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Treating

Incurable Disease

Palliative Homeopathy

No conflict of interest statement

Dr. Ian Luepker has no financial conflict of

interest in presenting the following

information. There are no off-

label/experimental drugs or devices

referenced in this talk. This presentation is

for educational purposes only and is

motivated by his wish that people live

happy, meaningful, and purposeful lives up

to the end of life!

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Dedicated to my Grandmother Louise(1919-2009)

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End of Life as a stage of

human development“For age is opportunity

no less than youth itself,

though in another dress.

And, as the evening

twilight fades away the

sky is filled by stars

invisible by day.”

-Henry Wadsworth Longfellow

Organon

• The physician’s highest calling, his only calling,

is to make the sick healthy—to cure, as it is

termed.

~Aphorism 1

• The highest ideal of cure is the rapid, gentle

and permanent restoration of health; that is,

the lifting and annihilation of the disease in its

entire extent in the shortest, most reliable, and

least disadvantageous way, according to

clearly realizable principles.

~Aphorism 2

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Acute disease

A disease characterized by a relatively

sudden onset of symptoms that are usually

severe. An episode of acute disease results

in recovery to a state comparable to the patient’s condition of health and activity before the disease, in passage into a chronic phase, or in death. Examples are

pneumonia and appendicitis.

From Mosby’s medical dictionary

Leading causes of death in the

18th century was infectious

disease• Tuberculosis (TB) and Pneumonia #1

• Diarrhea (Typhoid and Cholera) #2

• Scarlet Fever (streptococci)

• Scrofula

• Smallpox

• Syphilis

• Typhus Fever

• Whooping Cough (Pertussis)

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Leading Causes of Death 1900 and 1950

1900

• 1. Pneumonia and Influenza

• 2. Tuberculosis

• 3. Diarrhea and enteritis

• 4. Heart Diseases

• 5. Strokes

• 6. Nephritis

• 7 Accidents

• 8. Cancer

• 9. Senility

• 10. Diphtheria• Source: www.cdc.gov/nchs/data/dvs/lead1900_98.pdf

1950

• 1. Heart Disease

• 2. Cancer

• 3. Strokes

• 4. Accidents

• 5. Early infancy death

• 6. Influenza and Pneumonia

• 7. Tuberculosis

• 8. Arteriosclerosis

• 9. Nephritis

• 10. Diabetes Mellitus

Chronic disease

A disease that persists over a long

period. The symptoms of chronic

disease are sometimes less severe

than those of the acute phase of the

same disease. Chronic disease may be progressive, result in complete or

partial disability, or even lead to death.

From Mosby’s medical dictionary

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How we die: 2016www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

2016

1.Heart disease (633,842)

2.Cancer (595,930)

3.Chronic lower respiratory diseases

(155,041)

4.Accidents (146,571)

5.Strokes (140,323)

6.Alzheimer’s disease (110,561)

7.Diabetes (79,535)

8.Influenza and Pneumonia (57,062)

9.Nephritis, Nephrotic syndrome,

and nephrosis (49,959)

10.Suicide (44,193)

The Chronic Diseases: Their Peculiar Nature and Their Homeopathic Cure ( Hering’s preface to the 1845 American

edition)

• Originally written in 5 parts

(volumes) between 1826

and 1837.

• The Organon and The Chronic Diseases can be

seen as companion volumes

that offer a complete view of

the homeopathic healing art.

• The Organon focuses on

the law of similars with an

emphasis on the maxim: if

the symptoms are removed – the cause is removed.

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The Chronic Diseases: Their Peculiar Nature and Their Homeopathic Cure ( Hering’s preface to the 1845 American

edition)

By contrast, The Chronic Diseases emphasizes the use of anti-miasmatic remedies and the maxim: If the cause ceases – the effects cease.

The Organon emphasizes signs and symptoms while in The Chronic Diseases, Hahnemann emphasizes the etiological constellation and causation of disease.

5th edition of Organon, 1833: Hahnemann changes his view on causation and the process of pathology

• “Useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, as also the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm. In these investigations, the ascertainable physical constitution of the patient (especially when the disease is chronic), his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function, etc., are to be taken into consideration. Aphorism 5 (Organon 5th edition, 1833)

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“Silver Tsunami”

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Incurable disease

• A 67 year old woman is admitted with severe chest and

abdominal pain from a bowel obstruction that ruptured her

colon, causing her to have a heart attack, and sending her into

septic shock and kidney failure. The surgeon removed the

damaged part of the colon and gave her a colostomy. A

cardiologist stented her coronary arteries. She was put on

dialysis, ventilator and IV feeding. After a couple weeks, it was

clear she wasn’t improving. The septicemia had left her with

heart and respiratory failure, as well as dry gangrene of her

foot (which needed amputation). She would not be able to eat,

and required artificial nutrition. Her kidneys had failed requiring

dialysis for the rest of her life.

