Think of the final stage of life and planning it can be a difficult time for patients and their families. Each person has unique needs and copes in different ways. This time is easier when patients, families and providers of health care talk openly about plans for the final stage of life. For many patients and their families, this can be a time of personal growth. Often, these events offer people the opportunity to discover more about themselves and appreciate what is most important to them.

This summary is about health during the last days and hours of life, including treatment of common symptoms and ethical questions that may arise. This information can help patients and their families to make plans in advance about the kinds of decisions that may be needed during this period.

Develop plans for the final stage of life can reduce stress on both the patient and the family.

When treatment choices and plans are discussed before the last days of life, it can reduce stress on both the patient and the family. Knowing the patient’s wishes can help make it easy to take important decisions for the patient during a very emotional time. It is extremely useful when planning and making decisions related to the final stage of life begin to take place soon after diagnosis and continue during the course of the disease. Having these decisions in writing, may make the patient’s wishes clearer, both for the family and the team of health care.

Planning for the final stage of life includes decisions about the following aspects

* Goals of care (for example, whether to use certain medicines during the last days of life.
* Place where the patient wishes to spend his last days.
* Treatments the patient wishes to receive in the final stage of his life.
* Type of palliative care and hospice care the patient wants to receive.

Palliative care relieves symptoms and can improve the quality of life of patients and their families.

The goal of palliative care is to improve the quality of life of patients and family because they prevent and relieve suffering. This includes treating physical symptoms such as pain and consideration of the concerns mental, social and spiritual.

When palliative treatment is received at the final stage of life, care must be taken to respect the wishes of the patient about the treatments they want to receive.

Hospice programs provide care given by specialists on topics related to the final stage of life.

Hospice care is a program that provides care for people who come to the final stage of life and have stopped treatment to cure or control cancer. Generally, the hospice care addresses patients who are not expected to live more than six months. Hospice care focuses on quality of life than the length of it. The goal of hospice care is to help patients live each day to the fullest by making them comfortable and relieving their symptoms. This may include palliative care to control pain and other symptoms, so the patient can be as alert and comfortable as possible. Services to assist and support the emotional, social and spiritual needs of patients and their families are also an important part of hospice care.

The programs of hospice care are designed to keep patients at home, with family and friends, however, these programs also provide services in centers and hospice care in some hospitals and nursing facilities. The team of hospice care including physicians, nurses, spiritual counselors, social workers, nutritionists and volunteers. Team members are specially trained on issues presented in the final stage of life. After the death of a patient, the hospice program continues to provide support, including guidance on coping with grief or mourning.

Palliative care treatment goals in the dying stages (last stages) are monitoring and care of the patient in preparing for death. The terminal illness is defined not sharp. It is characterized in that the death probably occurs within hours to days. In the last stages of terminal cancer characteristic symptoms occur, such as general physical weakness and fatigue, loss of appetite, nausea, constipation and shortness of breath with little stress. Frequently, the speech itself is exhausting.

Rarely, the terminal cancer patients will still be able to leave the bed. Difficulty in breathing is a common symptom, is added a loud rattling sound. This is caused by the increased formation of bronchial and pulmonary edema; the dying out of weakness can not cough up enough. In the last stages of terminal cancer everything that could weigh on the dying patient in addition is avoided. Term medication has been limited to a few drugs. Analgesia, control of dyspnea and vomiting, sedation, anxiolysis, and if necessary, are priorities in this phase.

The decision on the use of sedation should be based on the presumed intention of the patient and may in some cases be difficult. Non-opioid analgesics in the terminal phase are often no longer required, if they do, are benzodiazepines (e.g. midazolam, lorazepam or flunitrazepam) are used. In delirium symptoms can Haloperiodol (4-8 mg po, sc or iv) to apply. The application of drugs to be in the dying process must be carefully checked and adjusted if necessary to the development of symptoms in the dying phase to allow the patient a symptom-controlled dignified death.

The palliative care is medical procedure unit for patients with terminal cancer. You have reached the end of their ordeal. According to conventional medicine, there is no salvation for them more opportunities. In the palliative care units of hospitals to the quality of life of these patients can be increased by trying to alleviate severe symptoms. Palliative radiotherapy to reduce pain and prevent such bleeding and difficulty breathing – which in practice in some cases, unfortunately, does not work anymore (more about palliative radiotherapy here: Radiation therapy caused additional suffering).

