Clinical Aromatherapy has become more widely recognised as being an entirely separate entity from beauty therapy over the last 20 years. As we develop a more comprehensive understanding of the true potential and scope of aromatherapy, the list of issues that can be dramatically improved or at the very least assisted by this form of therapy, grows!

With over 400 different essential oils, and a huge range of base oils now available, the impact of these amazing natural plant oils, and our understanding of how they work is growing. As always, the challenge has been to prove the results that any professional with experience will know – that aromatherapy, practiced with a caring holistic approach, can really improve quality of life and often the health of almost everyone that we see.

This has never been important than in the area of Palliative Care. Far from stepping back from the care of someone who might not recover from their condition, aromatherapists can offer sensitive, profoundly helpful relief and support at this difficult time. Unlike many other therapies, what we can offer can sometimes be as important for the carers of the individual, as it can for the person who has a life limiting condition. This is even more important in the current healthcare environment – where the wishes of patients (and the pressures on the NHS) mean that more and more people are at home for the final stages of their lives.

The powerful therapeutic impact of aromatherapy in “end of life care” is expressed very clearly in the fact that almost all hospices now have aromatherapists who are part of their essential staff, or who are invited in to practice. For those who want to know more about the impact of aromatherapy in palliative care, there is now a much more positive body of research on the internet. Trials and studies cite benefits that include:

• A decrease in stress
• A lowering in levels of anxiety
  
• A reduction in depression
• A reduction in levels of pain
• A reduction in constipation
• An improvement in sleep patterns

In my experience, some of the most important additional aspects have been the reduction in inflammation and oedema, which causes pain, and is often part of terminal conditions. If you proceed with gentle massage and an appropriate blend of aromatherapy oils, it can bring immense relief. Often, the swelling and puffiness of your client's feet and ankles will gently reduce before your very eyes. There may be a “weeping” of lymph from the toes or skin - it is part of the weakened system trying to release the excess – so ensure you place towels under their legs if possible.

Remember also the importance of your role in supporting the loved ones – your positive impact on relatives and friends, as well as the client themselves. Loved ones can feel so helpless when caring for their relative or friend in such circumstances. Giving them some specific additional tasks – such as oils to vaporise or blends to use in gentle foot, hand or facial massage in between your visits, can have a profound effect on all parties.

When people suffer from conditions which mean they spend long periods of time lying down, many different aspects of health we normally take for granted, such as regular bowel movements, peaceful sleep and normal blood and lymphatic circulation can become compromised - again, aromatherapy can be a great help here too!

Our sense of smell is far more acute than we realise, and lifting the atmosphere of a room by bringing in fresh air regularly – and vaporising beautifully uplifting, mood enhancing aromatherapy blends can have a dramatic impact. This is particularly important when the condition (i.e. certain forms of cancer), plus the clinical treatments themselves, can create a sensory atmosphere in the room that is far from pleasant, and that can be embarrassing and distressing for all concerned.

There are specific training courses for Aromatherapists for wish to specialise in this type of therapy, and some of the most rewarding work I have ever experienced has been working with clients in this field, so I can totally understand the value and desire to follow this direction. However, if you only occasionally care for the very sick in your practice, doing some research in the field, and then relying on your holistic training model and your own instincts, will still give you valuable tools and resources to have a powerfully positive impact . As I've mentioned, in my experience, one of the most important aspects is to care for the carers themselves too.

As a check list – there are a few essential factors to consider before treating terminal clients. As with all serious ill health – you should consult with the client's health care practitioners prior to treatment, and ask them if they have any particular concerns or suggestions before you proceed. There are certain aromatherapy oils that can be contra-indicated (see below), and various points of reference are accessible for further information:-

Contra-indicated essential oils

• Cancer: Anise (Aniseed), Basil, Fennel and Nutmeg
• Oestrogen-dependent cancers: Anise (Aniseed), Fennel, Lemongrass, Melissa, Citronella, Bergamot, Eucalyptus
• Cardiac disease: Peppermint
• Epilepsy: Rosemary, Peppermint, Basil
• Hepatic disease: Anise (Aniseed), Basil, Juniper, Bay, Cinnamon, Clove
• Renal disease: Bay, Cinnamon, Clove

Such lists vary according to where you trained and which organisation you are insured with/affiliated to, so doing some additional research to update/refresh your knowledge can be a sensible point of action.

