I was recently diagnosed with a very rare and very aggressive incurable cancer. I was referred to palliative care, but I am often in so much pain that I end up in the emergency room and they have to inject me with morphine.
I’m 67 and retired, but I’ve run two very successful restaurant businesses. Now I have trouble opening a bottle of water.
When can I say I’ve had enough?
This is a very difficult and very important question – although it is not for any doctor to decide when a patient has “enough”.
End of life plans should be developed by a patient and their loved ones. In the case of incurable cancer, the goal of treatment is usually to prolong life. But the point can come where that might not be what one wants.
It’s perfectly acceptable to say it’s become too much, and you want to discuss other options. But that does not mean having no treatment at all, far from it.
The goal of palliative care is not to treat the disease itself, but rather any uncomfortable or distressing symptoms.
End of life plans should be developed by a patient and their loved ones. In the case of incurable cancer, the goal of treatment is usually to prolong life. But the time may come when it may not be what we want
Pain and weakness, as well as immobility, bleeding, and difficulty with normal bodily functions, are all horrible symptoms that ruin quality of life. Palliative care teams try to find ways to control or lessen the worst of these problems.
If the symptoms are adequately addressed, life can become a little more bearable, and that feeling of just wanting it all to end can dissipate somewhat. Of course, this doesn’t change the final result, but it helps to make the most of the time we have left.
Palliative care may be provided at home or in hospital, and may also involve hospice.
A palliative care team can also offer emotional and practical support around death and dying.
It may be worth having a conversation with Marie Curie Cancer Care. Their nurses care for anyone with a terminal illness and can offer support at home and overnight. Call them on 0800 090 2309 and ask your GP or palliative care team to refer you to their services. They may also work alongside other people involved in your care.
I recently visited my GP to ask about the pneumonia vaccine as I had turned 65.
They refused to give it to me, saying that because I had a private travel stroke for pneumonia in 2019 – before a holiday in India – I was not eligible. What must I do now ?
We give a pneumococcal vaccine, known as the pneumonia vaccine, to babies, adults aged 65 or over, and some adults with long-term health conditions that put them at higher risk, such as heart disease or kidney disease.
Standard guidelines are that people aged 65 and over only need one pneumococcal vaccination rather than a repeat as with the flu shot.
Some people with underlying chronic health conditions need to be vaccinated against pneumonia again every five years, and your GP should tell you if you fall into this category.
More Dr Ellie Cannon for The Mail on Sunday…
Private clinics sometimes offer younger patients a type of pneumococcal vaccination called the Prevenar 13 vaccination. A different type is given on the NHS for adults over 65, the polysaccharide pneumococcal vaccine, or PPV.
There are actually many different strains of bacteria that cause pneumonia: Prevenar 13 protects against 13 strains of the bacteria while PPV protects against 23.
An adult who has had Prevenar 13 is not protected against all the strains that PPV protects against, so they should still have PPV at age 65, as is the norm.
Anyone over 65 who has not had PPV should do so.
This, to me, looks like an administrative error. Discuss with the nurse practitioner or GP to resolve the issue.
I am 29 years old and have acne on my neck and ingrown hairs after shaving. It’s been going on for at least two years. I have tried so many products but nothing works. Can you help ?
It actually looks like folliculitis, an inflammation of the hair follicles. It can happen anywhere on the skin, but the beard area is particularly prone.
Our skin is covered in bacteria that are generally harmless and even protective. But shaving can damage the skin, and bacteria can grow and invade the follicles, causing infection.
Folliculitis is very similar to acne, with itchy, painful areas of red spots and filled with pus.
Unlike normal acne, however, it tends to spread, getting worse day by day, with the area also feeling swollen and warm.
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Dr. Ellie can only answer in a general context and cannot answer individual cases, nor give personal answers.
If you have a medical condition, always consult your own GP.
Shaving can also cause ingrown hairs – where the hair shaft grows back at the wrong angle, pushing into the skin. What you see are red, irritated patches.
Of course, it can also be acne which may require a doctor’s prescription to treat.
The GP or pharmacist can determine what condition it is and recommend treatment.
For folliculitis, a short course of an antibiotic cream or lotion is used, and possibly a mild steroid cream, to reduce inflammation.
Depending on its severity, it may be recommended to use an antibiotic tablet in the same way as when we treat acne.
Sometimes the folliculitis infection persists because razors can be contaminated, so be sure to change disposable items regularly or sterilize metal parts with boiling water or an antiseptic solution.
It may also help to shave less often or less closely, which would cause less skin trauma.
This “silent killer” gives warnings
It’s now a cliché to call certain cancers “silent killers,” meaning those that cause few symptoms until they’re too advanced to be cured.
And this is too often accepted as an explanation for why some cancers have such terribly terrible prognoses.
But are they really silent or are the doctors not listening loud enough? One of the findings of surveys of poor NHS maternity care is that women are often not taken seriously when they say they are sick. This may well be the case with ovarian cancer.
In the early stages, the problems it causes are similar to irritable bowel syndrome, which is why it is often missed. But there are other signs.
If you have urinary tract infections, new constipation, bloating, or lower back pain that isn’t normal, and you’ve been told it’s nothing, I urge you to go back and ask more of questions.
Visit eveappeal.org.uk for more information.
Kim’s weight loss stunt doesn’t add up
Social media megastar Kim Kardashian has claimed she went on a diet so she could fit into the Marilyn Monroe dress she wore to the Met Gala fashion event last week.
She said she lost 16 pounds in three weeks by drastically cutting calories and running on a treadmill. What a plunger.
For starters, I doubt someone already so thin could lose more than a stone in such a short time, even if they’re starving. People with serious illnesses do not waste away at such a rate.
And massively restrictive dieting on top of feverish exercise like this is simply a form of eating disorder – a mental illness.
At worst, it sends a message to those who struggle with these kinds of conditions that it’s okay, a good way to behave, or maybe even glamorous.
So why claim it? For attention, I guess. Well, she got it.
Of course, it’s been said by others commenting on Kim’s seemingly limitless stupidity that she’s a bad influence. But I doubt she has that many admirers these days – I think most smart girls will just think, how much she has to resort to stunts like this.
Social media megastar Kim Kardashian has claimed she went on a diet so she could fit into the Marilyn Monroe dress she wore at the Met Gala fashion event last week