Palliative Pearls

Time to Dust Off the Surprise Question

Time to Dust Off the Surprise Question

We are seeing more patients who are referred too late to benefit fully from hospice care. The surprise question is simple: “Would you be surprised if this patient died within the next year?” A “No” answer from a medical provider is more predictive than other...

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It Takes Time

It Takes Time

Many interventions have a time to benefit interval. As people age they may not have time to benefit from some preventative measures. Keeping Hgb A1c less than 7 takes 8 years for most patients to prevent dialysis and retinopathy. This tool from UCSF can help put some...

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The Three P’s in Dementia

The Three P’s in Dementia

Poop.  Pee.  Pain. When patients with dementia are unusually agitated or unusually withdrawn, check for constipation, urinary retention and untreated pain.  Behavior is communication. For more information, call our providers at 360-814-5550 or email: Erika...

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What Would We Do Without UpToDate?

What Would We Do Without UpToDate?

UpToDate is filled with information about palliative management of symptoms and disease states. Just search with the words “Palliative care for . . .”, then the symptom or condition, such as cough or congestive heart failure. Bonus resource:  Palliative Care Network...

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When the Cough Won’t Stop

When the Cough Won’t Stop

If a patient's cough won't stop, the first-line medication for palliative treatment is benzonatate (Tessalon Perles) After evaluating and treating the underlying causes of cough, treat the symptom of cough with benzonatate. Treating cough can be invaluable for the...

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A Poem of Renewal

A Poem of Renewal

The long dark days of December can dampen spirits. We appreciate all you do to help patients despite heavy workloads and busy waiting rooms. Wishing you peace and renewal over the holidays! The Journey by David Whyte Above the mountains the geese turn into the light...

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Roger That!

Roger That!

Making treatment recommendations that meet your patient’s goals requires that they understand their condition. We use the following phrases to assess understanding when discussing a difficult diagnosis or prognosis. “I have been doing a lot of the talking. Could you...

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Behavior is Communication

Behavior is Communication

In dementia, when language and logic are failing, behavior communicates comfort and distress. Yelling in the middle of the night might be communicating many things: “Where am I?” “My hips hurt.” “I’m afraid.” “I’m cold.” Behavior is a two-way street. Keep it slow....

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MAID Update

MAID Update

Access to Medical Aid in Dying improved  The Washington State legislature made these changes, effective July 23, 2023: Physicians Assistants and Advanced Registered Nurse Practitioners may now serve as the consulting OR prescribing provider for a patient. The waiting...

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Goodwill and Good ZZZZZZZZZs

Goodwill and Good ZZZZZZZZZs

Wishing yourself and others well is better than counting sheep . . . . . . and safer than a sedative. Try this beautiful meditation for sleep.  Repeat twice for each person.  Start with yourself, then slowly move outward, starting with those you hold most dear, then...

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