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Constipation: A Common Problem In End-Of-Life Care

December 11th, 2011 by KennyLinMD in Health Tips, Research
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Family physicians who care for terminally ill patients must manage a wide range of bothersome symptoms, including pain, fatigue, dyspnea, delirium, and constipation. According to a Cochrane for Clinicians article in the December 1st issue of American Family Physician, constipation affects up to half of all patients receiving palliative care and nearly 9 in 10 palliative care patients who use opioid medications for pain. Unfortunately, a Cochrane systematic review found limited evidence on the effectiveness of laxatives in these patients, as Dr. William Cayley Jr. comments:

“For patients with constipation, especially those with opioid-induced constipation, there is insufficient evidence to recommend one laxative over another. The choice of laxatives should be based on past patient experience, tolerability, and adverse effects. Methylnaltrexone is a newer agent that may be useful especially for patients with opioid-induced constipation that has not responded to standard laxatives, but there is limited evidence of potential adverse effects. Therefore, judicious use preceded by a discussion with patients about known risks and benefits is warranted.”

The Cochrane Library recently discussed this review in its Journal Club feature, which includes open access to the full text of the review, a podcast by the authors, discussion points, and a Powerpoint slide presentation of the review’s main findings.

Additional resources for physicians and patients on advanced directives, hospice care, and ethical issues are available in the AFP By Topic collection on End-of-Life Care.
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The above post was first published on the AFP Community Blog.

*This blog post was originally published at Common Sense Family Doctor*

Military Plastic Surgery: Using Liposuction To Make The Weight Cut

December 18th, 2010 by John Di Saia, M.D. in News
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The Orange County Register blog posted on military plastic surgery and mentioned liposuction:

Army Times reports that soldiers are turning to liposuction to remove fat if extreme dieting, laxatives and other methods fail to get them under the Army’s weight limit for their height, age and gender.

“Liposuction saved my career. Laxatives and starvation before an [Army Physical Fitness Test] sustains my career,” a soldier told the periodical. “Soldiers are using liposuction, laxatives and starvation to meet height and weight standards. I did, do and still do.”

I am well aware of the military patient looking to stay within military parameters to stay in the service as my San Clemente office is quite close to Camp Pendleton, and I give military discounts. I have seen several of these patients in my decade in San Clemente. Surgery for wives still outnumbers surgery for soldiers, though.

As some of these clients have explained, the Marine administration requires active duty soldiers to have certain measurements at a certain weight. Those who do not fall within these expected norms are first warned and then penalized. Liposuction has worked at times to keep some of these soldiers in the service.

– John Di Saia, M.D.

*This blog post was originally published at Truth in Cosmetic Surgery*