Anxiety At The End of Life

Feelings of nervousness, also known as anxiety, are normal responses when things feel uncertain or beyond your control. Because of the many physical and emotional changes associated with illness, feelings of nervousness may occur. Although anxiety is a natural response, being nervous is uncomfortable and can affect the quality of your life.

Causes of Anxiety
Over the course of an illness, there are things that can cause feelings of anxiety or nervousness. It is helpful to identify what may be causing you to feel anxious. Identifying the cause of your nervousness will be helpful in determining what to do about it. However, it is possible to feel anxious without being able to say why. Some of the things that may cause feelings of anxiety include:

• Fear of the unknown
• Changes in how the disease is advancing
• Fear about relieving symptoms such as constipation, pain or shortness of breath
• Concerns about medications
• Fear about giving or receiving care
• Fear about not being able to care for yourself 
• Fear of physical or emotional loss
• Responding to changes in your life
• Concerns about your family or loved ones
• Concerns about moving to a nursing home or assisted living facility
• Unexpected news, favorable or unfavorable
• Fear related to making decisions about the future
• Concerns about making the right decisions
• Questions or concerns about spiritual or religious issues
• Financial concerns
• Changes in your role within the family or the community

Signs and Symptoms of Anxiety
Each person responds differently to situations which cause feelings of anxiety. Your body has many different ways of showing anxiety. Knowing that you may be nervous is the first step to feeling better. Some of the more common symptoms of anxiety include:

• Restlessness or not being able to relax
• Irritability
• Stomach upset or nausea
• Butterflies in the stomach and/or feeling as though there is a lump in your throat
• Muscle tension, aches, soreness or just feeling tense
• Feeling very tired or exhausted
• Trouble falling or staying asleep or having nightmares
• Getting upset about things which normally would not upset you
• Worrying about what could or may happen
• Trouble concentrating or feeling overwhelmed
• Headaches
• Eating more or eating less than usual 

What You Can Do
While feelings of anxiety are normal, it is important to decrease the effect these feelings may have on you or the people you care for. The symptoms of anxiety are your body's way of letting you know it needs to relax. It your body is relaxed, it helps you cope with what is happening in your life. Talking to someone you trust is usually a good place to start. Other suggestions to reduce anxiety may include: 

• Talk about your feelings, fears and concerns with someone who will listen and provide support, including family members, friends, clergy and/or your Arbor Hospice team
• Take slow, deep breaths
• Enjoy a relaxing activity such as a hot bath, a good book
• Take a short walk or find a place that you can relax, uninterrupted for awhile
• Seek spiritual support from your clergy and/or the Arbor Hospice spiritual care coordinator
• Allow yourself to cry
• Keep a journal and write about your fears, feelings, concerns and/or things that are happening in your life
• Listen to soothing music 

Choose Hospice Care To Improve Quality of Life And Perhaps Even Extend It

Dr. Ira Byock, an expert on palliative care and end-of-life issues, recounts his first hospice referral decades ago:

"I called up the hospice of St. Agnes, and it was the first time anybody from this medical center, the county hospital, had tried to make a referral. You know, hospice was a countercultural movement at the time, Krista. It was a social movement often by nurses and others, but very few doctors, in response to people dying badly, often dying in pain, often in hospitals, too often alone. It has grown up and now been incorporated back into sort of the corpus of medicine, but its roots have been as a countercultural response. And we've made a big difference, though we're by no means done."

Important progress has been made in recent years, as Byock notes, but his observation that "we're by no means done" is also significant.

In many ways, hospice continues to feel countercultural, at least to many doctors and their patients.

Far too many terminally ill patients and their families remain unaware of hospice services or come to those services too late to achieve their full value.

Referral to hospice, in the eyes of some doctors and patients, means giving up rather than improving the quality of life, and in some cases even extending it.

That means that some patients and their families endure needless suffering as futile and expensive health procedures are employed in the face of the inevitable.

As a hospice volunteer, I have talked with patients who told me that their doctors actively opposed hospice care even when the consensus of medical opinion was that they had at best months to live.

There are two reasons why it is important to begin hospice care early rather than in the final days or hours of life:

1. Hospice care enables a higher quality of life. Palliative medical care addresses pain and other symptoms. The hospice interdisciplinary team supports the patient and family in addressing the physical, emotional and spiritual aspects of the illness, the dying process and grieving.

2. In some cases, hospice may enable a longer life as well as a better one. A combination of palliative and interdisciplinary care can extend life as well as enrich it.

What benefits have you or loved ones experienced because of hospice care?

This blog entry was written by Dennis Sparks, Arbor Hospice volunteer. You may contact Dennis by commenting below or emailing him at thinkingpartner@gmail.com.

Advice For Individuals With Lung Diseases In Winter Weather

Winter continues to pummel Michigan with extreme temperatures and record-breaking levels of snow. While this weather may give reason to gripe, it poses an extra challenge for those living with respiratory ailments, such as congestive obstructive pulmonary disorder (COPD). Arbor Hospice and Arbor Palliative Care recognize these challenges and makes several suggestions to patients and caregivers.

"Changes in weather can trigger COPD symptoms to suddenly worsen or flare-up," said Adam Marks, MD, Arbor Palliative Care Medical Director. "Cold weather may cause a person's airway to tighten, restricting airflow. This can be especially dangerous for individuals with respiratory ailments. These temperatures may cause people with COPD to feel exhausted, short of breath, cough more frequently or produce more phlegm. But there are ways for individuals to reduce the risk of a flare-up."

Arbor Palliative Care offers the following tips for individuals living with COPD during the winter months:

1. Minimize the cold as much as possible by avoiding the outdoors. When you go outside, remember to dress accordingly. Cover your nose and mouth with a scarf or mask. Individuals with COPD are more susceptible to complications such as pneumonia.
2. Preparation is important. Before temperatures drop and the snow begins to fall, make sure you are prepared. Buy extra groceries so you will not have to brave the elements. Get a flu shot to prevent unnecessary illness.
3. Avoid smoke exposure. Cigarette smoke, in of itself, is an irritant to individuals with lung diseases. When paired with cold air, COPD symptoms are much more common. Similar to cigarette smoke, smoke and particles from wood-burning stoves and fireplaces can irritate airways. Try using an energy-efficient electric heather to stay warm.
4. Make sure furnace filters are clean so the air in your home is not hurting your breathing. It is also a good idea to have your furnace and ductwork cleaned to eliminate dust and remove airborne contaminants.
5. Make sure your doors, windows and fireplace are properly sealed to eliminate drafts.
6. Maintain a normal humidity level inside your home. The air humidity should ideally be at 40 percent and can be maintained with a humidifier.
7. If you go outside, place oxygen tubing (if you use it) inside your clothing to keep the air as warm as possible.

People living with serious illness, such as COPD, who experience ongoing pain or other distressing symptoms may be eligible for palliative care. Palliative care is specialized medical care that focuses on relief of symptoms, including shortness of breath, cough and exhaustion. Palliative care works alongside other medical care to prevent and alleviate symptoms in order to improve quality of life. It is appropriate at any age and any stage of an illness.

This blog post was featured as an article in local newspapers and online editions.