Aromatherapy practitioner - hospice care - case studies in essential oil use

The Benefits of Clinical Aromatherapy in Hospice, Palliative, and End-of-Life Care – 9 Case studies

Saloni Malhotra RN BSN HNB-BC CCAP

I work as a RN Case Manager and Holistic Nurse Consultant and Educator for Compassionate Care Hospice (CCH) in Boston, Massachusetts. When I joined CCH in June 2008, the company was just opening its Boston office and was very receptive to using a holistic approach. At CCH we are utilizing reiki, guided imagery, music therapy, massage, art therapy, pet therapy, aromatherapy, and reflexology. In the previous three hospices I have worked for, some nurses did reiki, volunteers did massage, brought pets for visits, or played music, but an applied holistic approach care-planned is still virtually unheard of. Some hospices have a few lavender-bergamot blends made and use them for dementia patients, but have never used clinical aromatherapy to manage symptoms, where every blend is custom made with a look at the patient’s diagnosis, medication list, and allergies. This is what makes my job so unique and rewarding when I bear witness to the difference it makes in the life of my patients.

For the purpose of this paper I will be focusing and sharing with you what a blessing the use of clinical aromatherapy has been to our patients in improving their quality of life, often with astounding results. First a little bit about my journey and how I arrived to this point.

Nursing

Nursing is my second career; my previous degrees were in English literature and Mass Communication. Since both degrees were from India, I really could not proceed very far with them in the United States, and my aptitude test indicated I would do well in nursing. I graduated with a bachelor’s degree in Nursing in 1992 and took a circuitous route that involved hospital, rehab, and long-term care until I arrived at hospice and found my niche, as long as I got to do holistic. Having been born and raised in India until I was 22, my roots and upbringing kept me anchored to homeopathic, ayurvedic, herbal, and kitchen remedies. I also knew reflexology, some acupressure, massage, and meditation.



After getting my feet wet and adjusting to working in a hospital, I was restless and desired for something more from my nursing practice. I wanted to be able to bring more to my patients than I was able to provide. In 1994 and 1995, I learned reiki and found that piece. In 1996, I learned to teach reiki and found the more I taught, the more learning pathways appeared. At present, I am certified in 23 different modalities. I am also a registered aesthetician. Clinical Aromatherapy application is marvelous in both my practices.



I studied Dr. Jane Buckle’s Clinical Aromatherapy for Health Professionals program. It was taught by Kathleen Duffy in four modules. We studied chemistry, 33 essential oils considered safe for clinical use, and did a case study for each of the 33 oils, to cultivate a relationship between essential oils and carrier oils. It concluded with a research paper that had to be presented and defended and, of course, the written exam.



All this took a lot of time, effort, and money. The rewards from the study and applications have far exceeded my wildest expectations. They have elevated my nursing practice and improved the quality of care that I (and our hospice team) deliver to our patients. Clinical Aromatherapy is a passion I love to share with others.



Quality of Life & Death/Dying



In USA, Medicare has a specific criterion for hospice eligibility for each diagnosis. Every hospice has a team that encompasses a registered nurse, a social worker, a chaplain, and a home health aide to provide patient care. Volunteers are provided when accepted. The main goal for the team is to help the patient live and die in comfort and with dignity, while having their physical, mental, emotional, and spiritual needs met. I have often found the LIVE part often gets overlooked and all the focus is on dying. Time is of the essence for everybody, but especially when you are on hospice. A hospice team often has a very small window of opportunity to meet a patients living & dying needs. A patient’s needs encompass the patient’s caregivers and whomever they call family. Our hospice team collectively does the live and dies exceptionally well holistically.



CASE STUDIES



I will present 9 different patients and how they LIVED well and DIED well, and how Clinical Aromatherapy remedies assisted them to do so.



Patient privacy is being maintained, so all names have been changed. The diagnosis, treatment, and outcomes/results are factual.



Marlene P



Marlene was an attractive 56 year young woman, who had a diagnosis of stomach cancer with metastasis.



