Friday, July 21, 2017

sometimes hospice is a good option

you can say no to aggressive medical care.

John McCain has a glioblastoma, and the press is saying, hey there is treatment so don't give up the fight.

even though the dirty little secret is that the survival rate is low and the treatment is lousy.

I often criticize "QALY" criteria that deny treatment to the elderly or handicapped, figuring they are better off dead, but there is a good argument that people with weak bodies from age or handicaps might get a lot more side effects and less benefits from aggressive therapy.

This is an individual choice:

Yes when Joy's sister got malignant melanoma with metastases, I got her in a trial for experimental immunotherapy in Manila, (which didn't work, by the way). But she was only 45. Ditto for my "young" 60 year old brother in the US, whose cancer was put into a six year remission with a drug that was still in the trial mode when he started taking it.

But at age 80, the body is older, and many organs have vulnerabilities.

In many cases, hospice care is a good alternative.

Which is why my husband refused chemo for his Chronic leukemia: it might have put him into remission but he already had heart and kidney problems from his high blood pressure so the books noted that in such patients it was considered "optional".

Comfort care at home was his choice, and he died in his own bed, with family present.

Of course, this does have a downside: Lack of hospice care. One of Lolo's cousins had a lot of pain for a fractured hip that was treated with bedrest (no money for the expensive prosthesis needed due to osteoporosis, and he had medical problems that made surgery dangerous). He died after a few months anyway, but after a lot of suffering despite good home care by his niece and her son.

And we see a lot of stroke patients limping around town with post CVA footdrop... a lot of strokes and heart attacks due to high blood pressure because they can't afford the medicine for this...

There are free clinics, but often people don't go, and medicine alas is not free.

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