My Guide for Caregivers When Your Loved One is in the Hospital Part II

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If you haven’t already, check out Part I of this series: My Guide for Caregivers When Your Loved One is in the Hospital to get caught up on the first five tips!

5. Seek Out Supportive Services


Many hospitals have Integrative Medicine Consult Services, providing services such as Reiki, Music Therapy, Art Therapy, Acupressure, Therapy Dog visits and basic relaxation/stress management support. I have just started to connect with the Integrative Medicine Consult team as part of my health system and have made an effort to advise my patients/families of the available services and ask if they would like such services during the course of their stay.

Spiritual counsel is also readily available. Nearly all hospitals have trained chaplains, who are more than happy to work with you and your loved one during their hospital stay. People can often be afraid to ask or unsure if the available service will match their personal beliefs, but chaplains, no matter their personal affiliation or beliefs, are specifically trained to be vessels for universal spiritual healing, being present with you and your loved ones no matter the differences that exist between your family’s beliefs and those of the chaplain. 

And lastly palliative care services can be an absolutely life saver. Life saver you say? Yes, palliative care is not simply symptom management at the end of life. It is alleviating the burden of symptoms, providing spiritual and emotional support and directing care towards the most patient oriented of problems at any stage of life. In Episode 006 of my podcast: A Medicine Mind: Wisdom and Well Being, I spoke with Jonathan Bartels, one of my most impactful mentors and one of the leading experts in palliative care, and I encourage you to check out this conversation to hear how Jonathan seeks  relieve suffering in those most in need, and when the time calls for it, to support patients and families through the transitional process of death and dying.


6. Academic Medical Centers Can Be Your Friend!

I know my joke in Part I of this series about facing the army of white coats is somewhat of an exaggeration, but I recognize that being confronted with so many people at one time can be quite overwhelming, Having studied at the University of Virginia School of Medicine, I saw many patients and families expressing uneasiness (or frank refusal) with regards to medical students and residents taking part in their care. While at first glance you may feel your loved one will be better off with less (or more experienced) clinicians involved, I can assure you that there are many benefits to having a true team of caregivers at very different stages of training.

While this is my personal bias and driven from my experience as a student caregiver, I encourage you to seek out the medical students and speak with your team of nurses. Residents, Fellows and the Attending Physicians are often burdened with lots of work (and not that medical students and nurses aren’t), but medical students and nurses can be your gateway to more personal discussions, story-telling and really digging into what is troubling you and your loved one. And through these lengthier and perhaps more vulnerable discussions, the student and nurse can become an additional advocate, speaking to the broader team about new ideas, needs and history garnered from you as the caregiver that otherwise may never have reached the surface. Medical students are eager to learn and nurses understand the holistic needs of the patient often better than anyone and while neither may be completely “running the show,” they can be tremendous advocates for you and your loved one.

7. The Use of Outside Medications/Supplements

Now I will preface the following statements by saying this topic is very institution dependent and potentially controversial, BUT, in general, if you as a caregiver bring in a loved one’s supplements and certain home medications in clear labeled containers, hospital institutions and staff will allow and want you to take such medications. Is your loved one currently taking some curcumin, methylfolate and a combination of adaptogens? Bring them with you in the containers and express your desire for your loved one to be supported by these herbs and supplements. If the primary provider is uncomfortable with the products that you wish to provide your loved one, than ask to engage in a mutual discussion seeking understanding clarification and intentions behind their use, but I strongly advise you to NOT hide and keep such products secret as certain products do have known negative interactions with medications and the potential negative effects can be quite devastating.

I will commonly search Mytavin to look at possible nutrient depletion in my patients based on their current medications.

http://www.mytavin.com/

For institutions with access, (The Institute for Functional Medicine is one) one can get also get access to Natural Medicines Database in order to examine available data about natural products, possible adverse drug interactions, and nutrients that can be depleted while taking certain medications.

http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND

I cannot and am not going to give you recommendation for specific supplements, but I will provide some options to consider that are generally well accepted at most institutions and can be quite beneficial as part of a healing regimen

  1. Magnesium

  2. Curcumin- Turmeric

  3. Melatonin

  4. Certain B Vitamin or Multivitamin Complexes

  5. Probiotic

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8. Ask Questions and Engage in Shared Decision Making