When I met Marlene for the first time it was for an informational, after her doctor’s office recommended hospice. The faxed paperwork indicated that Marlene had abdominal surgery to remove her stomach and the goal was to put a j-tube in, but when they opened her up, the cancer had spread all over the abdominal cavity. Given the fact that she had a history of juvenile diabetes, she was not a candidate for chemotherapy and/or radiation.



During our informational, Marlene was angry, weepy, and had a laundry list of complaints. Her doctor’s assistant had wished me, “Good Luck, she is the most temperamental patient we have. A real drama queen!” My intention when I saw her was to set aside that comment and be open to assist her to the best of my capability. She showed me her stomach incision: two centimeters looked infected, red, warm, swollen, and draining. She had severe nausea, her blood sugars were all over the place, she had not moved her bowels in five days, she hated taking medications, and she was in excruciating pain. She did not like taking “all these stupid pain pills that make me a space cadet.”



Marlene used half a box of tissues during our two hour informational. I knew she was anxious because she shred the tissues she used. She screamed, “Look at me! Just look at me! I was a perfect 140 pounds three months ago and now I am down to 103 pounds. I have no boobs left, look at my stomach I’ll never wear a bikini again. I am not ready to die.”



Marlene had questions about the holistic aspect of our hospice, which I answered while doing reiki per her request. She concluded our session by stating, “I think I will call Dana Farber for a second opinion about my cancer.” I left, wishing her well.



The next morning she called to request hospice because, “Whatever you did, I pooped after you left and my pain was less, I felt better and lighter.”



Marlene admitted herself to hospice. She was alone for both the informational and the admission. That in itself was unprecedented in my experience to date. Most patients have a significant other, children, siblings, a friend, or a health care proxy (HCP) with them; supporting them during the admission process. Marlene was estranged from everybody; she lived alone. Her daughters were estranged, as well as her significant other, an 80 year old wealthy man, who was with a younger woman so,  “She can care for me. I am too old to take care of somebody who is dying.”



Marlene’s diverse needs presented a huge challenge to the team. My first visit post admission, I honored her request for no additional pills by bringing her a ginger essential oil sniffer to manage her nausea and vomiting. She used it (with refills) throughout her six months on hospice. She never needed any anti-emetic. She went on to eat with a preference for pepperoni pizza and macaroni and cheese. We did get her weight up to 117 pounds.



I used a blend of Tea-Tree and Myrrh in Aloe Vera for the infected incision and applied it two times daily until it healed. By then, Marlene was complaining about abdominal cramps and deep muscle pain. I used a 10% blend of Lemongrass and Clary Sage in Jojoba Oil. I ended up adding Sweet Marjoram because of its ability to increase peristalsis. She was on Dilaudid, a narcotic for pain management, refusing to be on a bowel regimen, but agreed to drinking 6 ounces of apple cider daily and eating applesauce three times a day to keep the bowels moving. By no means idyllic but it did the job. I want to add here that Marlene decided she wanted to rent a cottage at Hampton Beach one last time. We had to contract with another hospice in New Hampshire to visit her two times during that week, to meet her needs while she was there. She ended up extending her stay for two weeks. It was reported that she opened the cottage door for the New Hampshire Hospice nurse wearing a red bikini. The essential oils had healed her so well, there was no scarring. No conventional medical treatment would have allowed such healing, especially to somebody with low protein and albumin and metastasized with cancer. Wound healing protocols here also call for Zinc and Vitamin C. Her diet was not particularly good quality or protein rich.



Marlene’s anxiety was managed with flute music and a blend of Lavender, Bergamot, and Angelica. Angelica was used for its hug-around-the-heart benefit. After using a combination of guided-imagery/visualization, music, and aromatherapy, I invited her to visualize her perfect passing. We did this 6 times. Marlene passed exactly as we visualized. She stayed continent until 2 days before she passed, on very few medications, and she reconciled with her brother. He and her nieces were present, the flute music was playing, the scent of aromatherapy permeated the air, and she was in her own bed, with her hair looking perfect. Needless to say, Mother Nature’s bounty played a major role in helping her live well.



