and used therapeutically are many. Critical to maintaining quality of life for those with Alzheimer�s is management of emotions and preserving the connection with others. Music is conducive to keeping those connections strong as long as possible while helping the participant to focus, increase awareness and orient to the environment. A number of research studies have looked at music therapy as an important adjunct to medical treatment and findings suggest a possible link between the use of music and slowing the progression of dementia.
From the rhythms of the heartbeat experienced in the womb to the stirring sounds of a marching band, rhythmic patterns and music surround us. Language itself has a musical quality to it and from the beginning of mankind, as expressed through chanting and drumming, resembled music more closely than speech. Music is primal to life and expressed by each of us every day whether through dancing to a favorite tune, keeping rhythm with a pencil or remembering a special time when hearing a forgotten melody. It is central to our lives and is embedded in our culture, defining how we acknowledge milestones, rites of passage and celebrations as well as providing comfort, transformation and inspiration. Music links us to our world and provides a pathway back to our past.
You don�t need to have any special musical training to institute a therapeutic music program. You will need to select appropriate music, however. This music consists of familiar tunes from the 30s, 40s and 50s with more contemporary music included, depending on the preference or age of the participant. Before you invest in any CDs, check in your own home for possible sources of music. Your local library is a good source. Consider individual preferences and select music that is singable and upbeat.
Steve Toll, a professional musician and trainer, and his wife Linda Bareham, a writer and researcher in the area of alternative therapies for seniors with dementia, formed the company Prescription-Music. Mr. Toll is on the Speaker�s Board for the National Alzheimer�s Association and trains professional and family caregivers in the development of music therapy programs where his intent is to spread the word of the healing power of music for those afflicted with Alzheimer�s.
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