Category Archives: #FOAMPal

Highlights from #ANZSPM16 pre-conference workshops

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The Australian and New Zealand Society of Palliative Medicine (ANZSPM) 2016 Conference opens today. A number of excellent pre-conference workshops were held yesterday, including:

  • A comprehensive trainee day, including a great workshop from Katrina Anderson on self-care and reflection about love, strength, vulnerability and respect; the use of methadone (Pippa Hawley); the challenges of providing palliative care in residential aged care facilities (Douglas McGregor), patients and families with vulnerable personalities (David Kissane), and the neuroanatomy of distress (Lisa Miller)
  • A great presentation on the role of media in palliative care, followed by a hands-on workshop in the afternoon, under the encouraging guidance of Marie Mills; and
  • Supervisor workshop, lead by Michelle Gold and Brian Le

Team Palliverse will be broadcasting from the #ANZSPM16 Conference for the next three days. If you are at the conference, please come and say g’day – and recharge your devices – at the social media hub!

Delirium in palliative care – 10 tips in 140 characters

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Here are the first ten tips that came to mind for the management of delirium in specialist palliative care.* Of course, there are many more to list. Please share your top tips in the comments. Continue reading →

Palace of Care / I think therefore I am? #gotjnrbak The final update.

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What would happen after the joyous reunion of Poppa and Junior? This was a question asked at our multidisciplinary meeting two and a half months ago. From the accumulated experience of our staff members we thought it could go either of two ways:

  1. Poppa might get a “boost” from being reunited with Junior and other family members, and might improve.
  2. Poppa had used what was left of his energy holding on to see Junior and would continue to deteriorate.

Continue reading →

Delirium: Why we should (palliative) care

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In palliative care, delirium is everyone’s business. Anyone can get delirium if they are seriously ill. It is a distressing symptom – for the person with delirium, their loved ones and the professionals who care for them. Although it is common, potentially preventable and may be reversible, it is often missed, misdiagnosed and mismanaged despite our best intentions.

This 5-minute video is an excellent resource for the public and health professionals alike, (and seems to cover everything that it takes me 45 minutes to teach to nurses or doctors!). I discovered it via its co-creator, Delirium Champion Dr MS Krishnan.

This week, I am taking over Palliverse to share posts about delirium in palliative care – from conferences to clinical standards to a heart-wrenching personal story. Continue reading →

Planning care for people with dementia

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Two new resources are now available to help with planning care for people with dementia. Palliverse talked to driving force Prof Meera Agar about the ‘whys’, ‘hows’ and ‘whats’.

Q: Why develop care planning resources just for dementia?

A: People with dementia face unique challenges and decisions related to their care and health care needs as their illness progresses; and supporting their choices is made more complex as they become less able to communicate their needs and articulate decisions about what they want from care. While good intentioned, many health professionals in aged care and other settings may not understand the course of dementia, and there may not always be good communication, involving the person with dementia whenever possible and their families,  and also between the different health professional involved in the persons care.

Q: So how do the new resources help?

A: The two new resources are a website offering practical support for family case conferencing and a report providing guidance on critical recommendations to improve advance care planning. Continue reading →

Palace of Care – Parallel Lives

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Cape Reinga the northern-most tip of New Zealand, where the spirits of Maori depart on their final journeys. Photo by Gadfium.

The first time I met the young ladies I had been cross-covering at the hospital, and was taken to see each of them as they both had severe pain and discomfort. They came from completely different backgrounds, had lived completely different lives but somehow ended up on the same journey.

About a week or so later they had both been admitted into our inpatient unit for pain control. Adjustments were made and they became more comfortable, but a few days later pain had returned again, as well as other problems. We had to aim at constantly moving targets, and so it would be over the next three months of their individual roller-coaster rides.

The similarities were startling; the same diagnosis, the same poor response to treatment, and in the end the same prognosis. What was completely different was their individual experiences of the same outcome. Continue reading →

Palace of Care/I think therefore I am? – #getjnrbak – Nervous anticipation

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Yesterday we were left with a number of questions.

Was Poppa going to be able to hold on?

Was Junior going to be okay during the flight?

What tie should I wear tomorrow?

A nervous night was spent with as many fingers crossed as possible, finger cramps set in disturbing sleep – and that was just me.

The answers to the questions above are contained in the photo below:

Continue reading →

I think therefore I am? – A thought provoking interview with Cory Taylor

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Photo by Britt Reints, used via creative commons

Driving to work on Saturday morning I listened to RNZ National’s Kim Hill interviewing celebrated Australian novelist Cory Taylor. Cory talked about the experiences that led to her writing her last book, Dying: a Memoir (Text Publishing), while dying of metastatic melanoma with brain metastases. Topics discussed include Euthanasia, Palliative Care, and writing about dying.

You can listen to the RNZ National interview here.

*Updated* 13/05/16 – Palace of Care/I think therefore I am?: #pallanz Mercy mission #getjnrbak

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Hi everyone,

Situation:  

Poppa is my patient. Grandson “Junior” in Sydney unable to fly back to Auckland because of eye injury. Tearful conversation via internet this morning. Two men heartbroken at the thought that they will never be able to hug each other again.

Background:

Poppa very unwell and worsening rapidly, admitted this morning for hospice care.

Family have tried Cruise lines, Courier companies, travel agents to no avail so far.

Assessment:

Re-uniting Poppa with Junior would provide the greatest comfort.

Recommendation:

Spread the word through all available palliative care networks to see if we can #getjnrbak!

It might have to be via sea because of Junior’s eye injury.

Thanks in advance for your help.

Let’s see if we can provide another example of a real world translation from our Palliative Care virtual community of practice.

Cheers,

James

UPDATE 11/05/16 1700 NZT:

Junior’s medical details were obtained with his permission.

Sean Coleman from Air Ambulance NZ has been very helpful, again – Shipping companies contacted – minimum of 4 day trip by ship.

Freighter Travel company contacted.

Suggestions:  Make-a-Wish foundation could be approached?

Anyone know any super-rich people with a spare super-yacht?

UPDATE 12/05/16 1100 NZT:

Cruise ship company contacted.

No commercial flight options available. Low cabin pressure private jet would cost at least $30000+ one way.

The search continues, people have been leaving suggestions in the comments section, thanks.

UPDATE 12/05/16 1700 NZT:

I made contact with P&O Cruises and they did not have anything available this year.

Junior’s family are also exploring freighter ship options apparently there is a Brisbane to Auckland ship sailing next week. Hamish from Freighter Travel also told me about the same possibility, he was very helpful.

Poppa remains very unwell.

Fingers crossed.

UPDATE 13/05/16 1400 NZT:

No news on the travel front, but Poppa woke up and was comfortable today!

Fingers double crossed that its the start of a trend.

Modern dying from a doctor’s perspective

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A thoughtful article regarding our modern attitudes to dying by Dr Craig Bowron, an internist (i.e. physician in internal medicine for us Down Under, or general medicine consultant)

Opting to try all forms of medical treatment and procedures to assuage this guilt is also emotional life insurance: When their loved one does die, family members can tell themselves, “We did everything we could for Mom.”

In my experience, this is a stronger inclination than the equally valid (and perhaps more honest) admission that “we sure put Dad through the wringer those last few months.”

I agree with Dr Bowron, that sometimes we may not consider the cost to the person (not the financial cost, other costs) of being able to say, “We did everything we could.”

What do you think? Does this apply where you are?

Regards, Sonia

PS Thanks to Tegan, a social worker I work with, for pointing me to this article.