Peter P



Peter was a 72 year young engineer, a much loved husband, and a father of two children. He came to us with a diagnosis of Lung Cancer with metastasis to the brain. Peter was also status post surgery for removal of a brain tumor. His persistent headaches had prompted him to seek medical attention when they got really severe and unresponsive to Acetaminophen. By the time he was diagnosed, his cancer had metastasized to the point that it was difficult to pinpoint the originating site. He declined further treatment opting to enjoy the time he had left with his family.



His hospital discharge papers and prognosis gave him two weeks to live. His symptoms to manage were nausea, Charlie-Horses/severe leg cramps, and bilateral heels which had multiple cracks that were like fissures. The cracks were so deep you could have slid a dime halfway, and they were very painful.



Peter was admitted to our hospice at the end of November. He verbalized, “I just have two wishes, I want to live to see my only grandchild’s first Christmas, and I want to be able to walk up and down my living room holding and carrying him so that my daughter and son-in-law can sleep-in during the mornings when they come on Fridays from New Jersey.” Peter’s problem was the fissures in the heels, which made walking painful and difficult.



The only treatment I knew that could help his heels heal fast and also help with the Charlie-Horses/leg cramps was holistic - using essential oils. I explained this to Peter and his wife; I also made sure they understood that essential oils stained. They were open to Peter wearing sweatpants and doing a twice daily application of the blend I made. I used Almond oil with a 7% titration of German and Roman chamomile. I selected German chamomile because of its anti-inflammatory and analgesic properties, and Roman chamomile for its anti-spasmodic effect. The heels healed within 9 days; all fissures in both heels closed. Peter slept well all night without Charlie-horses, except for one night when he slept at his son’s house and forgot the essential oil blend at home. We used a ginger sniffer for the nausea throughout and visualization of him being present for his grandson’s Christmas. Peter passed peacefully at home surrounded by his family. He was on hospice for two months, without morphine or oxygen until his last week. Essential oil use gave his life the quality he desired. He had 5 weekends and Christmas morning of walking his grandson, until he was too weak.



Jim C



Jim came to us with a diagnosis of pancreatic cancer with metastasis to the brain. His symptoms to manage were severe pain, constipation, and depression. He was 87 years old. Jim also had the the worst case of psoriasis and eczema I had ever seen. Except for the soles of his feet and a very concave stomach, he pretty much had skin that was red, dry, flaky, peeling, blotchy, and itchy, as evidenced by numerous scratch marks on both arms and legs. I asked his sister, his health care proxy, if I could use some essential oils to treat his psoriasis. She replied, “Oh nothing works on him. Trust me we have tried everything over the years. Jim has had it since he was fifteen.” Jim had never been on a date, never socialized; he worked as a draftsman and lived with his mother until her death. He was a recluse and a well known local artist, whose work was bought by galleries and donated to libraries. Jim lived in an apartment in an affluent assisted living facility. He also had private twenty-four hour care. I was informed he never left his apartment.



On admission, we do a complete assessment. After spending two hours with him, I had no clue to his eye color, or whether his sclera was white or slightly jaundiced. Jim closed his eyes and would not make any eye contact. Jim was a man of few words, he hardly spoke and when he did his words were mumbled, so I had to ask him to repeat his answers. Of course, we treated him around-the-clock medically for severe pain and titrated bowel medication to prevent constipation both with medications and diet. I was obsessed with treating his psoriasis and eczema, so I could get him comfortable.



Jim’s sister had agreed to the use of an essential oil blend, provided she did not have to pay for another useless treatment. In his care plan, I identified Jim as also having social pain related to social isolation. There is no drug to ease social pain. I went home and pulled out my essential oils and Jim’s medication list to see what would be suitable. Over the years I have learned not just to use my book and studied learning, but also to trust my intuition. While mulling German Chamomile, Helichrysum, Frankincense, Myrrh, Mandarin Red, I rejected them for Jim and chose a 5% titration each of Lavandula Augustifolia and Bergamot. My intention while I made Jim’s blend was to treat his skin and his depression. I instructed the private care giver to apply the essential oil using the less is more effective principle twice daily.



