End-of-Life Diseases: Part 2

Cancer: Overview

 

Cancer refers to any one of a large number of diseases characterized by the development of abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal body tissue. Cancer often has the ability to spread throughout your body.

Cancer is the second-leading cause of death in the world. But survival rates are improving for many types of cancer, thanks to improvements in cancer screening and cancer treatment.

Symptoms

Signs and symptoms caused by cancer will vary depending on what part of the body is affected.

Some general signs and symptoms associated with, but not specific to, cancer, include:

  • Fatigue

  • Lump or area of thickening that can be felt under the skin

  • Weight changes, including unintended loss or gain

  • Skin changes, such as yellowing, darkening or redness of the skin, sores that won't heal, or changes to existing moles

  • Changes in bowel or bladder habits

  • Persistent cough or trouble breathing

  • Difficulty swallowing

  • Hoarseness

  • Persistent indigestion or discomfort after eating

  • Persistent, unexplained muscle or joint pain

  • Persistent, unexplained fevers or night sweats

  • Unexplained bleeding or bruising

When to see a doctor

Make an appointment with your doctor if you have any persistent signs or symptoms that concern you.

If you don't have any signs or symptoms, but are worried about your risk of cancer, discuss your concerns with your doctor. Ask about which cancer screening tests and procedures are appropriate for you.

Causes

Cancer is caused by changes (mutations) to the DNA within cells. The DNA inside a cell is packaged into a large number of individual genes, each of which contains a set of instructions telling the cell what functions to perform, as well as how to grow and divide. Errors in the instructions can cause the cell to stop its normal function and may allow a cell to become cancerous.

What do gene mutations do?

A gene mutation can instruct a healthy cell to:

  • Allow rapid growth. A gene mutation can tell a cell to grow and divide more rapidly. This creates many new cells that all have that same mutation.

  • Fail to stop uncontrolled cell growth. Normal cells know when to stop growing so that you have just the right number of each type of cell. Cancer cells lose the controls (tumor suppressor genes) that tell them when to stop growing. A mutation in a tumor suppressor gene allows cancer cells to continue growing and accumulating.

  • Make mistakes when repairing DNA errors. DNA repair genes look for errors in a cell's DNA and make corrections. A mutation in a DNA repair gene may mean that other errors aren't corrected, leading cells to become cancerous.

These mutations are the most common ones found in cancer. But many other gene mutations can contribute to causing cancer.

What causes gene mutations?

Gene mutations can occur for several reasons, for instance:

  • Gene mutations you're born with. You may be born with a genetic mutation that you inherited from your parents. This type of mutation accounts for a small percentage of cancers.

  • Gene mutations that occur after birth. Most gene mutations occur after you're born and aren't inherited. A number of forces can cause gene mutations, such as smoking, radiation, viruses, cancer-causing chemicals (carcinogens), obesity, hormones, chronic inflammation and a lack of exercise.

Gene mutations occur frequently during normal cell growth. However, cells contain a mechanism that recognizes when a mistake occurs and repairs the mistake. Occasionally, a mistake is missed. This could cause a cell to become cancerous.

How do gene mutations interact with each other?

The gene mutations you're born with and those that you acquire throughout your life work together to cause cancer.

For instance, if you've inherited a genetic mutation that predisposes you to cancer, that doesn't mean you're certain to get cancer. Instead, you may need one or more other gene mutations to cause cancer. Your inherited gene mutation could make you more likely than other people to develop cancer when exposed to a certain cancer-causing substance.

It's not clear just how many mutations must accumulate for cancer to form. It's likely that this varies among cancer types.

Risk factors

While doctors have an idea of what may increase your risk of cancer, the majority of cancers occur in people who don't have any known risk factors. Factors known to increase your risk of cancer include:

Your age

Cancer can take decades to develop. That's why most people diagnosed with cancer are 65 or older. While it's more common in older adults, cancer isn't exclusively an adult disease — cancer can be diagnosed at any age.

Your habits

Certain lifestyle choices are known to increase your risk of cancer. Smoking, drinking more than one alcoholic drink a day (for women of all ages and men older than age 65) or two drinks a day (for men age 65 and younger), excessive exposure to the sun or frequent blistering sunburns, being obese, and having unsafe sex can contribute to cancer.

