Few stories are as inspiring and affecting and Baxter's.  The "golden chow" rescue dog turned hospice hero spent the last seven years of his life volunteering at San Diego Hospice.  He brought comfort and calm to patients facing death, he brought solace and a smile to grieving loved ones, he graced hospice staff and volunteers with his gentle soul.  He was a beautiful dog, inside and out.  His teddy bear looks and loving nature touched everyone he met.  His story is inspiring and deserves to be heard and shared.

Melissa Joseph, Baxter's owner, wrote a book about Baxter's work.  <i>Moments With Baxter</i> is a collection of 36 stories of how Baxter impacted the lives of those he touched.  I received my copy in the mail a couple of days ago and I've already read 25 of the stories.  I made the mistake of taking the book to my daughter's gymnastics class and ended up crying in the lobby because I was so moved!  Baxter has an international fan club and the book is a top seller.  Baxter even has his own stuffed animal replica complete with a pet therapy vest.  Shhh....my daughters are each going to get one for Christmas!

Read Baxter's story to learn more about this amazing dog.

Don't miss my Q&A with Melissa Joseph, Baxter's owner and author of <i>Moments With Baxter</i>

Learn more about pet therapy volunteers and how to get your pet certified.

Trisha Torrey, About.com Guide to Patient Empowerment, knows all to well the importance of being a patient advocate.  She herself was misdiagnosed with a serious illness for which the treatment could have killed her.  She pursued a second opinion and was thankfully given good news.  In her blog today, she shares another personal story with readers - the story of her mother's death.

Trisha's mother suffered with Alzheimer's Disease for many years and died peacefully last week under the care of hospice.  Please visit Trisha's blog to read her touching personal story.

Mom - No Longer a Prisoner of Alzheimer's Disease

Flexible spending accounts (FSA's) are employer-sponsored benefits that allows you to pay for eligible medical expenses on a pre-tax basis.  If you have set up one of these accounts with your employer and haven't used up the money you've set aside, now is a good time to start spending those dollars.  Most plans don't allow you to carry over money each year so you might need to get creative on how you can spend the money before you lose it.

An FSA will cover items that can be very useful to palliative care patients and their caregivers.  It allows for reimbursement for things you might be spending on regularly, such as:

• Adult diapers and other incontinent supplies
• Wound care dressings and first aid supplies
• Latex gloves
• Medical equipment (walkers, shower chairs, wheelchairs, etc.)
• Fees for hospital services, qualified long-term care services, accident and health, and qualified long-term care insurance premiums, nursing services, laboratory fees, prescription medicines and drugs, and insulin.

If you are a palliative care patient or the caregiver of one, chances are your spending money on at least one of these items.  Why not spend pre-tax dollars to get them?  Use up your hard earned money sitting in your FSA and remember to sign up for an FSA next year.

November is nationally recognized as Hospice and Palliative Care Month.  This is an excellent time to do whatever you can to raise awareness of hospice and palliative care and to support local and national programs providing or supporting palliative care.

What is National Hospice and Palliative Care Month?

How Will You or Your Organization Honor National Hospice and Palliative Care Month?

What is Palliative Care?

What is Hospice Care?

A recent report by Human Rights Watch found an alarming number of Indian cancer and HIV patients are left to suffer without adequate, if any, pain control. The 108 page report, released on October 28, 2009 found that "many major cancer hospitals in India do not provide patients with morphine, despite the fact that more than 70 percent of their patients are incurable and likely to require pain treatment and palliative care." According to Diederik Lohman, senior health and human rights researcher at Human Rights Watch:

"India's health care system abandons so many patients to severe pain. They are left to suffer; many told us that their pain was so bad they would prefer to die."

The report identified three key factors responsible for this underuse of affordable and effective pain control:

1. Restrictive drug regulations in India: Many Indian states have excessively strict narcotics regulations that make it very difficult for hospitals and pharmacies to get morphine. In 1998, the central government recommended that states adopt modified regulations, but more than half of India's states have not done so.
2. The failure to train doctors: Most medical students and young doctors receive no training on pain treatment and palliative care because the government does not include such instruction in relevant curricula. As a result, most doctors in India simply do not know how to assess or treat severe pain.
3. Poor integration of palliative care into health services: National cancer and AIDS control programs do not contain meaningful palliative care components, thus depriving such care of public funds and relegating it to second-tier status.

Interestingly, India is one of the largest producers of Opium, the key ingredient for Morphine.  Yet, the majority of the crop is exported while millions of Indian people suffer unnecessarily without adequate pain control.

Read the full Human Rights Watch report, "Unbearable Pain:  India's Obligation to Ensure Palliative Care"

What is Palliative Care?

Finding Palliative Care

Pain Management in Palliative Care

Medical marijuana advocates, users, and suppliers recently received some good news.  President Obama has implemented a new policy advising federal prosecutors to stop targeting people involved in the sale and use of medical marijuana in compliance with state law.  Fourteen states have legalized the medicinal use of marijuana, although the laws vary widely between them.  While this new Obama policy is good news for legally diligent citizens, many are still worried about complying with the web of state laws, which can be quite confusing.

