Bonus Content: Let’s Regard End Of Life As A Distinct Stage
Posted: Jan. 4, 2012, 3:00 p.m. EST
Twenty-year-old Missy pictured with Marilyn Wayne of Palos Verdes, Calif. Missy entered Pawspice with presumptive gastric lieomyosarocma. Instead of surgical gastrectomy at 18, Missy was given the option of vincristine chemotherapy and is now on maintenance masitinib.
EDITORS' NOTE: This is special bonus content for Dr. Villalobos' article, Let's Regard End of Life as a Distinct Stage. To read the full story, click here.
Here are three examples of the End of Life stage:
1) Hemangiosarcoma in dogs is often diagnosed at extremely advanced stages after acute collapse from a hemoabdomen crisis. Those with rampant metastases are advised that surgery is unhelpful. These TIPs are immediately in late EoL phase. Most terminally ill patients would be offered the gift of euthanasia at the emergency clinic. Some might be released with a belly wrap, steroids, Yunnan Paio and pain medication with a signed consent form, to go home for hospice care and farewell with home euthanasia.
2) Hemangiosarcoma dogs with hemoabdomen from ruptured splenic lesions that undergo splenectomy may go from crisis to good health following surgery. Overall survival times are 89 days and not much better with treatment. These TIPs are in the middle EoL phase. We are seeking these dogs for a clinical trial using T-Cyte. Contact me at email@example.com.
3) Dogs with lymphoma in Stage IIIa and healthy appearing cats diagnosed with low volume GI lymphoma would land in the early EoL phase. These TIPs are often treated with chemotherapy protocols and may hold remissions for a year or longer.
Living without pain is the primary goal for all TIPs. Sustaining a patient’s basic needs and desires for QoL is prioritized over most other considerations. Every case is unique. The family’s wishes, tolerance levels and finances vary.
Each patient is different due to physiologic age at onset, degree of illness at diagnosis, comorbid conditions and personality. Despite the variables, the most agreed upon treatment goal for EoL stage patients of any age is quality of life.
This is achieved through attentive palliative care. We place less value on diagnostics and more value on symptom management as the patient slips from early to middle to late Eol Stage. This philosophy distinguishes EoL medical care from other stages, especially as the patient approaches death.
Does Diet Matter?
We can support EoL patients by carefully adjusting their nutrition to improve their particular situation. Use special diets formulated for organ failure or adjusted for diabetes, obesity and cognitive dysfunction. Trustworthy nutraceuticals and supplements that enhance the immune system (immunonutrition) and support the musculoskeletal system are of great value.
Some nutraceuticals and some non-toxic medications are proven to have anticancer activity (chemoprevention). Immunonutrition and chemoprevention may be the only treatment allowed by some families. Various supplements have been shown to target specific actions with beneficial effects. When clients report that their EoL pets are more active and happy than before, it is truly rewarding.
What Else Helps?
Physical and complementary medicine using acupuncture, massage, chiropractic and rehabilitation techniques may increase patient comfort and function. These techniques may reduce the need for increased doses of analgesics, keeping the patient more alert.