You can change these habits to lower your risk of cancer — though some habits are easier to change than others.

Your family history

Only a small portion of cancers are due to an inherited condition. If cancer is common in your family, it's possible that mutations are being passed from one generation to the next. You might be a candidate for genetic testing to see whether you have inherited mutations that might increase your risk of certain cancers. Keep in mind that having an inherited genetic mutation doesn't necessarily mean you'll get cancer.

Your health conditions

Some chronic health conditions, such as ulcerative colitis, can markedly increase your risk of developing certain cancers. Talk to your doctor about your risk.

Your environment

The environment around you may contain harmful chemicals that can increase your risk of cancer. Even if you don't smoke, you might inhale secondhand smoke if you go where people are smoking or if you live with someone who smokes. Chemicals in your home or workplace, such as asbestos and benzene, also are associated with an increased risk of cancer.

Complications

Cancer and its treatment can cause several complications, including:

  • Pain. Pain can be caused by cancer or by cancer treatment, though not all cancer is painful. Medications and other approaches can effectively treat cancer-related pain.

  • Fatigue. Fatigue in people with cancer has many causes, but it can often be managed. Fatigue associated with chemotherapy or radiation therapy treatments is common, but it's usually temporary.

  • Difficulty breathing. Cancer or cancer treatment may cause a feeling of being short of breath. Treatments may bring relief.

  • Nausea. Certain cancers and cancer treatments can cause nausea. Your doctor can sometimes predict if your treatment is likely to cause nausea. Medications and other treatments may help you prevent or decrease nausea.

  • Diarrhea or constipation. Cancer and cancer treatment can affect your bowels and cause diarrhea or constipation.

  • Weight loss. Cancer and cancer treatment may cause weight loss. Cancer steals food from normal cells and deprives them of nutrients. This is often not affected by how many calories or what kind of food is eaten; it's difficult to treat. In most cases, using artificial nutrition through tubes into the stomach or vein does not help change the weight loss.

  • Chemical changes in your body. Cancer can upset the normal chemical balance in your body and increase your risk of serious complications. Signs and symptoms of chemical imbalances might include excessive thirst, frequent urination, constipation and confusion.

  • Brain and nervous system problems. Cancer can press on nearby nerves and cause pain and loss of function of one part of your body. Cancer that involves the brain can cause headaches and stroke-like signs and symptoms, such as weakness on one side of your body.

  • Unusual immune system reactions to cancer. In some cases the body's immune system may react to the presence of cancer by attacking healthy cells. Called paraneoplastic syndrome, these very rare reactions can lead to a variety of signs and symptoms, such as difficulty walking and seizures.

  • Cancer that spreads. As cancer advances, it may spread (metastasize) to other parts of the body. Where cancer spreads depends on the type of cancer.

  • Cancer that returns. Cancer survivors have a risk of cancer recurrence. Some cancers are more likely to recur than others. Ask your doctor about what you can do to reduce your risk of cancer recurrence. Your doctor may devise a follow-up care plan for you after treatment. This plan may include periodic scans and exams in the months and years after your treatment, to look for cancer recurrence.

Prevention

There's no certain way to prevent cancer. But doctors have identified several ways of reducing your cancer risk, such as:

  • Stop smoking. If you smoke, quit. If you don't smoke, don't start. Smoking is linked to several types of cancer — not just lung cancer. Stopping now will reduce your risk of cancer in the future.

  • Avoid excessive sun exposure. Harmful ultraviolet (UV) rays from the sun can increase your risk of skin cancer. Limit your sun exposure by staying in the shade, wearing protective clothing or applying sunscreen.

  • Eat a healthy diet. Choose a diet rich in fruits and vegetables. Select whole grains and lean proteins.

  • Exercise most days of the week. Regular exercise is linked to a lower risk of cancer. Aim for at least 30 minutes of exercise most days of the week. If you haven't been exercising regularly, start out slowly and work your way up to 30 minutes or longer.

  • Maintain a healthy weight. Being overweight or obese may increase your risk of cancer. Work to achieve and maintain a healthy weight through a combination of a healthy diet and regular exercise.

  • Schedule cancer screening exams. Talk to your doctor about what types of cancer screening exams are best for you based on your risk factors.

