Gigi Ghirotti

I’ve got to get out of this place

Palliative Cure

Il dolore nei pazienti oncologici

However, when the pain occurs as a traveling companion along the road that leads to death, it is exacerbated by the state of psychological fragility and involves all dimensions of the person, not only the somatic. The pain in these conditions is defined as “total pain” and it is clear that can not be dealt with drug therapy alone.
It requires a multidimensional approach that takes into account the psychological, spiritual and social, which must be carefully considered and addressed at the same time to the care of physical pain

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Three Men in a Boat (To Say Nothing of the Dog)

Forget it.

Three Badante in a boat (With me as the dog).

Badante:  A person who looks after old or infirm people.
The story of Zoya,Galina and Svetlina
Zoya
ruby-2301[1]An attractive ucranian woman about 50 odd , contacted via telephone to stay with  my wife in hospital during the night. Met her the day after,asked about the night passed with my wife ,her how did it go ?, how was my wife,did she sleep ecc……..On the fourth day (I dunno know what god did on the 4° day , but will investigate) she came to our house, just me alone.
Conversation “What is a good looking young man like you doing with a woman like that, she’s old, get yourself a younger woman,shave off that beard which makes you look older and start living” and she offered services. Very attractive.
In Italy or at least in Genoa we call them “Troie” in English”bitches” and “‘ho’s
Bye Bye Zoya

Galina

peasant_woman[1]My wife was discharged from hospital ,contacted via telephone another ucranian woman, hefty build  peasant type about 55 odd  to stay at our house 24/7 live in, cook,clean,meals and look after my now bedridden wife. She could cook and clean the house Ok, wash,iron,dust, polish,but had very little experience of the handling of an infirm person, after 4 days (again the 4° day) her trial period ended and she left to be replaced by yet another badante.
Bye Bye Galina

Svetlana

Zhukova[1]Third time lucky ?
Contacted via telephone yet another ucranian woman (my Italian badante dealer Neirina had only Ucranians,Russians,or Bulgarian women). I explained that  I needed a person who loked after the personal care of my wife, not interested in much housework. She told me that the person had some hospital care experience, and she had. Again 24/7. But…… There is always the but, the situation in Ucraine was  preoccupying, mother not well, sister unemployed,daughter unhappily marrried. She was very pro russian, the good old days of the USSR, Putin a great guy ecc….. Found BBC russian on the internet for her to watch ecc…….. Again on the 4° day (again), she was worn out and nervous and tired and myself more ever so,we agreed to change from 24/7 to only the night turn 20.00 to 08.00 in the morning with a newly graduaded young female nurse during the daytime (still here after about 7/8 days and my wife says she gives her good vibes, even if she is a bit of a brain basher after a while). The situation ended up that the  badante was walking me up at 4 or 5 o’clock in the morning cos’ my wife was getting anxious, the badante anxious, so it ended up John,john………………….. and no sleep

Bye Bye Svetlana

Hello Monica
$T2eC16hHJHIE9nysfrP7BRE9kt7WF!~~60_35[1]The other day I telefoned a Nurses Cooperative (ABA Studio Infermieristico Associato here in Genoa) and a professional nurse named Monica came (a little lightly built woman about 7stone from Ecuador), so delicate and caring. The first thing she did after changing into her white nurses uniform was to clean my wifes mouth with love and care using a special cloth, then got my wife to rinse her mouth.
Angels exist. I woke up the same at about 5 o’clock, then back to bed, everything under control.

What god did on the fourth day ?
On the fourth day, God created the sun, moon and stars.
Good man yerself

Plus many thanks to all the professional help and care from all the people involved in Gigi Ghirotti
Sito dell’Associazione Gigi Ghirotti O.N.L.U.S. di Genova

ABA Studio Infermieristico Associato
https://www.facebook.com/pages/ABA-Studio-Infermieristico-Associato/449957615075970

Pallative Care

As my wife said/says to me The people who  make cigarette tabacco are all liars, they say “Smoke Kills”, but you’re still alive” ?????????????????????????????????????????????????????????????????????????????????????

