Termial patient who needs help

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Hi guys ....It seems im the only one who talks about what happened today LOL...I was blessed to treat a fifty five year old man with bone cancer ... A lovely man. He has been given about six months , but, likes to walk.... He now has metastaces in the foot specifically the talus and first MPJ... I had "no " answer for him about how to facilitate a better way to walk....I suggested "off the shelf " orthotics....but to be honest guys , was at a complete loss on how to help this man . We chatted for about 45 mins.....it seemed to lift his spirits.... albiet , I said very little.... mostly listened.... Im not asking for answers... I just wanted to say that our job sometimes hurts... at an emotional level.

thanks all

Hope to hear from you and hopefully hear some good advice...

FDCB AKA craig also sorry about the spelling .. I meant to give the title as Terminal..patient....sorry for the spelling mistake cant fix it ..

 

It can be draining some of the things you hear, some we can help with others a good ear does the trick.

For you patient might need a bit more info to help, but I assume it is also painful to walk - the 1st thing that springs to mind in a Rocker sole.

Sketchers, MBT type of device, but you would need to look at available strength and balance. If the balance is good and strength ok (especially the Gastroc/Sol complex) then the soft rocker might be the way forward.

 

Yes, I agree. A BK post-op armour boot with a rocker bottom would probably do the job and at least keep this poor chap going.

All the best

Bill

 

"Classic Trainers" eg Nike/Reebok. The thicker sole add a bit of stiffness, but the trainer is overall lighter, and has a good rocker. Otherwise, i agree with Mikes suggestions, provided your man has the strength.

Picking up your point about the job. I assessed a little girl a few years ago, with joint laxity/pes planus. the concerned father told me he was terminal, (young lad he was), and that he was sorting out his childrens concerns before he "left"

Cracked me up, still does, typing this

 

It can be hard listening to some people's stories, but I'm glad that they are comfortable enough to open up to me. I've had a couple of people lately that have kids with cancer, and another that told me all about her grandson's funeral. Like Peter, typing this is choking me up.

 

It's not often we are confronted with problems that medics have to deal with concerning relaying news concerning terminal illness. I had a patient a few years ago suffering from severe pain on the plantar surface of his left foot. it was hot, extremely swollen and throbbing and clearly way beyond anything in my experience. This was in a private hospital, so I was able to send him for an immediate MRI. The Radiologist 'phoned me to say that the diagnosis was osteosarcoma, almost certainly with extensive secondaries and should he send the patient for immediate oncology opinion. I had already promised the patient that I would ring him with the result, so (whilst naturally observing ethical criteria), I had to tell him that the condition was very serious and he should attend the oncological appointment the following day. He was a tough WWII character and asked if he was going to die, because he needed to tell his son. I told him that I didn't know and that he should wait for the appointment the following day. He asked if I could rule it (death) out. I told him that I was not in a position to do so.

I 'phoned the GP (who appeared somewhat upset that the matter was as serious as it was - the patient having been originally referred for orthoses), but despite my verbal and written request, she did not keep me informed of the outcome.

Anyhow, it just goes to show that in this game we come across all sorts of things and that 'breaking bad news and dealing with it's outcomes' should be part of job assessment in the U.K. NHS.

All the best

Bill

 

This reminds of a similar however less serious situation with a Cantonese patient who visited with a booked interpreter.
I cant remember what his foot problem was however on asking him about medical problems he produced a letter and via the interpreter he said he did not understand what it said and had no one at home who could tell him.
The letter was from his local GUM clinic and advised him that he ha been found to have Hepatitis C and could he make and appointment ASAP to discuss future management.
No comparison to the other scenarios but I felt uneasy given him the diagnosis and advising him to get an appointment sorted. I never envisaged when I trained to be a podiatrist I would be giving someone such a diagnosis

 

On occasion we encounter news we find uncomfortable to handle.

My own experience is probably similar to many clinicians. Our trouble seems to lie in the fact that sometimes we have known the patient sometimes for a short time, sometimes for many years. We build a relationship with patients (even inadvertently) . They build a history of us by chance remarks & we in turn build a history of them & their lives.

I like to think sometimes we can make a difference. Not always just by providing podiatric intervention. As clinicians in podiatry we are indeed fortunate that sometimes we are the 'ear' while we treat.

Not all stuff in life is important. The link with peoples lives is.

Love my job. Sometimes it can choke you though.

Feel gratified if those who have a choice to share their woes choose you to share them with. Be honoured.

The hard part is remembering when the patient goes home your next appointment is chuntering in the waiting room.

Love my career, dentists ask questions when you are unable to share.

Kind regards,

Mandy.

 

Hey , Thank you all for sharing your experiences on a clinical and personal level.. Private practice on ones own can be a little isolating sometimes but the forum has alleviated my feelings of inadequacy with respect to this issue..

Thanks again..

FDCB craig

 

I recently have spent a year with a consultant Radiologist as part of my ultrasound qualification. On a regular basis, they have to inform pts of the stuff they find. One memorable case, was a bairn (small child to our American cousins) who needed a liver transplant. The manner in which these specialists deal with this worst-case scenario is more than admirable. We have students occasionally coming to our dept, and occasionally we get asked if you have ever been asked to break bad news (like it is some sort of proud achievement), Im pleased not to have, it must be horrible to think that is part of your job.

respect to those souls who have to.

good post footdoctorcb, very reflective