  • Ask your doctor about immunizations. Certain viruses increase your risk of cancer. Immunizations may help prevent those viruses, including hepatitis B, which increases the risk of liver cancer, and human papillomavirus (HPV), which increases the risk of cervical cancer and other cancers. Ask your doctor whether immunization against these viruses is appropriate for you.

Diagnosis

Cancer screening

Diagnosing cancer at its earliest stages often provides the best chance for a cure. With this in mind, talk with your doctor about what types of cancer screening may be appropriate for you.

For a few cancers, studies show screening tests can save lives by diagnosing cancer early. For other cancers, screening tests are recommended only for people with increased risk.

A variety of medical organizations and patient-advocacy groups have recommendations and guidelines for cancer screening. Review the various guidelines with your doctor and together you can determine what's best for you based on your own risk factors for cancer.

Cancer diagnosis

Your doctor may use one or more approaches to diagnose cancer:

  • Physical exam. Your doctor may feel areas of your body for lumps that may indicate a tumor. During a physical exam, he or she may look for abnormalities, such as changes in skin color or enlargement of an organ, that may indicate the presence of cancer.

  • Laboratory tests. Laboratory tests, such as urine and blood tests, may help your doctor identify abnormalities that can be caused by cancer. For instance, in people with leukemia, a common blood test called complete blood count may reveal an unusual number or type of white blood cells.

  • Imaging tests. Imaging tests allow your doctor to examine your bones and internal organs in a noninvasive way. Imaging tests used in diagnosing cancer may include a computerized tomography (CT) scan, bone scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, ultrasound and X-ray, among others.

  • Biopsy. During a biopsy, your doctor collects a sample of cells for testing in the laboratory. There are several ways of collecting a sample. Which biopsy procedure is right for you depends on your type of cancer and its location. In most cases, a biopsy is the only way to definitively diagnose cancer.​

In the laboratory, doctors look at cell samples under the microscope. Normal cells look uniform, with similar sizes and orderly organization. Cancer cells look less orderly, with varying sizes and without apparent organization.

Cancer stages

Once cancer is diagnosed, your doctor will work to determine the extent (stage) of your cancer. Your doctor uses your cancer's stage to determine your treatment options and your chances for a cure.

Staging tests and procedures may include imaging tests, such as bone scans or X-rays, to see if cancer has spread to other parts of the body.

Cancer stages are generally indicated by Roman numerals — I through IV, with higher numerals indicating more advanced cancer. In some cases, cancer stage is indicated using letters or words.

Treatment

Many cancer treatments are available. Your treatment options will depend on several factors, such as the type and stage of your cancer, your general health, and your preferences. Together you and your doctor can weigh the benefits and risks of each cancer treatment to determine which is best for you.

Goals of cancer treatment:

Cancer treatments have different objectives, such as:

  • Cure. The goal of treatment is to achieve a cure for your cancer, allowing you to live a normal life span. This may or may not be possible, depending on your specific situation.

  • Primary treatment. The goal of a primary treatment is to completely remove the cancer from your body or kill the cancer cells.

Any cancer treatment can be used as a primary treatment, but the most common primary cancer treatment for the most common cancers is surgery. If your cancer is particularly sensitive to radiation therapy or chemotherapy, you may receive one of those therapies as your primary treatment.

  • Adjuvant treatment. The goal of adjuvant therapy is to kill any cancer cells that may remain after primary treatment in order to reduce the chance that the cancer will recur.

    Any cancer treatment can be used as an adjuvant therapy. Common adjuvant therapies include chemotherapy, radiation therapy and hormone therapy.

  • Palliative treatment. Palliative treatments may help relieve side effects of treatment or signs and symptoms caused by cancer itself. Surgery, radiation, chemotherapy and hormone therapy can all be used to relieve signs and symptoms. Medications may relieve symptoms such as pain and shortness of breath.

    Palliative treatment can be used at the same time as other treatments intended to cure your cancer.

Cancer treatments

Doctors have many tools when it comes to treating cancer. Cancer treatment options include:

  • Surgery. The goal of surgery is to remove the cancer or as much of the cancer as possible.

  • Chemotherapy. Chemotherapy uses drugs to kill cancer cells.

  • Radiation therapy. Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation treatment can come from a machine outside your body (external beam radiation), or it can be placed inside your body (brachytherapy).