• You are sitting down with her family to discuss artificial

nutrition and amputation. She is unmarried and without

children. What would you say to her siblings and mother?

Would your care plan be focused on cure or palliation?

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What is palliative care?

• “Patient and family-centered care that optimizes quality of life by anticipating, preventing and treating suffering. During continuum of care it is

addressing physical, intellectual,

emotional, social and spiritual needs to

facilitate autonomy, access to information

and choice. It is rooted in the

interdisciplinary hospice model of care. National Consensus Project, 2013

What is palliative care?

”Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” -World Health Organization, 2013

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World Health Organization: Palliative care(a very misunderstood field)

• provides relief from pain and other distressing symptoms;

• affirms life and regards dying as a normal process;

• intends neither to hasten or postpone death;

• integrates the psychological and spiritual aspects of patient care;

• helps patients live as actively as possible until death;

• offers a support system to help the family cope during the patients illness,

including bereavement counseling, if indicated;

• will enhance quality of life, and may also positively influence the course

of illness;

• 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

• Hospice (AAHPM) is palliative care for patients in their last 6 months of life.

Hospice can be provided in patients’ homes, hospice centers, hospitals,

long-term care facilities, or wherever a patient resides. Comfort care,

medicare benefit requires volunteer involvement.

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Ira Byock, MD: Dimensions of Care

• 1.Physical-discomfort, fatigue, pain

• 2.Functional: social, childcare, paying bills

• 3.Interpersonal: personal relationships, family, friends, others. Family is “the patient” too!

• 4.Well-being- self assessment, what is their personal sense of well-being, anxiety, peace, depression, denial, anger, how do we help family understand.

• 5.Transcendent-pt and family‘s relationship with spiritual and religious values, existential concerns, perception and meaning of life. Suffering, death, afterlife, etc…

Balancing quality and quantity of life at the end of life

• “Weighing an intervention’s

potential benefits against its

burdens/risks, underlies the

process of care-planning

and decision making.~ Ira

Byock, MD

• The fulcrum of this on-going

decision making process

include someone’s values,

goals, and currently

experienced quality of life.

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Hahnemann’s view on Palliation (dissimilar medicine):

Primary and Secondary Actions

• Every power that acts on life,

every medicine, alters the vital

force more or less and brings

about in human health certain

modifications of greater or lesser

duration. We call this the

primary action. Our vital force

strives to oppose its energy to

this influence. This, its life-

preserving reaction, is an

automatic activity called

secondary action or

counteraction.

– Aphorism 63

• The primary effect of certain

drugs may simulate Heaven,

but their secondary effects give

a remarkably good imitation of

Hell.

Hahnemann’s view on palliation

• …Therefore all pains of any duration allayed in a palliative and temporary manner by opium by means of its stupefying and pain-subduing power, return immediately when the stupefying primary action is exhausted, and

that at least as severely as

before, as the experience of

all observant physicians

testify.” (Hahnemann, MMP,

Opium, p. 287)

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Palliative ‘remedy’ plus natural disease

“In the beginning, this palliative remedy makes the vital

force insensible to the natural disease in an apparent

dynamic neutralization, but its effect quickly disappears by itself—all medicinal diseases do—leaving behind the natural disease unchanged. Moreover, upon the primary action of the palliative, an

opposite counteraction follows from the vital force. This secondary action, counteraction, is similar to the existing natural disease which hasn’t been destroyed, and strengthens it and augments it. Therefore the disease symptom becomes worse after the action of the palliative has ceased; the larger the

dose, the greater the aggravation. Ie., the stronger the

opium dose, the more the pain increases over its original

intensity as soon as the opium has ceased to act.” Aphorism 69.

Complicated/Complex Disease

....the dissimilar artificial disease of chronic nature is added making the patient doubly ill and so difficult to cure that sometimes he is incurable…. Forming a complex disease. ie., Mercury in high doses being used to treat syphilis, and gonnorhea.

Aphorism 41

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Re-visiting Hahnemann’s definition of cure and health:

adding the individually defined “higher purposes of existence.”

