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Showing posts from December, 2014

Tramadol-induced hypoglycemia: another reason not to use it

Note: This post was originally published on PalliMed as part of the World Series of Blogs Payback-Ed.

In 2013, there were 43.8 million prescriptions for tramadol filled in the U.S. It has a slightly different method of action from many other pain medications, as tramadol is both a mu-opioid receptors agonist and a reuptake inhibitor of serotonin and norepinephrine. It is also thought that the opioid activity is due to both the parent compound and the more active O-desmethylated metabolite (which, like codeine is metabolized by CYP 2D6 and therefore gives the same big inter-individual differences in pharmacokinetics).

The overall efficacy as a pain medicine is comparable to that of other weak opioids. Most people know it is associated with serotonin syndrome as well as seizures especially when used with other medications that lower seizure threshold. A new study that came out in JAMA IM reveals a pretty robust association between tramadol use and hospitalizations for hypoglycemia, even…

What you can do today to pull the plug on Sarah Palin's "death panel" myth

Perhaps enough time has passed that when you think about Sarah Palin, her antics seem almost cute in their absurdity.  You know, "I can see Russia from my house!" or nicknaming herself a "Mama Grizzly."  With any luck, you might think, the biggest dent she'll leave on American history is her quirky run for the vice presidency that will make for great Trivial Pursuit fodder one day.

Unfortunately, one seriously un-cute gift that Sarah Palin gave the American people during her five minutes of fame just keeps on giving.  In August 2009, she coined the term "death panel" in a Facebook post intended to smear Obama and malign the Affordable Care Act.  She said,

"The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether they are worthy of health…

Bumper Sticker Gaming for Geri-Pal Thinkers

Since there seems to be some serious competitions and analysis happening on this blog, I thought I'd put in my two cents so as to gain some broader and serious Geri-Pal thinking about how bumper stickers apply to client care.

Really? Yeah, really.

So, I will not lie to you. I read and analyze bumper stickers as a clinical hobby, of sorts.

 I live in a place that values and cherishes their viewpoints through a bumper sticker phenomenon. Some vehicles are plastered with them. I kind of like that people are into it! I travel a lot so this bumper sticker viewing amuses and inspires me on what could be a solemn day.

Bumper stickers remind me to think carefully. I believe it's truly valuable to watch, listen and think carefully about big and small matters alike. It promotes that life-long-learner concept as well as helps me remember to have a good sense of humor. Bumper stickers are put on cars and other items to share and discuss so it makes sense this gaming experience has…

Gifts for Seniors: Holidays 2014

As stores and the internet light up with gift ideas in time for Christmas, you may have a senior or two on your list. Last year we put together a long list of potential gifts for older adults, which can he found here.


Please enjoy this updated list that I hope can help you give thoughtfully and generously.

For the senior who enjoys walking:

Fitbits, Jawbone and other devices to help seniors live a quantified life, share it, and remain motivated. Says a GeriPal: “Family members can set things up on the computer so friends and family can stay connected and challenge each other to walk do many steps.” (Rebecca Sudore)

For the senior who loves to read, but maybe can’t as much these days because of low vision or other impairments:
A subscription to audible books.A connection to programs at the library, where many have programs for people with vision impairment and audible books. Download old radio programs they may enjoy and put them on CD for them to play.      Boxed sets of TV comedy s…

Make Advance Care Planning Routine

The following is part of a three-post progressive blog about the Center for Medicare Medicaid Services (CMS) choosing not to pay for the new advance care planning codes in this year's Medicare Physician Fee Schedule.  However, now is the time tell CMS why you support reimbursement for advance care planning services in their call for comments.  Please see also Phil Rodgers post on CMS considering reimbursement for Advance Care planningat Pallimed, and Gregg VandeKieft’s update on the state of ACP advocacy at the AAHPM blog.

What will it take for advance care planning to become routine for patients with serious illness?

It is time for US policy makers to put away the negative connotations of the "Death Panel" days and have a mature discussion about serious illness.  No matter what your political persuasion, it is time for us to act to improve the quality of care given to all patients by promoting health advance care planning.  With excellent communication and advance care …