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Showing posts from October, 2014

Addressing Unmet Palliative and Geriatric Needs of Zombies

Considerable evidence indicates that zombies do not receive optimal palliative or geriatric care.  High prevalence of untreated pain, depression, decreased socialization, and impaired sleep and mobility, as well as lack of access to proper medical care are universal issues facing this population of undead. It is therefore not surprising that zombies and their loved ones often express dissatisfaction with after-life care, which may play a role in zombies' seeming unquenchable desire to eat the brains of the living. In the following post we will address some of the most common issues facing zombies, and some potential palliative and geriatric solutions to providing truly Zombie Centered Health Care (ZCHC). Hospice Care One of the most surprising issues facing zombies is the lack of coordinated health care focused on the care of the dead. Many zombies may benefit from an interprofessional team based service like hospice. However, the hospice benefit is limited to those wi

Don't just do something, stand there... why it's too soon for talk of physician aid in dying

by Laura Petrillo ( @lpetrillz ) When Brittany Maynard announced her plans to end her life on November 1st, the news rippled through social and national media like the foreshocks of an earthquake.  Ms. Maynard is a beautiful, relatable 29 year-old woman with a fatal brain tumor, who went public earlier this month with her decision to move to Oregon in order to obtain barbiturates via the Death with Dignity Act.  She has partnered with the organization Compassion and Choices to create a campaign to advocate for increased access to aid in dying legislation.  As bioethicist Arthur Caplan said on NBC News, "there are no new arguments in anything Brittany has to say," and yet, she has captured the attention of a new generation, and sparked a conversation about the amount of control patients should have over their own deaths.  In this post I will not opine about whether patients should have access to physician aid in dying. But I will share my concern that like Brittany&

It's on! SF Giants and GeriPal vs. KC Royals and Pallimed

KC BBQ meal we look forward to receiving from Pallimed Christian Sinclair of Pallimed and Kansas City has challenged us to a friendly wager.  As many of you know, many of the bloggers at GeriPal (including me and Eric) are based in San Francisco. The world series is the San Francisco Giants vs. the Kansas City Royals.  What an opportunity! The basic rules are simple: For each loss in the series, the losing blog must write a post for the opposing blog.  So, for example, after the Giants win Game 1 Tuesday night, a Pallimed blogger will owe GeriPal a post, to be published on GeriPal. Timing doesn't have to be the same night, so if the Giants win the series 4 to 1, then Pallimed owes GeriPal 4 posts, and GeriPal owes Pallimed 1 post, to be written in a reasonable time frame.  If it's the same night, that's fine too.  At the end of the series, the losing blog must send a dinner themed from their city.  So for example, in the unlikely event that the Royals steal the

GeriPal Hits 2 Million Pageviews

The Places Where GeriPal is Read Last week GeriPal hit 2 million pageviews.  We celebrated quietly when the counter showed a whole line of 0's, but I thought it would be worth creating a list of the top 25 most read posts to commemorate the occasion.  Enjoy! The Dangers of Fleet Enemas Length of Stay in Nursing Homes at the End of Life End Stage Dementia: A Terminal Disease Needing Palliative Care  What to give Uncle Ernie, Grandma Mabel and Great Aunt Rose?  Dying without Dialysis  Beers Criteria Contest: Submit the Craziest Medication Combinations  When Surrogates Override the DNR: A Terrific Geriatrics and Palliative Care Teaching Video  MMSE and Copyrights Part II: Is the MMSE Derivative of Some Other Work?  Atul Gawande New Yorker Article "Letting Go"   Coffee Is Bad For You. Coffee is Good For You. Why Am I So Confused?  Survival from severe sepsis: The infection is cured but all is not well  Why is Forest Laboratories discontinuing Namenda? 

A Call for Maternalism in Medicine

by: Laura Petrillo @lpetrillz After a recent family meeting, I received a piece of feedback from a social worker that took me by surprise:  "You were very maternalistic in there, but it worked," she said. I reflected on the conversation we just stepped away from.  Our palliative care inpatient consult team had been asked to talk with the family of a patient who had been in the intensive care unit for weeks.  Mr. B* had severe vascular disease and a systemic infection that had caused his organs to shut down, and he was now being kept alive by a ventilator, vasopressors, dialysis, transfusions and artificial nutrition.  His legs had turned purple and cold the day before, so the surgeons had amputated both of them in an attempt to save his life.  Now the purple was beginning to creep up his abdomen, and the surgeons did not have any more procedures to offer. We met the patient's surrogate decision maker, a young woman named Devon. She was working and in school thr

Atul Gawande, just what the doctor ordered

by: Stephanie Rogers @SERogersMD Atul Gawande is expanding the conversation about care at the end of life with his new book, Being Mortal . Will people take notice? The introduction to his book came a few days ago in his opinion piece “ The Best Possible Day ,” in the New York Times. It fueled a series of emotions for me and I reread his 2010 New Yorker article “ Letting Go: What should medicine do when it can’t save your life? ” As a doctor who recently finished training in internal medicine, I had many stories like his from my time in the hospital. I saw patients and families who would go to great lengths to try to extend their life in spite of an exceedingly poor prognosis. They continued to plea, “What else can we do?” and “What other therapies exist?“ Many aggressive treatment options were offered, despite the fact that it was unclear how much these interventions would extend their life, and many times they produced complications including pain, infections, and

Do you think hearing loss is important in hospice and palliative care?

by: Alex Smith, @AlexSmithMD Do you think age-related hearing loss is important in hospice and palliative care?  We'd like to know!  We're conducting a brief (less than 5 minute survey).  You have an opportunity to tell your stories about caring for patients and caregivers with hearing loss, if any.  Here is the link: Please consider helping out.  And pass this link on to anyone you know in hospice and palliative care!  All members of the care team that work primarily in hospice and palliative care are welcome to participate (docs, nurses, chaplains, social workers, etc).  International responses are welcome! This is an anonymous survey.  We will disseminate our findings on GeriPal. Thank you! Alex Smith, MD Meg Wallhagen, PhD, GNP-BC