While on placement recently I encountered this patient:
Patient A, a 14 yr old who had presented with a 6 month hx of increased frequency ad intensity of headaches, increasing dizziness, balance disturbances, vomiting and right sided visual disturbances. On CT a large posterior fossa/cerebellar medulloblastoma was found. This particular type of tumour is highly aggressive and given the location of the tumour not all of it was able to be removed with surgery. The patient had a rough course in ICU with 3 further operations being conducted.
I began to treat this patient when she was transferred to the wards 1 month after the first surgery with the aim of treatment to improve her strength and mobility before commencement of radiotherapy. At this point the patient was given 1-2 months to live (even with radiotherapy), as the tumour was so aggressive. This prognosis in its self I found to be hugely confronting and upsetting as the patient was only 14 years old. Watching the parent’s reactions to the situation and changing condition was also distressing.
Upon commencing treatment with this patient it was evident that the patient’s severe fatigue, frequent nausea/vomiting and dizziness was effecting our treatment sessions. Although small improvements were made I found it really hard to push a patient who was obviously very nauseous (vomiting nearly every session) and fatigued. I mean, this patient only had 1-2 months to live. So my question is- is it really necessary to push her to doing 1 more minute on the treadmill or should she be out enjoying the little time she had left?
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3 comments:
This is really sad and if I were the therapist, I would not push my patient too much. The aims of the treatments are muscle strengthening and increase mobility, so I will try to negotiate with my patient and see whether we can do something she enjoys. For example: Instead of running on a treadmill, why not try to play some sport/fun games with her? It makes treatment more fun and at the same time she gets her treatment done as well.
That is very good of you to think of her family rather than being over-focused on her physio sessions. Given that this patient's prognosis is only 1 - 2 months, I would perhaps give her more time to spend with her family, though, you would have to weigh out, are those small improvements worth the extra few minutes of the patient's time that she could be spending with her family? However, I do agree on Kent's comment about creating a fun environment whilst treating her impairments, and perhaps involve her family in the activities, which would allow her to spend time with her family and carry out her physiothreapy treatment.
Again,
i Agree w. Wei and Kent i think it is a great idea to involve the family and make the treatment environment a little more fun. I gather that your aims of treatment are just to maintain the mobility/ fitness that she has, and stopping her from being bed ridden i.e improving her QOL and decreasing her chance of pneumonia, DVT, etc. I would also educate the family on the clinic reasoning behind Rx session, so that they understand why it is important, and then perhaps they can help to encourage the pt to participate in the PT sessions. but perhaps educating the pt directly coming from you may be a little bit too confronting for her. So yeah get the family involved, make it fun and educate the family on why it is important! hope this helps.
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