View unanswered posts | View active topics It is currently Wed Nov 26, 2014 5:40 pm



Reply to topic  [ 63 posts ]  Go to page Previous  1, 2, 3, 4, 5  Next
 Slow Medicine 

Is quantity of life more important than quality of life?
Poll ended at Thu Feb 11, 2010 4:56 pm
yes 17%  17%  [ 2 ]
no 83%  83%  [ 10 ]
Total votes : 12

 Slow Medicine 
Author Message

Joined: Sun Oct 21, 2007 4:18 pm
Posts: 835
Location: Acton, MA
Post 
I did watch the video, did find it interesting but not sure I understand the term "slow medicine". Would it be to avoid any meds or proceedures that aren't really necessary and aren't likely to give any quality to ones life? I have decided, after talking with Frank, not to schedule any more Urology, Neurology or colonoscopy(sp?) appointments. He just had an eye appointment, he has nothing horrible going on, so I don't know that I'll do any more of them either. He wasn't able to communicate well enough for the Dr to be confident with the results. I will never fully understand this disease.


Thu Jan 28, 2010 9:23 pm
Profile

Joined: Sat Oct 06, 2007 4:28 pm
Posts: 758
Location: LA
Post CC
Lynn, does the video have closed caption?

DrP


Thu Jan 28, 2010 11:28 pm
Profile

Joined: Sat Oct 06, 2007 4:28 pm
Posts: 758
Location: LA
Post Specialists
Gerry, don't be too quick to sever ties with the urologist. I'm thinking of UTIs. That must be watched for and treated. True, your GP could check for and treat a simple urinary track infection but suppose a blood clot formed in the bladder, blocking the flow... you do not want to let that go untreated. It is painful. Every symptom needs to be considered as it stands alone and an infection of that sort is a good example. Yes, it is a fine line. To treat or not.

DrP


Fri Jan 29, 2010 1:58 am
Profile

Joined: Sun Oct 21, 2007 4:18 pm
Posts: 835
Location: Acton, MA
Post 
Dorthea, Thank you, I guess when I said I wasn't going to make anymore appointments with the Urologist I was only thinking about Frank's prostate cancer. His prostate was removed 15 yrs ago and his Dr still sees him every 6 mths, PSA has always been very low so that just didn't seem necessary. I will expand my thinking.


Fri Jan 29, 2010 8:35 am
Profile

Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3432
Location: Vermont
Post 
Good morning - here is the quote I included in the first posting:

"Slow Medicine is not a plan for getting ready to die. It is a plan for caring, and for living well, in the time that an elder has left." Dr. Dennis McCullough

Here is the link to a 1.5 page paper written by Dr. McCullough which kind of sums up the Slow Medicine philosophy:

http://dartmed.dartmouth.edu/spring08/h ... rounds.php

Towards the end of the article he says "Some elderly patients are fruitlessly subjected to what some critics now call Death by Intensive Care...."

Here are a couple of examples of how I am interpretting this in caring for my dad - he has a pressure sore on his butt because he will not or cannot do anything but sit all day. He is getting antibiotics applied so it doesn't get infected. His eyesight is getting bad, he needs his 2nd eye operated on for cataract surgery but refuses, saying "I'm too old". I have to respect that even though I think it would improve his quality of life. His former dr. said he possibly has 3 types of cancer but he refuses all invasive tests (as well as the simple PSA). I have to respect that also, despite the fact that he has a cancer insurance policy that pays out some money on the initial cancer diagnosis, and that money could go towards his ALF expense, which is huge. I cannot make him have invasive procedures just for the sake of this policy which he apparently took out 35 years ago. Just a couple of day to day examples for me. Some doctors will pressure patients (even in the deplorable health condition my dad is in) and their families to have all sorts of tests and procedures. If his other hip needed replacement I would say no to that, or if he "needed" a pace maker or something like that I would say no, let nature take its course.
I hope this is helpful. It's a tough discussion for many people to even read about, but thank goodness my parents discussed this stuff with my sister and me ad nauseum for years, made their advanced directives when they were about 60. Now I am really glad they did.... I watched my mom suffer for 4 days on a respirator, etc. after having no oxygen for 20 minutes because the rescue squad tried to "save her" when it was too late. Something she absolutely did not want. She died in what she herself would have called an "undignified state".