• The physician’s highest calling, his only calling, is to make the sick healthy—to cure, as it is termed. ~Aphorism 1

• The highest ideal of cure is the rapid, gentle and permanent restoration of health; ….. ~Aphorism 2

• In the healthy human state, the life force that enlivens the material organism as dynamis, governs without restriction and keeps all parts of the organism in admirable, harmonious, vital operation, as regards both feelings and functions, so that our indwelling, rational spirit can freely avail itself of this living, healthy instrument for the higher purposes of our existence. ~Aphorism 9

But…what if disease is incurable AND we still want our patients live the higher purposes of their existence with the time they have left.

Healing versus Curing

“Seasonsed clinicians working in palliative care

recognize that people who have been hardened

and made cynical by life frequently soften when

illness forces them to accept kindness and caring from others. Anger that has kept them at

odds with a family member or previously close

friend commonly gives way to an attitude of openness to reconciliation. Those who have

felt isolated may once again, or for the first time,

be able to feel loved.” –Byock & Corbeil, 2014

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Coping with Cancer Project: What Patients WantJAMA. 2008 Oct 8, 300(14)

• Avoiding suffering

• Strengthening relationships with family/friends

• Maintaining mental awareness

• To not be a burden to family/friends

• Cultivate a sense of life being complete

People with serious illness have priorities beyond simply

prolonging life!

Aphorism 9: “So that our indwelling, rational spirit can freely avail itself

of this living, healthy instrument for the higher purposes of our

existence.” The “higher purposes of existence will mean something

different to each individual!”

Incurable cases:Can we heal when cure isn’t possible?

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JT Kent, “How to Ensure an Easy Death”

• I am frequently asked,

“What should be done in

times of great suffering for

immediate relief?” To those

who desire to obtain reliable

information, and who wish to

practice in accordance with

our principles, I would say :

“Take the symptoms of each individual case and select the remedy capable of producing similar symptoms.”

Herbert Roberts, MD “The principles and art of cure by homeopathy.”

Chapter XIX, The law of palliation

• The law of similars is the fundamental law also in the palliation of incurable states. The result of

palliative treatment with

narcotics becomes a vicious

cycle from which there is no

escape except to be sent to

the ultimate end in a

confused and half-deadened

condition, instead of being

helped to live out as many

years as possible in the

easiest, quietest and most

gentle manner.” p.162

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Stuart Close, MD “Homeopathy in terminal conditions and

apparently incurable diseases. Is it sufficient?

• “Some stand up, manfully, proclaiming that the similar remedy is the best palliative, and all-sufficient for every medical emergency. Every emergency requiring the use of medicine is best met by administering the similar medicine.”

• ..If similar remedies in medicinal doses only are used, for the action of the homeopathic remedy is always along the line of, or in the direction of cure. It is curative in nature as far as it goes, and it is the highest good we can attain!”

Stuart Close, MD

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Stuart Close, MD “Homeopathy in terminal conditions and apparently incurable diseases. Is it sufficient?

• “It may be stated as a general proposition that the homeopath always treats his case as if it were curable. He observes and studies

its phenomena, and selects his remedy

according to the method of symptom

similarity…he knows that death comes to all men; that some cases are incurable by any

means; and that the most that can be done for some cases is to make their condition as tolerable as possible as long as they live.”

When is a disease incurable?– Most incurable cases have fewer symptoms. (Incurable

patients don’t have a vital reaction strong enough to bring

out the original symptoms.) (Stuart Close has opposite

view.)

– The closer the remedy is to the simillimum, the more

intense the aggravation will be. Thus the need for lower potencies!

– After correctly indicated remedy, the aggravation is lasting,

BUT the general condition continues to deteriorate. (1st of

Kent’s 12 remedy observations.)

– After the indicated remedy, there is a quick/short

amelioration followed by an aggravation. OR amelioration

doesn’t last in spite of there being no obstacles to cure.

(Kent’s 5th remedy observation)

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Homeopathic palliation in incurable

disease: • When is the use of homeopathic palliation in

incurable cases indicated:

– Cases with irreversable and structural damage such as

advanced cases of cancer, CHF, COPD, Renal Failure,

nephrotic syndrome.

– The material pathological changes are used as the

guide rather than the root cause. (Stella’s case)

– Though in general it is important to only use low potencies with incurable disease because of a

compromised vital force, palliation of the dying patient

can sometimes require very high potencies—such as

Tub CM given for anxiety, restlessness and fear in a

patient’s last dying moments.

Treating Incurable Chronic Diseases with Palliative Homeopathy

• Cardiovascular Disease(1)

• Cancer/Chemotherapy Side Effects (2)

• Chronic Lower Respiratory Disease (3)

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Cardiovascular Disease

• Number one cause of death globally.

