TCM looks death in the face. We do not camouflage it as if it were poisonous. "We must allow our patients to die but we cannot allow them to perish," was my first lesson the day I met my teacher as a teenager.
Perishing is not being certain if one's truth is real because it is denied or avoided by physicians or family. Perishing is not being given the dignity to know your future honestly, to feel no power or sanctity in the process of leaving your body, to feel minimal support of difficult symptoms. It is being continually re-checked by physicians who have withdrawn chemo, surgery or other treatments but who have not honestly and kindly, discussed the patient's future or offered increased comfort. It is avoidance, isolation, feeling powerless or lonely as you die. It is being told a cure may yet exist when there isn't one or that grueling treatment is worth pursuing when, in fact, it isn't.
End of life is a sacred time to intervene with a patient, their family and caregivers. We can get high-impact results and provide meaningful comfort and information. Improvements can be dramatic and gained by simple protocol changes and treatments. One needn't have decades in the profession to find gratification with this patient population. There are many things you can do to enhance end of life for your patients.
Contradict past medical experience by offering personal, simple explanations. Even as physicians exert their best efforts, many patients have felt objectified, frightened and confused by their Western medical treatment. Often they have experience high side-effect protocols while being given minimal understanding of how to maintain dignity and self-esteem. Explain simply what TCM has to offer and what your goals for treatment are. Be honest. Don't hang carrots in front of them. You may have only palliative care, comfort based improvement, to offer. Sometimes that you care enough and offer kindness can be your biggest contribution.
Create teamwork. Most end of life patients don't have a clue what to do to make themselves feel better and they desperately want to. Action steps that are comfortable, positive and within their ability ranges boost confidence and empower even hours before death. Support their dignity and acknowledge their remaining abilities by providing doable tasks such as raising their feet above their hearts to address lower body edema, sipping a glass of medicinal tea, using a TDP lamp or Biomat on the lower burner to minimize the cold that remains as Yang chi departs upward, using a 7 star or plum blossom needle on their lower CV line to stimulate chi, listening to a visualization exercise that you record to help them relax, dissipate pain, etc., (you can easily record a visualization for your patient on their phone voice memo system while they are getting a treatment from you) drinking magnesium supplements that calm the mind (Xymogen's Neuro-Mag, crosses the blood brain barrier), holding crystals, magnets or precious stones in their hands or placing them on body parts to provide mini-treatments, listening to a Pandora channel of happy music, etc.
Teach simple concepts, for example, food caloric count vs. nutrient density. "Your body must use it's energy to break down everything you put into it. If you are going to ask your body do this work it should benefit by getting good nutritional support out of what you eat. "White food" refined white sugar and white flour products like white bread, pasta, and sweet desserts, are not the best for you now because they have lots of calories but they don't give a lot of nutrients back for your body's efforts of breaking them down."
Don't punish the dying for their few comforts. Sometimes even the smallest change is too much. Some patients will not drink herbs, stop eating sugar or go for walks around their house. They wont quit smoking, eating ice cream before bed or putting a cell phone to their head, even with brain tumors. They don't need your judgments as to how they end life so don't provide them.
Suggest small protocol changes that make a big difference. Many patients are told to drink a lot of fluid after meals. When patients are already not producing sufficient digestive enzymes due to their body's fight with it's disease or medical protocol, how could diluting stomach and pancreatic secretions be a good thing? That one suggestion has eliminated nausea and fatigue in more than one of my dying patients. Many are told to suck on ice chips because they crave cold. You can use this as a teachable moment by saying, "You crave cold because you have inflammation inside but the method your body is using to try to relieve and cool itself, drinking and eating cold things, doesn't work even though your body is doing the craving. We can cut inflammation in other ways. How about drinking room temperature water instead?" Some of these suggestions are more routine disruptive than the patient can handle. Others will make a substantial difference.
Can you provide alternative remedies that are more effective yet do not conflict with prescriptions? What is being used topically to sooth radiation burns, bed sores or rashes? One patient's oncologist suggested Vaseline to sooth her radiation burned neck. By using an aloe vera/vitamin E combination she got comfort and true healing of those tissues without sabotaging her oncology protocol.
If a patient is not able to detoxify a medication due to their genetic profile, they will experience more of it's side effects. When presented with a patient's genetic information, most physicians will consider changing a patient's medications to include those that are more readily metabolized. By running some simple tests like 23 and me (found online) or Genova Diagnostics Labs Detoxigenomic profile, you and their MDs can learn more about what a patient is able to break down and prescribe more appropriately.
Patients unable to consume food by mouth are probably getting very low quality food tube food with high levels of inflammatory agents produced by the Hershey company (yes, the chocolate makers) who have a substantial portion of the market. Liquid Hope is an organic, highly nutritional tube food that can be purchased through www.functionalformularies.com. There are several highly nourishing products on the market.
Acupuncture can be very powerful – a little goes a long way. Remember that needle tips can destroy cellular tissue upon insertion and manipulation so needle gently. For the very weak, needles cause too much damage and Tuina is the better option.
These are not simple cases. There are more syndromes going on than layers of an onion. Take your time in determining your treatment plan and be prepared to change paths quickly. You must be respectful of your patient's limitations. This person will lose his or her life but if you ensure that they do not perish in that process, you will have done your job well.
If you are working with a dying patient and would like to discuss the case with me please send an email. I would be happy to help.
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