Jim was seen daily until we had his physical pain and symptoms managed. The private caregiver was instructed to call the hospice number 24/7 with any changes, questions, or concerns. I had last seen Jim on Thursday; I stopped on Sunday to follow up on some medication concerns.  Jim was not in his apartment. It really threw me off. All sorts of questions flew through my mind. Had he passed? Had the nurses at the assisted living facility sent him back to the hospital? I raced downstairs and asked the receptionist about him. She smiled at me and asked, “Are you Saloni?”

After my puzzled nod she gave me a hug and walked me towards the dining room.



I recognized the private caregiver, but I did not recognize Jim. This was not the Jim I had last seen on Thursday. His skin was clear, he was eating in the dining room, looking around, and smiling at people! I did a double take, and stopped five feet from the table and just stared, quite speechless. The private caregiver rushed to hug me exclaiming, “You are an angel. You made a miracle; he has no more skin problems. IT IS ALL GONE!” It had been 8 days since the essential oil was started.



I bent down and cupped Jim’s chin and said, “Jim you look absolutely amazing.” He cupped his hand over mine on his chin, made eye contact, his blue-grey eyes shining and smiling and whispered, “Thank you.”  It was the sweetest gift I have ever received and one I will always cherish. A true miracle brought forth by clinical aromatherapy and some intuition. Jim’s social pain was history. His sister was ecstatic.



Jim was on service for three months. He was at activities, in the dining room, and at music performances. He lived and died well!



Ralph S



Ralph spent 19 months in the hospital with a whopping staph infection and bilateral necrotic heels and feet. Ralph had a left sided Cerebral Vascular Accident (CVA) several years ago and was bed and wheel chair bound. He was told he needed bilateral above the knee amputation (AKA) secondary to severe peripheral neuropathy and gangrene in multiple toes. Ralph agreed to get his right small toe and three middle left toes amputated but refused the Bilateral AKA. He was on multiple IV antibiotics and lost 70 pounds in the hospital. He begged his family to take him home. He got discharged to home with Clostridium-Diffecele, and multiple diabetic foot ulcers to the Visiting Nurses Association (VNA) for home care. After six months on VNA services, he was discharged to hospice as his feet, skin, and neuropathic pain got progressively worse. I met him and his drawer full of wound products during his post admission visit. After seeing the condition of both feet and legs, and talking to Ralph about his pain, I spoke with his daughter, his Health Care Proxy, and explained I used to be a wound nurse. I told her the products filled in the drawer were all good, but not what I desired to use for Ralph. With her approval and his physicians, I tried some holistic interventions that our hospice supplied. I started Ralph on a Tamanu oil leg and foot application. I picked Tamanu oil for its natural analgesic properties. I put Tamanu oil on a non-adhering pad and placed it against his heels and wrapped it in place.

Tamanu has been effective with burn patients and known to help with neuropathy. This was my intuition at work. Ralph’s feet were in such deplorable condition, they could not possibly get worse. His doctor, when he agreed to the treatment told me, “You will be calling me for Antibiotics all the time, just like the VNA nurses.”



Ralph has been on our hospice service since of July 2010. I have yet to call the physician for any antibiotics or medications! Ralphs toes continue to turn gray but bilateral necrotic heels have almost healed. When we first started the Tamanu oil there was drainage, and dressings were changed daily. Once the drainage stopped, the dressing was changed less frequency to two times each week.



Ralph is very prone to fungal infections of the groin, axilla, and abdomen. I have treated him with a 5% titration in Jojoba oil with Lemongrass and Palma Rosa, both selected for their anti-fungal properties. The mixture was applied once daily to the affected areas, and cleared in a week. We have done this 8 times since Ralph’s admission.



In October 2011, with a particularly bad snow storm with severe wind gusts and fallen trees, Ralph’s town lost power for 30 hours. His alternating pressure mattress deflated. When I saw him the next day he had progressed to a stage two wound. I used Tamanu oil again with a Tegaderm non-adhering island dressing that was changed every other day. The area healed within a week. Amazing Tamanu to Ralphs rescue!



