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COMPLEMENTARY AND ALTERNATIVE MEDICINE IN PALLIATIVE CARE Michael Marschke, MD Medical Director of Horizon Hospice Objectives Understand the various alternative therapies to palliative care including: Local measures Physical modalities Mind-focusing techniques Energy work
Michael Marschke, MD
Medical Director of Horizon Hospice
Mr. B is a 46yo self-employed computer processor who comes into your office with a 6 month history of progressive mid- to low-back pain. His pain is worse after sitting at the computer or after long car rides, and better in the morning, though he is stiff. He never has exercised much but is not obese, and in fact has been losing weight recently without trying. This pain has affected his ability to work over 2 hours straight at his computer. Over the last month he has noted a radiating, sharp pain down the back of both legs with numbness in the back of his right leg. This pain has affected his life so much he is now depressed, losing income, and it is affecting his marriage and sex life.
Plain X-rays reveal lytic lesions in the lumbar spine. Further work-up revealed a lung mass, biopsy proven to be adenocarcinoma of the lung with wide-spread mets to the bone. There was no spinal cord compression on MRI.
Now faced with this life-threatening disease, he went into a deeper depression, though he wanted to undergo chemotherapy and radiation, which he did begin. Narcotics were started, though he never wanted to take a lot of these while he tried to keep up his work. He is willing to try anything to help with his comfort.
LOCAL TOPICAL MEASURES:
Mr. Z is a 60yo Hispanic gentleman with pancreatic cancer. He was diagnosed 3 months ago when he came in with weight loss and epigastric pain. He was found to have liver mets on CT scan and he elected palliative care and home hospice. He does have recurring pain but never complains a lot about it. He has difficulty eating without nausea and vomiting. His pain has never been severe; it is mainly the vomiting that is causing him suffering. On social history he has a large family and they are economically challenged. He was always the bread-winner and now that he cannot work he is very anxious about his family and worried that he will be a burden to them.
On exam, he is in no obvious pain, but jaundiced, and cachectic. Other significant findings just include a mildly enlarged liver and tenderness in his epigastrum.
Though reluctant to take medications, he is willing to try other measures to help his pain, especially since herbs and other alternative therapies are familiar to him and his family culture.
Ms. C is a 76yo woman with extensive end-stage breast cancer, originally diagnosed 2 years ago. Now she has tumors in her lung with recurrent pleural effusions that have been tapped many times and are now loculated. She has exhausted all chemotherapy and radiation therapy and is entering hospice. She has no pain but suffers from recurrent dyspnea. She is dependent on oxygen, and still has a difficult time walking or lying flat without getting acutely short of breath. She has become very dependent on others. This situation has created much anxiety in her life.
She is used to living alone and now has a caregiver 6 hrs a day. She does get afraid at night – not afraid to die, but afraid to be short of breath.
On exam, Ms. C. is out of breath. She is cachectic, has edema mildly in both legs, decreased breath sounds with dullness just at the bases of both lungs.
She is on diuretics, occasionally takes Ativan which does help, but reluctant to take morphine because it makes her too sleepy.
- chiropractic manipulations should be avoided with neck osteoarthritis and nerve impingement
- beware of avoidance of proven medical therapies because of CAM