• 6 types of heart disease: rheumatic, hypertensive,

ischemic, cerebrovascular, inflammatory, congenital.

• Left sided heart failure symptoms: dyspnea, nocturnal

dyspnea, pulmonary edema, dry throat, hypoxia.

• Right sided heart failure symptoms: jugular venous

distension, dependent edema, splenomegaly, N&V,

weight gain

Cardiovascular Disease

A few remedies to consider:

• Digitalis

• Naja

• Aurum

• Cactus

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Effect of cancer treatment

on the body

• Mouth sores

• Nausea and vomitting

• Hair loss

• Fatigue

• Anemia, neutropenia, thrombocytopenia

• Skin changes

Chronic Obstructive Pulmonary Disease

• Usually associated with chronic

inflammation and progressive

airflow limitation.

• Diffuse pulmonary diseases

including asthma, chronic

bronchitis, emphysema,

bronchiectasis, and cystic

fibrosis.

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Chronic Obstructive Pulmonary Disease

• Cough, dyspnea, chest

tightness, anorexia and

weight loss, fatigue and

exercise intolerance,

anxiety, recurrent

respiratory infections,

poor sleep, morning

headache.

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Remedies for End of Life: Aconitum

napellus(Hering’s guiding symptoms)

• Aconite: for the patient with great fear of death Predicts day of death, bids her friends good-bye. Tendency to apoplectic congestion, plethora. Stupid, eyes closed, facial muscles twitch, mouth compressed, no power of speech. Clairvoyance, conscious that his beloved, miles away, was singing a certain piece. Thrice he became blind and affirmed that death was at hand. Delirium, crying out, staring look—inflammation of brain. Delirium, with talk about death. Pains are so intolerable, they drive him crazy, he becomes very restless. Screams aloud at slightest touch, screams with pains, cannot bear light, will not be touched or uncovered, buzzing in ears. Music is unbearable, it makes her quite sad. Ailments from fright: afraid in dark, vertigo, faintness, trembling, cardiac weakness. Hahnemann says: "Whenever Aconite is chosen homeopathically, you must, above all, observe the moral symptoms, and be careful that it closely resembles; the anguish of mind and body; the restlessness; the disquiet not to be allayed.” Congestion to head, heart disease. Head hot, throbbing carotids, limbs cold, left side lame, staring, burning pain in brain. Constantly puts hand to head, meningitis. Breathing: short, in sleep, after twelve PM, labored, anxious or quick, and superficial, deep, slow, sighing, difficult, must breathe deeply, slow, rattling (apoplexy), whistling (croup in old age), short, when raising one's self. Agony, sits up straight, can hardly breathe, pulse like a thread. Difficult breathing, endocarditis. Breathes with Diaphragm—pneumonia. Uncomplicated cardiac hypertrophy, especially with numbness in left arm and tingling in fingers. Great agitation of heart, anxiety. Feeling of fullness, pulse hard, strong, contracted, stitches at heart, lies on back, with raised shoulders, constriction of chest.—pericarditis.

Remedies for End of Life: Antimonium Tart.(Hering’s guiding symptoms, TF Allen’s Handbook)

• Antimonium tart. Breathing quick, short, trembling, as it were. Pneumonia, pertussis. Breathing carried on only by aid of abdominal muscles. Attacks of unequal breathing. Breath panting, more depending on abdominal muscles than on chest, right half of chest immovable. Must be supported in a sitting posture in bed. Dyspnoea: in croup, nostrils widely dilated, thorax elevated, much rattling, with heat in chest, when awakening. Danger of suffocation with rattling of phlegm, always comes on suddenly. Acute oedema of lungs. Dilatation of heart. Suffocated and oppressed about three AM, must sit up to get air, after cough and expectoration she became better. Child gets insensible, limbs cold, pulse weak, almost imperceptible. Asphyxia: mechanical, as apparent death from drowning; from mucus in bronchi; from impending paralysis of lungs; from foreign bodies in larynx or trachea; with drowsiness and coma. Asphyxia, After vomiting once, a heavy asphyxia, and when coming to herself again, violent colic. Asphyxia from drowning. Unable to speak a word—oedema of lungs. Rattling of mucus when coughing or breathing. Ratting originates in upper bronchi and can be heard at a great distance. Much ratting of mucus in trachea, cannot get it up. Velvety feeling in chest. Heart disease. Anxious, with oppression of chest and warm rising from heart. Heat in chest with dyspnoea. Pain dull, pressing and burning extending to sternum. Violent pains from chest to shoulder, lancinating and tearing. Motion of chest very quick but heavy, like under a heavy load, with suffocative anxiety and stertorous rattling of phlegm. Edema of lungs. Frequent vomiting of a bloody, foamy fluid. Emphysema. The death rattle of mucous with minimal expectoration. Coughing and gasping. Edema. A drowsy or comatose patient.

