314 episodes

A geriatrics and palliative care podcast for every health care professional.

We invite the brightest minds in geriatrics, hospice, and palliative care to talk about the topics that you care most about, ranging from recently published research in the field to controversies that keep us up at night. You'll laugh, learn and maybe sing along. Hosted by Eric Widera and Alex Smith. CME available!

GeriPal - A Geriatrics and Palliative Care Podcast Alex Smith, Eric Widera

    • Health & Fitness
    • 4.9 • 256 Ratings

A geriatrics and palliative care podcast for every health care professional.

We invite the brightest minds in geriatrics, hospice, and palliative care to talk about the topics that you care most about, ranging from recently published research in the field to controversies that keep us up at night. You'll laugh, learn and maybe sing along. Hosted by Eric Widera and Alex Smith. CME available!

    Urinary Incontinence Revisited: George Kuchel & Alison Huang

    Urinary Incontinence Revisited: George Kuchel & Alison Huang

    I have to start with the song.  On our last podcast about urinary incontinence the song request was, “Let it go.”  This time around several suggestions were raised.  Eric suggested, “Even Flow,” by Pearl Jam.  Someone else suggested, “Under Pressure,” but we’ve done it already.  We settled on, “Oops…I did it again,” by Britney Spears.
    In some ways the song title captures part of the issue with urinary incontinence.  If only we lived in a world in which much of urinary incontinence was viewed as a natural part of aging, the normal response wasn’t embarrassment and shame, but rather an ordinary, “Oops…I did it again.”  And if only we lived in a world in which this issue, which affects half of older women and a third of older men, received the research and attention it deserves. We shouldn’t have therapeutic nihilism about those who seek treatment, yet urinary incontinence is woefully understudied relative to its frequency and impact, and as we talk about on the podcast, basic questions about urinary incontinence have yet to be addressed. I don’t see those perspectives as incompatible.
    Today we talk with George Kuchel and Alison Huang about:
    Urinary incontinence as a geriatric syndrome and relationship to frailty, disability, and cognitive decline
    Assessment of incontinence: the importance of a 48 hour voiding diary, when to send a UA (only for acute changes)
    How the assessment leads naturally to therapeutic approaches
    Non-pharmacologic approaches including distraction, scheduled voiding, and pelvic floor therapy
    “Last ditch” pharmacologic treatments. 
    Landmark studies by Neil Resnick and Joe Ouslander.  
    Enjoy!
    -@AlexSmithMD 
     

    • 45 min
    Cachexia and Anorexia in Serious Illness: A Podcast with Eduardo Bruera

    Cachexia and Anorexia in Serious Illness: A Podcast with Eduardo Bruera

    I always find cachexia in serious illness puzzling. I feel like I recognize it when I see it, but I struggle to give a clear definition or provide effective ways to address it.
    In today's podcast, we had the opportunity to learn from a renowned expert in palliative care, Eduardo Bruera, about cachexia and anorexia in serious illness. Eduardo established one of the first palliative care programs in 1984, created the Edmonton Symptom Assessment Scale (ESAS), and significantly contributed to the evidence base for palliative care symptoms that many of us rely on daily.
    During our discussion with Eduardo, we delved into how we can define cachexia and anorexia, why they occur in conditions like cancer, how to assess for them, and explored the interventions that are helpful and those that are not in the treatment of these conditions.

    • 48 min
    Sexual Function in Serious Illness: Areej El-Jawahri, Sharon Bober, and Don Dizon

    Sexual Function in Serious Illness: Areej El-Jawahri, Sharon Bober, and Don Dizon