Associazione Gigi Ghirotti

associazione-gigi-ghirotti[1]

Gigi Ghirotti

I myself am not suffering from a terminal illness or in need of end of life care (at this very minute)  but a person very close to me is (my wife):

People from the Associazione Gigi Ghirotti (and a 1000…. thanks to them) are helping the patient, myself,  my family and friends
92_big_LogoFondazioneGhirotti[1]vivere-fino-alla-fine-libro[1]

 

Palliative care

What is it ?

Palliative care, which is defined as ‘the active total care of patients whose disease is not responsive to curative treatment’ traditionally  associated with the care of cancer patients.

Emphasis should be placed on improving quality of life for the patient and relieving troubling symptoms rather than prolonging life. Good palliative prescribing is important but drugs are rarely the total answer for the relief of pain and other symptoms. Always consider the psychological, social and spiritual needs of the person. The use of nondrug measures is as important as medication in relieving suffering.

29052013_093541sfondo_sollievo[1]

General principles

Try to follow a systematic approach to symptom control in palliative care:

  • Individualised treatment: the patient should determine treatment priorities. Set realistic goals of treatment together. Take precise drug histories – what is being taken currently, what has been tried before, problems with medication and concerns affecting concordance.
  • Supervision: regular monitoring of symptom control is important in order to ensure that the treatment goals are being achieved and to avoid unacceptable side-effects.

Other important palliative care prescribing issues:

  • Written advice – reinforce spoken instructions – a chart is usually helpful for the patient and family to work from, with timing, names of drugs and dose (as quantity of liquid, number of tablets, etc.) and purpose outlined.
  • Continuity of care – communication is essential between all prescribers (GP, out-of-hours service, palliative care specialists), nursing teams and pharmacists so all are aware of changes and so that the patient and family are not confused by any alterations to medication made. Availability of equipment and drugs needs to be assured, particularly out-of-hours, and changes in prescriptions should be anticipated to avoid delays in obtaining vital medication.
  • Progressive disease – will alter how drugs are handled. In particular, worsening renal failure will lead to an accumulation of morphine-6-glucuronide (active metabolite of morphine). Signs of morphine toxicity may develop (increasing drowsiness, myoclonic jerksdelirium) and the morphine dose should be reduced down or the dose interval increased. Severe hepatic insufficiency will affect the metabolism of morphine and similarly may necessitate a dose reduction.[3]
  • Individual differences – some patients may require very high doses of morphine compared with others – this may reflect age (older patients tend to require less), use of adjuvant drugs and nondrug measures, pharmacokinetic differences (absorption, hepatic and renal function), pain tolerance threshold, previous use of strong opioids, duration of treatment and adequacy of management of other symptoms.

Care of patients in the dying phase

Diagnosis of dying

One of the biggest barriers to good care of the dying is healthcare professionals’ reluctance to diagnose dying. Recognising the key signs and symptoms is an important clinical skill. In cancer patients, usually death is preceded by a gradual deterioration in functional status:

  • The patient becomes bed bound.
  • The patient is semicomatose.
  • The patient is able to manage sips of fluid only.
  • The patient can no longer manage oral drugs.

The predictability of the dying phase is not as clear in some other chronic incurable diseases. Where a patient is recognised by his healthcare team to be in the dying phase (within days or hours of death), this can be communicated to the patient, if appropriate, and to the relatives. Appropriate care goals and prescribing can also be put into place to facilitate a ‘good death’.