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Remedies for End of Life: Arsenicum alb.(Hering’s guiding symptoms)

• Arsenicum album: Loss of consciousness. She lay upon bed in a state of unconsciousness, muttering, eyes fixed, cold sweat on forehead, trembling all over, pulse small, hard, and very rapid. When alone, he falls to thinking about disease and other things, which he can scarcely keep out of his mind. Gloomy forebodings while lying in bed, in evening, fears something may have happened to his relatives. Thoughts of death and the incurability of his complaint. Cancerous inoculation. Thinks he must die. He sees all kinds of vermin on his bed, throws handfuls of them away, and tries to escape from them. He imagines that he sees burglars in his room, and listens under the bed, he is bathed in cold sweat. Mania, headache, terrible anxiety, noise in his ears as of many bells, sees a man who has hanged himself beckoning him to cut him loose, on failing to accomplish this, he attempts to hang himself, being prevented he falls into despair, and becomes so restless he can scarcely be kept in bed, loses speech, with full consciousness, tries to write, but can make only unintelligible characters, he trembles, weeps, his forehead is covered with anxious sweat, finally kneels down and lifts his hands in supplication. Lamentations, despair of life. Picking of bedclothes. Tranquillity of soul-- In a man affected with melancholy. Fear of being left alone. Dread of death when alone, or on going to bed. Anxiety and restlessness, worse after midnight. Frequent attacks of anxiety, worse at night, fears death. Great anxiety, with constriction of chest and dyspnoea. As a consequence of fright, inclination to commit suicide. Cannot rest in any place, changing his position continually, wants to go from one to another, and lies now here and now there. Restless, constantly moving head and limbs.

• JT Kent: A “friend of the dying.”Resisting death with every fiber and every cell of their body. Gives quiet and ease to the last moments of life when given in high potency.

Remedies for end of life: Aurum met.

• Frequent attacks of anguish about heart, with tremulous

fearfulness, great anguish increasing to self-destruction, he

cannot do anything fast enough, and does not succeed in

satisfying himself, is constantly impelled to be in motion, and is

sorry for his inactivity, he imagines he is neglecting something and deserves reproaches in consequence. Violent palpitation, anxiety and congestion of blood to head

and chest. Angina pectoris. Action of heart floundering. Pains

wander from joint to joint, and finally become fixed in heart,

must sit upright, feels as though heart ceased and then

suddenly gave one hard thump. Pulse small, but accelerated,

small, feeble, rapid, irregular. Pulse quick, full, corresponding

to heat of heart, and omitting before single strong beat.

(Hering’s Guiding Symptoms)

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Remedies for end of life: Cactus

Heart feels as if clasped and unclasped rapidly by an iron hand; as if bound, "had no room to beat.”

Fear of death; believes the disease incurable (Ars.).

Pricking pains impeding breathing and movements of the body; oppression; cannot lie on the left side; blue face; pulse quick, throbbing, tense and hard.

Pains in the apex of the heart shooting down left arm to the ends of the fingers; feeble pulse; dyspnoea.

Remedies for End of Life: Carbo-veg.• Carbo Vegetalis: ‘the corpse reviver.’ “Carbo veg given in extreme

cases either saves the patient or allows them to die easily.” (S. Close)

• The patient must have air with the windows open and be fanned*. Carbo veg. in water every hour for six hours, and stopped, will give rest and beatitude with many thanks.”(JT Kent)

• Face blue, bloating in distended abdomen. Collapsed, cold states with stasis. Prior to collapse, much belching and desire to be fanned. Complete collapse with blue, icy cold body and fear of darkness and ghosts. The patient is almost lifeless, but head is hot. Breath is cold. The pulse very weak, and the respiration quickened. Face cold, blue, pale, covered with cold sweat (Tab.).

• “When the ghastliness of the picture has not changed, and to it we have added the pains of dying cells–death pains, the last suffering. Such pains come on when mortification beginsVital surfaces nearly exhausted, cold surface, especially below knees to feet, lies as if dead, breath cool, pulse intermittent, thready, cold sweat on limbs. (C. Hering)

• Relationship: compare Camphora – Icy coldness of body, breath cold. Prior to collapse patient refused covers.