Note:

This can not call to treat a cancer diagnosis. It’s much more mainly about that one gets information from various sources and does not rely only on the testimony of the medical school. It’s about your own life – survival. And that’s why you should own responsibility accordingly deal with it, so do not shirk the responsibility entirely to others. Ultimately, it is always your own decision on which method of treatment you choose for them. Because no one except yourself, the consequences will have to take it. Read the rest of this entry

People with end-stage tumor disease / terminal cancer patients can be bearable if they get a highly effective pain management. A good preventive of constipation problems can help for terminal cancer patients to improve the quality of life enormously.

People with incurable diseases need special attention. According to the cancer company treatment, if all the causal therapy steps have failed, now only to the relief of symptoms that we can do: Medical use for the term “palliative care“. And it is said that complaints about covers only, but can not be treated.

One of the primary objectives of palliative medicine is the remaining life with no more pain. But in cancer patients Effective Pain Management Help for Terminal Cancer Patients. Anyone taking as concerned modern opiates must suffer no more pain. Instead, he can even with full awareness, investigate the circumstances, needs and interests. However, the treatment of pain with opiates leads to new problems.

Almost all terminal cancer patients are very difficult for chronic constipation, if action is not taken in time. The symptoms are bloating, anorexia and nausea, and reduce the quality of life of seriously ill patients.

It was a whole lot more effective measures against the blockage. In addition to many laxatives to offer a wider and complementary care methods. This would provide wrap with yarrow or clay, moist heat or cherry pit pillow for just agonizing flatulence relief.

Intestinal cramps, constipation and not by natural means outgoing flatulence often speak well to intestinal massage. Here, the abdominal wall at five points in a circular motion is synchronized massage with breathing. The pressure movements go from belly to the anus and should of course be used only as far as perceived by the patient as comfortable.

For very obstinate, the goal is a careful evacuation of the colon by the administration of larger quantities of liquid using a rectal tube. She recommended an enema of milk and honey (two tablespoons of honey to a pint of warm milk) or a coffee enema (with a pint of lukewarm coffee). The addition of olive oil, glycerine or sodium chloride in warm water may also work well laxative. However, enemas are presented not a permanent solution and should be prevention or a reasonable duration of therapy does not replace, the expert stressed.

Patients do not want to be told they are dying and doctors do not want to tell them, but new recommendations state that doctors should be honest and not take the time to give the news.

Many times, said the American Society of Clinical Oncology, patients do not find out until the end of alternatives treatment to relieve their agony or chemotherapy and cease to have effect.

The organization has drafted a booklet for families of patients who reported on the treatment possibilities of relief and provides tips about what to ask doctors to increase the time in the last days of terminal cancer patients.

“This is not a conversation that can take 15 minutes, and should not happen in a road ambulance to the intensive care unit at 3 am,” said the director of the Company, Allen Lichter. “When all well and in control of his consciousness than it is the time to start the process.”

Pearl Moore, a retired nurse from Pittsburgh, advises people to start planning these possibilities even when not ill, it is easier to talk about it.

Her mother died of stomach cancer but came to talk about the end with his family and doctors. Therefore, Moore returned to college and majored care of cancer patients and helped his patients to talk about their quality of life “for them to be able to live until they died,” he says. “It’s the way they raised.”

Years ago, Moore prepared his will and instructions for medical care and gave copies to his daughter Cheryl. “In memory of my mother, we had this conversation,” said Moore.

The initiative of the Cancer Society is an unusual effort to encourage patients to plan their lives.

“It’s a wake-up call to the oncologist to take the lead in reducing the use of ineffective therapies and ensure that there is a focus on palliative care and symptom relief for the duration of the disease,” according to the recommendations.

However, the proposal is part of a movement that grows gradually and it is controversial attempt by the ruling party in Congress to include in the health reform of 2009 ended with accusations that the Democrats wanted to create “panels of death”.

The movement spawned and Closure program, an initiative of community conversations in Pittsburgh, which involved the former nurse Moore. The program teaches family members to talk among themselves and with their doctors about what they want and not want for the last days of terminal cancer patients.

