During a recent audit, an observation stating that ceiling of care DNACPR should not be documented explicitly in the patient records was made. In the first entry of our new series, focusing on the relationship between the contemporary palliatrist and the law, we focus on understanding decision making associated with treatment limitation. Both treatment de-escalation… — read more

Referral was sought for a middle aged female patient with CNS relapse post allogeneic stem cell transplant, who had undergone prophylactic cranial irradiation in the past and had history of prolonged cytopenia following BFM protocol. She had a diagnosis of mild meningitis on MRI and had presented with features suggestive of raised ICT (Headache, projectile… — read more

I have been part of an international group of experts in non-cancer palliative care (PCAND – Palliative Care for advanced Non malignant diseases), for more than two years now, and while there have been ferocious discussions on the suitability of peritoneal drains in our online group, there continues to be a lack of consensus. NICE… — read more

While reviewing a patient with multiple comorbidities, admitted with decreased urine output and a presumptive diagnosis of MODS with shock, in the ICU, this palliatrist encountered a realisation regarding ceiling of care decision-making, which appears worth documenting. The family of the geriatric patient had requested admission under palliative care; internal medicine had flagged a difficult… — read more

In my last place of work, junior doctors were advised not to assist me in their work. I was never made aware of the reasons for this antagonism. Perhaps I had issues with their lack of experience or expertise, or both. My concerns about a lack of respect, despite being a faculty member, were also… — read more

A review was sought for a geriatric patient whose infarct had undergone a malignant transformation and whose family had decided to forego surgical decompression and antecedent Neuro ICU stay for a request for admission. The review proceeded in the following stages: Discussion with the Neurology resident – understanding poor prognosis and expected course of disease.… — read more

A middle-aged male with a diagnosis of compressive myelopathy, with compression at the thoracic level, ten days post-surgical excision with biopsy suggestive of small round cell tumor (lymphoma, sarcoma) on monitoring for TLS was reviewed by the palliatrist and prescribed the following – radiotherapy, dexamethasone and bisphosphonates? However this advice was found not to be… — read more

A recent systematic review by Chow et al, reported the following evidence for the efficacy of olanzapine 2.5 mg in CINV remained sparse and was informed by one study comprising primarily female patients receiving doxorubicin-cyclophosphamide. These findings suggest that olanzapine 2.5 mg may potentially preserve antiemetic efficacy while improving tolerability, but the certainty of evidence remains limited.… — read more

Managing breathlessness has always been a challenge. In fact, most of my learning and understanding of specialized palliative medicine has emerged from model questions that are expected to appear in the specialty certificate examination. I remember coming across a question on dyspnea crisis in advanced cancer and the means to address it. Reassuring the patient… — read more

Any physician who recommends limiting treatment must possess the knowledge necessary to judge what treatment can realistically achieve. A Palliatrist simply encounters this responsibility more often than most specialties. While reviewing a patient with multicentric, recurrent glioblastoma, the following issues were identified. Targeted therapy does not appreciably impact survival, however it is still expected to… — read more