Palliative Pearls

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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Tailoring Care for Parkinson’s Patients

Tailoring Care for Parkinson’s Patients

Parkinson’s disease has a variable trajectory and patients can be quite disabled months and years before they are hospice eligible. Here are cues that it may be time to transition to a palliative approach: Functional loss Orthostatic hypotension that persists with...

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Struggling with stubborn nausea?

Struggling with stubborn nausea?

Olanzapine has “broad spectrum” activity for treating nausea. Recent studies confirm olanzapine’s effectiveness for difficult-to-treat nausea in cancer patients whether or not the nausea is related to chemotherapy. Olanzapine acts through multiple receptors, and we...

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Handling Heart Failure at Home

Handling Heart Failure at Home

When rescue efforts don’t work well, consider hospice referral for in-home CHF management. Prognosis in heart failure is tricky.  These pieces of history indicate poor prognosis. Brittle fluid management, including use of metolazone, Spending more than 50% of time in...

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Comfort Medication Dosing

Comfort Medication Dosing

This month our Palliative Pearls reviews comfort medication dosing. You will find guides for assessment and effective dosing recommendations to enhance a patient's comfort. Comfort Medication Dosing For more information, contact Dr. Leslie Estep, Dr. Anita Meyer, or...

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It’s a Crisis — Who’s on First?

It’s a Crisis — Who’s on First?

Choosing a health care agent is an important place to start advance care planning.  Decision making can get messy if this choice isn’t made before a crisis. This graphic below shows the hierarchy for surrogate decision making under Washington state law if otherwise...

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Self Care

Self Care

As we enter a new year, this is a worthy time to remember to practice self-care, to take care of ourselves as providers for others. We shared this years ago and feel it is worth revisiting. Double-booked patients, charts, emails, curbsides, phone calls, meetings. . ....

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A Blessing for the New Year

A Blessing for the New Year

We recognize 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 some peace over the holidays! Beannacht: Blessing for the New Year by John O’Donohue On the day when...

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The Dialysis Dilemma

The Dialysis Dilemma

For elderly and frail patients, hours of quality life saved by starting dialysis may not stack up well when compared to medical management of chronic kidney disease. Many studies show that for patients over 75, starting dialysis leads to poorer functional status and...

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I Can’t Catch My Breath

I Can’t Catch My Breath

Fear is a major component of the suffering patients feel when breathless. Consider our Breathlessness Action Plan to help palliative-care-minded patients and families with the anxiety. Stay calm: Quiet the room. Speak slowly in a calm voice. Reposition: Usually...

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