MEN'S HEALTH MATTERS:Palliative care is provided during the course of terminal illness, to support patients and families
Q I am a 55-year-old man and have been receiving chemotherapy for colon cancer for the last two years. My oncologist has now referred me for palliative care. What does this involve?
A The World Health Organisation (who.int /cancer/palliative/definition/en) defines palliative care as "an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness".
This approach involves a comprehensive and diligent assessment by the healthcare team to identify pain and other problems. These symptoms and problems often have varying physical, psychosocial and spiritual components, and the holistic nature of palliative care integrates these aspects in management.
Furthermore, support is not only provided to patients but also to their families. Depending on their requirements, bereavement counselling may be offered to families.
The WHO definition explicitly states that palliative care is "applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications".
Palliative care specifically does not hasten or postpone death, but through its early introduction in the course of the illness, the patient may be enabled to live as actively as possible until death.
Hospice care and palliative care are largely synonymous. The modern hospice movement originated in the 1960s partly because of dissatisfaction with an increasingly medicalised approach to end-of-life care at that time.
Although hospices had a predominantly terminal focus of care in the last century, they now have a much broader role including rehabilitation and subsequent community discharge of patients with pain and other symptom control issues; day hospice care with access to various therapies; and respite admission of patients to give family caregivers a rest.
Palliative care is delivered by a team of therapists that is predominantly led by nurses and doctors. In addition to its hospice origin, it is now delivered in acute care hospitals and in the home through home care teams.
Q I am 45 years old and have recently been diagnosed with a kidney stone. This stone was picked up during investigations for another condition. I thought kidney stones were supposed to be painful, but I never even knew I had one as I had no symptoms. How come there was no pain? If I get it treated will it come back?
A One of the functions of the kidney is to filter salts from the blood and allow them to pass in the urine. Sometimes these salts can form crystals and if these are not passed in the urinary stream they can act as a focus for more crystals to form, which in turn can clump together and form a small stone.
This in turn can predispose to infection (which in turn causes it to increase again in size) or lead to further clumping. This can happen if you are dehydrated such as being in a hot climate or (in a minority of cases) if you have an underlying condition causing abnormalities of salt production or excretion. Predisposition to stones can sometimes run in families.
Stones that are confined to the kidney frequently do not cause any symptoms and are very often only detected during investigation for recurrent urinary infections or blood in the water.
Classical stone pain comes about when a fragment lodges itself in the delicate tube connecting the kidney to the bladder (ureter) causing spasm and a backpressure on the kidney.
Approximately 50 per cent of people with a kidney stone who have it treated will get a further stone within 10 years. To decrease your chances of a second stone the best advice is to keep yourself well hydrated, particularly during the summer months or if you are abroad in a hot climate.
To make sure you are adequately hydrated during periods of warm weather it is best to ensure that urine passed is clear and not concentrated looking.
With regard to diet, advice varies from patient to patient and depends on the make-up of the stone. The majority of stones contain calcium - however, reducing calcium intake does not seem to make a difference for these stones. In some cases a low-protein, low-sodium diet has been shown to be effective. Most doctors advocate that investigations to determine if you have an underlying predisposition to stones should only be undertaken after you have had a second episode.
• This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Dr Peter Lawlor, consultant in palliative medicine, Our Lady's Hospice and St James's Hospital, Dublin and Mr Frank D'Arcy, urology specialist registrar, Beaumont Hospital, Dublin