Soon after we had the stage two healed, the home health aide left me a note to check the left side of Ralph’s neck. Ralph had always had a small pea size node near his left carotid artery. This node was now the size of a golf ball. I gently palpated the area and asked him if it hurt. It did not. I informed him since I did not know what it was, I would call his doctor and he could get it checked out. I spoke with Ralph’s daughter, who promised to get back to me after speaking with her four brothers, and getting their opinion. I did do reiki while I examined him and checked to see if the shape seemed regular or irregular. It was regular! Ralph expressed his desire to never have to go to a hospital again!



By my next visit three days later, his daughter had not yet called. Nature took the decision out of our hands the golf ball was oozing clear white drainage. I cleaned it with a normal saline gel, dried it, and applied an absorbent island dressing. I spoke with my boss about the necessity for daily visits secondary to the draining abscess’ proximity to the left carotid artery. The doctor and daughter were apprised about the change in condition.



The next day I used a 3% blend of Myrrh and Frankincense in an Aloe Vera gel. I picked Myrrh for its anti-tumor, anti-inflammatory, good for wound qualities, and Frankincense for its analgesic, cicatrizing, immuno-stimulant properties. I applied the blend on an absorbent island dressing and to Ralph. For the next two days it drained copiously. Day 3 it trickled, day 4 it had scabbed and was less than half the size. I continued with the treatment and some reiki. Day 7, it was draining copiously again, it followed the same trickle scab, smaller course, and I continued the daily treatment. Day 14, I pulled the island dressing off and out popped a teardrop size white cyst intact. That was quite a wow moment for both Ralph and me. Two days later with continued treatment the skin healed perfectly. Now you cannot even tell he had a gaping hole on the side of his neck, right by his carotid.



Karen H



Karen was discharged to hospice services after surgery for throat cancer/laryngeal cancer. She had a tracheotomy and a J-tube for tube feeding. Prior to admission, she had been in and out of hospitals five times in the three months, with bilateral pneumonias and a number of pulmonary infections treated with IV antibiotics. Karen and her family were open to using a holistic respiratory spray twice daily. I made her the following respiratory spray in a 5% titration.



A little background history lifted from my research project is necessary understand my respiratory spray: My research project for the clinical aromatherapy program was titled, “The Effectiveness of Lavandula Angustifolia, Rosemarinus officinalis, Eucalyptus globulus & Cymbopogon martini var.motia on Preventing Upper Respiratory Infections (URI’S) in High Risk Healthcare Professionals”



The idea for this study first germinated while reading Dr. Jane Buckles Book, Clinical Aromatherapy-Essential Oils in Practice. I was in awe reading that hat, boot, and luggage makers did not get sick during the Black plague because of the use of essential oils. I tested this by making a respiratory spray and involving my co-workers. The spray was used by each participant twice daily while in their car, to be breathed in a contained space. The control group had rose-essence used in middle-eastern cooking. For my project, I played around with a whole list of essential oils that prevent infection and tested various small blends in 2 ounce spritzer bottles. The internet is a veritable storehouse of information. Dr. Buckle recommends Bob Harris’ database site published research articles. Information can be found either by Essential Oil or by disease. Just typing the words aromatherapy and bronchitis yielded 15 Essential oils that help with Bronchitis. You can also read research blogs. After sifting through too much information I finally picked the following 4 oils for the experimental group in the study. Lavandula Angustifolia, Rosemarinus officinalis, Eucalyptus globulus and Palma Rosa, Cymbopogon martini var.motia.



The first oil picked is probably the most recognized Essential Oil on the planet- Lavandula Angustifolia (True Lavender). It is also one of the safest essential oils. True Lavender was picked for its anti-septic, anti-venous, anti-viral, anti-biotic-effective against MRSA (Nelson R.), Typhoid, diphtheria, tuberculosis (Valet’s) & 75% against Pseudomonas aeruginosa (Lorrondo et al). T. Lavender is also Fungi static (Perrucci et al), it may prevent fungal infections. True Lavender has anti-spasmodic qualities that would be beneficial for asthma, bronchitis, hay fever, and allergies. Since all the participants in the study were women aged 27 years old to 54 years old who worked in hospice, the PMS, calming, anti-depression-possibly as effective as Diazepam (Tissarand.R) were also deemed benefits from True Lavender.