  • Bone marrow transplant. Bone marrow transplant is also known as a stem cell transplant. Your bone marrow is the material inside your bones that makes blood cells. A bone marrow transplant can use your own cells or cells from a donor.

​​

A bone marrow transplant allows your doctor to use higher doses of chemotherapy to treat your cancer. It may also be used to replace diseased bone marrow.

  • Immunotherapy. Immunotherapy, also known as biological therapy, uses your body's immune system to fight cancer. Cancer can survive unchecked in your body because your immune system doesn't recognize it as an intruder. Immunotherapy can help your immune system "see" the cancer and attack it.

  • Hormone therapy. Some types of cancer are fueled by your body's hormones. Examples include breast cancer and prostate cancer. Removing those hormones from the body or blocking their effects may cause the cancer cells to stop growing.

  • Targeted drug therapy. Targeted drug treatment focuses on specific abnormalities within cancer cells that allow them to survive.

  • Clinical trials. Clinical trials are studies to investigate new ways of treating cancer. Thousands of cancer clinical trials are underway.

Other treatments may be available to you, depending on your type of cancer.

Alternative medicine

Alternative medicine options may help you cope with side effects of cancer and cancer treatment, such as fatigue, nausea and pain.

Talk with your doctor about what alternative medicine options may offer some benefit. He or she can also discuss whether these therapies are safe for you or whether they may interfere with your cancer treatment.

Some alternative medicine options found to be helpful for people with cancer include:

  • Acupuncture

  • Hypnosis

  • Massage

  • Meditation

  • Relaxation techniques

  • Yoga

Here are some ideas to help you cope:

  • Learn enough about cancer to make decisions about your care. Ask your doctor about your cancer, including your treatment options and, if you like, your prognosis (The expected outcome of a disease.) As you learn more about cancer, you may become more confident in making treatment decisions.

  • Keep friends and family close. Keeping your close relationships strong will help you deal with your cancer. Friends and family can provide the practical support you'll need, such as helping take care of your house if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.

  • Find someone to talk with. Find a good listener who is willing to listen to you talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

 

Your time with your doctor is limited, so preparing a list of questions can help you

make the most of your time together. List

your questions from most important to

least important in case time runs out. For cancer, some basic questions to ask your doctor include:

  • What type of cancer do I have?

  • What stage is my cancer?

  • Will I need additional tests?

  • What are my treatment options?

  • Can treatments cure my cancer?

  • If my cancer can't be cured, what can I expect from treatment?

  • What are the potential side effects of each treatment?

  • Is there one treatment you feel is best for me?

  • How soon do I need to begin treatment?

  • How will treatment affect my daily life?

  • Can I continue working during treatment?

  • Are there any clinical trials or experimental treatments available to me?

  • I have these other health conditions. How can I manage them during my cancer treatment?

  • Are there any restrictions that I need to follow?

  • Should I see a specialist? What will that cost, and will my insurance cover it?

  • Is there a generic alternative to the medicine you're prescribing?

  • Are there brochures or other printed material that I can take with me? What websites do you recommend?

  • What will determine whether I should plan for follow-up visits?

(www.mayoclinic.org)

 Images of Four Types of Cancers:

Renal (Kidney) Cancer

Everything You Need To Know About Stroke

Stroke is the fifth leading cause of death in the United States. In fact, nearly 800,000 people have a stroke each year. That equates to around one person every 40 seconds.

There are three main types of stroke:

  • Ischemic stroke: This is the most common type of stroke, making up 87% of all cases. A blood clot prevents blood and oxygen from reaching an area of the brain.

  • Hemorrhagic stroke: This occurs when a blood vessel ruptures. These are usually the result of aneurysms or arteriovenous malformations (AVMs).

  • Transient ischemic attack (TIA): This occurs when blood flow to a part of the brain is inadequate for a brief period of time. Normal blood flow resumes after a short amount of time, and the symptoms resolve without treatment. Some people call this a ministroke.

Stroke can be fatal. According to the American Heart Association (AHA), the age-adjusted mortality rate for 2017 was 37.6 in every 100,000 stroke diagnoses. Doctors have made a great deal of progress in managing strokes, meaning that this mortality rate is 13.6% lower than it was in 2007.

This article explains why strokes occur and how to treat them. It also explores the different types of stroke, as well as the steps a person can take to prevent them.

