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Aromatherapy within a Palliative Setting
by Judith Dendy

Judith Dendy is a intervenante at Maison d'Hérelle since 1992. She is also a Special Educator, Coordinator of Alternative/ Complementary approaches to medicine and clinical Aroma Therapist. She is a therapist in integral approach and she practises therapeutic touch to help diminish pain and help people on their last journey on earth.

I am a Special Care Counsellor who has been working with people in different stages of HIV/AIDS (Acquired Immunodeficiency Syndrome) within a hospice (Maison d’Hérelle) located in Montreal, Quebec Canada for about 15 years.

When a person’s immune system is seriously compromised as it is with diseases such as cancer and AIDS, all of the levels of their Being are affected. Their physical, emotional, psychological, social and spiritual selves are greatly challenged at this end stage of their lives. Part of my job is co ordinating the Complementary/Alternative approaches to medicine which include Naturopathy, Homeopathy, Aromatherapy, Art therapy, Music therapy, Zoo therapy, Massage therapy, Therapeutic Touch, Shiatsu, Acupuncture, Reflexology and Reiki. All of these approaches are carried out by staff members like me and volunteers who are certified in their respective fields.

Introducing Aromatherapy to the Hospice
Aromatherapy was introduced to our hospice in 1993 by one patient called Jamie (whose name has been changed to protect his identity). Jamie was a practising Aromatherapist until he became too sick to live at home. He was admitted to our facility so that he might benefit from the palliative care program offered at the hospice. Upon his death the hospice was gifted with one of his books, The Complete Book of Essential Oils & Aromatherapy by Valerie Ann Worwood and a dozen or so of his essential oils.

At that time the use of essential oils for therapeutic purposes was not accepted by the medical profession so we had to step carefully. We slowly began to use the oils, first by means of a diffuser. A few drops of lavender (Lavandula angustifolia), eucalyptus blue gum (Eucalyptus globulus) and lemon eucalyptus (Eucalyptus citriodora) were diffused for 10 minutes every 2 hours. This helped patients who were anxious due to their difficult breathing, also known as dyspnoea (Davis, 1997) which may occur during the last stage of their lives. Both Eucalyptus globulus and Eucalyptus citriodora are used in Brazilian folk medicine for the treatment of various medical conditions such as cold, flu, fever, and bronchial infections. Studies have shown that they possess central and peripheral analgesic effects as well as neutrophil-dependent and independent anti-inflammatory activities (Silva et al. 2003).

Patients choose lavender oil
Up until that point the massage therapists who came to the house only used cold pressed sweet almond oil (Prunus amygdalus) (Mitchell, 2005) but they were willing to try adding a few drops of an essential oil, chosen by the resident at the time. Many chose lavender stating that the scent reminded them of their grandmother and the little bundles she would make and put in drawers to keep their clothes smelling nice. Looking at the literature we can see why. Lavender (Lavandula angustifolia) is well known for being a mild sedative, for its calming and relaxing effects, and for reducing emotional and behavioural stress levels (Guillemain et al. 1989) (Buckle, 1993). Lavender has also been shown to improve a person’s mood and to lower perceived levels of anxiety (Dunn et al. 1995). Moreover it reduces physical pain intensity and pain unpleasantness (Gedney et al. 2004). According to Julia Lawless (2002), “Lavender is generally regarded as the most versatile essence therapeutically”.

We have used lavender in so many ways over the years that it is difficult to think of a time when it wasn’t a part of our lives. Just the other day a resident was very agitated and confused and the caregiver called me for advice. I suggested using the electric diffuser; 10-20 drops of pure lavender oil for 10 minutes and the offer of their company in silence by their bedside. Not 5 minutes later, the resident fell asleep and awoke 5 hours later. She was no longer agitated and a little less confused.

The therapeutic value of other essential oils in palliative care
Peppermint oil (Mentha piperita) is another essential oil widely prescribed for nausea, headaches, lack of appetite as well as being added to other recipes that requires an antalgic and anaesthetic action (Baudoux, unknown) (Mitchell, 2005) (Franchomme and Pénoël, 1990) (Sheppard-Hanger, 1995) (Ellwood, 2001) (Raudenbush, 2001). Some of the residents experience these symptoms on a daily basis due to medication and stress.

Tea tree oil (Melaleuca alternifolia) and Niaouli oil (Melaleuca quinquenervia var cineole) have antibacterial, antiviral, antifungal, antiseptic and anti-inflammatory properties (Franchomme and Pénoël, 1990) and are the main ingredients in a recipe we have repeatedly used for patients with candida/herpes, with excellent results.

Listed below are the essential oils which are used most frequently in the hospice for the symptoms most commonly experienced by the patients.

