[BeExcellent]

Hey straight talkers. I need some insight. I have a pt/family that does not want to use any conventional medicine. Pt is elderly female with end stage CHF. Mildly symptomatic at this time. Reasoning and education has not convinced them to use conventional meds. Herb therapies are bought and tried by family. My goal is to direct care toward pt comfort using interventions agreeable to pt/family. I did ask them to list what they are giving the pt. so I can know. Anyone else had this experience? Any suggestions?

[doodlemom]

Originally Posted by BeExcellent

Hey straight talkers. I need some insight. I have a pt/family that does not want to use any conventional medicine. Pt is elderly female with end stage CHF. Mildly symptomatic at this time. Reasoning and education has not convinced them to use conventional meds. Herb therapies are bought and tried by family. My goal is to direct care toward pt comfort using interventions agreeable to pt/family. I did ask them to list what they are giving the pt. so I can know. Anyone else had this experience? Any suggestions?

I have had pt's like this before and what I do is just keep at it by recommending sx mgmt meds and usually when the symptoms become so bad, they will give in and agree that comfort is more important than worrying about taking pharmaceuticals. I've never had a pt that lasted until the end without comfort meds. Is it the patient AND the family that don't want the meds?

[indigo girl]

With all due respect, I am not a hospice nurse although I do frequently work with the dying in LTC and certainly in home care. I'm just wondering, if this family insists on homeopathic treatment, could they not involve an actual homeopathic MD in the care perhaps just as a consultant? An MD would at least be realistic as to what can and cannot be done, clearly just comfort measures at this point, and could help support the family in this. And, being a physician, he may be supportive of the conventional pain meds. Of course, the family would have to pay for this out of pocket, but they are already paying for homeopathics without any guidance. Is this patient at home or in LTC? Just a thought.

[doodlemom]

Indigo girl has a good idea. A homeopathic physician might be able to give them realistic guidance. Are they actually taking homeopathic remedies or are they taking herbal remedies? Homeopaths deal strictly with homeopathic preparations, not herbal remedies. If they're taking herbal then you may want to suggest a Naturopath.

[BeExcellent]

Thanks for input. It relieves me to know that it has been done before. This family has a Herbalist in the family that trained with a Naturopathic physician. They use both homeopathy and herbs. One of challenges is dtr/CG takes advise here and there, including a book, and uses the shatter gun approach. By history pt at 87 ys has had little to do with conventional medicine her entire life. She has a co-mo of dementia now and dtr/POA is making decisions. They have been on service about three months and were
greatly minimizing extent of alternative treatment and not giving conventional meds. My case load is low so I just took on the challenge. This is what I have done so far. 1. met with dtr at her work to partner with her (pt has day CG), 2. Discussed use of alternative approach with hospice MD and got order that they may give alternative meds 3. asked dtr to give us a list of what pt is getting 4. talked to dtr about selecting ONE avenue of reference for treatment (Herbalist, Naturpath or book). 5. examined pt to make sure she isn't in crisis now. I like the idea of d/c everything but comfort meds (They are not being given anyway.) And gently educating dtr on use of comfort meds if alternatives not able to control symptoms. There I feel better already. Any other suggestions? Anyone know of any "natural" intervention for acute dyspnea caused by CHF? (planning ahead, as usual)

[doodlemom]

You could argue that morphine is a "natural" medicine - derived from the opium poppy. It's a hard sell and she probably won't go for it. If the pt goes into respiratory distress, has the dtr stated that she would not use comfort meds? If the pt is demented and uncomfortable and the dtr is refusing to treat sx, as a last resort you could call APS. Just a thought. It sounds like you are doing a great job so pat yourself on the back.

[BeExcellent]

I am not sure APS would be appropriate since pt before the dementia used herbs in place of most conventional medicine. Even with pt's mild cognitive impairment she says, "I don't like taking meds." Has anyone had a hospice pt that was a Christian Scientist and didn't take any meds? (My pt is not. Just wondering.)

[indigo girl]

Originally Posted by BeExcellent

I am not sure APS would be appropriate since pt before the dementia used herbs in place of most conventional medicine. Even with pt's mild cognitive impairment she says, "I don't like taking meds." Has anyone had a hospice pt that was a Christian Scientist and didn't take any meds? (My pt is not. Just wondering.)

This is my experience. The patient, I'm thinking of was LTC, not hospice, and a Seventh Day Adventist. She took mostly herbal remedies. She fell while in our care, and was later found to have soft tissue injuries. Her physician was very respectful of her wishes. I believe she was only in our rehab for strengthening. When she fell, while waiting for the physician to get back to us, I used some techniques with her permission (Reiki, and Reconnective Healing), very briefly to help control her pain. She went to sleep almost immediately. Now, I know, this is not what you are asking, but I would suggest it's another avenue to ask the family about if you feel comfortable with it. This was in Maine, and the hospice we used in that facility also had volunteers who were trained in Reiki. I'm thinking that family may be OK with this or maybe not. I assume, you are looking for anything that will help, and this may not be enough if she truly needs morphine. We later used tylenol on our little lady. She took so few meds in her life that just about anything could knock her out.

[Cing_angels]

I work with a Guatemalan Nurse practioner in Hospice. She has made some very good suggestions for those who use only homeopathic methods. Here is a web site she suggested which give examples for some of their uses.
http://www.thebody.com/bp/sept99/herbal.html

[BeExcellent]

All great feedback. I am starting to have a plan and I love a plan!