    As Eric notes at the end of today’s podcast, we talk about many difficult issues with our patients.  How long they might have to live. Their declining cognitive abilities. What makes their lives meaningful, brings them joy, a sense of purpose.  But one issue we’re not as good at discussing with our patients is sexual health.
    On today’s podcast Areej El-Jawahri, oncologist specializing in blood cancers at MGH, says that sexual health is one of the top if not the top issue among cancer survivors.  Clearly this issue is important to patients.  Sharon Bober, clinical psychologist at DFCI, notes that clinicians can get caught in an anxiety cycle, in which they are afraid to ask, don’t ask, then have increased anxiety about not asking.  Like any other conversation, you have to start, and through experience learn what language is comfortable for you.  Don Dizon, oncologist specializing in pelvic malignancies at Brown, suggests speaking in plain language, starting by normalizing sexual health issues, to paraphrase, “Many of my patients experience issues with intimacy and sexual health. Is that an issue for you? I’m happy to talk about it at any time.”  All guests agree that clinicians feel they need to have something they can do if they open Pandora's box.  To that end, we talk about practical advice, including:
    The importance of intimacy over and above physical sexual function for many patients
    Common causes and differential diagnoses of sexual concerns in patients with cancer and survivors
    Treatments for erectile dysfunction - first time the words “cock ring” have been uttered on the GeriPal Podcast - and discuss daily phosphodiesterase 5 inhibitor therapy vs prn
    The importance of a pelvic exam for women experiencing pain
    What is “pelvic physical therapy?”
    Treatments for vaginal dryness and atrophy
    ACS links, NCCN links, Cancersexnetwork, and a great handout that Areej created
    And I get to sing Lady Gaga, also a first for GeriPal!  And let me tell you, there’s nothing like the first time (sorry, I couldn’t help it!).

    • 51 min
    Palliative Care for Kidney Failure: Sam Gelfand, Kate Sciacca, and Josh Lakin

    Palliative Care for Kidney Failure: Sam Gelfand, Kate Sciacca, and Josh Lakin

    The landscape of options for treating people with kidney failure is shifting.  It used to be that the “only” robust option in the US was dialysis.  You can listen to our prior podcast with Keren Ladin talking about patients who viewed dialysis as their only option, and structural issues that led to this point (including this takedown of for profit dialysis companies by John Oliver).  One of the problems was a lack of an alternative robust option to offer patients.  As one of our guests says, you have to offer them something viable as an alternative to dialysis.
    Today we interviewed Sam Gelfand, dually trained in nephrology and palliative care, Kate Sciacca, a nurse practitioner (fellowship trained in palliative care), and Josh Lakin, palliative care doc, who together with a social worker and other team members started KidneyPal at DFCI/BWH, a palliative care consult service for people with advanced kidney disease.  As a team, they provide a robust alternative to dialysis for patients with kidney failure: conservative kidney management.
    And “conservative,” as they note, can mean not only a “conservative approach,” as in non-invasive/less aggressive, but also an effort to “conserve” what kidney function remains.
    We get right down to the nitty gritty of kidney supportive care techniques they incorporate in clinic, including:
    Communication about the choice between dialysis and conservative kidney management: what are the tradeoffs?  Function often declines after initiating dialysis, at least among nursing home residents. Dialysis may extend life, but those “additional” days are often spent in the hospital or dialysis, away from home. Symptoms are common in both options, though more anxiety and cramping in dialysis, more pruritus and nausea in conservative kidney management..
    Introducing the idea of hospice early, at the time of diagnosis with kidney failure. Listen also to our prior podcast with Melissa Wachterman on hospice and dialysis.
    Approaches to treating fatigue
    Approaches to treating pain - the second most common symptom (!) - and the answer isn’t tramadol (or tramadon’t) - rather think buprenorphine patch or methadone, and how to dose gabapentin and pregabalin. Also, don’t count out the NSAIDS!
    Approaches to treating itching/pruritus
    Approaches to treating nausea
    Our guests were deeply grateful to their colleagues Dr. Frank Brennan, Dr. Mark Brown, and clinical nurse consultant Elizabeth Josland of the renal supportive care team at St. George Hospital in Sydney, Australia (down under) for teaching them the ropes of palliative care in kidney failure.  And we got to learn some new vocabulary, including the meaning of “chunder.” 
    Enjoy!
    -@AlexSmithMD
     

