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.
Rethinking Opioid Conversions: Mary Lynn McPherson and Drew Rosielle
A patient is on morphine and you want to convert it to another opioid like hydromorphone (dilaudid). How do you do that? Do you do what I do, pull out a handy-dandy opioid equianalgesic table to give you a guide on how much to convert to?
Well on today’s podcast we invited Drew Rosielle on our podcast who published this Pallimed post about why opioid equianalgesic tables are broken and why we shouldn't use them, as well as what we need to move to instead.
But wait, before you throw out that equianalgesic table, we also invited Dr. Mary Lynn McPherson, PharmD extraordinaire who published this amazing book, Demystifying Opioid Conversions, 2nd Ed., which advocates for an updated, wait for it… equianalgesic table!
Oh boy, what should we do? Should we throw out the equianalgesic table like some are advocating we do with advance directives (see here), or should we just modernize it for the times with updated data? Listen to this spicy podcast with these wonderful guests to make up your own minds (I’m sticking with the equianalgesic table for now).
If you want to take a deeper dive into some of the references, here you go:
Pallmed Post on why “Opioid Equianalgesic Tables are Broken” Pallimed post on “Simplifying Opioid Conversions” Dr. Akhila Reddy and colleagues study looking at converting hospitalized cancer patients from IV hydromorphone to PO morphine, PO hydromorphone, or PO oxycodone. Our previous podcast with Mary Lynn titled “All the Questions You Had About Opioids But Were Afraid To Ask”
Palliative Care in India: M.R. Rajagopal
In today’s podcast we talk with Dr. Rajagopal (goes by “Raj”), one of the pioneers of palliative care in India. Raj is an anesthesiologist turned palliative care doctor. He is also author of the book, “Walk with the Weary: Lessons in Humanity in Health Care,” and was featured in this Atlantic article. Raj is the founder of Pallium, an organization dedicated to improving palliative care throughout India. We are joined by guest-host Tom McNally, a rehab and pediatric palliative care doc at UCSF. In this podcast, we cover a great deal of ground, including:
Early challenges Dr. Raj faced in pain management: access to opioids, corruption, a system that doesn’t see addressing suffering as a priority Prognosis communication and the subtle ways we may communicate it without intention Social pain and loneliness Community-based palliative care networks Raj’s reflections on the state of palliative care in the US How definitions bind us, for example the division between chronic pain and palliative pain in much of the US Ways listeners can learn more and contribute (see this link in the US) Because the song request was the short theme-song for Pallium, I recorded it two ways. The intro is the upbeat guitar driven version. The outro is the synthesizer (new toy!) slowed down version.
Hearing Loss in Geriatrics and Palliative Care: A Podcast with Nick Reed and Meg Wallhagen
Think about the last time you attended a talk on communication skills or goals of care discussions. Was there any mention about the impact that hearing loss has in communication or what we should do about it in clinical practice? I’m guessing not. Now square that with the fact that age-related hearing loss affects about 2/3rd of adults over age 70 years and that self-reported hearing loss increases during the last years of life. Screening for addressing hearing loss should be an integral part of what we do in geriatrics and palliative care, but it often is either a passing thought or completely ignored. On today's podcast, we talk to Nick Reed and Meg Wallhagen about hearing loss in geriatrics and palliative care. Nick is an audiologist, researcher, and Assistant Professor in the Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health. Meg is a researcher and professor of Gerontological Nursing and a Geriatric Nurse Practitioner in the School of Nursing at UCSF.
We talk with Nick and Meg about:
Why hearing loss is important not just in geriatrics but also for those caring for seriously ill individuals How to screen for hearing loss Communication techniques we can use when talking to individuals with hearing loss The use of assistive listening devices like pocket talkers and hearing aids Their thoughts on the approval and use of over the counter hearing aids If you want to take a deeper dive into this subject and read some of the articles we discussed in the podcast, check out the following:
Hearing Loss: Effect on Hospice and Palliative Care Through the Eyes of Practitioners COVID-19, masks, and hearing difficulty: Perspectives of healthcare providers Association of Sensory and Cognitive Impairment With Healthcare Utilization and Cost in Older Adults Over-the-counter hearing aids: What will it mean for older Americans? Addressing Hearing Loss to Improve Communication During the COVID-19 Pandemic
Comics and Humor in Palliative Care: A Podcast with Nathan Gray
Comics. Cartoons. Graphic Novels. Graphic Medicine. I’m not sure what to title this podcast but I’ve been looking forward to it for some time. Heck, I’m not even sure to call it a podcast, as I think to get the most out of it you should watch it on YouTube.
Why, because today we have Nathan Gray joining us. Nathan is a Palliative Care doctor and an assistant professor of Medicine at Johns Hopkins. He uses comics and other artwork to share his experiences in palliative care and educate others about topics like empathy and communication skills. His work has been published in places like the L.A. Times, The BMJ, and Annals of Internal Medicine.