Fri Jan 29, 2010 10:31 am
Profile

Joined: Sun Jan 11, 2009 8:17 pm
Posts: 104
Location: Arkansas
Post 
I just finish McCullough video and all is so relavent. My mom 90 yrs. old is on a decline but still has good days. She is having continuous UTI's and has been taking antibiotic almost none stop for several months. There seems to be no change in her behavior or is in any pain from this. The V.A. nurse just come and take urine sample 10 days after finishing the anitbiotics. Her flucuations physically or mentally happen at will no matter what is done. I and the caregivers keep good records of everything. Taking medicine is nearly impossible on some days. I don't know what is best for mom when it come to the course of antibiotics. Show medicine seems so right and how mom feels. Why, what,andwhen about having continuous UTI's ????


Fri Jan 29, 2010 1:55 pm
Profile

Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3432
Location: Vermont
Post 
Dorthea - I don't believe the video had closed captioning. Perhaps someone could watch it with a hard of hearing person and translate it or something?????
Laurie - it sounds like you are questioning whether or not to continue with antibiotics. That is one of those very complex, ethical questions and one I think about all the time. I talk with other close relatives and my dad's doctors about these sorts of things, and this afternoon I will be talking with someone from Dartmouth Medical School's center for shared decision-making (not sure if I have the name right) about my dad's situation. If I get info. that I think will be of use to you and others I will post it later today.
I also try to think "what would my dad choose to do if he were of sound mind?" and "what conversations did we have about this sort of thing before he became so incapacitated?"
Best wishes, Lynn


Fri Jan 29, 2010 2:08 pm
Profile

Joined: Tue Jan 05, 2010 5:27 pm
Posts: 146
Location: Fl.
Post 
OK all,
Let me make sure I understand about slow Medicine.
It is about stoping the long term medications, and test that just would not help her anymore.
I have made up my mind not to send her to the hospital if something happends. She has a DNR, and a very detailed living will. Not to use ANY thing to prolong life.
So does this include the BP meds and the Colestrol meds? She is taking 2 of each and 2 more of depression meds. Do thosse meds help her NOW? I talked it over with her Nerologist, He told me the most I could do for mom is just make her coftorble. and we slowed and stopped her Parkinsons meds. It was not doing her any good. It even says it does not usually help LBD . The parkinsons meds evern had a side affect of Hallucinations and delusions. She didn't need any more help with that. It has helped her not having to go to the bathroom as much. and she has been calmer. :)
What are ya;lls thought on this?
Anyway, she has a doctor apointment Thurs and I want to go iver all this with her doctor.

_________________
I Can Do All Things Through Christ Which Strengthens Me! Phil. 4:13


Tue Feb 02, 2010 10:47 am
Profile

Joined: Thu Aug 30, 2007 6:15 pm
Posts: 231
Location: Charlotte, NC
Post 
What effect did taking the carbidopa levodopa away haved? Did they get stiffer, shuffle more, pain? Tony takes it 3 times a day and he does have hallucinations, big time. He also is experiencing dysphagia...am wondering if removing the parkinson meds would make this worse, or is the swallowing issue a brain function not a stiffness issue. Will probably leave well enough alone.


