Category: Dementia

What about all these medications?

February 7th, 2010 · Dr. Brian Byrd · Dementia, Palliation, Spirituality 4 comments

Some of our patients come to us taking 5 or more medications.  We try to take them off as many as we can.

There are lots of good reasons for stopping medicines.  Many patients, particularly those suffering from dementia, have a hard time swallowing pills.  And studies show that over-medication is a common cause of falls in the elderly population.

In hospice, here in Fort Worth or anywhere, we emphasize palliation.  So we look at each medicine and determine whether or not it is providing symptom control.  If it isn’t, we discontinue it.

Often it is easy to make this determination.  Examples of non-palliative drugs are cholesterol medicines, and iron or calcium supplements.

Sometimes, though, it isn’t easy to determine whether or not a medicine should be pulled.  For example, most people feel that blood pressure medicines are not appropriate in hospice; however, some blood pressure medications also keep the heart rate in check.  Stopping one of those might induce shortness of breath.

The most common medicines we use in hospice are pain relievers.  These are miracle workers for many.  But they don’t come without side-effects, such as constipation and changes in sensorium.  So we have to be careful.

Some of my friends feel that when we take medications, we are not trusting God to heal, or take care of us.  I used to be fairly aggressive in countering that opinion, but I have lightened up in recent years.  For some people, God may ask them not to take treatment.  He may be working on something else within them.

Generally, I feel that science is a gift from our Lord, who created the universe and all its physical laws.  God has allowed humans to study these laws and use them to relieve suffering and treat all kinds of disease.

One of the aspects of Jesus’ healing that strikes me is that he would always engage people in conversation when he healed them.  He could have blinked and healed all sick folks within a five-mile radius of Him.  If his intent was only to heal, He probably would have done that.  But He wanted something more, and that was relationship with us.

My favorite example is the blind man, Bart, I believe was his name.  After some townspeople led Bart to Jesus, Jesus asked him, “What do you want me to do for you?”  I’m sure Jesus knew that this guy was blind and that he wanted Jesus to restore his sight.  But He wanted the Bart to tell him.  I think He wanted closeness and relationship with Bart, just as He wants with each of us.

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Graduating from hospice

January 11th, 2010 · Dr. Brian Byrd · Dementia, Hospice Agency Operations, Spirituality Comments Off

A small percentage of Texas Hospice patients do not follow the normal, expected course of decline toward death.  Instead, they return to good health after receiving our care.  These are our graduates.

A good example was a patient of ours who suffered from dementia.  After receiving daily hospice aid visits, music therapy, a cleaner bed and body, and attention from nurses, chaplains and social workers, she began to perk up.  She regained some lost speech ability, and began to feed herself again.

In these situations, often the family caregiver receives needed rest.  Well-documented studies tell us that caregiving can be so stressful so as bring on heart disease, or even early death.  Hospice care goes beyond the patient.

All along, we at our Fort Worth hospice agency monitor our patients’ progress or decline.  We praise our Lord when they improve.  And, when hospice is no longer appropriate, we help them receive other care, such as what a good home health agency would provide.

The story doesn’t end there.  This past week we admitted a patient who had previously been on our service.  While we were previously involved in her care, she improved, and we were able to graduate her from hospice.  Over the past few months, however, her condition declined, and our services were again needed.

And so, though most of our patients follow a normal hospice course, we are able to see, about once a month, a human being regain health that was lost.  It is another facet of hospice that makes the work so fulfilling.

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