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Palliative Pearls

Comfort Medications

February 2018 – For patients unable or unwilling to come onto hospice quickly, here is a basic toolkit of medications for typical end of life symptoms. Even patients who can no longer swallow ca...

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“Good Enough” Prognostication

January 2018 – The point of prognostication is not to be right, but to help people prepare. Avoid the trap of exact numbers.  Develop a prognosis that is good enough to allow for important deci...

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Anticoagulation in Frail Patients

December 2017 – The risk of intracranial or GI hemorrhage in a debilitated ambulatory patient at risk for falling likely exceeds the benefit of stroke reduction.* Most experts agree that anticoa...

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Words Can Heal

October 2017 – VitalTalk Tips – A free app to help you with difficult conversations. VitalTalk Tips is free and easy to use. Its layered structure allows you to use it to quickly review a topi...

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Your patients need your help

November 2017 – Patients are being referred too late to benefit fully from hospice care. Hospice of the Northwest patients are being referred very late in their illness.  35% of patients ad...

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Taper BP Meds for Falling, Frail Elders

July 2017 – Study shows burden may outweigh benefit for managing hypertension in elders with a history of falls. Antihypertensive medications were associated with increased risk of serious fall ...

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Use Senna as First Line for Opiate Induced Constipation at End-of-Life

September 2017 – Opiates cause constipation by several mechanisms: Binding intestinal mu receptors and slowing peristalsis Delaying gastric emptying Increasing anal sphincter tone Increasing wat...

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Who Will Decide if You Can’t?

August 2017 – Establishing Durable Power of Attorney for Healthcare (DPOA-HC) is a gentle way to start advance care planning. In the state of Washington, if no DPOA-HC has been established, the ...

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Olanzapine (Zyprexa) for Nausea

June 2017 – Olanzapine has “broad spectrum” activity for difficult to treat nausea. Olanzapine has broad activity at dopaminergic and serotonin receptors as well as activity along histaminic...

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Hand-held fan for dyspnea

May 2017 – Treating dyspnea improves function in late stage COPD and CHF. Studies show the use a hand held fan directed to the face reduces dyspnea. Low dose opioids (not only morphine) also red...

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