Prescribing when providing end of life care

  • Review current medication – stop all non-essentials. Also, stop any inappropriate monitoring (such as blood tests and vital signs).
  • Conversion to continuous subcutaneous infusion (CCSI) – see also separate article Syringe drivers. Essential drugs, eg opioids, anxiolytics, and antiemetics, should be converted to the SC route via a syringe driver in most instances. It is slightly more complicated where a patient has previously been using opioid transdermal patches (see below). The use of a ‘just in case’ box has been instituted in some areas, enabling these drugs to be prescribed in advance and stored at home until needed, once the dying trajectory has been recognised.
    • Restlessness and confusion:
      • Haloperidol (little sedative effect).
      • Levomepromazine.
      • Midazolam (useful where a patient is restless or fitting).
  • ìAs required medication should be prescribed and available, including:
    • Analgesics: eg diamorphine/morphine (as required dose will depend on regular dose).
    • Antiemetics: eg metoclopramide or levomepromazine.
    • Sedative: eg midazolam.
    • Antisecretory drug: eg hyoscine butylbromide.
    • Delirium: haloperidol.
  • Anticipatory prescribing should ensure that there is no delay in responding to a symptom if it occurs. All patients starting the Care Pathway for the last days of life at home should have diamorphine (or alternative), cyclizine, midazolam and hyoscine available in the home, with sufficient for use over a weekend (plus bank holidays). Do not omit water for injection.[10]
  • Patient comfort – consider, for example, the need for mouth care and urinary catheterisation or pads where the patient is incontinent.
  • Monitoring – regular checks should be made to ensure good symptom control is maintained and to assess response to any changes in medication. Also important is regular monitoring of syringe drivers to check for precipitation, discoloration and to ensure the driver is running at the correct rate. If there is evidence of an injection site reaction, if the infusion is running too slowly or if there is pain or obvious inflammation, the injection site should be changed.

Pain control

See  Pain control in palliative care.

Nausea and vomiting

See  Nausea and vomiting in palliative care.

Restlessness

Consider:

  • Pain/discomfort – the patient may not be able to communicate the source. Treat any reversible causes, eg catheterisation for urinary retention, bowel care for constipation, hyoscine to dry up excess secretions in the throat.
  • Opiate toxicity – the dose of morphine may need to be reduced as the patient’s renal function deteriorates.
  • Biochemical abnormalities such as hypercalcaemia and uraemia may cause restlessness but, in the end of life phase, it is not usually appropriate to check for them. They may be associated with delirium.
  • Psychological or spiritual distress.

Management options:

  • Haloperidol – less sedating.
  • Midazolam – sedating.
  • Levomepromazine – highly sedating; use in place of haloperidol if the patient remains agitated despite haloperidol and midazolam.

Dyspnoea

See  Dyspnoea in palliative care.

  • Usually multifactorial, as anxiety is almost always associated.
  • General measures – reassurance and explanation, upright positioning, good ventilation (fan, open window), chest physiotherapy and relaxation exercises.
  • Drug measures – nebulised saline, oral or SC morphine (start with oral morphine or equivalent), benzodiazepines (eg diazepam), oxygen (variable effect).

Palliative sedation and the doctrine of double effect

Prescribing for patients at the end of life is often full of ethical anxiety for the prescriber, particularly in situations where a person at the end of life faces refractory symptoms. Palliative sedation is the poorly defined practice of continuous deep sedation used in patients at the end of life where normal medical treatment is failing to relieve severe symptoms of pain or agitation, and the ultimate option is to sedate beyond perception of these symptoms.

Doctors are duty-bound to relieve suffering but not to cause the patient’s death. The use of medication to end someone’s life constitutes euthanasia and is currently illegal in the UK. However, the doctrine of double effect is widely accepted and refers to the use of higher doses of opioids and sedatives to relieve end of life suffering without the intention of causing the patient’s death, even though the risk of hastening death is foreseen. In reality, evidence suggests that palliative sedation in the last hours of life is not associated with shortened survival overall so that the doctrine of double effect need not routinely be invoked to excuse this aspect of end of life care.[14]

Info from http://www.patient.co.uk/doctor/Prescribing-in-Terminal-Care.htm

Vedi questo pagina : http://scienzareligione.blogspot.it/2013/11/11-novembresmartino-giornata-nazionale.html

Non-piu-soli-nel-dolore[1]

 