It is your right to ask about the role of certain tests, medications or procedures in the course of your loved one’s healing. Those of us desiring to be more integrative in our approach can easily tune out to invasive tests or drugs just by their label, but you must remain open and inquire with your team as to their reasoning and logic behind the overall care plan. Ask specifically about each medication- how does it work, how might it help, what are possible adverse effects and risks, what are the alternatives, how likely will my loved one benefit and what it the expected magnitude of this benefit?
Ask about lab tests, following up on results as you desire, ask for printed results or copies. Ask similar questions about the reason behind certain labs, what is the perceived benefit of this test and what exactly does the result mean? Usually it is not so cut and dry as disease or no disease. And most importantly inquire into how such testing will change or improve treatment for your loved one.


9. Protect the Microbiome

I left this for last because it is arguably the most important and perhaps the least well understood in acute hospitalized medicine. As we come to understand the vital role for maintaining a balanced and diverse microecology of bacteria, viruses and fungi on many of our body surfaces and organs, we see that antibiotics are not a silver bullet even in the most appropriate of circumstances. Recommendations from recently compiled data and systematic reviews are beginning to echo the importance and efficacy of probiotic supplementation during courses of antibiotics and in the healing period in general to prevent adverse effects and difficult to treat hospital acquired infections (1,2).

An example of such data is a recent review from the American Academy of Family Physicians summarizing the currently available and broad research on probiotic supplementation for various gastrointestinal conditions.

A sample from the conclusion:

“There is high-quality evidence that probiotics are effective for acute infectious diarrhea, antibiotic-associated diarrhea, Clostridium difficile–associated diarrhea, hepatic encephalopathy, ulcerative colitis, irritable bowel syndrome, functional gastrointestinal disorders, and necrotizing enterocolitis. “

“Probiotics are safe for infants, children, adults, and older patients, but caution is advised in immunologically vulnerable populations”


Of particular interest is the high level of evidence supporting probiotics in preventing antibiotic associated diarrhea, infectious diarrhea and in the prevention of C. Difficile, a rather terrible intestinal infection often acquired during hospital admissions involving extensive antibiotic treatment.

It is important to recognize that probiotics are not for everyone including the critically ill, septic or otherwise immunocompromised. There are numerous case reports of probiotics entering the bloodstream (likely due to intestinal permeability and dysregulation of mucosal barriers) and causing serious blood infections.

That being said, most institutions have pharmaceutical grade probiotics that can be given in conjunction with antibiotic treatment, but not all doctors and staff may be entirely aware of their availability. You can be an advocate for your loved one to ensure that a discussion regarding the use probiotics during a hospital stay occurs and that the right steps are taken to help support your loved one’s microbiotic ecosystem and overall health.

There is even emerging research now regarding the use of probiotic based cleaning solutions to minimize antibiotic resistance and decrease total hospital associated infections in inpatients (3). Who knows how we will be “cleaning” hospital surfaces in 5 years time?

There are many other ways besides probiotic supplementation to support and “protect” your loved one’s gut ecosystem. Incorporating fermented foods and prebiotics as tolerated in a palatable and easily digestible forms can be quite helpful to support the gut ecosystem. Focusing on our other key lifestyle factors including sleep and stress management will also help to regulate the intestinal mucosal barrier and maintain a diverse and supportive environment

Conclusions

I hope this has been a helpful guide and introduction into integrative and supportive care for those requiring hospitalization. Hospitals will never be perfect, but we can all make greater efforts to support our patients and our loved ones through the plethora of means available in order to remove obstacles to cure, and in the end, promote flourishing and joy for all.

References

1. Probiotics for Gastrointestinal Conditions: A Summary of the Evidence
http://www.aafp.org/afp/2017/0801/p170.html?cmpid=em_AFP_20170801#sec-9

2. Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection: A Systematic Review With Meta-Regression Analysis.
https://www.ncbi.nlm.nih.gov/pubmed/28192108

3. Impact of a Probiotic-Based Cleaning Intervention on the Microbiota Ecosystem of the Hospital Surfaces: Focus on the Resistome Remodulation
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0148857

Rob Abbott