Cananga odorata Totum Extra - Ylang-Ylang:
Tachycardia, tonic for dry scalp, nervous tension, pain, panic & shock

Cinnamomum camphora - Ravensar:
Shingles, infections of the respiratory system, insomnia, muscle fatigue, herpes zoster

Cinnamomum verum - Cinnamon (bark):
Foot fungus, toothache

Citrus aurantium ssp amara - Neroli:
Fatigue & nervous depression, insomnia, immuno-stimulant

Citrus paradisi - Grapefruit:
Anorexia, depression, airborne disinfectant

Citrus reticulate - Mandarin (zest):
Hiccups, indigestion, difficulty in breathing, insomnia

Cupressus sempervirens - Cypress wood:
Poor circulation, hemorrhoids, muscle cramps

Cymbopogon martinii - Palmarosa:
Thrush, eczema (dry & wet), sinusitis

Eucalyptus citriodora - Lemon eucalyptus:
Arthritis, rheumatism, tendonitis, fungal infection, herpes, athlete’s foot

Eucalyptus globules -Eucalyptus blue gum:
Pneumocystis carinii, laryngitis, otitis, sinusitis, bronchitis

Gaultheria procumbens -Wintergreen:
Sore muscles, arthritis, rheumatism, sciatica, hypertension

Helichrysum italicum -Everlasting
Muscular aches & pains, herpes, spasmodic coughing

Laurus nobilis -Sweet bay:
Muscle contraction, viral infections, swollen glands, hypertension

Lavandula angustifolia -True lavender:
Anxiety, insomnia, nervous spasms, wounds, bedsores, eczema, burns, itching, muscle cramps

Melaleuca alternifolia -Tea tree:
Infections of any kind, otitis, sinusitis, viral, bacterial, candidosic & parasitic enteritis
Melaleuca quinquenervia cineole -Niaouli:
Respiratory infections, herpes,& genital herpes, shingles, hemorrhoids

Melissa officinalis -Lemon balm:
Insomnia & herpes simplex

Mentha piperita - Peppermint:
Nausea, vomiting, indigestion, migraines, shingles, sciatica, inflammatory pains, to stimulate appetite

Mentha spicata -Spearmint:
Dermatitis, all respiratory problems, fatigue, nervous strain

Ocimum basilicum var. basilicum -Sweet basil:
Viral infections, gastric spasms, depression, anxiety, nausea, sinus congestion, asthma

Origanum majorana -Sweet marjoram:
Neuralgia, psychosis, tachycardia

Pelargonium asperum cv Egypt -Geranium
Mycosis, dermatitis, rheumatoid, spinal pain

(Baudoux, unknown) (Franchomme et al. 1990) (Mitchell, 2005) (Schnaubelt, 1999) (Sheppard-Hanger, 1995)


Healing and improving family relationships
The emotional impact of dying differs for each individual and for the people surrounding them, whether loved ones or care-givers. Particular care is given to ensure that the transition takes place in an atmosphere of peace and tranquility, free of physical and emotional pain. Towards the end, when a resident is no longer able to leave their bed, we increase their massages from once or twice a week to every two hours. During the treatment, they are repositioned, thus avoiding bed sores, muscle cramps and poor blood circulation. When possible, a blend of essential oils chosen by the resident is added to a carrier oil such as grapeseed (Vitis vinifera) or cold pressed sweet almond oil to achieve maximum absorption. The caregiver will invite family members or close friends of the patient, who are often afraid to touch for fear of hurting and or disturbing them, to assist in a gentle massage. As a result, we have witnessed significant changes vis-à-vis family members, such as healing within relationships, a decrease in feelings of helplessness and gratitude for the quality of time spent in their presence, rather than sadness for the time left.


Complementary and Alternative Therapy (CAT) Manual
Over the years, with the help of volunteers and co-workers interested in complementary and alternative therapies (CAT), a reference manual has been created with information on CATs that is available for the different pathologies that we have encountered at Maison d’Hérelle. This manual has become an important support tool for the team and we intend to publish it in the near future. In the meantime you may consult our website www.maisondherelle.org for the recipes that we have found most beneficial.


Aromatherapy in the world-wide palliative care community
I know of at least one hospice in Toronto, Ontario which offers Aromatherapy to their residents. Casey House will, “incorporate if the need arises, essential oils into a massage, to enhance the quality of life of their residents”.

Similarly Dr. Hann is part of the Integrative Palliative Aromatherapy Care Program which began five years ago at the Center for Palliative Studies and Care at San Diego Hospice. As a pioneer and trail blazer, Dr. Hann goes on record stating that her care team turns to aromatherapy for help when they are confronted with tough patients, difficult-to-manage pain or complex psycho social issues. Moreover she hopes to see this wonderful therapeutic option become available for all of her patients (Schwan, 2004).

Rhiannon Harris in her article entitled, Aromatic Approaches to End-of-life Care (2004) states that the use of aromatherapy in palliative care and a hospice environment is increasing and that Aromatherapists are being regularly included as part of the care team.


