Does anyone know what your wishes are if you’re sick and dying from coronavirus?



Shutterstock/sfam photo

Louise D. Hickman, University of Technology Sydney; Jane Phillips, University of Technology Sydney, and Patricia Davidson, Johns Hopkins University

With more than 170,000 coronavirus deaths worldwide so far, including 71 in Australia, the COVID-19 pandemic has highlighted the importance of talking to your loved ones about dying and your wishes at the end of your life.

If you become seriously unwell with COVID-19 and are likely to benefit from active treatment and need a ventilator or are dying, do those closest to you know what type of care you would want?

COVID-19 steals the luxury of time but these are the questions busy health-care providers assessing you will want to know to inform your treatment.




Read more:
Why are older people more at risk of coronavirus?


If you haven’t had these important conversations, start them today. Have them with someone who will be able to advocate for your care preferences and wishes when you are unable to do it yourself.

Who should be having these discussions?

Older people have more chronic health conditions that place them at higher risk of severe illness or death. They are more likely to find themselves in a variety of situations where health-care decisions need to be made.

Although older people and those with chronic conditions are at more risk, no one is protected against COVID-19, so everyone should have these conversations.

What are the options?

COVID-19 is a respiratory virus that can cause lung infection. If you were likely to benefit, you could be sent to an intensive care unit (ICU). Some patients will need to have a tube put down their throat so they can be attached to a ventilator to help their body breath. Would you want this to happen to you?

In crisis situations, who can be with you in hospital while you are sick or dying changes. You may be allowed one person with you or no-one.

Health-care providers are working creatively to ensure patients and their families remain connected through the use of technology, such as FaceTime, WhatsApp, Viber, Zoom or texting. Would you still decide to go to ICU if you knew you could only communicate with those you love using technology?

What if you don’t want aggressive treatment?

Good health care involves understanding people’s preferences and wishes, and developing clear goals of care. Not everyone will want to have aggressive treatment, which can be burdensome and difficult to cope with if you have other chronic illnesses or are very old.

If you elect to have good symptom management only, rather than aggressive treatment, do you know what palliative care might look like for you in this situation?

Palliative care aims to relieve symptoms and promote quality of life.

Palliative care symptom management is focused on making you as comfortable as possible, by managing any distress, breathlessness, anxiety and pain. The health-care providers will endeavour to communicate regularly with your family and keep them informed about your situation and how you are responding to these comfort measures.




Read more:
Why do more men die from coronavirus than women?


If you want to know more, look at the caresearch COVID-19 website.

If you do not want to receive aggressive medical treatments, then Advance Care Planning Australia has some great resources to help you frame and document your care preferences.

What questions do you need to think about?

This list provides some helpful questions for a written plan. You can also give your answers to your advocate, someone you want to speak to the treating doctor or nurse on your behalf if you’re too sick to talk.

1) Who is the nominated person you want to speak on your behalf?

2) What are your:

  • goals of care?

  • health priorities?

  • current conditions?

3) Do you know what treatment you want or do not want should you be too sick to tell health professionals yourself?

4) If it becomes clear you are dying, what does a comfortable dignified death look like to you?

5) What is your preference if your condition gets worse, even after health professionals try everything? If you are dying, do you want to be put on a ventilator?

6) Do you want be resuscitated (with CPR) if your heart and lungs stop working?

7) Would you rather not go to the hospital and prefer to stay in your home or residential aged care home if given the choice?

8) Have you had your wishes documented and does your advocate have a copy of your care preferences and wishes?