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Remedies for end of life:

DigitalisConstant pain or anguish in region of

heart, at times pain and palpitation

greatly aggravated, worse from

exercise of body and mental emotion,

but at times suffering were greatly

worse without any apparent cause,

while sitting perfectly at rest,

paroxysms accompanied by sinking

sensation, face purple, syncope,

believes she is dying, constant

dizziness of head and ringing in ears,

sharp pain in left shoulder and left

arm, tingling in arm and fingers,

creeping all over skin, sometimes

paroxysms come on at night, when it

seems as if she were suffocating,

wakes up in great anguish, terrifying

dreams.

(From Hering’s Guiding Symptoms)

Remedies for End of Life: Lachesis• Lachesis: Thinks she is dead, and that preparations are being made

for her funeral. Cancer of stomach. Hopelessness. Dread of death,

fears to go to bed, fears of being poisoned. Weary of life, looks at

everything from dark side, worse morning, better through day, least

noise disturbs sleep. Satiety of life with longing for death. (C. Hering)

• The distressed suffocation and inward distress in chest and stomach,

streaming perspiration, great sinking, must have the clothing away from

the neck, chest, abdomen, ghastly countenance, and choking, call for

Lachesis, and it may be given as often as occasion requires, but to give

satisfaction and prompt relief, not lower than the two hundredth

potency. (JT Kent)

• Nervous; excitable. LOQUACITY; rambling, frequently jumping from

one subject to another, Suspicious. Malice. Mischievous (Phatak)

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Remedies for end of life: Naja

Fluttering of heart, with headache,

pulse regular in rhythm, but irregular

in force, acute pain and sense of

oppression in chest as though a hot

iron had been run into it and a

hundred weight put upon it, cannot

lie a moment on left side. Inability to

speak, with choking, nervous, chronic

palpitation, chronic hypertrophy and

valvular disease of heart. Pressing

pain in vertex as from a weight,

shortness of breath, palpitation of

heart, worse walking and lying on

side, constrictive sensation in cardiac

region, as if heart was screwed

together, great anxiety, loss of

appetite.

Remedies for End of Life: Latrodectus-m

• Latrodectus-m : for the anxious patient, screaming with

pain typically in heart failure. Gasping breath, fear of

asphyxiation. Extreme breathlessness, with gasping

respiration and fear of losing his breath. The skin is as cold

as marble.

• The praecordial region seems to be centre of the attack.

Praecordial anxiety. GASPS, FEARS TO LOSE BREATH

AND DIE. Screams with pain. ANGINA PECTORIS. PAIN

IN THE REGION OF THE HEART, EXTENDING TO THE

LEFT ARM. Constriction of chest muscles, with radiation to

the shoulders and back. Cardiac pain: violent, sharp, to

shoulder or both arms, with numbness. Skin as cold as

marble. Quick, feeble, thready pulse. Sinking at the

epigastrium. Paraesthesia of the lower limbs. Weakness of

the legs followed by cramps in the abdominal muscles.(

Lippe)

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Remedies for End of Life: Opium• Opium: Painlessness of all complaints. Heavy, stuporous sleep,

and noisy irregular breathing. The patient’s skin is hot and damp. >cold applications, <warm applications, <during/after sleep.

• Unconsciousness, eyes, glassy, half closed; face pale deep coma. Drunkenness, with stupor, eyes burning and dry. Apoplexy, with vertigo, buzzing in the ears, loss of consciousness, red, bloated, hot face; tetanic rigidity. Congestion of blood to the head, with pulsations in it. Bloated, dark, red and hot; red; pale, clay - colored, sunken countenance and eyes, with red spots on the cheeks; bluish (purple), swollen face. Muscles of face relaxed, lower lip hangs down. Trembling, twitching and spasmodic movements of facial muscles. Corners of the mouth twitch; distortion of the mouth. Short inspiration, long, slow expiration, epigastrium drawn in; fine rales, constant cough, sopor, face bluish; great anguish and dread of suffocation; looks as if dying; slightly better from cold air and bending forward. (C. Hering)

Remedies for End of Life: Rhus Tox• Rhus tox: extreme restlessness. Continual change of

position. Apprehension at night, patient wants to get out of

bed. Before midnight, sleeplessness. Thoughts of

suicide. <noc, <sleep, <rest and <cold. Fears he will be poisoned. Anxiety, timidity; worse at twilight; restless

change of place; wants to go from bed to bed. Satiety of

life, with fear of death. Thoughts of suicide; wants to drown

himself. Paralysis: after unwonted exertion; after

parturition; rheumatic, from getting wet or lying on damp

ground; from sexual excesses; after ague or typhoid; parts

painless; or painfully stiff and lame, with tearing, tingling

and numbness. Hemiplegia, right - sided; sensation as if

"gone to sleep. " (C. Hering)

