September 2004

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=120 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="03f8dfe1esnpes.jpg"> <div> <B>September 2004</B></div> <bR> <div> <A HREF="id3.htm" TARGET="_top" TITLE="Calendar"><U><B><U>Calendar</U></B></U></A><A HREF="id3.htm" TARGET="_top" TITLE="Calendar"><U><B> </B></U></A><B>  |   </B><A HREF="id60.htm" TARGET="_top" TITLE="Carers Group"><U><B><U>Carers Group</U></B></U></A><B>   |   </B><A HREF="id2.htm" TARGET="_top" TITLE="Group Guidelines"><U><B>Group Guidelines</B></U></A><B>   |  </B><A HREF="id61.htm" TARGET="_top" TITLE="Library"><U><B> </B></U></A><A HREF="id61.htm" TARGET="_top" TITLE="Library"><U><B><U>Library</U></B></U></A><B>   |   </B><A HREF="id4.htm" TARGET="_top" TITLE="Current Newsletters"><U><B><U>Current Newsletters</U></B></U></A><B>   |   </B><A HREF="id16.htm" TARGET="_top" TITLE="Archived Newsletters"><U><B><U>Archived Newsletters</U></B></U></A><B>   |   </B><B><U>Pamphlets</U></B><B>  |  </B><A HREF="index.htm" TARGET="_top" TITLE="Northern Beaches Prostate Cancer Support"><U><B><U>Hom</U></B></U></A><B><U>e</U></B></div> <div> </div> </td> </tr><tr> <td valign="top" height=360 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="03f8dfc3.jpg"> <div> <B><U>NEWSLETTER</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>No. 27. September, 2004</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Editor: John Conroy<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>1. REPORT OF THE MEETING HELD ON:</B> Tuesday,3 August.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> a. Apologies were received from Richard Darmopil, Robin Casson, Jim Rogan, Ernie and Freda Treloar, and Phillip and Wallis West. We welcomed new members: Norm Evangelides and Ron Jones.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> b. Our speaker for the evening was Dr Peter Moore who is the doctor in charge of the medical team at the Palliative Care Unit located at Mona Vale Hospital. Dr Moore has a long and varied experience in the field of Palliative Medicine. Peter began his talk by clarifying what is meant by Palliative Care. He gave us the following definition:<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Palliative Care is a multidisciplinary specialty, in the health system, aimed at reducing the suffering which can result from advanced illness.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The exact nature of the illness is not important. While traditionally palliative care has mainly been seen as service for cancer patients, this role must be widened to include any disease process which can no longer capably be controlled by medical means - diseases such as heart failure, respiratory failure, kidney failure and progressive degenerative neurological disease.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The major considerations of palliative care are control of symptoms which lead to physical suffering and support to reduce the emotional suffering, not only of the patient, but also of family and others affected.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Every human life ends in death. Dying is, therefore, a natural process and it is vital that life-prolonging measures be avoided in order to reduce suffering. Invasive interventions and investigations must be avoided in the terminal phase of life, and rigorous attention to symptom control must take precedence, and support for the family is paramount.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> In the hospital setting palliative care is provided by a palliative care specialist and the hospital team. This comprises nursing staff, social workers, occupational therapists, physiotherapists, speech pathologists and other services who may be involved in the wholistic care of our patients. Referral to other medical and surgical specialists may also be involved.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> It is expected that all medical and surgical teams in the hospital setting would refer appropriate patients to the palliative care team, whether for symptom control and support as inpatients, or for longer term follow up in the community setting - including aged care facilities.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> There is no excuse, given the services provided by the health system, for any patients to be allowed to suffer for lack of referral to palliative care.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Moore then gave us a brief outline of the structure of Palliative Care in the Sydney Metropolitan Area. It is under the auspices of the Anglican Archdiocese of Sydney and is administered by Hope Healthcare in two major areas: South Sydney (working from Braeside) and North Sydney (working from Greenwich, Neringa and the Northern Beaches). There are no clinics as such. At Mona Vale the staff consists of a doctor, two nurses, a social worker, and a volunteers co-ordinator.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Specialist Palliative Care is a small part of the whole; the role of the specialist is to support the generalists. Most - the vast majority - of the work is generalist Palliative Care, comprising local doctors, community nurses providing hands on nursing, and other community services to maintain people in their own homes. Volunteer workers are seen as specialists; they undergo training and provide outreach into the community.