BOOK REVIEWS

SUPPORTIVE CARE FOR THE RENAL PATIENT

Oxford Supportive Care Series

E. Joanna Chambers, Michael Germain and Edwina Brown (Eds)

Oxford University Press, 2004
276pp
ISBN 0-19-851616-9
RRP £49.95, $US95.00.
More Info & Purchase

Supportive care is the multidisciplinary holistic care of patients and their families from the time of diagnosis, through treatments aimed at cure or prolonging life, and into the phase currently acknowledged as palliative care. In simple terms, it is the application of the holistic multidisciplinary approach to care that is known so well in palliative care, applied earlier in the course of the patient’s illness.

The opening chapters deal with the need for this type of supportive care for patients with end-stage renal disease (ESRD) and how to make it happen. The clinical practice guideline developed by the Renal Physicians Association and the American Society of Nephrology regarding decision making in end-stage renal disease is particularly instructive. There are useful chapters on the control of symptoms related to both the renal disease and to co-morbidities. These chapters and the separate chapter on the management of pain contain a number of useful tables for the adjustment of medication doses in ESRD. There are chapters that discuss advanced directives, health-related quality of life, psychological and psychiatric considerations, sexual dysfunction, and spiritual care. The closing chapters deal with traditional palliative end-of-life care for patients with ESRD.

The introduction of this type of supportive care earlier in the course of the disease for patients with ESRD is long overdue and this book should be required reading for anybody training in nephrology. It certainly should have a place on the library shelf in any dialysis unit. It will also be useful to people who work in palliative care, as it will allow a better understanding of the particular problems and symptoms patients with ESRD bring to palliative care. The chapters on symptom control and the information about medication adjustments are particularly useful.

CICELY SAUNDERS
Founder of the Hospice Movement

Selected Letters 1959-1999

David Clark, Editor

Oxford University Press, 2005
ISBN 0-19-856969-6
397pp
RRP £19.95, $US39.50
More Info & Purchase

This volume provides a truly privileged view of the life and work of Dame Cicely Saunders, as seen through a selection of her correspondence, over the four decades that she has championed hospice and palliative care.

The letters are grouped into three time periods: the years leading up to the opening of St. Christopher’s Hospice (1959-1967); those in which Cicely Saunders was it’s Medical Director (1968-1985); and her years as it’s Chairman, up to 1999. David Clark provides brief but informative biographical and professional notes at the beginning of each section but allows the letters, unedited and in chronological sequence, to speak for themselves.

In the early letters, we hear of the development of St. Christopher’s Hospice. How "The Scheme", the 10-page outline of the vision that was to become St. Christopher’s Hospice, was circulated to carefully selected individuals who would provide help and support. Followed by ten years of tireless work and organisation. As the palliative care movement expands, we hear her talking to a large number of people from around the world. There are letters to a young Robert Twycross about possible career paths, to Josefina Magno about her International Hospice Institute (that fostered the American Academy of Hospice and Palliative Medicine (AAHPM), and went on to become what is now the International Association for Hospice and Palliative Care (IAHPC)), to Balfour Mount about his Montreal conferences, to Derek Doyle about the new journal Palliative Medicine, and even to my future mentor, Walter Moon. Points are made where they are due and both Elizabeth Kubler-Ross (with whom she otherwise seems to have had a most productive relationship) and the editor of The Times are admonished for referring to ‘St. Christopher’s Hospice for the Dying’ - "those last three words are not part of our title". And whilst actively contributing to all the positive aspects of hospice and palliative care, there is a thread running through the years that underlines her unshakeable opposition to euthanasia; her letters to Jack Kevorkian and to the Dutch doctor who advocated that euthanasia was part of good palliative care are very clear.

As wonderful as all the history is, the real jewel in these pages is Dame Cicely herself. Through her letters, we hear a truly remarkable person. Her vision and determination are legendary, and the indomitable energy and attention to detail are almost overpowering. But we also hear a compassionate and kind person - caring towards patients, concerned about family, supportive of colleagues. And, considering her achievements, a person of some humility.

This is a most enjoyable and interesting book. Trained as a nurse and a social worker before graduating in medicine at the age of thirty-nine, Dame Cicely’s remarkable contributions to the development of hospice and palliative care over the following 40 years are well illustrated in the letters presented here. Listening to her on all manner of issues to do with hospice and palliative care over the years, one cannot help feeling some of her enthusiasm and motivation. Balfour Mount concludes his Foreword by saying "These letters have helped to shape medical history. We are indebted to Dame Cicely and David Clark for this precious gift". Very true.