The second oil Rosemarinus officinalis was selected for its anti-bacterial properties, because various studies indicate it is effective undiluted against 90-100% of some gram positive organisms as compared to gram negative organisms (Hethely et al). Rosemary Essential oil was tested to show good inhibition against Candida, Cryptococuss, and Mycobacterium. The relatively high anti-fungal activity of Rosemary could make it a potential in the use for AIDS patients with cryptococcal meningitis and pneumonia, and for a topical application to skin conditions and for diarrhea caused by Candida Albicans (Soliman et al). Rosemary was also selected because of its anti-inflammatory properties and because it increases alertness. All Hospice staff is on the road driving from patient to patient, using cell phones and juggling information, this was considered a fabulous added benefit.



The third oil Cymbopogon martini var.motia or Palma Rosa is a cosmetic industry favorite, particularly in “rose” soap. It has been found to be strongly anti-infectious, anti-fungal, especially Cryptococcus neoformans (Viollon et al), anti-bacterial-Staph aureus, E.coli, Klebsiella, Salmonella, Shigella, Vibrio (Pattnaik et al) anti-viral-the best antiviral (Maury.M), and an immune moderator working on Immunoglobulin A (IgA). Palma Rosa is considered by many the best oil to put into the air.



The fourth Essential Oil has been in use for a long time, Eucalyptus globulus, it is used in many proprietary brands like Vicks Vapor rub (most famous). Hmaamouch et al studied the anti-bacterial and anti-fungal properties of Eucalyptus essential oil and found that Eucalyptus inhibited the growth of 6 gram positive bacteria including MRSA and Staph aureus, its actions were comparable to orthodox antibiotics. It was found to be more effective against bronchial inspiration strains than any other essential oil. As a anti-viral, Eucalyptus had a concentration dependant antiviral effect when in contact with viruses prior to or during absorption (Schnitzer et al) Eucalyptus was also picked for its anti-inflammatory & analgesic properties. Eucalyptus was the most medicinal smelling of all the essential oils picked.



Dr. Jane Buckle replicated my study and cited it in the keynote address/PowerPoint presentation in Minneapolis this year.



Back to Karen, when she was admitted she needed to be suctioned very frequently, with thick copious secretions, clear because of recently finishing IV antibiotics. She was on hospice with a diagnosis of End Stage Pulmonary Disease-status post cancer. She also had malabsorbtion issues with her tube-feeding, was deemed a high risk for aspiration pneumonia, constipation, and skin issues. She also had some episodes of nausea and vomiting.



Karen had expressed a desire never to see the inside of a hospital again. Karen’s family of four sons and two daughters plus her alcoholic husband were divided on this issue. So, my primary goal was to make sure Karen’s needs were met. For seven months the respiratory spray kept her from having any respiratory infection. Guess what? None of the other occupants in the house got one either while the spray was used, six of those months were winter months!



Karen’s care involved frequent education and family meetings. Her skin broke down when she became incontinent. Tamanu oil healed it in no time at all. I know the power of essential oils kept her antibiotic free and aspiration free. She died with her skin intact despite being bed bound for the last 10 days.



Sherry H



Sherry came to us with a diagnosis of End Stage CVA. She had her first stroke before she was forty. She had a history of multiple strokes, and was completely bedridden, unable to move anything except her right hand that too, with limited range of motion. She is totally dependant for all activities of daily living. On admission, she had a stage three on her coccyx. She also had a caregiver, her husband, who is in very poor health, and not capable of expending energy to turn and reposition her every 2 to 3 hours. Sherry needs to be disimpacted two times a week, and has a Foley catheter, so incontinence had never been a factor in her skin breakdown, just poor circulation. Tamanu oil with a Duoderm dressing, changed two times a week healed the stage three, so well there were no tell-tale signs of there ever having a skin breakdown.



Sherry also had a long history of urinary tract infections. A peri spray of Lavender, Juniper, and Tea-tree, to clean her catheter at insertion site/peri area kept her free of a UTI while in my care.

She is currently transitioning to active after almost a year on hospice. There is no magic wand to have given her any more quality of life than to keep her husband supported and her comfortable, and away from any unnecessary antibiotics.