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> At present there are not enough Palliative Care Doctors to do the work needed. The job is expanding and replacement of medical staff is slow. Education of nurses, junior doctors and GPs is necessary.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Peter Moore next described his typical day: It begins with a hospital round, which can be in both private and public hospitals. This will be followed by community visits. He will make contact with patients' doctors and specialists, as networking is most important to work efficiently, and continuity of care is wanted by all. There will also be meetings during the week with other members of the team.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Peter pointed out that we are in the 'tow-away zone' as we get older. We will probably eventually reach the position of having a carer - and our carers may be elderly also. The causes of death 100 years ago were: infectious diseases, accidents, and child birth - what we might call 'sudden death'. Life expectancy then was in the 50 years age range. Nowadays, only 1 in 8 will die suddenly; the other seven will linger. These changes are largely due to clean water, good food and antibiotics, with control of blood pressure being another modern advance.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Death from cancer is due to metabolic failure; that is, tumors release molecules that wreck our metabolism which normally works to store up energy and repair and replace tissue. The rate of progression to the point of no longer being up and about can be thought of in five stages:<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 0 1 2 3 4<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> up and about, up and about needing rest needing rest<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> (a) chair fast no symptoms + symptoms less than half day more than half day<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> (b) bed fast<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> (a) no nursing needed </div> <bR> <div> (b) needs nursing<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The gradient may be vastly different in different circumstances. When the Palliative Care doctor makes a visit to a patient in the early stages, the idea is to build up a planning framework, especially focusing on pain control. The first task is to picture the patient as a person, to simplify things and to find out if he is needing help. With Prostate Cancer, bone pain with movement can occur when the cancer spreads to the bones. Spot welding' with radio-therapy can make a huge difference.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> It is not only physical help that might be needed, but psychological help also. Peter referred to the excellent work being done by Professor Stewart Dunn at the Psycho-oncology Unit at Royal North Shore Hospital, - which we heard about at our June meeting. If the family is struggling, all the Palliative Care staff try to help. Referral may be made to the Social Worker, Maree McCausland, who spoke to us last year. Positive steps will be taken to help all the people in the family, children as well as adults, to deal with the situation. Sometimes the size of the problem may outweigh the resources available. If they are struggling to cope, it is important to talk to someone.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> In-patient Palliative Care is usually limited to a period of six weeks. It may occur in a Public Hospital (Mona Vale in the Northern Beaches, which has four beds) or a Private Hospital (Manly Waters or the Peninsula in the Northern Beaches). Other alternatives may include Aged Care Facilities such as Hostels (though these are not used much in Palliative Care) or Nursing Homes. Other patients may wish to stay in their own homes for as long as possible through the use of community services.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Peter concluded by highlighting the onerous and demanding task of the carer. What makes his own task interesting is that no two people are exactly the same. He feels rewarded when a patient can say: 'You make me feel as if I'm a person'.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>2. INFORMATION UPDATE</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> a.) <B>Golf Day.</B> The Manly-Warringah Division of the Master Builders' Association held their Golf Day at the Cromer Golf Club on Tuesday, 17 August. The Chairman and Committee of the Association have generously offered to donate proceeds from the day to the Northern Beaches Prostate Cancer Support Group to help us with our program and activities.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Despite some late heavy rain, the day was a great success. Our thanks to the Organising Committee, to the sponsors of the day, to Cromer Golf Club, to all those who donated goods and services for auction, to the golfers, to the Master Builders' Association for their offer of support for our cause, and special thanks to John Reid for carrying our flag to the Master Builders.