![]() Most of us have heard this term. It is the noisy rattling sound that a dying person makes that can be very disturbing to hear. Death rattle happens when secretions gather in the throat because the person is too weak to swallow. The gurgling sound happens when air passes through the secretions upon exhale. This doesn’t necessarily mean the person is having trouble breathing.
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![]() Agitation can be one of the worst symptoms to encounter at the end of life. Most in the field refer to this kind of restlessness as terminal agitation or terminal restlessness. It can be extremely difficult to treat. Not only can this be very distressing for the person ill, it is very difficult for the family. When someone has this condition, some of the following is seen: picking in the air, at clothes or at *his skin, trying to get out of bed and then wanting to get back in within 5 minutes or less or constantly changing his mind about ![]() When someone is dying a natural death, there is a breathing pattern that usually happens. It goes something like this: a deep breath or 2, then holding it, followed by a shallow breath or 2, and so on. It is an uneven pattern of inhales and exhales. It can be scary if you don’t know it is coming. Another thing that happens is as the person gets closer to death, the time between inhales widens. When breaths are towards 20-30 seconds apart, death may be happening very soon. I say “may” because there is always someone who may have this breathing pattern and live much longer. Overall, breaths will be getting more shallow and the time between inhales will space out. There are exceptions to everything, but generally this is what you will see. Of course right now I want to tell you all the ways it could be different and how many ways breathing can look even with the above very general guidelines. The best thing to do is when you are going through this time, ask you hospice doctor or nurse about it and ask them to show you ![]() Here’s a great resource for people who are dealing with a family member or patient with advanced dementia–Palliative Care Dementia Resources. It separates the resources by topics and is easy to follow. To me, some of the most disturbing symptoms of dementia are emotional and mental pain. It can be devastating for everyone, but not as much as for the person who is sitting with that kind of discomfort. Medical professionals are getting better ![]() Morphine is one of many drugs that is used to treat moderate to severe pain and also it is used to treat shortness of breath. Not many people know that. In hospice medicine we use it all the time for both and it is one of the standards for the treatment of shortness of breath. If someone is allergic or for whatever reason cannot take morphine, there are other drugs in this same category to try. There is the thought in the medical community (outside of hospice) that ![]() There’s some snobbery in a person judging if another person is in denial, don’t you think? Sitting around tables we shake our heads or we tsk-tsk or the like because some unfortunate soul is not coming to terms with their own death or with that of their loved one. How rude. Suffering, hope, depression, grieving, coping, etc. have faces and nuances we don’t always recognize or understand in people. To cope with hope….what’s wrong with that? ![]() Regarding medical care, we are in technological wonderland in some areas and in others we are still behind. Regarding the management of dyspnea, (dyspnea is shortness of breath), we haven’t done so well in end-stage diseases which are not yet terminal. Research is showing that morphine and like drugs (opioids) are effective in its management so that people, no matter what their disease process, can live and have a quality life as well. In this discussion we are referring to the person who is not classified as terminal. ![]() Have you ever seen someone struggling to breathe as part of their illness? I’m referring to people living with ‘end stage’ lung or heart disease or advanced cancer with breathing difficulties. Living with end stage illness or late stage cancer does not necessarily mean you are terminal. Often, a person is not. People, especially those with the various chronic lung diseases struggle for several years like this. The anxiety that accompanies these attacks seems to be written off The American Gastroenterological Association’s medical position statement on nausea and vomiting (n&v):
“…It must be conceded that, with the notable exception of postchemotherapy and postoperative nausea and vomiting, relatively few controlled trials have compared either various therapeutic strategies or available pharmacologic agents in the symptomatic therapy of nausea and vomiting…” I went on a search to see how nausea and vomiting (n&v) is being handled in different medical settings to compare it to how it is done in the hospice setting. I wanted to see if palliative care is really all that different during the time of life when hospice is the last thing on someone’s mind.
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AuthorIn fall 2014, I moved some old blog posts here that I had written years ago from 2007 to 2010. Hope they are helpful. Archives
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