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Remedies for End of Life: Tarentula cubensis• Tarentula cubensis: a favorite of the old

masters, it soothes the final agony, especially when there is nervous restlessness, difficulty breathing, anxiety to point of delirium, atrocious pain with great prostration. Hypersensitivity, <touch. “Tarent. C. soothes the dying sufferer as I have never seen any other remedy do. I have seen Arsenic, Carbo vegetabilis, Lycopodium, Lachesis, act kindly and quiet the last horrors, but Tarentula cubensis goes beyond these. The pain, the rattling in the chest, with no power to throw the mucus out; the patient has but a few hours to suffer, but he can be made as quiet as with the terrible Morphine in a very few minutes by Tarentula cubensis in the thirtieth potency. (JT Kent)

Remedies for End of Life: Veratrum• Veratrum: attacks of pain, with delirium driving her

to madness, cursing and howling all night. Delusions he will become rich. Suffer from collapse with extreme coldness, blueness, and weakness. Restlessness. Incontinent bowel. Cold perspiration on the forehead. <noc, > warmth. Delirium, heavy, soporous sleep; restless, thirsty, cramps in legs, cold sweat, tingling; irregular pulse. Mania: with desire to cut and tear, especially clothes; with lewdness and lascivious talk. Loquacity, he talks rapidly. Talks much about religious things; praying. Cerebro - spinal meningitis. Craves fruit, juicy food or salty things. (C. Hering)

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Homeopathic EOL pain relief

• Belladonna: All senses more acute. Great irritability and

impressionableness of senses, he tastes and smells

everything more acutely, sense of taste, of sight and of hearing

is keener, and the mind is more easily moved, and thoughts

more active. Excessive nervous excitability, with exalted sensibility of all organs, least noise, least light is annoying. (C. Hering)

• Bryonia: An irritable mood and inclined to be

angry.Rheumatic pains in the limbs with tension, aggravated by motion and contact. Stiffness in the joints.

Oversensitiveness of the senses to external impressions.

Pricking, darting and stinging in the joints, muscles and

inner parts Inflammations of the inner parts (lungs and liver).

Pain in the bones, as if the flesh had been beaten off. (Lippe)

Homeopathic EOL pain relief

• Chamomilla: Oversensitiveness to pain, and of the organs of sense,

to fresh air and wind (Bell., Coff., Nux-V.). Pain: seems unendurable, drives

to despair; worse by heat; worse in the evening before mid-night; with heat,

thirst and fainting. Pulsating pain, as from concealed suppuration. The pain

almost drives him crazy. Pain with numbness of the affected part. Mental

calmness contra-indicates Chamomilla. (Lippe)

• Hypericum: It is the Arnica of the nerves. Consequence of spinal

concussions Injuries of the nerves in general. Bed effects from falls or

blows upon the head, or concussion of the spine Neuritis: the surrounding

parts are inflamed; there is tingling, burning pain and numbness. INJURIES

TO PARTS RICH IN SENTIENT NERVES, ESPECIALLY FINGERS, TOES,

AND MATRICES OF NAILS. Headache and meningitis depending upon an

injury to the nervous system LACERATIONS, WHEN INTOLERABLE PAIN

SHOWS THAT THE NERVES ARE INVOLVED. (Lippe)

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“The Conversation”

Illness, caregiving, dying and grief are not

medical. They are very personal! - Ira Byock, MD

• 60% of people say ensuring their family isn’t burdened is

“extremely important.”

– Yet, 56% have NOT communicated their EOL wishes

• 70% of people say they prefer to die at home.

– Yet, 70% die in a hospital, nursing home, or long term care facility.

• 80% of people say that if they are seriously ill, they would want

to talk with their doctor about EOL care.

– Yet, 7% report having this conversation.

• 82% of people say it is important to put their wishes in writing,

– Yet 23% have actually done it.

• 64% of 765 doctors had created an Advanced Directive (AD) in

a 2003 study (from Wall Street Journal article, “why doctors die differntly.”)

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Starting the conversation-Advanced Care Planning and EOL

discussions are being postponedCancer. 2010 Feb 15; 116 (4): 998-1006

• Results: Interviewed 4,074 oncologists-- 65% would discuss prognosis with terminally ill patients (<6 months to live) now. 44% would discuss DNR status. 26% would discuss hospice. 21% would discuss site of death… preferring to wait until symptoms appear or there are no more treatments to offer.”

