DOLPHY AND THE NEED FOR DIALYSIS

English: Dolphy, Filipino actor

English: Dolphy, Filipino actor (Photo credit: Wikipedia)

“Most nephrologists would agree that patients who are likely to have an unacceptable quality of life should not be subjected to the discomfort of dialysis. Sparing such patients the inconvenience and discomfort of hospital attendances, surgical access procedures, and dialysis treatments is a major benefit.”

– Indranil Dasgupta and Hugh C. Rayner

  Consultant Nephrologist, Renal Unit, Birmingham Heartlands Hospital, United Kingdom

A living legend needs our prayers.  Comedy King Dolphy, whose comedic talent has brought laughter and cheer to multiple generations of radio, TV, and movie followers, was recently admitted to the Intensive Care Unit and is said to be suffering from Toxic Metabolic Encephalopathy.  The illness requires regular dialysis treatment, because his kidneys can no longer do the job of removing toxic wastes from the body.  This has affected his brain function, thus the medical term “encephalopathy”, which generally refers to an illness that affects brain.  As a hospice and palliative care practitioner, I decided to look into the benefits and risks of dialysis treatment on our 83-year-old comedy king.

According to studies,  patients on dialysis are subject to much more intensive medical care in the last month of life than are patients dying of cancer or heart failure.  Data reveal that 30% of dialysis patients receive intensive procedures, a rate that is three times higher than that of cancer patients. Also, only 20% of kidney-failure patients are referred to hospice, compared with 40% of the patients dying of heart failure and 55% of cancer patients.  Among patients 75 and older, the five-year survival rate for patients on dialysis is 15%.

This brings us to some  important questions.  Is it sometimes better to provide supportive and palliative care without dialysis to an elderly patient with renal failure?  Can dialysis be safely delayed when the benefits remain uncertain at best?  What does conservative management entail, and how should it be given?

According to experts, a patient over 75 who has heart disease, diabetes, liver failure, severe chronic obstructive pulmonary disease (COPD), or other significant chronic illnesses will have little to gain from dialysis.  A more conservative approach with the consent of the patients and relatives may be better.  What could be more cost-effective is to treat anemia and ensure acid-base and fluid stability.  Health care workers who are well-versed in hospice and palliative care should also be on hand.

However, it must be stressed that data can only serve as a guide.  The best medical decisions rest on a collaborated effort between doctors, nurses, caregivers, social workers, the patient’s family, and the patient himself.  Our prayers for Dolphy would also be invaluable, not just to prolong his life indefinitely, but to pray that he is at peace with himself and with his Creator.

Advertisements

4 comments on “DOLPHY AND THE NEED FOR DIALYSIS

  1. I agree with your observations, Raymond. I don’t think the attending physicians of Dolphy are aware what palliative care and hospice are all about. (Does it exist in Makati Med?)

  2. I believe that health and wellness is a choice people have to make in their life…unfortunately only a few knows that there is still hope for people with certain health conditions. I am a firm believer of taking the right type and amount of vitamin/nutritional supplements. I have heard, seen with my own eyes, and experienced people’s health getting better by taking proper vitamin/nutritional supplements with the same specific vitamins I am taking. Of course doctors will disagree or not totally agree because they were trained to cure sick people with medication-drugs-the traditional way. Little do they know that a human body would first need the basic thing which is the proper nutrition, before the body can respond positively to medications/drugs. I have learned this through experience. I have also read a book that discusses similar events, similar to what I am trying to emphasize. The title of the book is ” What your doctor doesn’t know about nutritional supplements may be killing you” by Doctor Ray Strand, MD. Read the book and try try supplementing with vitamins and nutritionals and you will know what I am trying to convey.

    • HI jd. Thanks for your comment. I have actually read Dr. Strand’s book, and he has some valid and interesting points. At the time of his writing, for instance, nobody thought about using C-reactive protein as an inflammatory marker for the early detection of cardiovascular disease. Now cardiologists are using it. But please understand the conservatism of physicians. Medical societies, just like lawyers, are governed by rules of evidence which limits the kind of information they disseminate to the general public. Strict rules of causation must be established before a physician recommends any nutritional supplement to the general public.
      Case in point: a few years ago, selenium provided great promise as a potent supplement to prevent prostate cancer. Several observational studies were performed, seemingly showing that higher intake of selenium was associated with a lower risk of prostate cancer. Because of this, the U.S.-based National Cancer Institute funded SELECT (Selenium and Vitamin E Cancer Prevention Trial). In the end, the study showed that selenium is not that effective. In fact, the data also showed a slight increase in the number of cases of adult onset diabetes in men taking selenium.
      However, I do prescribe supplements. I personally took care of a 97-year old patient, who was taking more than 5 medications for various illnesses. I decided to stop all of them due to weakness, because I wanted to prioritize nutrition. I gave her a liquid supplement. She regained her strength, and is doing better now. Will I also do it to all of my patients? No. It has to be on a case to case basis.
      Thanks and hope to hear more from you, jd.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s