If we fail to have these conversations now and are unfortunate to present to hospital acutely unwell, then there may not be the luxury of time to discuss these issues in detail with our family and the treating health-care team.The Conversation

Louise D. Hickman, A/Professor and Director Palliative Care Studies at IMPACCT (Improving Palliative, Aged & Chronic Care through Clinical Research & Translation), University of Technology Sydney; Jane Phillips, Director of IMPACCT, Professor of Palliative Nursing, University of Technology Sydney, and Patricia Davidson, Professor and Dean, School of Nursing, Johns Hopkins University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Feeling sick is an emotion meant to help you get better faster



The emotion of lassitude might help your body fight off infection by making certain adjustments.
Kalinka Georgieva/Shutterstock.com

Joshua Schrock, University of Oregon

You know what it’s like to be sick. You feel fatigued, maybe a little depressed, less hungry than usual, more easily nauseated and perhaps more sensitive to pain and cold.

The fact that illness comes with a distinct set of psychological and behavioral features is not a new discovery. In medical terminology, the symptom of malaise encompasses some of the feelings that come with being ill. Animal behaviorists and neuroimmunologists use the term sickness behavior to describe the observable behavior changes that occur during illness.

Health care providers often treat these symptoms as little more than annoying side effects of having an infectious disease. But as it turns out, these changes may actually be part of how you fight off infection.

I’m an anthropologist interested in how illness and infection have shaped human evolution. My colleagues and I propose that all these aspects of being sick are features of an emotion that we call “lassitude.” And it’s an important part of how human beings work to recover from illness.

Your body sets priorities when fighting germs

The human immune system is a complex set of mechanisms that help you suppress and eliminate organisms – such as bacteria, viruses and parasitic worms – that cause infection.

Activating the immune system, however, costs your body a lot of energy. This presents a series of problems that your brain and body must solve to fight against infection most effectively. Where will this extra energy come from? What should you do to avoid additional infections or injuries that would increase the immune system’s energy requirements even more?

Fever is a critical part of the immune response to some infections, but the energy cost of raising your temperature is particularly high. Is there anything you can do to reduce this cost?

To eat or not to eat is a choice that affects your body’s fight against infection. On one hand, food ultimately provides energy to your body, and some foods even contain compounds that may help eliminate pathogens. But it also takes energy to digest food, which diverts resources from your all-out immune effort. Consuming food also increases your risk of acquiring additional pathogens. So what should you eat when you’re sick, and how much?

We humans are highly dependent on others to care for and support us when we’re sick. What should you do to make sure your friends and family care for you when you’re ill?

My colleagues and I propose that the distinctive changes that occur when you get sick help you solve these problems automatically.

  • Fatigue reduces your level of physical activity, which leaves more energy available for the immune system.
  • Increased susceptibility to nausea and pain makes you less likely to acquire an infection or injury that would further increase the immune system’s workload.
  • Increased sensitivity to cold motivates you to seek out things like warm clothing and heat sources that reduce the costs of keeping body temperature up.
  • Changes in appetite and food preferences push you to eat (or not eat) in a way that supports the fight against infection.
  • Feelings of sadness, depression and general wretchedness provide an honest signal to your friends and family that you need help.

Of course these changes depend on the context. Any parents reading this article are likely familiar with the experience of being sick but pushing through it because a child needs care. While it may make sense to reduce food intake to prioritize immunity when the sick individual has plenty of energy reserves, it would be counterproductive to avoid eating if the sick person is on the verge of starvation.

Your body needs you to do (or avoid) a few things so it can concentrate on getting better.
tommaso79/Shutterstock.com

Sickness as an emotion

So how does your body organize these advantageous responses to infection?

The evidence my colleagues and I reviewed suggests that humans possess a regulatory program that lies in wait, scanning for indicators that infectious disease is present. When it detects signs of infection, the program sends a signal to various functional mechanisms in the brain and body. They in turn change their patterns of operation in ways that are useful for fighting infection. These changes, in combination with each other, produce the distinct experience of being sick.

This kind of coordinating program is what some psychologists call an emotion: an evolved computational program that detects indicators of a specific recurrent situation. When the certain situation arises, the emotion orchestrates relevant behavioral and physiological mechanisms that help address the problems at hand.

