News, Culture & Society

DR ELLIE CANNON: How do I tell my doctor I want to die?

I was recently diagnosed with a very rare, very aggressive incurable cancer. I’ve been referred to palliative care, but I’m often in so much pain I end up in A&E and have to be injected with morphine.

I’m 67 and retired but used to run two very successful catering businesses. Now I struggle to open a bottle of water. 

At what point can I say I’ve had enough?

This is a very difficult and very important question – although it’s not for any doctor to decide when a patient has ‘had enough’.

End-of-life plans must be made by a patient and those closest to them. With incurable cancer, the aim of treatment is usually to prolong life. But the point may come when this might not be what’s wanted.

It’s perfectly acceptable to say it’s all become too much, and that you want to discuss other options. But that doesn’t mean having no treatment at all – far from it.

The aim of palliative care is not to treat the illness itself, but rather any symptoms that are uncomfortable or distressing.

End-of-life plans must be made by a patient and those closest to them. With incurable cancer, the aim of treatment is usually to prolong life. But the point may come when this might not be what’s wanted

Pain and weakness, along with immobility, bleeding and difficulties with normal bodily functions, are all horrible symptoms which ruin quality of life. Palliative care teams try to find ways to control or alleviate the worst of these problems.

If symptoms are adequately tackled then life can become a bit more bearable, and that feeling of just wanting it all to end may dissipate somewhat. Of course this doesn’t change any ultimate outcome, but it helps make the best of what time we have left.

Palliative care can be offered in the home or in the hospital, and it can also involve a hospice.

A palliative care team can also offer emotional and practical support around death and dying.

It may be worth having a conversation with Marie Curie Cancer Care. Their nurses care for all people diagnosed with terminal illness, and can offer support in the home and overnight. Call them on 0800 090 2309 as well as asking your GP or palliative care team for a referral for their services. They can also work alongside others involved in your care.

I recently visited my GP to ask about the pneumonia vaccine, as I had reached 65. 

They refused to give it to me, saying because I’d had a pneumonia travel jab privately in 2019 – before a holiday in India – I wasn’t eligible. What should I now do?

We give a pneumococcal vaccination, known as the pneumonia vaccine, to babies, adults aged 65 or over, and certain adults with long-term health conditions that put them at higher risk such as heart disease or kidney disease.

The standard guidelines are that people aged 65 and over need only a single pneumococcal vaccination rather than a repeat one as with the flu jab.

Some people with underlying chronic health conditions do have to have the pneumonia vaccine repeated every five years, and your GP should tell you if you fall into this category.

   

More from Dr Ellie Cannon for The Mail on Sunday…

Private clinics sometimes offer younger patients a type of pneumococcal vaccination called Prevenar 13 vaccination. A different type is given on the NHS for adults over 65, the pneumococcal polysaccharide vaccine, or PPV.

There are actually a lot of different strains of bacteria that cause pneumonia: Prevenar 13 protects against 13 strains of the bug whereas PPV protects against 23.

An adult who has had Prevenar 13 is not protected from all of the strains which PPV protects against, so should still have PPV at 65, as is standard.

Anyone over 65 who hasn’t had the PPV should do so.

This, to me, sounds like an administrative error. Have a conversation with the practice nurse or GP to sort it out.

I AM 29 and get dreadful neck acne and ingrown hairs after shaving. This has been going on for at least two years. I’ve tried so many products, but nothing works. Can you help?

THIS actually sounds like folliculitis, an inflammation of the hair follicles. It can happen anywhere on the skin, but the beard area is particularly prone.

Our skin is covered in bacteria which are usually harmless and even protective. But shaving can damage the skin, and the bacteria can grow and invade the follicles, causing infection.

Folliculitis looks a lot like acne, with itchy, sore areas of red and pus-filled spots.

Unlike normal acne, however, it has a tendency to spread, worsening day by day, with the area feeling swollen and hot, too.

DO YOU HAVE A QUESTION FOR DR ELLIE? 

Email DrEllie@mailonsunday.co.uk or write to Health, The Mail on Sunday, 2 Derry Street, London, W8 5TT. 

Dr Ellie can only answer in a general context and cannot respond to individual cases, or give personal replies. 

If you have a health concern, always consult your own GP.  

Shaving can also cause ingrown hairs – where the hair shaft regrows at the wrong angle, pushing into the skin. What you see are red, irritated spots.

Of course it could also be acne which may require a prescription from the doctor to treat.

The GP or pharmacist can determine which condition it is, and recommend treatment.

For folliculitis, a short course of an antibiotic cream or lotion is used, and possibly a mild steroid cream, to reduce inflammation.

Depending how severe it is, it may be recommended to use a tablet antibiotic in a similar way to when we treat acne.

Sometimes the infection with folliculitis persists because razors can become contaminated, so make sure to change disposables regularly, or sterilise the metal parts with boiling water or an antiseptic solution.

It may also be helpful to shave less often, or not as closely, which would cause less trauma to the skin.

This ‘silent killer’ gives warnings

It is now a cliche to call some cancers ‘silent killers’ – those that cause few symptoms until they are too advanced to be curable.

And this is all too often accepted as an explanation as to why some cancers have such a relentlessly awful prognosis.

But are they really that silent, or are doctors just not listening hard enough? One of the results to have come out of inquiries into poor NHS maternity care is that women are often not taken seriously when they say they are ill. This may well be the case with ovarian cancer.

In early stages the problems it causes are similar to irritable bowel syndrome, which is why it’s often missed. But there are other signs.

If you have urinary tract infections, new constipation, bloating or lower back pain that is not normal, and you’ve been told it’s nothing, I urge you to go back and ask more questions.

Visit eveappeal.org.uk for more information.

Kim’s dim weight-loss stunt doesn’t add up 

Social media megastar Kim Kardashian claimed that she crash dieted so she could fit into the Marilyn Monroe dress she wore to fashion event the Met Gala last week.

She said she lost 16 lb in three weeks by drastically cutting calories and running on a treadmill. What a plonker.

For a start, I doubt anyone already so slim would be able to lose more than a stone in such a short amount of time, even if starving. People with serious illnesses don’t waste away at such a rate.

And a massively restrictive diet on top of feverish exercise like this is simply a form of eating disorder – a mental illness.

At worst this sends a message to those struggling with these sorts of conditions that it’s acceptable, a good way to behave or possibly even glamorous.

So why claim it? For attention, I presume. Well, she got it.

Of course, it’s been said by others commenting on Kim’s seemingly limitless stupidity that she is setting a bad influence. But I doubt she has that many admirers these days – I think most smart girls will just think, how sad that she has to resort to stunts like this.

Social media megastar Kim Kardashian claimed that she crash dieted so she could fit into the Marilyn Monroe dress she wore to fashion event the Met Gala last week

Social media megastar Kim Kardashian claimed that she crash dieted so she could fit into the Marilyn Monroe dress she wore to fashion event the Met Gala last week

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