We go through a lot of his work, including some of the comics you can see on our blog post. However if you want to take a deeper dive, check out his website “The Ink Vessel” or his amazing twitter feed which has a lot of his work in it.
Poetry & Palliative Care: Podcast with Mike Rabow and Redwing Keyssar
In celebration of National Poetry Month, we are delighted to share with you the second podcast in our series on poetry and medicine. In the first podcast, we talked with Guy Micco and Marilyn MacEntyre about poetry and aging.
In this second part in our series, we welcome Mike Rabow and Redwing Keyssar to talk about palliative care and poetry.
As with aging, poetry operates on multiple levels within the palliative care space.
Poetry puts us in our patient’s shoes. As Redwing’s poem says, “why not live as long as possible?”
Poetry holds us in that liminal space so many of our patients are in. Paradox. The impossiblity which is life, which is everything, and death, which is the end of life. As Mary Oliver tells us In Blackwater Woods, and I’m paraphrasing here, we must to hold it to our bones, knowing our lives depend on it, and when the time comes, to let it go. To let it go.
Or as in Mark Nepo’s poem Adrift, I am so sad and everything is beautiful.
Poetry helps us grapple with our own experiences of illness. Redwing, who is a cancer survivor, shares poems about her experiences with cancer. Mike Rabow shares his award winning poem about coming out to the world about his diagnosis with multiple sclerosis.
We talk not only about reading poetry, but also writing poetry, and using poetry in medical education as a healing modality.
And along the way, we really felt like we got to the heart of things. To the deeper emotions - of loss and grief, of wonder and transcendence - that are at the heart of the complex care we provide.
Links to Redwing’s poetry workshops:
Food for Thought Poetry for Resiliency
Loss, Losing and Loosening, poetry for grief and loss
Wounded Healer poetry sessions
Advance Care Planning
Links to Redwing Keyssar’s poetry collections
Redwing’s website: www.redwingkeyssar.com
Institute for Poetic Medicine
Mike Rabow’s Comprehensive Care Team randomized trial of outpatient palliative care
Look also for a forthcoming article by Mike and Redwing in Journal of Pain and Symptom Management on poetry as a healing modality, to be published mid May (will add link when out).
In addition to Redwing’s own songs and poems, other poems read by Mike and Redwing during the podcast:
In Blackwater Woods by Mary Oliver
Therapy by John Wright
Adrift by Mark Nepo
Talk Before Sleep by Elizabeth Berg
Late Fragment by Raymond Carver
Buprenorphine Use in Serious Illness: A Podcast with Katie Fitzgerald Jones, Zachary Sager and Janet Ho
Buprenorphine. It’s been around for a long time but is acting like the hot new kid in town. Just look at this year’s AAHPM meeting, where it felt like every other session was talking about how hot buprenorphine is right now. But does this drug really live up to the hype? On today’s podcast we talk with three experts on buprenorphine on why, when, and how to use it in serious illness. Our experts include Katie Fitzgerald Jones (palliative nurse practitioner and doctoral student at Boston College), Zachary Sager (palliative care physician at the Boston VA and Dana-Farber Cancer Institute), and Janet Ho (physician at UCSF in addiction medicine and palliative care).
We try to cover a lot in a 45 minute podcast, but if there is one take-away, it's that all of us who prescribe opioids should learn how to use buprenorphine and that we should all sign up for a DEA X-waiver at www.getwaivered.com or at www.buprenorphine.samhsa.gov (now you can treat up to 30 patients without completing the additional educational training, so signing up takes about 5 minutes).
And if you want to learn more about buprenorphine from these amazing palliative care clinicians and others, check out of some of these articles:
Learn more about caring for those with substance use disorder:
Adapting Palliative Care Skills to Provide Substance Use Disorder Treatment to Patients With Serious Illness Learn about using the low dose buprenorphine patch:
Low-Dose Buprenorphine Patch for Pain - Fast Fact Learn about how to initiate buprenorphine:
Sublingual Buprenorphine Initiation: The Traditional Method - Palliative Care Network of Wisconsin Low Dose Initiation of Buprenorphine: A Narrative Review and Practical Approach Good review on buprenorphine for pain
Understanding Buprenorphine for Use in Chronic Pain: Expert Opinion
A must-listen for all physicians
Excellent podcast with practical and insightful information for me as a doctor and medical director.
Best in the biz
Insightful questions and fantastic guests! This is how I stay up-to-date on advances (and controversy) in palliative care. Thanks guys!
Every geriatric social worker should listen!
This podcast makes otherwise inaccessible (because it is published in journals most of us don’t subscribe to), but valuable information understandable, useful, and fun! I look forward to every new episode. Highly recommend for anyone working with older adults.