Tue Feb 02, 2010 11:14 am
Profile

Joined: Tue Jan 05, 2010 5:27 pm
Posts: 146
Location: Fl.
Post 
nsalvadore,
I do not know about the swallowing issue. I know that it is a part of LBD. You forget how to swallow.
http://www.aafp.org/afp/20060401/1223.html
This is a link I got from the LBD form"Symptoms and Diagnos forum". It is what helped me talk to Her Nuroigist about the Parkinson's med. I jsut always wondered why she was still having such tremors in her hands and mouth and her walk. It just did not seem to help. When I read the info on that site, it said that patients with LBD do not react well. It also has side effects of Hallucinations and delusions. You see that when you scroll down on the page and see the medications. I have to say, she has not had major hallucinations, her delusions are still there. But she has not been violent as much at all. she use to pee all the time. her fluid intake was not much at all. I always had to try to talk her into drinking sometihing. But she was still going through countless pull ups. Now she does not. She still makes trips to the bathroom at night, she is just does not wet. Her tremors and her shuffle has not gotten worse.(It has been bad for a while and never gotten better.) Now I do see a sign when she is getting in and out of her bed, her legs shake bad. She needs help there. I know this disease is person by person. It works good for her. Talk to her Nerologist about it.If your LO is still showing strong tremors and is taking a antiparkinsons meds, I would talk to them about it. Hope this helps. :)
Tammy

_________________
I Can Do All Things Through Christ Which Strengthens Me! Phil. 4:13


Tue Feb 02, 2010 12:15 pm
Profile

Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3432
Location: Vermont
Post 
Hi Tammy - I am no expert on Slow Medicine - am just getting familiar with it myself. Some things are pretty clear to me - not doing various tests, like a colonoscopy or a pap test, for instance, or doing surgery.
When it comes to the blood pressure and cholesterol meds I have the exact same question, since my dad has been on those for years. He seems to be in or near final stages, he is 88, and he is miserable. I'm going to bring up this topic to his CNP and pscychiatrist next week. If there are meds that can make him less angry and nasty, I'd go for that. He doesn't do much hallucinating so I luckily am not having to deal with that and lots of delusions.
But, I know he wouldn't want any life-prolonging interventions, and isn't lowering blood pressure and cholesterol doing just that? So, I am going to chat with his health care providers. My sister and I, at least, are on the same page with our philosophies. There is no simple answer to some questions...... We'll just do the best we can do when we need to do it. Let's keep talking about this. I'll let you know how the dr. appt. goes next week. Lynn


Tue Feb 02, 2010 2:56 pm
Profile

Joined: Tue Jan 05, 2010 5:27 pm
Posts: 146
Location: Fl.
Post 
Ty Lynn, I will let you know what her Doctor says Thursday. My brother and my sister are on the same track to. Which is really good our families are together on these issues. I can't imagine how it would be going against one another on this.
I too just want her to be helped in the delusions and hallucinations as much as she can be to make life-as comftorable as possible for her and that is all she needs to be taking.
Tammy

_________________
I Can Do All Things Through Christ Which Strengthens Me! Phil. 4:13


Tue Feb 02, 2010 4:34 pm
Profile

Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post 
My husband did, at least initially, respond to Stalevo, a PD medication. He still takes it three times a day. I know it increases hallucinations and delusions but, to him, his mobility is more important than his mental state.


Tue Feb 02, 2010 4:46 pm
Profile

Joined: Tue Jan 05, 2010 5:27 pm
Posts: 146
Location: Fl.
Post 
I am going to see what the doctor says. Her mobility (which isn't great) is much better than her mental state. She is going faster mentaly than anything else.
Tammy

_________________
I Can Do All Things Through Christ Which Strengthens Me! Phil. 4:13


Tue Feb 02, 2010 4:57 pm
Profile

Joined: Sat Oct 06, 2007 4:28 pm
Posts: 758
Location: LA
Post Slow medicine
Lynn, I would rethink the blood pressure and cholesterol meds for fear of a stroke... a stroke added to the existing problems would be horrific and would have nothing to do with length of life. Of course, I could be wrong. How are the readings for those problems? Perhaps they would prove to be in control without the meds now. The doctor might want to check on that.

Mr B had been on diabetes meds for thirty years... two years ago his doctor had him stop the meds but continue with the readings which, surprisingly, showed good control.

DrP


Tue Feb 02, 2010 11:17 pm
Profile
Display posts from previous:  Sort by  
Reply to topic   [ 63 posts ]  Go to page Previous  1, 2, 3, 4, 5  Next

You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Powered by phpBB © 2000, 2002, 2005, 2007 phpBB Group.
Designed by STSoftware for PTF.
Localized by Maël Soucaze © 2010 phpBB.fr