“In the coming years will see a wave of people who will tell their doctors: ‘I do not want to die in tremendous pain, shortness of breath, alone, surrounded by lights and sirens and people I beat his breast,’” predicts Dr. Jonathan Weinkle, program advisor.

“Everyone wants a good death but not before what should be,” he explains. “But not everyone knows what to say to ask.”

In all cases of colorectal cancer surgery is necessary extension study preoperative imaging method such as ultrasound, CT Computed (CT) or sometimes magnetic resonance imaging (MRI), with two objectives: exclude the presence of liver metastases and to know the existence of benign lesions can be confused with those follow-up.

Objectives Preoperative staging

Evaluation preoperative hepatic resection should include: clinical examination liver tests, determination of carcinoembryonic antigen (CEA) chest radiograph in two projections, colonoscopy and a method staging of the liver. When there is suspicion of liver metastases from colorectal cancer by ultrasound or CT, the objectives of the study will exclude preoperative presence of extrahepatic disease and know the number, size and location of metastases, to plan the type of resection appropriate. The use of routine chest CT, chest X-ray normal is not justified because of its low yield and poor specificity (Positive predictive value 36%) In cases of rectum cancer should be a CT of the pelvis and any pelvic injury suspect must be subjected to fine needle aspiration (FNA) for locoregional extension rule.
Errors infraestadificacion are due to the low sensitivity of imaging methods for the diagnosis of peritoneal or nodal disease, as well as hepatic lesions smaller than 1 centimeter or very superficial.

Staging hepatic

Methods clinically useful for staging liver are ultrasound, CT scan (CT) with conventional intravenous contrast bolus or Porto-CT or CT portography (CT scan after intravenous contrast injection through a catheter placed in the superior mesenteric artery by femoral puncture), CT Helical biphasic CT portography, and magnetic resonance imaging (MRI) gadolinium. Today the standard is biphasic helical CT with previously published technical specifications. In general, metastases behave like hypodense lesions with respect to parenchymal normal and fail to capture the contrast in portal or parenchymal phase. 10-15% peripheral enhancement may occur as hemangiomas, calcifications, areas heterogeneous necrotic radiological or unusual behavior.

As already above, at present biphasic helical CT is the method most diagnostic reliability. If there is no TC helical CT with portography may be the method of choice, taking note that it is more useful to exclude new lesions to confirm as those already detected metastases. Gadolinium-enhanced MRI scan is choice in case of doubt about the diagnosis with hemangioma or infiltration focal fat.

Recently, positron emission tomography (PET) has demonstrated its value in the locoregional disease diagnosis, peritoneal or lymph node, but not has improved diagnostic accuracy in the diagnosis of new liver damage. Its main indication is the group Patients at increased risk of peritoneal or liver disease hidden. The group of Blumgart studied this aspect, getting to discriminate 20% of unresectable patients, half due to liver spread the other half by peritoneal or nodal disease previously undetected (In this second group, 72% were resectable liver metastases). There inoperability two predictors: multiple and bilobar lesions with 38% for both. In the latter group can be valuable PET.

Surgeons at the Mayo Clinic reported the first positive results of surgical treatment liver metastases of colorectal cancer, a disease considered to then as incurable, and from then until now have treated thousands of obtaining such patients survival at 5 years of surgery by 30-40%, and 10 years of 20-25%.

Surgical Treatment of Liver Metastases of colorectal cancer has gone through three phases very similar to those of clinical trials of new drugs. In the years 70, in a first phase (similar to Phase I trials in which values toxicity), was documented mortality for resection of metastases less than 10% liver. In the 80’s, in a second phase (similar to a Phase II trials in which response is measured), several authors resection showed improved survival of patients compared with the natural evolution of the disease. Finally, no one considered unethical to conduct a third phase to compare the new treatment with a control group (as is done in Phase III trials) because it shown good results with resection surgery.

The most appropriate indication of colorectal cancer treatment should be performed by a multidisciplinary team that includes radiologists, gastroenterologists, pathologists, oncologists and surgeons, as in our hospital since 1999 in which was the Gastrointestinal Tumor Unit. At present, there is enough Experience in retrospective studies to consider resection liver as treatment of choice for some patients with liver metastases of colorectal cancer, so it does not offer this therapeutic option where indicated, can be considered malpractice. Therefore, concepts of “classical” inoperable cancer liver metastases.