L’HOSPICE “GIGI GHIROTTI”

La parola e l’origine

Hospice è un termine inglese che oggi ha un preciso ed unico significato: luogo di accoglienza e ricovero per malati verso il termine della vita, soprattutto malati di cancro.
La parola non si può tradurre, senza snaturarne il significato peculiare; è accettata ormai universalmente nella sua forma originaria.
L’origine risale al Medio Evo quando “case di ospitalità furono costruite ai margini delle strade, lungo i percorsi dei grandi pellegrinaggi religiosi”. Il pellegrino vi trovava accoglienza, ristoro e riposo, per poi riprendere il suo viaggio. Per similitudine l’Hospice dei nostri giorni è il luogo di accoglienza di chi stà affrontando l’ultimo e più impegnativo viaggio della vita di questo mondo per altri ignoti destini. Un luogo ove trovare la massima attenzione non solo alle cure del corpo ma anche a quelle delle spirito.

La sua attualità

Nella medicina dei nostri giorni l’Ospedale ha assunto sempre più la funzione di cura della malattia, acquisendo ed applicando tecnologie sempre più complesse per giungere alla guarigione. Parallelamente al suo interno si sono sempre ristrette le cure palliative o di conforto, proprie per chi non ha più possibilità di guarire.
E’ indubbio che le cure di conforto abbiano le loro migliori possibilità se svolte all’interno dell’ambiente familiare.
La nostra Associazione è nata proprio per questo scopo: assistere a casa i malati di tumore nelle fasi avanzate della malattia. Nella Provincia di Genova, da diversi anni ormai, questa assistenza è prestata a circa 1000 malati ogni anno.
Vi sono però situazioni che impongono il ricovero, temporaneo o definitivo. Sono situazioni cliniche inerenti particolari emergenze della malattia; sovente sono motivi familiari, di ordine psicologico o sociale, per l’insostenibilità del peso assistenziale a casa. In queste situazioni il ricovero ospedaliero spezza la continuità assistenziale impostata sui cardini delle cure palliative e provoca un trauma, generalmente insanabile, per il malato ed i suoi familiari.
L’Hospice costituisce quindi una importante integrazione alla rete dell’assistenza domiciliare condotta dall’ Associazione Gigi Ghirotti nella nostra città. Una prima istituzione Hospice è stata realizzata nell’ex Ospedale Pastorino di Bolzaneto ristrutturata in residenza sanitaria assistenziale (RSA). Al suo interno un piano è stato destinato per i malati oncologici in fase avanzata per un totale di 10 posti letto. La A.S.L. 3 “Genovese” ne ha affidato la gestione alla nostra associazione.

I contenuti

Sono quelli propri delle cure palliative che l’èquipe dell’Associazione attua da anni. La terapia del dolore e la cura dei sintomi; il sostegno psicologico, sia al malato che ai suoi familiari; la considerazione dei problemi spirituali e l’apertura di spazi per la loro espressione.
L’èquipe delle cure palliative comprende volontari, non appartenenti ad aree sanitarie, che hanno lo scopo precipuo dell’ascolto, per cogliere ogni aspettativa, desiderio, speranza del malato. Il compito dell’èquipe nel suo insieme è quello di elaborare le risposte possibili.
L’Hospice e le cure palliative che vi si praticano non uccidono la speranza. La speranza non muore allorchè il malato intuisce di non poter guarire. La speranza è multiforme; è speranza sapere che si può sempre riporre fiducia in qualcuno e qualcosa, che si potrà ottenere sempre il controllo del dolore, che non si faranno cose contrarie alla propria volontà, che si potranno soddisfare ancora desideri ed aspettative, al di là dell’ impossibile guarigione.
Hospice e speranza non sono dunque antitetici perchè è proprio nell’Hospice che si dà la massima attenzione ai problemi psicologici e spirituali, fonti delle attese alle quali dare possibili risposte.
L’Hospice deve essere ancora il centro di riferimento e integrazione per la più vasta attività svolta a livello domiciliare. Un centro culturale per l’insegnamento delle cure palliative e per la discussione dei problemi etici emergenti che le caratterizzano, primi fra tutti quelli sulla comunicazione e sulla verità al malato, sulla condivisione delle scelte terapeutiche, sull’eutanasia.