    • 45 min
    How Pharma Invents Diseases: A Podcast with Adriane Fugh-Berman

    How Pharma Invents Diseases: A Podcast with Adriane Fugh-Berman

    Who gets to decide on what it means to have a disease? I posed this question a while back in reference to Alzheimer's disease. I’ll save you from reading the article, but the main headline is that corporations are very much the “who” in who gets to define the nature of disease. They do this either through the invention of disease states or, more often, by redrawing the boundaries of what is considered a disease (think pre-diabetes).
    On today's podcast, we invite Adriane Fugh-Berman to discuss the influence of industry, whether it be pharma or device manufacturers, on healthcare. Adriane founded PharmedOut, a Georgetown University Medical Center project that “advances evidence-based prescribing and educates health care professionals and students about pharmaceutical and medical device marketing practices.”
    I’ve listened to a lot of Adriane’s talks. It is clear to me that she is not anti-medicine or even anti-pharma but is very much against both the visible and hidden influences that pharma and device manufacturers use to sell their products.  This could be through overt marketing like advertisements or drug rep visits, or more covert measures like unrestricted grants to advocacy organizations, funding of CME, paying “key opinion leaders,” or the development of “disease awareness campaigns.”
    So take a listen and dont worry, while GeriPal podcasts offer CME, we never take money from industry.
    By: Eric Widera
     
     
     

    • 47 min
    Public Facing Education via Social Media: A Podcast with Julie McFadden, Matt Tyler, Sammy Winemaker and Hsien Seow

    Public Facing Education via Social Media: A Podcast with Julie McFadden, Matt Tyler, Sammy Winemaker and Hsien Seow

    On today’s podcast, we’ve invited four hospice and palliative care social media influencers (yes, that’s a thing!), all of whom focus their efforts on educating the general public about living and dying with a serious illness. Their work is pretty impressive in both reach (some of their posts are seen by millions of viewers) and breadth of work.  We’ve invited:
    Julie McFadden (aka Hospice Nurse Julie): Julie is a social media superstar, with 1.5 million subscribers on TikTok, another 400,000 subscribers on her YouTube channel, and another 350k followers on Instagram. She covers topics on death, dying, and hospice from a hospice nurse perspective, and she also has a book coming out called “Nothing to Fear: Demystifying Death to Live More Fully,” which is now available for pre-order.  
    Matt Tyler (aka Pallidad for those on Twitter): Matt is the Hospice and Palliative care doctor who created How To Train Your Doctor, which helps patients living with serious illness find tips on “owning” their healthcare plan on his Instagram and  YouTube pages.  He was also the one who we have to thank for suggesting this podcast!
    Hsien Seow & Samantha (“Sammy”) Winemaker: Hsein and Sammy's goal was to start a revolution with their podcast “The Waiting Room Revolution,” which is now in its 7th season! The hope was by going directly to those living with a life-changing illness, we could directly tackle the question that comes up so many times - “Why didn’t anyone tell me that sooner…”  They also just published a book,” Hope for the Best, Plan for the Rest,” and Sammy is a TikTok star in her own right, with some posts having over a million views.

    We covered a lot of topics in the podcast from:: 
    What motivated them to create public-facing social media channels?
    Why focus on the public rather than other health care providers?
    How do they deal with professional barriers and the barrage of comments?
    Advice for others who might want to dabble in social media outreach
     
    So, take a listen and check out their social media sites to get inspired. Just don't let Alex make me do another TikTok dance…
     
    Eric Widera
     

    • 47 min

Customer Reviews

4.9 out of 5
256 Ratings

256 Ratings

Nellyda A. ,

Staying in the loop

I’m a UCSF alumnus, and now I live and work in rural Oregon. Providing up to date geriatric and palliative care can present challenges in my community due to a lack of understanding about the “mission” of these specialty areas. Listening to this podcast helps me feel connected to experts and innovators in this field, and helps me stay focused on what matters. I love the conversational yet scientific reporting style. It feels like I’m part of a loving club of nerdy-smart clinicians. Thank you for keeping me in the loop!

The OGG ,

Great info, fun to listen

I love this podcast. Eric and Alex (and frequent guest cohosts) offer up-to-date and engaging information about hot topics in geriatrics and palliative care in a way that is fun to listen to. They have a really diverse group of guests and do a nice job with the interview. This is a great, easy way to stay informed! Definitely recommend.

indiaphile ,

Geripal

As a Geriatrician working in LTC I find Geripal a useful and enjoyable podcast. One of the best in the field.

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