Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and I'd like to welcome you to my podcast and videocast station. Today I'd like to talk about palliative care. And the reason that I'm interested in talking about palliative care is because we confront it all the time. In my last couple of weeks, I've had a number of patients who really have been very unwell. And this has really brought out the importance of palliative care conversations and discussions. And I thought I would share it with you today because it's such an important conversation to have. So I took a moment just today to look up the World Health Organization's comments, definition of palliative care and i thought i'd run through that because it's a very nice succinct and well thought out a number of points that allows us to have a better understanding of what we would be hoping for or aiming to achieve from the involvement of palliative care in an individual's best health care so The first point that the World Health Organization's list of comments about palliative care was, was that palliative care affirms life and it affirms that dying is a normal process of life. Now, that sounds terribly glib to say, but I think the truth is none of us really want to admit that death is part of life. We all, on a day-to-day basis, really are planning for tomorrow and that tomorrow that we're planning for is in fact something that we're going to be involved in and doing something and working toward so the very beginning of starting to recognize that the opportunity of life comes with the cost of death at the end of it is such an important and fundamental starting point that i think it warrants all of us to reflect on and certainly if you're in the process of a chronic disease with a poor prognosis it is something that's palpably present and clearly unavoidable palliative care is also said not to hasten nor postpone death So the process of palliative care is not one of knocking people off early or really under a guise of euthanasia allowing people to die sort of on demand. It's not that sort of process at all. But nor is it designed or nor is it there to make sure people's lives are extended. in any way that's ridiculous or counter to quality of life or expectation from the disease process they're in so palliative care is about really allowing nature life to take its course but supporting the process within it not accelerating it not slowing it down just making it better palliative care is to provide relief from pain and distressing symptoms. And look, this is a really important aspect of the care that people need at this time of life. Pain can be managed, but not everyone who's in the process of dying from a chronic illness will suffer with pain. Pain can be covered with... all sorts of techniques whether it's morphine syrup whether it's local blocking injections for blocking nerves there's all sorts of clever mechanisms for dealing with pain but it's also really important to understand that pain is not the only distressing symptom as people approach an end-of-life situation distressing symptoms may be secretions in the lungs which cause distress with breathing. And so medications that can dry those secretions out may be something that really provide a lot of relief. Really simple things like constipation can be part of the symptoms that are distressing at the end of life. And you don't even want to imagine how if you're dealing with the complexity of a of a life-ending disease that on top of that you have discomfort, bloating, pain with daily bodily functions. So the importance of not just dealing with pain but distressing symptoms is paramount and it can make a huge, huge difference. A patient I had from a number of years ago called Barney had a bad bad heart and he was he was destined to die from that condition at a relatively young age he was only in his 60s or thereabouts and this condition called amyloid had him infiltrated his heart and really was stopping his heart from working properly one of the consequences was that his body was retaining fluid and that fluid was accumulating in his legs and in his abdomen Well, the palliative care team over the course of somewhere around three to six months on a regular basis used to put a little needle into his abdomen and drain the fluid that was accumulating away. This was neither hastening his disease nor was it prolonging it, but it was making him so much more comfortable. And I think it's really important we understand the role. of making quality in this process. Palliative care also integrates the psychological and spiritual needs and aspects of care for the individual but also for the family. And this is really important. The patient is not the only person who suffers in this process and the importance of pulling people together and recognising those psychological challenges together with, interweaving that with their religious beliefs or spiritual beliefs is an art and an invaluable contribution to making the last few weeks, months, perhaps even years of the journey of life better for everyone. Palliative care also looks to support people to make sure they remain as active as possible right up until their death. And I think that's really important as well. Again, we come back to the first premise which we acknowledge that with life there has to be death. And we come back to the premise that we're really looking to give people quality and not either hasten or slow the process. but making sure that on a daily basis they're as well as possible. If we're able, through palliative care, to support people to do the things they want to do, then that's a great start. And it might be supplying oxygen to someone so that they could go to a soccer game or a football game and watch a grandson or a granddaughter play a sport. I don't know, but it's really important to recognise that there are... opportunities for us to support and help people achieve activity right up until the very last moment there is a team approach that goes with palliative care and that team approach is there to meet needs of the patient and the family and if you stop and think about it momentarily the team clearly includes a number of people who you can imagine straight off the bat. Well, of course, there's the primary care doctor, the general practitioner. There's a specialist caring for whatever the condition is that is the terminal condition. There's the palliative care physician, of course. So there's plenty of doctors involved. There may be a palliative care nurse. There may be an occupational therapist who's looked at the house to look for modifications. such that as the individual deteriorates, those modifications allow that individual to continue to live in their home residence for as long as possible. There may be a social worker involved to make sure that there's opportunity for government supports in terms of care where possible. There may be a physiotherapist involved to help with mobility and functional capacity. You can see immediately. Even without throwing in there someone who offers some spiritual guidance, whether it's some sort of psychology, whether it's someone associated with the church who comes and supports as well. There is a team that will help that patient and the family through this difficult but inevitable time. Palliative care is about enhancing quality of life on a daily basis. And it can even have a positive influence on the illness. So it's not designed to prolong life, but it may, through the actions of improving quality of life, have a positive impact on the illness. And that's worth bearing in mind. It's very important to understand that palliative care can be commenced and patients can be brought to palliative care very early on in their illness. They don't have to be, if you like, at death's door or about to wind off their mortal coil before engaging with palliative care. And more and more, the recommendation is that we engage the supports of palliative care and begin the process of education and understanding as early as possible in the process and then you might imagine for example with someone with a cancer that's going to require chemotherapy or radiotherapy may allow those individuals to connect with a palliative care team who can support them through those early stages where there's so much uncertainty where nausea, for example, could be a problem from some of the therapy that's given, where patient support could be found and the journey of others could provide the reassurance for the individual concerned. If there is a big problem with palliative care It's probably two things. The first is that we just don't talk about it enough. We all try and ignore, or we all allow the fact that dying is really part of the normal process if we accept life. And so we often don't bring it up. And we don't bring it up for fear of what patients will think about it. So this is about opening that conversation. If you are in a position where palliative care could be beneficial for you or a loved one, ask about it. Start the conversation. Because doctors at times do find it difficult to start that conversation and they're often looking for the right time. And often it's the case, the right time just doesn't present itself. But if we're all thinking about it, we get to talk about it more if there is one other issue with palliative care that's a big deal that is that it's just difficult to access and there really really are not enough palliative care physicians in most situations in major cities towns and certainly more remotely even rarer and harder to come across i'm going to wrap up palliative care there i hope you found the information helpful informative if you have any queries or questions as always please drop us a note at info at dr Warrick bishop online if you have any suggestions for future podcasts also let us know at info at dr Warrick bishop online i really like to thank you for joining me today i really do encourage you to embrace this important message I wish you the very best until next time and please don't die from a heart attack. Goodbye. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