What is a Stroke?

A stroke occurs when a blockage or bleed of the blood vessels either interrupts or reduces the supply of blood to the brain. When this happens, the brain does not receive enough oxygen or nutrients, and brain cells start to die.

Stroke is a cerebrovascular disease. This means that it affects the blood vessels that feed the brain oxygen. If the brain does not receive enough oxygen, damage may start to occur.

This is a medical emergency. Although many strokes are treatable, some can lead to disability or death.

Treatment

Because ischemic and hemorrhagic strokes have different causes and effects on the body, both require different treatments.

Rapid diagnosis is important for reducing brain damage and enabling the doctor to treat the stroke using a suitable method for the type.

The sections below cover the treatment options for ischemic stroke and hemorrhagic stroke, as well as some general rehabilitation tips for both types.

Ischemic stroke

Ischemic stroke occurs due to blocked or narrowed arteries. Treatment tends to focus on restoring an adequate flow of blood to the brain.

Treatment starts with taking drugs that break down clots and prevent others from forming. A doctor may administer blood thinners such as aspirin or an injection of tissue plasminogen activator (TPA).

TPA is very effective at dissolving clots. However, the injection needs to take place within 4.5 hours of the stroke symptoms starting.

Emergency procedures include administering TPA directly into an artery in the brain or using a catheter to physically remove the clot. Research is ongoing as to the benefits of these procedures.

There are other procedures that surgeons can perform to reduce the risk of strokes or TIAs. A carotid endarterectomy, for example, involves opening the carotid artery and removing plaque that could break and travel to the brain.

Another option is angioplasty. This involves a surgeon inflating a small balloon inside a narrowed artery using a catheter. Afterward, they will insert a mesh tube, or a stent, into the opening. This prevents the artery from narrowing again.

Hemorrhagic stroke

Blood leaking into the brain can cause a hemorrhagic stroke. Treatment focuses on controlling the bleeding and reducing the pressure on the brain.

Treatment often begins with taking drugs that reduce pressure in the brain and control overall blood pressure, as well as preventing seizures and any sudden constrictions of blood vessels.

If a person is taking blood-thinning anticoagulants or antiplatelet medication, such as warfarin or clopidogrel, they can receive medications to counter the effects of the blood thinners.

Surgeons can repair some of the problems with blood vessels that have led or could lead to hemorrhagic strokes.

When an aneurysm — or a bulge in a blood vessel that may burst — causes a hemorrhagic stroke, a surgeon can place small clamps at the base of the aneurysm or fill it with detachable coils to stop the blood flow and shrink the aneurysm.If the hemorrhage occurs due to an AVM, a surgeon can remove it. AVMs are connections between arteries and veins that can be at risk of bleeding.

Stroke occurs due to a decrease or blockage in the brain’s blood supply. A person experiencing a stroke needs immediate emergency treatment.

Rehabilitation

Stroke is a potentially life changing event that can have lasting physical and emotional effects.

Successful recovery from a stroke will often involve specific therapies and support systems, including:

  • Speech therapy: This helps with problems producing or understanding speech. Practice, relaxation, and changing communication style can all make communicating easier.

  • Physical therapy: This can help a person relearn movement and coordination. It is important to stay active, even though this may be difficult at first.

  • Occupational therapy: This can help a person improve their ability to carry out daily activities, such as bathing, cooking, dressing, eating, reading, and writing.

  • Support groups: Joining a support group can help a person cope with common mental health issues that can occur after a stroke, such as depression. Many find it useful to share common experiences and exchange information.

  • Support from friends and family: Close friends and relatives should try to offer practical support and comfort after a stroke. Letting friends and family know what they can do to help is very important.

Rehabilitation is an important and ongoing part of stroke treatment. With the right assistance and the support of loved ones, regaining a normal quality of life is usually possible, depending on the severity of the stroke.

Know the Signs of a Stroke: Think "F A S T"

F = Usually one side of the Face will droop

 A = Arm will become weak

 S = Speech may become slurred & difficult

 T = Time is of the essence! Quickly Call 911 (or Emergency Services in your country). 

End-Stage Kidney Disease

Kidney failure, also called end-stage renal disease (ESRD), is the last stage of chronic kidney disease. When your kidneys fail, it means they have stopped working well enough for you to survive without dialysis or a kidney transplant.