Highly recommended.

ORAL CARE IN ADVANCED DISEASE

Andrew Davies and Ilora Finlay (Eds)

Oxford University Press, 2005
221 pp
ISBN 0-19-263243-4
RRP £39.95, $US75.00
More Info & Purchase

This is a welcome book given the enormous effect that oral pathology can have on the quality of life for patients with advanced disease. The introductory chapters provide a clear description of oral assessment and oral hygiene, following which there are chapters on the various types of infections and some of the common symptoms including taste disturbance, halitosis and pain. The closing chapters deal with oral complications of cancer therapy, HIV/AIDS, chronic neurological diseases, and paediatric problems.

The book is comprehensive in scope and is well set out and there is a special section with 38 colour photographs that are particularly useful. However, I was a little surprised to see no mention of the cytoprotective agent, amifostine. Even if it is not yet available in the UK , I would have thought the published results of the randomized controlled trials are impressive enough to be mentioned. The increasing number of reports of osteonecrosis of the jaw associated with bisphosphonate therapy (particularly zoledronic acid) also escapes mention. But these quibbles aside, this book will be a useful addition to the library shelf in the palliative care unit where I work.

DYING WELL

A Guide to Enabling a Good Death (2nd edition)

Julia Neuberger

Radcliffe Publishing 2004
159pp
ISBN 1-85775-940-0
RRP £21.95 $US 39.95
More Info & Purchase

This is the second edition of Julia Neuberger’s book that was first published in 1999. The order of the material has been shuffled a bit and the discussion has been expanded and brought up to date with the discussions that are occurring in both professional and lay societies.

As for the first edition (although the order has been altered), ‘I found out about the origins of the attitudes to death and bereavement with which I grew up; I learned about the teachings and customs regarding death of the world’s major religions and how palliative care professionals can best deal with them; I was treated to an erudite discussion on the meaning of a “good death”, covering everything from common sense to euthanasia; and how we, whether we are health care professionals, family members, clergy, or friends, can help achieve it; and finally, a description of our society’s approach to grief and bereavement that does not shy away from pointing out what is wrong and why.’

Reading this book will be both enjoyable and beneficial to anyone who works in hospice and palliative care.

THE PAIN SYSTEM IN NORMAL AND PATHOLOGICAL STATES: A PRIMER FOR CLINICIANS

Louis Villanueva, Anthony Dickenson and Helene Ollat (Eds)

IASP Press 2004
347pp
ISBN 0-931092-53-1
RRP $US71.
More Info & Purchase

This book is a comprehensive review of pain mechanisms for both teachers and clinicians. It aims to present the key molecular, anatomical, physiological, and pharmacological studies on the basic science of pain mechanisms in a manner that is more easily understood by practicing clinicians and teachers.

The book is divided into five parts. The first deals with peripheral nociceptive inputs to the dorsal horn. The second part looks at the consequences of injury at the dorsal horn level. The third part is devoted to the anatomical and functional organization of ascending pain pathways. The fourth deals with the role of other endogenous neuronal mechanisms in pain processing. The last part relates to preclinical and clinical approaches to novel therapeutic strategies.

There is a lot of information in this book and I was left wondering how much of it would in the future become relevant to the clinical syndromes I treat. This clinician also felt that the more liberal use of conceptual diagrams would have been helpful. However, the book largely meets its goals and will be of interest to anybody wanting an in-depth and up to date review of what we know about pain mechanisms.

CD REVIEW

CARE FOR THE JOURNEY

Messages and Music for Sustaining the Heart of Health Care

Michael Stillwater and Gary Malkin

A Wisdom of the World Production, 2005
RRP $US 19.95 plus shipping
Available from www.careforthejourney.net

From the creators of Graceful Passages, Michael Stillwater and Gary Malkin, Care for the Journey is a wonderful compilation of music with inspiring and insightful messages for the practising health care professional. It acknowledges the stresses under which we work and takes us a step back to the real meaning of healing and caring, which includes the emotional and spiritual dimensions of both patient and practitioner; it accepts death as the natural end of life.

This CD would be a useful resource for any health care practitioner, but I think it will be particularly valuable for anybody who works in palliative care. If you are feeling in any way stressed, or wondering about the meaning and value of your work, you need to listen to Care for the Journey.

Highly recommended.

Roger Woodruff
Medical Oncologist and Director of Palliative Care,
Austin Health, Melbourne, Australia
(June 2005)