Paul G



Paul was a 92 year old very sharp, dapper, and well traveled widower, admitted with Colon cancer with metastasis. His symptoms were severe nausea, unrelieved by any anti-emetic: severe weight-loss, and weakness resulting in multiple falls. He also had a long standing history of constipation. Needless to say he was hardly eating, drinking, or retaining even if he did. Paul was very realistic that his prognosis was poor. Paul verbalized craving beef broth, eggs, and applesauce. Paul denied pain except for the occasional twinge, and the only thing that brought him anxiety was vomiting, or not being able to move his bowels every second or third day. It was a challenge to get him to take any bowel medications. Paul was skeptical, but he agreed to a ginger sniffer and an oil to rub on his stomach.



I took Paul a ginger sniffer the next day. He reluctantly held it to his nose and inhaled; He announced, “The real test will be if I can keep broth down.” He never vomited after he got the ginger sniffer. Paul lost it once, it fell from his pocket into the toilet bowel, and he raved and ranted at the aide for not letting him fish it out of the toilet. He was extremely panic stricken without the sniffer, and effusive with his words of gratitude when he had another one delivered within two hours. An oil blend of Sweet Marjoram for its ability to strengthen peristalsis and Lemongrass to help with organ pain was used to massage his abdomen twice daily. Paul passed after six weeks of beef broth, scrambled eggs, and lots of applesauce, thanks to a ginger sniffer. He was out of it for the last two days, but the assisted living staff and private care givers had noted his attachment to the sniffer, and anxiety if you removed it from his hands while he was actively dying. Paul died holding his ginger sniffer. I asked the funeral home to leave it in his hand. Paul was very extremely bowel fixated, and I had a challenge on my hands, because of his non-compliance with medication recommendations. The massage oil, reiki, and enemas every three days kept Paul on an even keel moving his bowels until the day before he passed. The assisted living nurses were absolutely amazed at what essential oils had achieved.



Bob T



Bob came to us because he had chronic kidney failure, an explored mass on his liver. His appetite had decreased and he was refusing to eat. Bob was also an insulin dependent diabetic with stage four diabetic foot ulcers. He had an ongoing picking disorder. His skin was a mess of scabs in various stages, bleeding, scratch marks, flaky, raw, red, and peeling. After three years of trying every pharmaceutical treatment the staff had ruled in that nothing worked. Bob’s niece, his HCP, and the nurse practitioner agreed to have the hospice aide use a blend of Lavender, Bergamot and Myrrh. I have mentioned reasons for using Lavender and Bergamot before, Myrrh was used for its anti-inflammatory properties, and being great for dry skin. The staff was in awe with the results. He passed with his skin on the rest of his body (barring diabetic foot ulcers) intact.



Susan K



Susan was 91 years young with a diagnosis of small cell lung cancer with metastasis, status post chemotherapy. She had severe nausea and weight loss. She was also in deep denial of end of life on the horizon. Susan would deny pain, deny diarrhea (a side effect of Tarveva), deny loss of appetite, and deny that she was sick. She disliked the way she looked with her hair loss but refused to wear a wig. As a nurse, a patient who wears a mask of contentment and smiles at you while (FLACC, a scale assessing pain by looking at the face, legs, arms, crying, and consoling, with two points for each) I was scoring Susan a 5 for pain. A patient denying pain can be more challenging than a patient who is temperamental or belligerent. Why? Because, pain is subjective, we cannot tell the patient we know that they are lying. That pain is etched into their face and reflected in their movements. All we can do is ask the same question three different ways: Does anything hurt? Are you uncomfortable? Are you in pain?



When a patient wears a social mask and a smile and treats the nurse like she is a social obligation, there is no initiating a plan to make things comfortable for the patient. The patient continues to suffer by their denial. No hospice issues a magic wand to its nurses. It all starts with the nurses intention to assist a patient live and die comfortably by doing their best to manage their care. I felt like a failure when visit after visit, was spent only supporting the patient’s daughter, as mom continued to decline and deny her pain. I intuitively changed strategy and met the patient on as a social visit, discussing a common interest in art, attempting to foster a relationship that evolved from friendship and mutual interests.