Remember, when it comes to pain, certain forms of massage and essential oils can bring great relief. However, when you are working with clients who are in a fragile state of health, only the lightest massage pressure is usually indicated, as you don't want to risk moving blood clots or causing bruising in tissues that are more fragile than usual. Performing light reflexology and reiki can also be very helpful.

Remembering to use carrier oils that are analgesic as well as the essential oils themselves can help to maximise results. Base oils such as Comfrey, Olive oil and St John's Wort can be indicated here, as well as Aloe Vera. See “Essential Oils” by Jennifer Peace Rhind – there is an excellent section on “Essential Oil Prescriptions for Pain”.

Remember, whatever literature you refer to – your clients preferences are the most important influence. If they are conscious and able to choose their preferred oils – these will be the oils most strongly indicated for them. If they are not conscious, their family or friends may be able to tell you if they have any particular favourites.

Recommended essential oils

In my experience, some of the most effective essential oils for pain are:

Lavender, Clary Sage, Marjoram, Black Pepper, Roman and German Chamomile, Peppermint, Yarrow, Geranium, Pine and Camphor.

In addition, for oedema and as digestives:

Fennel, Orange/Mandarin, Ginger, Rosemary, Juniper and Cypress.

For anxiety, stress and depression:

Lavender, Neroli, Rose, Sandalwood, Jasmin, Bergamot, Thyme, Petitgrain, Geranium, Orange, Clary Sage, Melissa, Patchouli, Ylang Ylang and May Chang.

Recommended blends

Here are some of my favourite aromatherapy blends, although you will no doubt create your own individual prescriptions according to your clients circumstances.

Soothing/Uplifting Atmosphere Spray:

120ml Rose Hydrolat, 20 drops Bergamot essential oil and 5 drops each of Rose, Neroli and Patchouli.

Massage Oil for Pain & Relaxation:

5ml Comfrey, 5ml St John's Wort, 20ml Olive Oil, 8 drops Lavender essential oil, 3 Clary Sage, 2 Roman Chamomile and 2 Neroli.

Massage Oil for Oedema & Inflammation:

5ml Comfrey, 5ml St John's Wort, 10ml Jojoba, 10ml Olive Oil, 6 drops Lavender essential oil, 4 drops Juniperberry, 2 German Chamomile and 2 Cypress.

Never under-estimate the impact a gentle caring word or kind touch can have on those who are in the final stages of their life. Even if you are not sure of the impact of your treatment – because the person may be unable to feed-back to you in the way you are used to – there are other ways they can reflect the results. I have worked with people who were semi-conscious, but their faces still often reflect wonderful peacefulness after the session.

I will never forget a lovely lady I was referred to by our local GP years ago. I saw her for 2 weeks, 3 times a week very near to the end of her life. She was in her own home, and being cared for by her daughters. When I first went into her room it was very hot and stuffy with an unpleasant smell. She was semi- conscious. Her face was puckered and drawn with confusion, pain and anxiety. After her hours session of the lightest touch with some wonderful aromatherapy oils, a little fresh air and then some essential oils vaporised – the change was wonderful. Her swollen legs had reduced in size – her toes and feet had lost their tight, puffy look. Her face was the real joy – her forehead had smoothed out and the frown had disappeared. She looked peaceful and the strain had left her face. She looked as if she was resting peacefully. Her daughters were over joyed, and I left some blends and instructions with them to use between my visits. What a privilege to help during their time of need!

Joannah Metcalfe
Consultant Aromatherapist

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