316 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 • 258 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!

    Palliative Care in Liver Disease: A Podcast with Kirsten Engel, Sarah Gillespie-Heyman, Brittany Waterman, & Amy Johnson

    Palliative Care in Liver Disease: A Podcast with Kirsten Engel, Sarah Gillespie-Heyman, Brittany Waterman, & Amy Johnson

    In May we did a podcast on KidneyPal (the integration of palliative care in renal disease), which made us think, hmmm… one organ right next door is the liver. Maybe we should do a podcast on LiverPal? (or should we call it HepatoPal?)
    On today’s podcast, we do that by inviting four palliative care leaders who are integrating palliative care into the care of those with liver disease: Kirsten Engel, Sarah Gillespie-Heyman, Brittany Waterman, and Amy Johnson.
    It’s a jampacked 50 minutes, filled with pearls on taking care of patients with liver disease.  We cover:
    How each of their LiverPal teams are structured
    Why and how LiverPal differ from general palliative care or other palliative care specialty areas (KidneyPal, PalliPulm, etc)
    How to prognosticate in liver disease and how they communicate this with patients
    How to think about expectations of transplants and limitations of it
    How to manage complications and symptoms ranging from ascites, hepatic encephalopathy, pain, itching, cramps, and depression
    Also, if you want to take an ever deeper dive, check out our 2022 podcast on End Stage Liver Disease with Jen Lai, Ricky Shinall, Nneka Ufere, and Arpan Patel

    • 51 min
    Anxiety in Late Life and Serious Illness: A Podcast with Alex Gamble and Brianna Williamson

    Anxiety in Late Life and Serious Illness: A Podcast with Alex Gamble and Brianna Williamson

    “Anxiety is a lot like a toddler. It never stops talking, tells you you’re wrong about everything, and wakes you up at 3 a.m.”  I’m not sure who wrote this quote, but it feels right to me. We’ve all had anxiety, and probably all recognize that anxiety can be a force of action or growth but can also spiral to quickly take over our lives and our sleep. How, though, do we navigate anxiety and help our patients who may end up in the anxiety spiral that becomes so hard to get out of?
    On today’s podcast, we’ve invited Alex Gamble and Brianna Williamson to talk to us about anxiety. Alex is a triple-boarded (palliative care, internal medicine, and psychiatry) assistant professor of medicine at Stanford. Brianna is one of UCSF’s palliative care fellows who just completed her psychiatry residency.
    We start by defining anxiety (harder said than done), move on to talking about when it becomes maladaptive or pathologic, and how DSM5 fits into all of this. We then walk through how we should screen for anxiety and how we should think about a differential.  Lastly, we talk about both non-pharmacologic and pharmacologic treatments.
    It’s a lot to cover in 45 minutes, so for those who like to take a deeper dive, here are some of the references we talked about:
    Alex Sable-Smith’s great BATHE video on YouTube: 
    Two books that Alex Gamble often recommends to patients can help build up your capacities to sit with anxiety (per Alex, both are from an Acceptance and Commitment Therapy framework)
    Things Might Go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety
    The Reality Slap
     

    • 56 min
    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

Customer Reviews

4.9 out of 5
258 Ratings

258 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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