My break arrived when the patient’s daughter asked me to check the area under her mother’s breasts. Susan had a fungal infection, and I offered to treat it with an essential oil, but did not like fragrances. She was very skeptical about the effectiveness, but upon her daughter’s encouragement, she agreed to try it if the smell did not bother her. I made a 5% titration of European basil and Fennel both for their anti-fungal properties and because they were familiar as herbs used in cooking. The rash was history after four days. This gave me a rung up into building some trust. Once the trust came, the pain got managed.



A spiritual synergistic blend of Frankincense, Myrrh, Rose, Sandalwood and Ylang Ylang, was used to help her pass, as she struggled to let go. She smiled and squeezed my hand, as her daughter said, “Mom, Saloni says its time to go.” She half smiled and said, “I know.” Susan squeezed my hand again. I told her daughter, “This is her goodbye. She is ready to go.”

Her daughter said, “She has been trying to go for over a week.”  Susan went early the next morning. Susan was not the first person who was struggling to die that this spiritual blend helped let go. Susan’s case was just the most challenging and memorable because I had to work outside my comfort level to foster an outside relationship in order to meet her needs. I could not have done it if I was not passionately enamored with further discovery with essential oils and their clinical applications.



Parting Notes



In three and a half years, I have had the opportunity to use many holistic remedies and interventions. Hundreds of patients in our hospice have benefited with the use of clinical aromatherapy, and lived well & Died well because it enhanced their care. I know I have barely scratched the surface in terms of the use of essential oils in my practice. I dislike using the word conclusion, because it seems so final. I am happy to answer any questions, or dialogue to expand my own knowledge and encourage others to explore and learn about aromatherapy or hospice. I can be reached @ reiki_woman@yahoo.com.





Saloni Molhatra















































DIGEST of conditions and oils





Analgesic

Tamanu oil

Antibactrial

Lavender, Juniper, Teatree

Anxiety

Angelica, Bergamot, Lavender

Cracked heels

German, Roman Chamomile, Almond

Cramp

Clary sage, Lemongrass, Sweet Marjoram, Jojoba

Fungal infection

Lemongrass, Palmarosa, Jojoba

Basil, Fennel

Nausea and vomiting

Ginger

Social pain

German chamomile, Helichrysum, Frankincense, Myrhh, Mandarin Red

Spritual

Frankincense, Myrhh, Rose, Sandalwood, Ylang

Upper Respiratory Infections

Lavender, Rosemary, Eucalyptus, Palma Rosa

Wound healing

Myrhh, Tea tree, Aloe Vera

Myrhh, Frankincense, Aloe Vera

References



Buckle J. (2003). Clinical Aromatherapy, Second Edition. Churchill Livingston.



Nelson R (1997) In vitro activities of five essential oils against MRSA and Vancomycin-resistant Enterococcus faecium. J Antimicobial Chemotherapy. 40305-306



Valnet J. (1990). The practice of Aromatherapy. Healing Arts, Rochester,VT. P148



Larrando J, Agut M, Calvo-Torres M. (1995) Antimicrobial activity of essences from Labiates. Microbios 82: 171-172



Perrucci S, Macchioni G, Cioni P C et al. (1996) The Activity of compounds from Lavandula angustifolia against psoroptes cuniculi. Phytother res. 19 (1) 5-8



Tissarand R. (1998) Lavender beats benzodiazepines. Journal of Aromatherapy. 1, 1. 2.2



Hethely I, Kaposi P, Domonkox J, Kernoczi Z. (19870 GC/MC investigation into EO’s of Rosmarinus officinalis. Acta pharm hung. 57 (3-4) 159-169



Soliman F, EL-Kashoury E et al. (1994). Flavor Fragrance Journal.



Voillon C, Chaumont JP. (1994. Antifungal properties of essential oils

And their components upon Cryptococcus neoformans. Mycopatholgia. 128 (3) 151-153



Pattnaik S, Rath C, Subramanyam V R, Kole C R, Sahoo S. (1995) Antimicrobial activity of essential oils from Cymbopogen : inter and intra-specific differences. Microbios. 84: 239-245



Maury M. referenced from Clinical Aromatherapy for Health Professionals. Copy right 2006 Jane Buckle.