Palliative Pearls

March 2022 - Patients and families can (and do!) refer themselves for hospice care. The percentage of referrals we receive from patients, families and caregivers (rather than from medical providers) has increased from 20% five years ago to 25% in 2021. Our community...

February 2022 - Our old friend, propranolol Propranolol is effective in palliating panic/anxiety in elders who are sensitive to the sedation and delirium side effects of benzodiazepines. Consider Mrs. Li: She has moderate dementia and is struggling with the recent...

January 2022 - Hearing impairment can look like dementia or depression, and makes both of those worse. SuperEar® is a personal sound amplifier (for around $60) that can be cleaned and reused for patients with hearing deficiency. Great for clinic visits, hospital care,...

December 2021 - A Thank You A poem, as we enter the darker days of winter, holding the suffering of so many. Blessed are you who bear the light in unbearable times, who testify to its endurance amid the unendurable, who bear witness to its persistence when everything...

November 2021 - Palliative Pearl - Communication Tip: Address the emotions you see “May I ask what’s going through your mind?” When we notice strong emotions, uncertainty, or closing down, our natural tendency is to explain more. Good evidence shows effective...

October 2021 - Palliative Pearl - We love Torsemide! We see torsemide provides better diuresis and better quality of life in many of our CHF patients. Torsemide is better absorbed and has a longer time of action than furosemide. Some studies show patients who use it...

September 2021 - Palliative Pearl - Acetaminophen for Agitation in Dementia Agitation in dementia may be a result of untreated pain.   The use of scheduled acetaminophen has been demonstrated to reduce agitation significantly in nursing home populations of patients...

July 2021 Palliative Pearls – Skip the Scope! The scopolamine patch has little utility as a drying agent in palliative care. Scopolamine patches can cause severe delirium and other side effects.  We rarely use them as they often bring a new symptom burden in someone...

June 2021 - Caring for a loved one who is up all night is not sustainable. Using a low-dose stimulant, like methylphenidate, in the daytime to treat apathy and daytime drowsiness has helped patients normalize sleep patterns in case reports.  ...

May 2021 - When assessing palliative wounds- not expected to heal, sometimes managing the odiferous drainage can be the greatest kindness for patients and visitors. Non-healing wounds are common at end-of-life, whether from pressure ulcers, vascular disease, or...