What causes kidney failure?

In most cases, kidney failure is caused by other health problems that have done permanent damage to your kidneys little by little, over time.

When your kidneys are damaged, they may not work as well as they should. If the damage to your kidneys continues to get worse and your kidneys are less and less able to do their job, you have chronic kidney disease. Kidney failure is the last (most severe) stage of chronic kidney disease. This is why kidney failure is also called end-stage renal disease, or ESRD for short.

Diabetes is the most common cause of ESRD. High blood pressure is the second most common cause of ESRD. Other problems that can cause kidney failure include:

  • Autoimmune diseases, such as lupus and IgA nephropathy

  • Genetic diseases (diseases you are born with), such as polycystic kidney disease

  • Nephrotic syndrome

  • Urinary tract problems

 

Sometimes the kidneys can stop working very suddenly (within two days). This type of kidney failure is called acute kidney injury or acute renal failure. Common causes of acute renal failure include:

  • Heart attack

  • Illegal drug use and drug abuse

  • Not enough blood flowing to the kidneys

  • Urinary tract problems

This type of kidney failure is not always permanent. Your kidneys may go back to normal or almost normal with treatment and if you do not have other serious health problems.

Having one of the health problems that can lead to kidney failure does not mean that you will definitely have kidney failure. Living a healthy lifestyle and working with your doctor to control these health problems can help your kidneys work for as long as possible.

What are the symptoms of kidney failure?

You may notice one or more of the following symptoms if your kidneys are beginning to fail:

  • Itching

  • Muscle cramps

  • Nausea and vomiting

  • Not feeling hungry

  • Swelling in your feet and ankles

  • Too much urine or not enough urine

  • Trouble catching your breath

  • Trouble sleeping

If your kidneys stop working suddenly (acute kidney failure), you may notice one or more of the following symptoms:

  • Abdominal (belly) pain

  • Back pain

  • Diarrhea

  • Fever

  • Nosebleeds

  • Rash

  • Vomiting

Having one or more of any of the symptoms above may be a sign of serious kidney problems. If you notice any of these symptoms, you should contact your doctor right away.

What are the treatment options for

kidney failure?

If you have kidney failure (end-stage renal disease or ESRD), you will need dialysis or a kidney transplant to live. There is no cure for ESRD, but many people live long lives while on dialysis or after having a kidney transplant.

There are just a few options for treating kidney failure, including kidney transplant and several types of dialysis. Your doctor can help you figure out which treatment is best for you.

What are the complications of

kidney failure?

Your kidneys do many jobs to keep you healthy. Cleaning your blood is only one of their jobs. They also control chemicals and fluids in your body, help control your blood pressure and help make red blood cells. Dialysis can do only some, not all, of the jobs that healthy kidneys do. Therefore, even when you are being treated for kidney failure, you may have some problems that come from having kidneys that don’t work well.

(www.kidneyfund.org)

Polycystic Kidney Disease (also known as polycystic kidney syndrome) is a 

genetic disorder in which the renal tubules become structurally abnormal, resulting in the development and growth of multiple cysts within the kidney.

End-Stage COPD

End-stage chronic obstructive pulmonary disease (COPD) refers to being in the final stages of the disease. At this stage, you can expect to experience significant shortness of breath even when resting. Because of the degree of lung damage at this stage, you are at high risk for lung infections and respiratory failure.

There are two types of COPD: 

Type A = COPD stems from Chronic Emphysema

Type B = COPD stems from Chronic Bronchitis

You might associate the term "end-stage" with imminent death or grave disability that's leading up to death. Certainly, there is a higher risk of death at this stage, but you can survive for years with advanced COPD. 

Symptoms

With advanced COPD, you can have symptoms all the time or almost all the time. And the effects of your disease at the end-stage will be so advanced that they will undeniably affect your day to day activities.

Symptoms you can experience with end-stage COPD include:

  • Chronic cough and phlegm production

  • Wheezing

  • Severe shortness of breath even when at rest

  • Difficulty eating

  • Difficulty communicating due to shortness of breath

  • Limited ability to get around

  • Confusion or dizziness

  • Fatigue

  • Difficulty sleeping

You are likely to have low oxygen saturation levels and you will probably be prescribed supplemental oxygen. If you take a break from your oxygen supplementation, you may notice your symptoms worsening.