Imagine you’re walking through the woods, thinking you’re alone, and suddenly you are startled by sounds suggesting a large animal is in the underbrush nearby. Your pupils dilate, your hearing becomes attuned to every little sound, your cardiovascular system starts to work harder in preparation for either running away or defending yourself. These coordinated physiological and behavioral changes are produced by an underlying emotion program that corresponds to what you might think of as a certain kind of fear.

Some of these coordinating programs line up nicely with general intuitions about what makes up an emotion. Others have functions and features that we might not typically think of as “emotional.”

Some psychologists suggest these emotion programs likely evolved to respond to identifiable situations that occurred reliably over evolutionary time, that would affect the survival or reproduction of those involved.

This way of thinking has helped researchers understand why some emotions exist and how they work. For instance, the pathogen disgust program detects indicators that some potentially infectious agent is nearby. Imagine you smell the stench of feces: The emotion of disgust coordinates your behavior and physiology in ways that help you avoid the risky entity.

Another example is the emotion of shame, which scouts for signs that you’ve done something that causes members of your social group to devalue you. When you detect one of these indicators – a loved one rebukes you for doing something that hurt them, say – the experience of shame helps you adjust your mental map of what kinds of things will cause others to devalue you. Presumably you will try to avoid them in the future.

Drawing from the emerging discipline of evolutionary medicine, my colleagues and I now apply the idea of these emotion programs to the experience of being sick. We call this emotion “lassitude” to distinguish the underlying program from the outputs it generates, such as sickness behavior and malaise.

We hope that our approach to lassitude will help solve problems of practical importance. From a medical perspective, it would be useful to know when lassitude is doing its job and when it is malfunctioning. Health care providers would then have a better sense of when they ought intervene to block certain parts of lassitude and when they should let them be.

[ Deep knowledge, daily. Sign up for The Conversation’s newsletter. ]The Conversation

Joshua Schrock, Ph.D. Candidate in Anthropology, University of Oregon

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What are parasites and how do they make us sick?



Giardia is an example of a parasite you don’t want to catch. Symptoms can include diarrhoea, abdominal cramps, fatigue, weakness and weight loss.
From shutterstock.com

Vincent Ho, Western Sydney University

A parasite is an organism that lives in or on an organism of another species.

Three main classes of parasites can cause disease in humans: protozoa, helminths, and ectoparasites. Protozoa and helminths largely affect the gut, while ectoparasites include lice and mites that can attach to or burrow into the skin, staying there for long periods of time.

The majority of protozoa and helminths tend to be non-pathogenic (meaning they don’t cause disease) or result in very mild illness. Some, however, can cause severe disease in humans.




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Faecal-oral transmission, where parasites found in the stool of one person end up being swallowed by another person, is the most common mode of transmission of parasitic protozoa and helminths.

The initial symptoms tend to be gastrointestinal symptoms like diarrhoea. When parasites invade the red blood cells or organs, the consequences can become more serious.

Protozoa

Protozoa are tiny single-celled organisms that multiply inside the human body.

The protozoa giardia, for example, has a classic two-stage life cycle. In the first stage, called trophozoite, the parasite swims around and consumes nutrients from the small bowel. In the second stage it develops into a non-moving cyst.

Cysts excreted in faeces can contaminate the water supply, and ingesting contaminated food or water results in transmission. Close human to human contact and unsanitary living conditions can promote transmission.

Symptoms of giardia can include severe or chronic diarrhoea, abdominal cramps, fatigue, weakness and weight loss.

Once the parasite has been diagnosed, it can usually be treated effectively.
From shutterstock.com

Other important protozoa are the plasmodium species. Plasmodium develop in mosquitoes, and infected mosquitoes transmit the parasite to humans by biting them. Plasmodium destroys red blood cells which impacts organ function and causes a disease in humans known as malaria.

Malaria causes the most deaths of all parasitic diseases. In 2017 it was estimated malaria resulted in 435,000 deaths globally, most of them young children in sub-Saharan Africa.




Read more:
How our red blood cells keep evolving to fight malaria


Helminths

Helminths, often called worms, are large multicellular organisms usually visible to the naked eye in their adult stages. As a general rule, helminths cannot multiply inside the human body.

