Medical Director Minute with Dr. Ellen Middendorf
Our goal in hospice care is to improve quality of life. At Hospice of Southern of Illinois, we are experts at managing pain and symptoms related to terminal illnesses. We utilize an interdisciplinary team, including a physician, nurse practitioner, doctor of pharmacy, nurses, social workers, bereavement counselors and hospice aides to provide care to patients and their families. Patients can experience a variety of symptoms at end of life. For example, symptoms may include pain, dyspnea or shortness of breath, constipation, nausea and vomiting, pharyngeal rales or a rattling noise in the back of the throat and terminal restlessness. In short, these are some of the most common. Next, continue reading more information on these specific symptoms.
Common End-of-Life Symptoms & Management
Pain is a widely prevalent symptom at end of life. It is experienced in up to 70% of patients with advanced cancer, 75% of heart failure patients and up to 93% of patients dying from HIV/AIDS. Pain is also very common in patients with dementia and neurologic diseases, such as multiple sclerosis and cerebrovascular disease. In hospice care, the class of medications called opioids most commonly treats pain.
Dyspnea is the uncomfortable awareness of breathing, and this symptom can be seen in all disease states. Its presence and severity cannot be inferred from physical exam or laboratory manifestations. It can occur in the absence of physical signs or abnormal findings on labs or radiographs. Therefore, our team must be very astute in listening to their patients and caregivers to ensure that this symptom is treated promptly. We can attempt nonpharmacologic treatment with oxygen and a bedside fan, but, once again, the mainstay of treatment is opioids.
Constipation is a troubling symptom that can be caused by a multitude of issues. Problems within the colon, such as cancer or strictures, can be the culprit. Metabolic issues, including chronic diabetes, hypothyroidism, hypercalcemia and chronic kidney disease can contribute. Neurological conditions that include spinal cord injuries, Parkinson’s disease, multiple sclerosis and paraplegia are often associated with constipation. Many medications have constipation as a common side effect, including opiates, some antidepressants, iron supplements, anti-epileptic drugs and anti-Parkinsonian agents. A low fiber diet and an inactive lifestyle often contribute, in addition. Multiple types of laxatives and stool softeners can be helpful.
Nausea and Vomiting
Nausea and vomiting can be particularly distressing and affect an individual’s ability to eat. Additionally, there are a variety of causes. For instance, medications, including chemotherapy, opioids, anti-inflammatories iron, antibiotics, anticonvulsants and antidepressants, are common agents to blame. Electrolyte disturbances, constipation, inflammation or tumors of the gastrointestinal tract, anxiety and bowel obstructions are other common causes. If intracranial pressure increases, either due to tumor or bleeding, this often leads to nausea and vomiting. There are many pharmaceutical agents available to treat nausea. Many are available to use in combination if needed.
Pharyngeal rales is otherwise known as the “death rattle.” This sound is caused by the airways accumulating oral secretions. As a result, the patient loses the ability to clear their airways by coughing and swallowing, and it often occurs within 48 hours of death. Suctioning is ineffective to treat this symptom and may cause discomfort to the patient and a reactive swelling to the airway. The mainstay of treatment is a class of medications known as anticholinergics. Anticholinergics dry secretions.
The final grouping of symptoms to discuss is terminal restlessness which is common in patients with advanced illness nearing death. The patient may have day-night reversal and is often anxious, restless and has hallucinations. This complex can be difficult to manage and is often irreversible. Therefore, we focus on symptom control and relief of distress for the patient and the family. Pharmacologic agents are used to treat the symptoms that the patient is experiencing.
The Hospice of Southern Illinois Difference
We will develop a personalized plan of care for all of our patients that meet their individualized needs. Our interdisciplinary team meets weekly to discuss our patients and their end-of-life symptoms to ensure that we are providing the best care possible. To learn more about our care, please visit hospice.org. Additionally, we are very proud to have a PGY2 Pain and Palliative Care Pharmacy Residency. By having a pharmacist on staff, our patients and their families have the benefit of a doctor of pharmacy reviewing and collaborating on every medication profile. To learn more about the medications mentioned above, please visit our app. As a result, you’ll have access to more medication information and other FREE resources.
Call Hospice of Southern Illinois to learn more about end-of-life care and hospice services, 800-233-1708. Request a chat,