Complications

You can develop complications of lung disease such as pneumonia, heart failure, and lower extremity edema (swelling of your legs). With end-stage COPD, you are likely to have limitations in your activity levels—which leads to a risk of blood clots, obesity, and pressure sores.

Diagnosis

By definition, "end-stage" refers to the last phase in the course of a progressive disease. There are criteria that help define this stage.

According to the Global Initiative for Obstructive Lung Disease (GOLD), there are four stages of COPD:

  • Stage I: Mild COPD. Lung function is starting to decline but you may not notice it.

  • Stage II: Moderate COPD Symptoms progress, with shortness of breath developing upon exertion.

  • Stage III: Severe COPD. Shortness of breath becomes worse and COPD exacerbations are common.

  • Stage IV: Very severe COPD. Quality of life is gravely impaired. COPD exacerbation can be life-threatening.

Each stage is defined according to the spirometry measurement of FEV1 (the volume of air breathed out in the first second after a forced exhalation). End-stage COPD is considered stage IV, or very severe COPD with an FEV1 of less than or equal to 30%.3

A number of factors influence COPD life expectancy, including your smoking history, your level of dyspnea (shortness of breath), fitness level, and nutritional status. Some people in stage IV are still able to function reasonably well with few limitations. On the other hand, there are also many people at this stage who are very sick.

Treatment

You may be worried that your doctors have done all they can do for you by the time you have been diagnosed with end-stage COPD. But there are still usually aspects of your health that can be managed to help make you feel more comfortable and to avoid complications of your pulmonary condition.

As the severity of your disease advances, the focus of your treatment may begin to shift to palliative care to relieve a patient's COPD symptoms.

With that, if you're facing a diagnosis of end-stage COPD, your doctor may prescribe the following treatments:

  • Bronchodilators: Both short-acting and long-acting bronchodilators are recommended if shortness of breath during regular activity is not relieved by short-acting bronchodilators alone.

  • Opiates: Morphine, in particular, may significantly improve shortness of breath. However, some studies show that it may have serious side effects and that it might not benefit everyone.

  • Inhaled glucocorticoids: These may be prescribed if you have an FEV1 less than 50 percent of the predicted value and a history of repeated COPD exacerbations.

  • Supplemental oxygen: Oxygen reduces breathlessness caused by activity and at rest.

  • Noninvasive positive pressure ventilation (NIPPV): Noninvasive ventilation may lessen carbon dioxide retention and improve shortness of breath, but it's not routinely recommended.

  • Pulmonary rehabilitation: This has been proven to benefit at all stages of the disease.

  • Nutritional counseling: This may be suggested because malnutrition is a common complication in end-stage COPD and increases the risk of death.

  • Complementary therapies: Relaxation and visualization techniques, therapeutic massage, and music therapy with live instruments, or CD can help soothe symptoms like shortness of breath.

Coping

Living with end-stage COPD can make you feel scared and isolated. Getting psychological and social support are important aspects of coping with the condition.

Even when you have already developed very advanced COPD, there are several lifestyle changes that you can incorporate to have the best outcome possible:

  • Quit smoking: Smoking cessation is vital because smoking continues to cause lung changes at the late stages of COPD.5

  • Exercise: Besides that, if you're going to make one lifestyle change after a diagnosis of COPD that will have the greatest impact on your life, consider a daily exercise program. Even just light walking (with your oxygen supply) several times per week can be beneficial for preventing complications and elevating your mood.

  • Eat healthfully: Good nutrition is essential because COPD causes your body to consume a lot of calories and can lead to malnutrition. Maintaining your nutrition will give you the energy you need to breathe and fight infection.​

  • Stay positive: Staying positive in the midst of a chronic illness diagnosis can be difficult, but can have a tremendous impact. It's all about developing some new coping mechanisms that will fit into your lifestyle.

End-of-Life Issues

If your doctors have discussed the chance that death is approaching due to your COPD, it's time to consider how you will manage end-of-life issues. Whether you or your loved one is taking charge of the decisions at this point, deciding how you will seek help during the end-of-life stage can make the process a bit easier for everyone involved. For example, you and your family may want to consider enlisting the help of hospice to guide you through this time.