Colorectal should be abandoned and only a specially trained surgeon discard the resectability of metastases, a decision that does not depend exclusively either the number or size, or bilateral location injuries.

The types of cancer that can spread more easily to the liver include colorectal, pancreatic, gastric and esophageal cancer, breast cancer, lung cancer and melanoma among others. The causes vary and depend on the spread of blood flow and certain characteristics of the different kinds of cancer cells, while cancers of the gastrointestinal tract often spread to the liver because blood flows directly from these organs to the liver, melanoma spreads to the liver through the blood vessels of the body. Symptoms of liver metastases can be: weight loss, pain in the upper right quadrant of the abdomen, jaundice, fever, sweating and nausea order to proceed with their diagnosis, were made the following tests: Test of bilirubin in blood tests liver function tests, CT or MRI, PET and ultrasound of the liver.

Once diagnosed, treatment depends on the primary site of cancer site, extent of spread to the liver, if it has spread to other organs and the patient. When cancer has spread to both the liver and other organs, systemic chemotherapy is used to treat the whole body. If, on the contrary, the spread is only in the liver, chemotherapy is used and attempt surgical removal. Another option is the use of toxic injection or radiofrequency waves to destroy tumors. Prognosis, it depends on where the primary cancer and the extent of spread to the liver. In a few cases, the healing of patients is achieved by surgical removal of metastases. In most cases, the metastatic liver tumor is not curable, although the above treatments can help shrink tumors, improve life expectancy and relieve symptoms.

Unlike other cancers, breast cancer is strongly influenced by our endocrine status, and more specifically by estrogen, the elimination at the end of its useful life is determined by the condition of the liver and intestines.

Unlike other cancers, breast cancer is strongly influenced by our endocrine status, and more specifically by the hormone estrogen stimulating cell replication in adulthood contributes to tissue regeneration. The sensitivity of breast cells to estrogen stimulation is due to the high concentration of estrogen receptors in their membranes.

These hormones are synthesized by the ovaries, but also by body fat. Once life is eliminated through the liver and the bile after conversion it into other metabolites. Just as there are several types of cholesterol, “good” (HDL) and “bad” (LDL), estrogen is also “good” and “bad.” The first are those that promote breast cancer, the second is not. Dairy products, because it contains growth hormones and pesticides for their effect of estrogen mimics and there are also a hormonal effect.

There are three types of estrogen: estrone, estradiol and estriol. The first two (especially estradiol) stimulate cell growth in breast, no estriol. After completing its life, estrone and estradiol are processed in the liver in estrogen C2 (good estrogen), C16 (bad estrogen) and estriol. The C2 is safe, while C16 is a cancer promoter. It is in the blood of women with breast cancer at higher levels than women without this disorder.

It is important to keep your liver health in the prevention of breast cancer, the condition of the liver is critical in how this conversion occurs. If you are in good condition, the conversion process will be more effective, increasing the production of good estrogen (estriol, C2), and decreasing the “bad estrogen (estrone, estradiol and C16). It has been found, for example, that the indole-3-carbinol (found in cruciferous broccoli, cabbage, brussels sprouts, radishes, etc.), Estrogen production decreases “bad” (C16) and estrogen increases “good” (C2, estriol).

A second phase of elimination is the gut. The excess estrogen are linked to dietary fiber and eliminated in the feces. It promotes slow transient intestinal putrefaction and the reabsorption of estrogen by the intestinal mucosa. An excess of animal fats that estrogen promotes is free in the intestine and the same thing happen.

The liver is also the key organ for detoxification of blood. The more toxic to debug, the greater overload may affect their work estrogen eliminator. Housewives know it is much more practical not to mess to clean up. With the liver’s the same: it is important to reduce their work, avoiding as far as possible what intoxicates: snuff, alcohol, pesticides, saturated and animal fats, smoked and braised foods, excess carbohydrates fast (candy, pastries, etc.) fat dairy products, chemicals, etc.

