fundamentals
Symptoms During a Fatal Illness
Digestive Tract Problems
Digestive tract problems, including a Dry mouth , A dry mouth can be relieved with wet swabs, ice chips, or hard candy. Various commercially available products can soothe chapped lips. To prevent dental problems, a caregiver should brush the person’s teeth or use mouth sponges frequently to clean the teeth, gums, inside of the cheeks, and tongue. These may be caused by drugs, an intestinal obstruction, stomach disorders, a chemical imbalance, increased pressure in the skull (which occurs with certain brain tumors), or many advanced diseases. Identifiable causes of nausea or vomiting should usually be treated. A doctor may have to change drugs or prescribe an antinausea (antiemetic) drug. Anintestinal obstructionmay cause nausea and vomiting. The most common cause of intestinal obstruction at the end of life is abdominal cancer. Nausea and vomiting caused by an intestinal obstruction may be less troubling when treated with antiemetic drugs and sometimes corticosteroids or other drugs. However, symptom relief may be only temporary. If drugs are ineffective, sometimes continuous suctioning of stomach secretions with a tube inserted through the nose into the stomach (nasogastric tube) may be tried. Surgical repair may be needed to open an obstruction. However, depending on the person’s overall condition, likely life expectancy, and reason for the obstruction, surgery may cause more harm than good. Opioids are useful for pain relief. Constipation is very uncomfortable and common among dying people. A limited intake of food, fluids, and dietary fiber; a lack of physical activity; and certain drugs such as opioids cause the intestine to be sluggish. Abdominal cramping may occur. A regimen of stool softeners, laxatives, suppositories, and enemas may be needed to relieve constipation, especially when caused by opioids. Relief of constipation is usually beneficial, even at late stages of a disease. Difficulty swallowing (dysphagia) occurs in some people, especially after a stroke, and in people with advanced dementia or results from an obstruction of the tube that connects the throat with the stomach (esophagus) with cancer. Sometimes the person can swallow safely by maintaining a certain body position while eating or by having only foods that are easy to swallow. Although people who are not near death and have difficulty swallowing can ask their doctors about the merits of and problems caused by Feeding tubes , feeding tubes are usually not inserted if people are closer to death or have severe dementia. Loss of appetite (anorexia) eventually occurs in most people who are dying. Many conditions that cause poor food and liquid intake can be relieved, including inflammation of the stomach lining, constipation, toothache, a yeast infection in the mouth, pain, and nausea. Some people benefit from appetite stimulants such as corticosteroids taken by mouth (dexamethasoneorprednisone),megestrol, ordronabinol. People who are close to dying should not have to force themselves to eat but they may especially enjoy eating small amounts of favorite home-cooked dishes. If death is not expected to occur within hours or days, artificial nutrition or hydration—given by vein (intravenously) or via a nasogastric tube—may also be tried for a limited time to see whether the person’s comfort, mental clarity, or energy improves. Improvement often does not happen, and thus many people opt not to continue. The dying person and family members should have an explicit agreement with the doctor about what they are trying to accomplish with these measures and when the artificial nutrition and hydration should be stopped if they are not helping. During the last few days of life, loss of appetite is quite common and does not cause additional physical problems or suffering, even though the ill person’s lack of eating or drinking may distress family members. Loss of appetite probably even helps people die more comfortably. As the heart and kidneys fail, an otherwise normal intake of liquids often causes dyspnea because fluid accumulates in the lungs. A reduced food and liquid intake may lessen the need for suctioning because of less fluid in the throat and may reduce pain in people with cancer because of reduced swelling around tumors. Dehydration may even help the body release larger amounts of the body’s natural pain-relieving chemicals (endorphins). Therefore, people who are dying should not usually be forced to eat or drink, especially if doing so requires restraints, intravenous or nasogastric tubes, or hospitalization. 