Palace of Care – Saying No – Part 2

Photo by Timothy Eberly on Unsplash

My usual approach to complementary or alternative therapies is to try to keep an open mind. A lot of treatments do not have much evidence-backing but can be important to the people wanting to try them. A lot of the patients I see have exhausted all that Western medicine has to offer, thus they seek alternatives. Some of these treatments may be expensive in financial and other costs. I am supportive of a patient’s right to choose whatever treatment they want. If it makes them feel better, who am I to judge?

I do draw the line if an alternative treatment is causing harm. First do no harm is the first concept they taught us in medical school, but it is not a concept taught in all therapy schools. Rarely have I directly intervened when it comes to my patients receiving complementary or alternative treatments, but that does not mean that I would not do so.

In my final year of Palliative Medicine Specialist training I was worked in a mixed job, spending two days at the hospice, and three days in the local hospital. I had a good grasp of the palliative care patients throughout our district. It was the same patient population in the community, in the hospice inpatient unit and also in the hospital.

One of the patients that I was following in all three settings was a Pasifika man in his 70s, who had aggressive oesophageal cancer which made swallowing difficult. He had to modify his diet and ate pureed or mashed food as those were easier for him to swallow. It was important for him to eat as he was steadily losing weight. I had been following his case for a number of months, as he returned to hospital with dehydration and electrolyte disturbance. The medical team would rehydrate him and then he’d go home, only to return a few weeks later.

What the heck was going on?

I found the answer during his third admission to hospital. Again he was dehydrated, and he looked to have lost even more weight. I asked him and his family what was going on? They said that they had been seeing another doctor at a different clinic. A colonic hydrotherapy clinic, which our patient had been attending to try to cure his cancer. He was receiving their specialised treatment which involved various enemas. This resulted in large watery bowel movements, which led to dehydration. That explained his regular admissions in recent weeks. The enemas involve harsh chemical agents, which led to electrolyte disturbances. The family explained that the hydrotherapy ‘doctor’ had also recommended dietary changes. He was advised to not eat mashed potato, and other foods. Some of the only foods that he could still eat because of his swallowing issue.

The treatments were expensive, were making him more unwell, and were depriving him of some of the last remaining pleasures he could get from life – food. I explained to my patient and his family my assessment. It was their choice to make but I needed to give them my best advice. I thought that the hydrotherapy treatments were doing him harm, physically and financially. I knew that he wanted to be at home with his family as much as possible and that his alternative treatments had directly led to his recurrent hospital admissions. I said, “No more, you have to stop having the colonic hydrotherapy treatment, it is making you sicker.” Everyone wanted him to be at home for whatever time remained and agreed to stop the treatments.

Caveat Emptor – Let the buyer beware.

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