How to manage patients with end stage illness

Patients with end stage illnesses are those whose ailments cannot be controlled by medications or any other medical approach.
Dr. Joseph Kamugisha
Dr. Joseph Kamugisha

Patients with end stage illnesses are those whose ailments cannot be controlled by medications or any other medical approach.

In most cases such patients require supportive care especially to motivate them psychologically and control their pain as well.

Pain is always one of the key things to manage in this category of patients. A drug known as morphine is preferred in most of our medical facilities.

Though morphine is predominantly known as the most effective painkiller in most of African health setups today, there are other medications that have stronger effect today for pain control.

Morphine is a 200-year-old drug that has been effective for pain control but on certain occasions, controversial. Medics are usually trained on its side effect especially its ability to depress respiration once administered in an overdose.

Some people can have allergy to the drug and thus need another option.

Critically ill or patients with end stage illnesses or diseases that have gone beyond chronic phase are always managed in palliative care departments or even centres. Most of the patients managed in palliative care units are those with cancer, diabetes among many other chronic illnesses.

In most cases medications for pain control will depend on its origin for example some cancer patients whose disease has metastases to the bones usually suffer from osteoporosis. They are usually treated with calcium containing drugs such as pamidronate along side pain killers to manage their pain.

Drugs that are used to treat nausea from cytotoxic chemotherapy drugs such as imend among others are used in many palliative-care programmes to treat nausea that dying cancer patients usually present even after chemotherapy has been stopped.

Patient with end stage illness whose pain is exaggerated and makes them not sleep at all are given morphine or sometimes anesthetic drug such as bupivicaine directly into the spinal cord to control the pain. This will often offer quick means for patients to get relief from the pain.

One of the disadvantages with the regular use of the epidural or spinal cord will be infection from the site of the drug administration since the patient is in most cases bed-ridden.

The palliative care units are also commonly termed as hospice. In this department, doctors will in most cases strive to control symptoms and complications of the disease. Sometimes you find yourself in a situation where you will apply medicine without follow-up of the protocols to create a problem-solution situation.

Sometimes to create symptom free situation in hospice patients require medics to become imaginative and juggle multiple medications to alleviate symptoms or complications of the disease.

However, the commonest problem for such patients is pain. Though some people might get scared of the increased morphine dosages due to its respiratory effect, studies have shown that the medication does not quicken death of the patient because the respiratory effect of morphine can be monitored and controlled. This means that morphine dosage will always be increased based on the need of the patient.

The study on morphine usage and its respiratory monitor has given medics confidence to use the drug in high doses depending on the severity of pain or need of the patient to control pain.

Under the situation of end stage illness or dying patients, you expect deep sadness from the patient and even caretakers as well as the family.

Regular counseling should be done to the caretaker to offer psychological support to create morally and socially stable environment around the patient. The patient himself is treated with anti-depressant such as Ritalin that does not have an immediate effect but have a longstanding effect.

However, precaution should be taken when to use Ritalin as it is contra-indicated in patients with heart problems and those suffering from delirium.

Doctors in the palliative care unit also tend to focus on spiritual and emotional aspect of the patient especially those who are conscious as they are encouraged to celebrate their lives and reach out to families and friends before they die.

Usually in patients with end stage disease, the medics tend to focus on supportive aspect than curative so as to allow the patients get enough benefits from palliative care services. And once well managed, the families and all people involved can very well understand the end of life of the patient as the time that was very challenging but extra-ordinary meaningful.

Dr. Joseph Kamugisha is oncologist resident based in Jerusalem, Israel.

 

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