Helping People Who Need Help

Associazione Gigi Ghirotti

The sad realities or beginning a new journey

In all the sadness of my day today, I have found wonderful people.

Someone in the family has terminal cancer.

The hospital more or less kicks them out, and the family decides better out of here,  get he patient home suffer with the patient.

Wonderful people  still exist

A psychosocial cancer phone center staffed by professional psychologists as an integral part of the standard process of care: Its utility during the course of illness.

The Good Shepherd

Find a caring Doctor. I found one tonight.

Dott. Molinello a mountain of a man

From http://www.panchitosway.com/eng-projects-gigi-ghiroti

The Gigi Ghirotti is a voluntary-based association whose aim is to alleviate the pain of cancer patients. It operates either at the patient’s home or in a Hospice, a structure that welcomes those patients who do not have access to care because they are alone or because the family members cannot bear the weight of the assistance. Associazione Gigi Ghirotti is a not-for-profit organization (“Onlus” in Italian) whose relentless dedication has raised the awareness on the issue of terminally ill patients’ pain amongst all those in the field of healthcare and social-health assistance.

The key pillar of this organization is the belief and desire to provide care even when healing is no longer possible. This motivation underlines the importance of the issue of suffering in gravely ill patients, both as to the physical aspects of the treatment, as well as to the emotional, psychological and social aspects.

WHY WE SUPPORT THE ASSOCIAZIONE GIGI GHIROTTI

During the last phase of his journey, clearly the most painful and challenging one in so many ways, Pancho received invaluable support from the Associazione Gigi Ghirotti in general and specifically from those individuals who have helped him by coming daily to Pancho’s dwelling. Through the use of palliative care, not only in its scientific dimension, but also focused on the human dimension, Gigi Ghirotti has accompanied Pancho and his family through a difficult but inevitable journey. The patient’s experience has profound implications also on those family and friends who are close to him.

Associazione Gigi Ghirotti is well aware of these themes, and this is why it pairs healthcare professionals with trained specialists capable of providing emotional and spiritual support.

This has been the experience of so many already helped by Gigi Ghirotti as it has been for Pancho, for his family and for those who were closet o him. Pancho and all of us have benefited from the organization’s help and courage in fighting for the patient until the very last moment, demonstrating with courage the belief in the value of life.

HOW WE HELP

Panchito’s Way will devolve the funds raised though its initiatives to the financing of specific projects of the Associazione Gigi Ghirotti of Genova, with whom it maintains a very close and trusting relationship.

Gigi Ghirotti will decide the prioritization of its projects as the case may be, depending on the importance and urgency of its evolving needs. These initiatives may include training courses for its volunteers, investment in healthcare equipment, or the construction of additional or complementary capacity as well as the ongoing maintenance thereof.

Our first objective is to contribute to the construction of the new Hospice Albaro of Genova (Via Montallegro 42). This hospice will welcome and provide care for terminally ill patients, mainly cancer patients, but also those affected by Amyotrophic Lateral Sclerosis (ALS) (wikipedia link: http://en.wikipedia.org/wiki/Amyotrophic_lateral_sclerosis), a new field for Gigi Ghirotti and one that represents a growing need in society.

Re-construction and refurbishment works are already underway on a building that will house 13 beds for cancer patients plus a yet –to-be defined number of SLA patients.

Furthermore, there is the possibility of expanding into an adjacent 120 square meter facility which would be dedicated to day-care and other clinical and support activities for the Hospice’s patients. The goal is to provide an integrated support center for the patient in one centralized facility, avoiding the need to move around different hospitals in search of the relevant doctor or facility as the needs of these patients are multiple and in constant evolution.
For further information follow the link http// www.gigighirotti.it