“It is always too soon….until it is too late.”~Ira Byock, MD

www.theconversationproject.org

Why are advanced care planning and EOL

discussions important?JAMA. 2008; 300(14): 1665-1673

• Issue: Physicians fear balancing patient autonomy with a

concern about inflicting psychological harm.

• 332 participants: 37% of patients reported having EOL

discussions. Such discussions were NOT associated with

higher rates of patient depression nor more worry. But were associated with lower rates of ventilation, resuscitation, ICU admission, and earlier hospice enrollment. By contrast, more aggressive medical care was associated with worse patient quality of life and higher risk of major depressive disorder in bereaved caregivers. Whereas longer hospice

stays were associated with better patient quality of life and

better patient quality of life was associated with better

caregiver quality of life at follow up 6.5 months after death of

patient.

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Oregon’s Advance Directive Law

“ I authorize my representative to direct my health care when I can’t do so.”

Having the Conversation:

Advance Care Planning into EOL discussionJ. Gen. Intern Med 2000;15:195-200

• 1. Initiating the discussion: Establish a supportive relationship

with family and patient. Elicit general thoughts about EOL

preferences/values/priorities. This is an ON-GOING discussion.

• 2. Clarifying Prognosis: Be direct yet caring. Be truthful, yet

sustain spirit. Use simple everyday language.

• 3. Identifying EOL goals: Open discussion about desired medical

care and EOL goals—most people share goals of maximizing time with

loved ones, avoiding hospitalization/unnecessary procedures, minimizing

pain.

• 4. Developing a treatment plan

“While I can’t cure you, there are still many things I can do for

you. I want you to be able to speak openly with me, so I can

best help you. No matter what happens, I can be here for

you—you are not alone.”

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Having the Conversation: Advance Care Planning

Initiating the discussion: Establish a supportive relationship with family and patient.

1. This is an on-going dialogue, a series of conversations, (it’s

not just completing legal forms) about the patient’s values and

feelings (that guide choices and preferences), about positive and

negative priorities (not just limiting care, but what to preserve.)

2. Do they understand their prognosis, What are their fears about

what is to come? What are their goals? What are the tradeoffs

they are willing to make for added time? Susan Block, MD

“Planning ahead makes sense in so many areas of one’s life. Starting to think

about the care you would want in the event you suddenly become very sick or

injured, might be useful. Is this something you have thought about?”

What are your goals of care? What is most important to you? What gives your life

meaning and purpose? Are there significant upcoming events that are important to you?

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Advance Care Planning Organizations

• The Conversation Project

�www.theconversationproject.org

• National Healthcare Decision Day: April 16th, 2018

�www.nhdd.org

National Hospice and Palliative Care Organization

�www.nhpco.org

Oregon’s Death with Dignity Act: 1997

On October 27, 1997 Oregon enacted the Death

with Dignity Act which allows terminally-ill

Oregonians to end their lives through the

voluntary self-administration of lethal

medications, expressly prescribed by a physician

for that purpose. The Oregon Death with Dignity

Act requires the Oregon Health Authority to

collect information about the patients and

physicians who participate in the Act, and publish

an annual statistical report.•https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx

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DWDA: Prescription Recipients and deaths by year, OR, 1998-

2014

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States and Countries with Physician Aid in Dying (PAD)

and/or Euthanasia: How are they different? Current Oncology, v 18 (2), April, 2011

• Oregon (1997): PAD

• Washington (1999): PAD

• Vermont (2013): PAD

• California (2015): PAD

• District of Columbia (2015): PAD

• Colorado (2016) : PAD

• Netherland (2001): PAD and Euthanasia

• Belgium (2002) PAD and Euthanasia

• Luxemborg (2009) PAD and Euthanasia

• Canada (2016) PAD

• Switzerland (1940) PAD

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Jane Kenyon (May 23,1947-April 22, 1995)

Otherwise

I got out of bed on two

strong legs.

It might have been otherwise.

I ate cereal, sweet milk, ripe,

flawless peach.

It might have been otherwise.

I took the dog uphill to the birch

wood.

All morning I did the work I love.

At noon I lay down with my mate.

It might have been otherwise.

We ate dinner together at a table

with silver candlesticks.

It might have been otherwise.

I slept in a bed in a room with

paintings on the walls, and

planned another day just like this

day.

But one day, I know, it will be

otherwise.

Ian R. Luepker, ND, DHANP

Madrona Homeopathy

1607 Siskiyou Blvd.

Ashland, OR 97520

Tel: 541-482-2824

www.madronahomeopathy.co

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