Follow-Up to NY Times’ article on Palliative Care

In the Sunday Times dated April 11th there were some very thought provoking responses to the article we posted last week regarding palliative care.  I think this is an area of great interest to our patient population and I would like to continue the discussion.  I read with great interest the responses from palliative care experts and I am convinced that so many of you would benefit from requesting that palliative care become part of your expert medical team.  Fran Heller a much respected member of NY Presbyterian Hospital/Columbia University will be leading a group as well as meeting with patients and family members who would like expert advice.  There will be many professionals from various disciplines on hand so please take advantage of their expertise.

Letters to the Editor, New York Times, April 10

If you haven’t read our previous blog, take a look here and also make sure to go through the comments sections.

Palliative Care and Difficult Decisions to Stop Treatment

This Sunday I was struck by the New York Times article titled “Helping Patients Face Death, She Fought to Live,” about Dr. Desiree Pardi, a leading clinician in palliative care who herself became a cancer patient faced with deciding when to stop treatment and when to focus on palliative care instead.

As a practitioner and health care advocate, I have often found myself involved with patients who are at the crossroads of ending active treatment and focusing on comfort care. This article highlights well the personal nature of such a decision. As practitioners, we can provide information and support, but it is the patient who ultimately must choose which path to follow.

I believe that in a situation in which a patient and physician find themselves at odds regarding topics of continuation or end of treatment, a mediator should be consulted to help resolve these difficult issues.  In the best case scenario a medical ethicist or palliative care practitioner should be asked to help to ease the burden that both the patient and healthcare provider are struggling with.  In theory, paternalistic medicine is no longer practiced and as healthcare providers, we are tasked with providing the patient with the education to make informed decisions (choices).  This also implies that a patient is able to make those choices based on free will and a good understanding of the impact the choice will have on their lifespan.  I imagine that as healthcare reform continues to evolve, end of life decision-making will become part of a national debate.  I know that, as a medical provider, I will continue to learn from my patients and their loved ones.

Read the article by clicking here.

Risks of Radiation Therapy

Many of you have now seen the article that was published in the NY Times on January 23rd (read article here). We are posting this article as we field many questions from community members about these new types of radiation therapy.  As we can see by this article, even some of the largest hospitals have had problems with both mechanical and human error.  I cannot stress enough that all mesothelioma patients considering new technology should investigate the experience of the center, the experience of the personnel designing the treatment and then the experience of those administering treatment.  We are fortunate to have developed relationships with expert radiation oncologists who assist me in determining where to send patients for therapy if they are unable to go to an expert mesothelioma center.
Cancer treatment often requires travel far from home, but to avoid these potential pitfalls, I truly believe that you need to be in the hands of experts.  Hospitals and Cancer Centers heavily market themselves and it is easy to be swayed when you are feeling vulnerable.  My mom always said the “proof is in the pudding”, in this case the reports of clinical trials using these machines in mesothelioma patients are proof of efficacy. If you enter a clinical trial using some of these new techniques, there are more personnel involved as the protocols must pass rigorous peer review and then IRBs (Institutional Review Boards) which were put in place to protect patients.
There is a role for radiation therapy and having a consultation with an expert to guide you is crucial.  Often times the therapy can be mapped out at an expert center and with the help of these seasoned radiologists, you can be placed in good hands to have the treatment delivered close to home.

~Mary Hesdorffer, NP

Click here to contact Mary Hesdorffer, Nurse Practitioner or call 877.363.6376

Cardiac Arrhythmias and Mesothelioma

There are a number of conditions that can contribute to cardiac arrhythmias in mesothelioma patients.  Arrhythmias are rapid atypical heartbeats which lose the characteristic patterns observed in the normal electrocardiogram (EKG). In mesothelioma, primary cardiac tumors of the heart (pericardial mesothelioma) or in most cases the spread of mesothelioma to the cardiac silhouette, can be responsible for arrhythmias.   The AV (atrial ventricular) node is composed of specialized tissues located between the atrium and ventricle.  The purpose of the av node is to set cardiac rhythm.  When malignancy impinges upon these tissues, arrhythmias can develop.  Common presenting symptoms are similar to those of congestive heart failure: cardiac and pleural effusions, shortness of breath and extreme fatigue.  Pulse will be irregular and in most cases rapid, greater than 100 beats per minute.

Surgery and the formation of scar tissue can damage this sensitive tissue following and EPP or PD.  These complications are described in papers reporting on large series of patients who have undergone this surgery.  In the immediate post operative period the major causes of arrhythmias usually reported are  incisional pain, hypovolemia due to blood loss and respiratory insufficiency due to anemia.

Tumor cells secrete substances not well understood that cause night sweats, fevers, anemia and sometimes a condition referred to as paraneoplastic syndrome.  Paraneoplastic syndrome can result in electrolyte imbalances and the heart muscle is sensitive to changes in electrolytes.

In most cases where we observe normal rhythm but rapid pulse, the cause is anemia.  In patients with cancer we describe a condition referred to as anemia of chronic disease.  In this group of patients we can transfuse regularly but the only true correction of this condition would be instituting effective chemotherapy. Thryoid dysfunction can also result in arrhythmias.

~Mary Hesdorffer, NP

Click here to contact Mary Hesdorffer, Nurse Practitioner or call 877.363.6376

Choosing a Surgeon

No matter how minor the surgical procedure there is always risk involved. Some of the important questions that need to be addressed are: How many of these surgeries have you performed? How many this year and were they at this particular institution? Will I meet with other members of your team before surgery? What complications have you encountered doing this procedure and how were these complications handled? What are the success and failures reported with this procedure? What are the alternatives to the procedure you are suggesting? Will you be away for any period of time during my post operative time? If so who will be the covering physician? Will you be performing the entire surgery, if you have residents and fellow what will be their role in the surgery? There appears to be a new crop of surgeons promoting themselves as mesothelioma experts. In my book an expert has published extensively in this disease and is at a well respected Academic Institution. Insurance companies are pushing patients to see surgeons and medical oncologists who are not familiar with mesothelioma…that to me is like playing Russian Roulette. In many cases you have one chance to do this right and you need to stop or slow down the process until you have been assured that you have identified the right person. Do not let yourself be intimidated or bullied…you have a right to full disclosure and to be informed about the risks and benefits associated with any procedure you are about to undertake. A second opinion can be a life saving measure and you should avail yourself of this if you have any hesitation that you not be receiving an unbiased opinion. Please call on me and I will help you with this process.

~Mary Hesdorffer, NP

Click here to contact Mary Hesdorffer, Nurse Practitioner or call 877.363.6376