When you have been diagnosed with late-stage COPD, be sure also to talk to your healthcare team and loved ones about your values and beliefs to help ensure that any end-of-life care is consistent with your wishes. For resources to help with planning end-of-life care, visit the National Healthcare Decisions Day website.

Advanced directives are documents that allow you to explain your wishes regarding end-of-life care so that your loved ones will know what you want when it comes to issues like resuscitation, feeding tubes, and ventilator support if you are unable to express your wishes at a later time.

Symptom management is one of the most important aspects of end-of-life care because COPD symptoms often worsen in the final days—most notably, dyspnea and cough, pain, anxiety and depression, confusion, anorexia, and cachexia.

As a caregiver, remember that simple gestures like holding your loved one's hand and being present can provide immense comfort for one who is struggling with End-Stage COPD. 

(www.verywellhealth.com)

Parkinson's Disease

Stages of Parkinson's

 

Parkinson’s disease (PD) impacts people in different ways. Not everyone will experience all the symptoms of Parkinson’s, and if they do, they won’t necessarily experience them in quite the same order or at the same intensity. There are typical patterns of progression in Parkinson’s disease that are defined in stages.

Stage One

During this initial stage, the person has mild symptoms that generally do not interfere with daily activities. Tremor and other movement symptoms occur on one side of the body only. Changes in posture, walking and facial expressions occur.

Stage Two

Symptoms start getting worse. Tremor, rigidity and other movement symptoms affect both sides of the body. Walking problems and poor posture may be apparent. The person is still able to live alone, but daily tasks are more difficult and lengthy.

Stage Three

Considered mid-stage, loss of balance and slowness of movements are hallmarks. Falls are more common. The person is still fully independent, but symptoms significantly impair activities such as dressing and eating.

Stage Four

At this point, symptoms are severe and limiting. It’s possible to stand without assistance, but movement may require a walker. The person needs help with activities of daily living and is unable to live alone.

Stage Five

This is the most advanced and debilitating stage. Stiffness in the legs may make it impossible to stand or walk. The person requires a wheelchair or is bedridden. Around-the-clock nursing care is required for all activities. The person may experience hallucinations and delusions. The Parkinson’s community acknowledges that there are many important non-motor symptoms as well as motor symptoms.

Rating Scales

Your doctor may refer to a scale to help them understand the progression of the disease. Parkinson's stages correspond both to the severity of movement symptoms and to how much the disease affects a person’s daily activities. The most commonly used rating scales focus on motor symptoms.

 

They are the:

  • Hoehn and Yahr stages follow a simple rating scale, first introduced in 1967. Clinicians use it to describe how motor symptoms progress in PD.

Rates symptoms on a scale of 1 to 5. On this scale, 1 and 2 represent early-stage, 2 and 3 mid-stage, and 4 and 5 advanced-stage Parkinson's.

  • The Unified Parkinson’s Disease Rating Scale (UPDRS) is a more comprehensive tool used to account for non-motor symptoms, including mental functioning, mood and social interaction.

  • Accounts for cognitive difficulties, ability to carry out daily activities and treatment complications.

New scales include information on non-motor symptoms (such as sense of smell).

While symptoms and disease progression are unique to each person, knowing the typical stages of Parkinson’s can help you cope with changes as they occur. Some people experience the changes over 20 years or more. Others find the disease progresses more quickly.

Theory of PD Progression:

Braak’s Hypothesis

The current theory (part of the so-called Braak's hypothesis) is that the earliest signs of Parkinson's are found in the enteric nervous system, the medulla and the olfactory bulb, which controls sense of smell. Under this theory, Parkinson's only progresses to the substantia nigra and cortex over time.

This theory is increasingly borne out by evidence that non-motor symptoms, such as a loss of sense of smell (hyposmia), sleep disorders and constipation may precede the motor features of the disease by several years. For this reason, researchers are increasingly focused on these non-motor symptoms to detect PD as early as possible and to look for ways to stop its progression.

Page reviewed by Dr. Ryan Barmore, Movement Disorders Fellow at the University of Florida, a Parkinson’s Foundation Center of Excellence.

Brain Scan of Patient with PD

Signs & Symptoms of

Parkinson's Disease

(in Chart Above)

Copyright © 2020 Vaishnavas C. A. R. E.  All Rights Reserved.

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