Most medical marijuana proponents are excited by this decidedly different take on marijuana use which is in stark contrast to the Bush Administration's view.  They are optimistic that this brings us one step closer to nationwide legalization of medicinal marijuana.  And indeed, it's looking more and more like legalization is in the future.  Fortune Magazine ran tantalizing cover story in September about the legalization of marijuana.  I was surprised to find out that Obama had introduced this marijuana policy all they way back in February of this year.  Interestingly, although this was a huge step forward in the legalization process, this move by the President received little to no publicity.  The article is a great read and admittedly thought provoking.

I happen to live in California, the pioneer of medical marijuana laws.  Hospice patients in my area don't have a hard time getting approved for medical marijuana (okay, if we're being honest here, anyone with enough cash and some form of medical condition, real or made up, won't have a difficult time either).  The use of medicinal marijuana is rapidly increasing in the palliative care community and we are already seeing positive outcomes - reduced nausea, increased appetite, improved pain control, etc.

You might have some questions about medical marijuana and whether it's right for you or your loved one.  Here's some information to get you started:

Medical Marijuana:  Frequently Asked Questions

The CDC has confirmed that the sickest patients with the pandemic H1N1 (swine flu) virus have other serious medical conditions.  The findings applied to both children and adults.  Among about 1,400 adults hospitalized with the flu, the most common pre-existing conditions were asthma, diabetes, chronic lung disease, chronic heart disease, and immunosuppression.

Most palliative care and hospice patients have at least one of these comorbidities, making the flu vaccine a near necessity for these patients and their caregivers.  Unfortunately, not all hospice agencies offer the vaccines to their patients.  If this is the case for you, contact your primary care physician and inquire about getting the vaccine.  Palliative care and hospice patients and their caregivers are a top priority for the vaccine so you shouldn't have much trouble finding the shots.

H1N1 Vaccine and You

Get ready to celebrate...and spread the word about quality end-of-life care.  Tomorrow marks World Hospice and Palliative Care Day. The event is celebrated annually on the second Saturday of October to raise awareness of hospice and palliative care around the world.  Hospice and palliative care organizations are celebrating around the world in 70 countries and working hard to get the word out about choices and quality care at the end of life.

This year Voices for Hospice falls on the same day.  Voices for Hospice occurs bi-annually on the same date.  The event is celebrated with a wave of musical concerts around the world.  Want to attend a concert near you? Find locations of registered Voices for Hospice events near you by visiting the World Hospice and Palliative Care Day page.  Enjoy the music and help raise funds to support hospice programs world-wide.

Is  your hospice organization participating this year?  Share how you or  your organization celebrated World Hospice and Palliative Care Day 2009.

What is Hospice?

What is Palliative Care?

Anger is one of the five stages of coping with death.  The five stages - denial, anger, bargaining, depression, and acceptance (also known as DABDA) - we're made popular by Elisabeth Kubler-Ross in the 1960's and are still very relevant today.  Anger is, perhaps, the most universal of these stages; nearly every dying person feels angry at some point during their journey.  A dying person's loved ones and caregivers often bear the burden of this anger and may have a difficult time coping with it's repercussions.

There are some strategies caregivers and loved ones can use to cope with anger, and perhaps even help the dying person cope with it as well.

5 Tips for Coping With A Loved One's Anger

An article published last week in the New York Times, After Death, The Pain That Doesn't Go Away, deals with the sometimes silent problem of complicated grief.  Complicated grief is grief that is prolonged, persistent, and severe and is sometimes referred to as "abnormal grief".  It interferes with a person's entire life, stripping them of their interests and desires in life and often takes the form of severe depression.

Complicated grief is being considered for spot in the DSM-V,the American Psychiatric Association's handbook for diagnosing mental disorders.  Until now, complicated grief hasn't been thought of as an actual mental disorder itself but rather an aspect of another existing disorder (think depression, post-traumatic stress disorder, etc).  That will all change if the decision is made to include complicated grief in the DSM-V, which is due out in 2012.

While there is no handbook for how one should grieve and for how long, there is a point when grief becomes serious and potentially dangerous.  An example of complicated grief offered in the NYT article:

In 2004, Stephanie Muldberg of Short Hills, N.J., lost her son Eric, 13, to Ewing's sarcoma, a bone cancer. Four years after Eric's death, Ms. Muldberg, now 48, walked around like a zombie. "I felt guilty all the time, guilty about living," she said. "I couldn't walk into the deli because Eric couldn't go there any longer. I couldn't play golf because Eric couldn't play golf. My life was a mess.

"And I couldn't talk to my friends about it, because after a while they didn't want to hear about it. 'Stephanie, you need to get your life back,' they'd say. But how could I? On birthdays, I'd shut the door and take the phone off the hook. Eric couldn't have any more birthdays; why should I?"

Four years of severe grief will take it's toll on a person's emotional and physical self and needs to be treated.  How can you know if your grief is complicate?

Grief:  What's Normal and What's Not