In addition to a clean diet, low fat and high in dietary fiber (vegetables, fruits, whole grains, organically grown vegetables …) can also be use beneficial foods to the liver: A vegetable is traditionally used to improve liver is Artichoke function. It has a cell regenerating liver and gallbladder stimulant and hypercholesterolemic. Blisters can be found in juice in combination with black radish, also interesting for its beneficial action on the liver and gallbladder. The chicory is a bitter vegetable with beneficial effects on the liver, and easily incorporated into salads.

Among the medicinal plants that help purify and improve liver function include: the Dandelion, For its hepato-renal cleansing properties, the Milk Thistle, Which increases the speed with which the liver removes toxins through the bile and helps liver cells regenerate, the Mint for its cooling effect on the liver decongestant, the Fumaria because it promotes the secretion and biliary drainage and has antispasmodic properties. Often part of formulas complete and balance the effect. It takes a certain time in addition to a cleanup plan, but has limited effectiveness if the dietary and lifestyle habits are unhealthy and are not modified.

A mystical approach to health is one that yields to the perfection of natural processes, which seeks to understand rather than control, Nature, trying to pace it, as the surfer riding the wave pacing

The placebo effect is paradox of medicine. It is a way of saying, or admitting that the confidence of patients in their self healing techniques can be sufficient to stimulate it. It is similar to the phenomenon of football teams: being all the same football field, everyone knows that playing at home “always improves the performance of players.

That is why studies on drug efficacy must be double-blind, the only way to ensure that the improvement has not been created by the patient’s mind. The placebo effect is simply the effect of the trust, faith that a medicine can cure us. But it is not compressed, but that confidence, which implements self-healing capacity. Stimulating this capacity by various means has always been the basis of folk medicine for virtually all peoples.

In his book “Spontaneous Healing”, Dr. Andrew Weil tells dozens of cases in which, against all odds, inner healing forces healed extraordinary people who were in critical situations. A good doctor or therapist is one who not only knows his technique, but also has the “plus” catalyst: the art of awakening the patient in their ability and willingness to heal. Many oncologists with a vision “holistic” know they have a variable psychosomatic illness and the prognosis is partly connected with the desire to live. When life has become unbearable and there is no change, the prospect of returning to it can be enough for the sick in some way “resign” to healing. A strong desire to live, however, is a powerful engine for self-healing techniques.

When studying physiology, or biology, or any of the natural sciences, it is inevitable fall to admiring the infinite perfection and intelligence inherent in every living system, whose aim is the life and health. A mystical approach to health is one that yields to the perfection of natural processes, which seeks to understand rather than control, Nature, trying to pace it, as the surfer in time with the wave. In many aspects of life, often in health, we are often like trying to tell surfer wave you have to do.

Recognizing that internal order of the natural processes that logic infinite both health and disease, leads to increasingly interested in the causes of the disorders that clumsily mending the consequences of our bad-living. And when it falls on the causes and work in favor of nature, the treatments is more simple and effective.

Complementary medicines are generally within this new paradigm of health: understand what are the best conditions under which blooms health, understanding disease as expressions of a system imbalance, and in any case, always encouraging and first body self-healing resources, that is, to improve any process. Any treatment, whether natural medicine or conventional, is to come later.

Have a transcendent meaning of life, as regards health, forces us to connect with another vision of our body is not a set of parts, but the realization in the physical world of physical reality, energy, emotional , mental, spiritual. This reality makes it inevitable that materialize in the physical disharmony in the physical, energetic, emotionally, mentally, spiritually.

Therefore, a warm and satisfying emotional life, a balanced mind that breeds confidence and optimism, a transcendent meaning of life, have the good fortune to devote your life to something that excites us and moves us to-, form a set circumstances that promote health as important as eating a healthy diet, exercise training, rest and leisure, living in a healthy place, etc.

Drs. Stephanie and Carl Simonton have been pioneers in research on cancer patients. His work has focused on discovering the emotional factors that influence the outcome of a malignant process. After working with numerous groups of patients, they have come to identify some variables that influence the ability of individual healing.

Have unresolved emotional conflicts; feel helpless before the difficulties of life, emotional deprivation are factors that predispose to disease, to “throw in the towel.” Belonging to a family community / friendly loving and supportive, to develop the ability to enjoy what you have, have an important and valuable view of life and what one has come to do, are the best stimulants of internal self-healing techniques.