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> b.) <B>Website.</B> Our website is now operating at: <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.nbprostatesupport.com.au" TARGET="_top" TITLE="http://www.nbprostatesupport.com.au"><U><B><U>www.nbprostatesupport.com.au</U></B></U></A></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> If you have any suggestions or comments, please contact by phone or e-mail.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> We are delighted to report that the website is being sponsored by Dr Michael Izard and his team at the Mater Hospital, and we extend to them our sincere thanks for their generous support.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> c.) <B>Brachytherapy</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Michael Izard advises that the Radiology Department at the Mater Hospital in North Sydney is about to install within the next few months an Integrated Brachytherapy Unit for treating Prostate Cancer. This will be the first such Unit outside Europe. We hope a member of his team will be able to talk to us about this facility in the New Year.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> d.) <B>Library</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> A series of booklets recently published by Andrology Australia has been placed in the Group's lending library. These are available for borrowing at any time.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * Prostate Enlargement in the Older Male: A Guide to Urinary Symptoms in Men;<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * Erectile Dysfunction: Impotence and related health Issues;<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * Testicular Cancer;<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * Male Infertility: A child of my own; and<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * Androgen Deficiency: Is low testosterone putting me in the slow lane?<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> You can also find full details about men's sexual health at the Andrology Australia website: <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.whateverymanneedstoknow.org" TARGET="_top" TITLE="http://www.whateverymanneedstoknow.org"><U><B><U>www.whateverymanneedstoknow.org</U></B></U></A></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> e. <B>Carers. </B>The next meeting of the Carers Group will be held on Tuesday, 12 Octoberat 6.30 pm in the Palliative Care Cottage. The speakers will be: Srs Pam Johnston & Jenny McGowan: Cancer, Palliative Care and the Sydney Home Nursing Service.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>3. REMINDER: - DATES OF NEXT MEETINGS: </B>(6.30 pm on the first Tuesday of each month in the Palliative Care Cottage, Mona Vale Hospital) All friends, partners, carers, and family members are welcome. Refreshments will be served.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 7 September Ms Christine Holbert: Stress Management (This session is the continuation of a series on mental and emotional factors which began with Stewart Dunn speaking on Cancer and the Mind in June, and was followed by the Carers meeting in August when Brenda Doherty spoke on Sleep Therapy. Christine Holbert is highly experienced in her field. Her talk will cover:<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> the physiology and effects of stress on the body;<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> the beneficial effects of relaxation techniques on the body and mind;<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> some practical exercises in relaxation;<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> examination of self-talk; and<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> discussion on present moment living' and its importance in stress reduction.) </div> <bR> <div> 5 October Sr Jane Matthews (St Vincent's Clinic): Rehabilitation after Treatment for Prostate Cancer<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Please note: during meetings, all discussion and comment about our individual circumstances and experiences is confidential and should not be repeated outside the Cottage walls!<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <bR> <div> <B>YOUR CONTACT NUMBERS</B></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1" WIDTH="664" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 116 WIDTH="357"><div> <U>Program Co-ordinator</U> </div> <bR> <div> Dr Peter Moore </div> <div> Northern Beaches Palliative Care<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> 9997 3555 </div> </tD> <tD VALIGN=TOP WIDTH="296"><div> <U>Group Leader</U></div> <bR> <div> John Conroy<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> 9918 9358<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <A HREF="mailto:conroyjs@bigpond.com" TARGET="_top" TITLE="mailto:conroyjs@bigpond.com"><U><U>conroyjs@bigpond.com</U></U></A></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 89 ><NOBR><div> <U>NSW Cancer Council Cancer Support Helpline</U></div> <bR> <div> 13 11 20<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> <U>Prostate Cancer Foundation of Australia</U></div> <bR> <div> 1800 220 099</div> </NOBR></tD> </tR> </TABLE></div> <bR> <bR> </td> </tr></table></body>