Conclusion
We at Maison d’Hérelle have come to the conclusion that the need for an aromatherapist in our palliative care program is a necessity. However slow a process, we believe that some day aromatherapy will no longer be considered as a potential element in a resident’s care package but rather a universally accepted treatment in an integrative holistic approach to managing symptoms within a palliative care setting for people with terminal illness.

Aromatherapy plays an important role within our palliative care program. It has successfully and considerably reduced many of the side effects of patients with terminal illness and has considerably improved their quality of life. As a caregiver, it lightens my heart when I see a person resting comfortably and peacefully as a result of Aromatherapy. I look forward to networking with my peers to further the advancement of Aromatherapy within a palliative care setting for people living with terminal illness.

References
Baudoux, D. (Unknown).Essential Oils, 2000 Years of Aromatherapy Discoveries: the Medicine of the Future. Belgium: Ed.Inspir.
Buckle J. (1993) Aromatherapy. Nurse Times. 89(20):32-35. Retrieved on 10-24-2005 at http://www.uspharmacist.com Combest, W. Alternative Therapies: Lavender.
Buckle, J. (2003) Clinical Aromatherapy: Essential Oils in Practice. 2nd Ed. New York: Churchill Livingstone.
Casey House. Complementary therapies being used in an AIDS hospice in Toronto, Ontario. www.caseyhouse.com
Davis, C. L. (1997) ABC of palliative care. Breathlessness, cough and other respiratory problems. BMJ315:931-4. Retrieved on 09-12-2005 at http://www.bmj.bmjjournals.com
Dunn C, Sleep J, et al. (1995) Sensing an improvement: an experimental study to evaluate the use of aromatherapy, massage and periods of rest in an intensive care unit. J Adv Nurs. 1995; 21(1):34-40. Retrieved on 10-24-2005 at http://www.uspharmacist.com Combest, W. Alternative Therapies: Lavender.
Ellwood, J. (2001) Using aromatherapy and massage in palliative care. Retrieved on 09-27-2005 at www.aromacaring.co.uk/palliative_care.
Franchomme & Pénoël, Dr.D. (1990). L’aromathérapie exactement: Encyclopédie de l’utilisation thérapeutique des huiles essentielles. France :Ed. Jollois.
Gedney J, Glover T, et al. (2004) Sensory and Affective Pain Discrimination after Inhalation of Essential Oils. Psychosomatic Medicine 66:599-606. Retrieved on 09-18-2005 at http://www.psychosomaticmedicine.org
Guillemain J, Rousseau A, et al. (1989) Neurodepressive effects of the essential oil of Lavandula Angustifolia .Mill.Ann Pharm Fr. 47 (6):337-343. . Retrieved on 10-24-2005 at http://www.uspharmacist.com Combest, W. Alternative Therapies: Lavender.
Harris, R. (2004) Aromatic approaches to end-of-life care. IJCA. Vol 1.Issue 2.10-20.
Lawless, J. (2002) Illustrated Elements of Essential Oils. London:
HarperCollins.
Maison d’Hérelle. Recipes for different problems encountered at a hospice for people living with HIV/AIDS can be found at www.maisondherelle.org
Merriam-Webster Medical Dictionary (2002) Peripheral Neuropathy. Springfield: Merriam-Webster, Inc.
Mitchell, M. (2005) Material taken from ¨200 Hour Certified Standard Aromatherapy Program¨ in Module # 5, # 6, & # 7.
Nicole, Maurice. Herbalist and founder of Institut D’Aromatherapie Scientifique. http://www.aromascientifique.com
Raudenbush, Dr.B. (2001). Pain threshold and tolerance mediation through the administration of Peppermint odor: a preliminary study. ACR-Vol. X, (2): 10-12. Retrieved on 09-12-2005 at http://www.olfactory.org
Schnaubelt, K. (1999) Medical Aromatherapy: healing with essential oils. California: Frog, Ltd.
Schwan, R. (2004) Integrative Palliative Aromatherapy Care Program at San Diego Hospice and Palliative Care. IJCA. Vol 1 Issue 2. 5-9.
Sheppard-Hanger, S. (1995) The Aromatherapy Practitioner Reference Manual. Florida: Atlantic Institute of Aromatherapy.
.Silva, J. Abebe, W et al. (2003) Analgesic and anti-inflammatory effects of essential oils of Eucalyptus. J.Ethnopharmacol. Dec; 89(2-3):277-83. Retrieved on 09-12-2005 at: http://www.pubmed.gov
Vazquez, JA. Zawawi, AA. (2002) Efficacy of alcohol-based and alcohol-free Melaleuca oral solution for the treatment of fluconazole-refractory oropharyngeal candidiasis in patients with AIDS. HIV Clin Trails. Sep-Oct, 3(5): 379-85. Retrieved on 01-19-2006 at http://www.pubmed.gov
Worwood, V. A., (1991) The Complete Book of Essential Oils & Aromatherapy. California: New World Library.

 
 
 
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