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.
4 Responses to “What about all these medications?”
Dear Dr. Byrd,
Thank you so much for supporting my thoughts on needed elder training on another blog a day or so ago. My new blog – http://stoppainindementia.wordpress.com – is an effort to spread the word that dementia victims feel pain as much or more than healthy individuals. Too often our loved ones are looked upon with tunnel vision and a belief that all negative behaviors are psychotic events which require sedation. As a Registered Nurse and daughter, I was a relentless advocate for my mom when we had to turn her physical care over to a nursing facility. Even though she wasn’t sure where I fit into her world, when our eyes met there remained a bond until the very end of her precious life. She had a history of osteoarthritis and frequent UTI’s. I knew her agitation was from pain when she was grinding her teeth, grimacing, bracing her body, etc. The nursing home continued to freely administer Ativan, Clonazepam, etc. but when I pushed for more pain control beyond Tramadol 50mg PRN q8h, the response was – “we don’t think she needs it and don’t want to place more chemicals in her body.” The resident physician didn’t feel we needed hospice 3 weeks before Mom’s death, but I called them in anyway. Unfortunately, the same physician was the medical director of the hospice. There was a definite pain management crisis in this facility. I suspect it started with corporate management. First line tx of agitation – Ativan. None of Mom’s pain signals were documented until grimacing was noted the last week of her life. No nurse ever contacted the resident physician to suggest analgesia without my insistence. While with hospice, the facility nurses did not call hospice when more frequent morphine was needed. It was left up to my family. I don’t know where to begin changing this antiquated way of thinking. Thank you for all you do for our loved ones. I can tell through your writings that your patients leave this world as comfortable as possible.
Candy,
Thanks so much for the thoughtful response. What a story.
My wife read it to me as we were driving home from Waco Monday evening, and she was quite taken back. Her grandmother is in a situation similar to what your mother endured.
I looked at your new blog and even had a chance to comment. Keep doing what you are doing.
Brian
To Brian AND your wife -
Yes, my mom’s story is quite distressing. Thank you so much for commenting on my writings. If you have suggestions on how I can increase the readership on this subject, please feel free to contact me via email. My best to you both in getting the best possible care for your grandmother. We must be their voice. Candy
Candy,
Can I ask how you heard about our blog?
Brian