One major group of helminths are flatworms. Flatworms literally have flattened soft bodies. Their digestive cavity has only one opening for both the ingestion and removal of food. It’s thought 80% of flatworms are parasitic.

Tapeworms are one type of flatworm. The most common human tapeworm in Australia is the dwarf tapeworm. The prevalence of dwarf tapeworm in isolated communities in northwest Australia is estimated to be around 55%.

Infestation in humans comes from ingesting dwarf tapeworm eggs. Transmission from person to person occurs via the faecal-oral route. As with other parasites, the major risk factors are poor sanitation and shared living quarters. Symptoms include diarrhoea, abdominal pain, weight loss and weakness.

Some parasites, like plasmodium, which causes malaria, are transmitted to humans via mosquito bites.
From shutterstock.com

Another major group of helminths are nematodes, commonly known as roundworms. Nematodes are the most numerous multicellular animals on earth and can be found in almost every environment. Unlike flatworms, they do have a digestive system that extends from the mouth to the anus.

More than 50% of the world’s population are thought to be affected at one point during their life by at least one of six main classes of nematodes.

The eggs or larvae of these nematodes usually develop in soil before being transmitted to the human host. For this reason these nematodes are often called soil-transmitted helminths. A good example are hookworms which infest humans by penetrating the skin from contaminated soil. So wearing appropriate footwear is an important way to prevent hookworm transmission.




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The pinworm Enterobius vermicularis has a different life cycle to the other nematodes. Pinworm larvae develop in eggs on the skin near the anus or under the fingernails.

Pinworm, also known as threadworm, is the most common helminth parasite in Australia. Itching around the anus is a major symptom of pinworm. Pinworms are easily passed from one person to another and it’s common for entire families to be infested.

Ectoparasites

The term ectoparasites generally refers to organisms such as ticks, fleas, lice and mites that can attach or burrow into the skin and remain there for long periods of time.

Scabies, for example, a contagious skin disease marked by itching and small raised red spots, is caused by the human itch mite. Scabies usually is spread by direct, prolonged, skin-to-skin contact.

Head lice are small, wingless insects that live and breed in human hair and feed by sucking blood from the scalp.

Head lice, a type of ectoparasite, are common in children.
From shutterstock.com

Prevention and treatment

Some parasites can lie dormant for extended periods of time. This can make the diagnosis of parasitic infestation challenging as there may be no symptoms, or symptoms can be vague and non-specific.

The good news is we have very good medications to treat many different kinds of parasites once they’ve been diagnosed. These medications do have side effects but on the whole are very effective.




Read more:
Six human parasites you definitely don’t want to host


Treatment of parasites should be accompanied by preventative strategies such as improving sanitation and ensuring the availability of appropriate clothing and footwear in affected areas.

The World Health Organisation has recommended periodic medical treatment (deworming) to all at-risk people living in endemic areas, but widespread implementation remains challenging.The Conversation

Vincent Ho, Senior Lecturer and clinical academic gastroenterologist, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Sick Again


Hi all – I have been trying to keep the Blog going in recent days despite being ill again – however, as I continue to get worse it is probably wise to have a complete break for the rest of the week and get as much sleep as I can.

I have had pneumonia 3 times since November last year (twice in November and once last month) and have come down sick again. Thought I was improving over the last couple of days but have once again developed the ‘shiver me timbers (chills and fever)’ tonight. So I plan to be away from the keyboard for the rest of the week in a bid to finally get over all of this illness. I apologise for the interruption to Blog posts in the mean time.

Back Very Soon


Hi all – my previous post suggested I would be away for about a week or so because of pneumonia. It turns out my absence was for a whole lot longer than that. I ended up with Double Pneumonia twice in 6 weeks and it has been a struggle to recover. I am feeling much better now and hope to return to Blogging over the next week, posting to each again over that time. Thanks for your patience.