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...
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...
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...
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...
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...
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. . ....
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...
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...
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...
There’s a helpful rule of thumb for prognosis near end-of-life, but first . . . It’s always a good idea to ask what’s behind the question. Many patients who ask this may be hunting for something else. We tend to follow up with a question like: “Could you tell me...
