Podcasts about polst

What does it take to ensure a "good death"? Join us as we explore this profound question with our esteemed guest, Susanna Bryan, a transformative figure in end-of-life care. Drawing from her rich experiences as a former hospice and oncology nurse, and founder of the Doula Givers Institute, Susanna offers enlightening insights into making the end-of-life experience more human-centered. Inspired by her volunteer work in Zimbabwe, she advocates for changes in the American system to focus on clarity, comfort, and dignity, and shares the nine essential questions that guide this process. Her journey underscores the importance of presence and a supportive community for those nearing life's end and provides a roadmap to align end-of-life experiences with personal values. This episode delves into the delicate task of discussing end-of-life wishes with loved ones, focusing on maintaining quality of life and ensuring wishes are respected. We recount the heartfelt story of Mary, who faced terminal cancer with grace and celebrated her life through a living funeral. Mary's journey is a testament to the power of prioritizing personal comfort and symptom management over medical interventions. We also explore the role of palliative care in enhancing quality of life, encouraging listeners to consider practical, physical, and emotional preparations for future decisions. Listeners are invited to consider their own end-of-life care preferences, from choosing a healthcare proxy to exploring environmentally friendly body disposition options. We highlight the significance of legal documents like the POLST form in ensuring wishes are followed and emphasize the value of clear communication with family. As we explore alternative end-of-life celebrations, such as body donation and living funerals, we encourage embracing personal choice to honor life and death. By empowering you with knowledge and confidence, this episode aims to make end-of-life planning a meaningful and sacred gift for both you and your loved ones.       SIGN UP FOR THE "GOOD DEATH" SEMINAR SERIES on March 12th at 7pm ET - Click here The Good Death Seminar Series will be hosted LIVE on Zoom! Space is limited! Save your seat now!     Mark your calendars! On March 22nd, I'm hosting a private virtual event to celebrate "THE GOOD DEATH," and I want YOU to join me. Pre-order the book today, and you'll get exclusive access to a full day of training, conversation about what makes life an AMAZING  journey. I will share my 5 pillar framework that I use every day, to create a life of fulfillment, joy and service- and you can too! I can't wait to share this journey with you. Grab your ticket here!           We dive into: (00:00) - Good Death Seminar Series (10:00) - End-of-Life Care and Planning Discussion" (20:11) - Quality of Life and Care Planning (25:48) - Personalized End-of-Life Care Preferences (36:23) - End-of-Life Care Planning Choices (46:52) - Home Funeral and Disposition Options (52:32) - Body Donation and End-of-Life Celebrations (59:50) - Ensuring Legal Medical Preferences         We want to hear from you!!! If you found this podcast helpful, Please Rate, Review, & Follow so we can reach more people.         Links mentioned in this episode: Doulagivers Institute The NEXT Free Level 1 End of Life Doula Training Registration LINK  Buy The Good Death Book   80-90% of a positive end of life depends on these two things: Knowing the basic skills on how to care for someone at the end of life and planning ahead - and BOTH Doulagivers Institute is giving you for FREE! Access them Below! Making your wishes known is one of the greatest gifts you can give to your loved ones. Download The Doulagivers 9 Choice Advance Directive now! It's FREE!     More about what we do at Doulagivers Institute - Click here!  

Unlock the secrets to a more peaceful and prepared end-of-life experience with insights from our latest session in the Good Death Seminar series. As a hospice and oncology nurse, I draw from my extensive experience to transform the fear and chaos surrounding death into an opportunity for growth and understanding. You'll learn how to have essential end-of-life conversations that not only honor loved ones but also teach us valuable lessons about truly living. Discover how the Good Death Movement is reshaping societal perceptions and inspiring a more meaningful appreciation for life. Our discussion delves into the importance of having advanced directive conversations with family and friends, ensuring that end-of-life wishes are respected and documented. Through poignant stories, such as that of Mrs. Murphy, we highlight the potential heartbreak and conflict that arise from avoiding these critical discussions. Learn about the role of certified end-of-life doulas and the significance of legal documents like advanced directives and the POLST form in making your wishes known and legally recognized. Join us as we explore advanced directives' profound impact on families and medical professionals, offering peace of mind and clear guidance for those difficult decisions. We emphasize the need for proactive communication and preparation to bridge gaps in care and prevent misunderstandings. By participating in our movement, you contribute to a cultural shift in how society views death, fostering conversations that lead to a more serene and dignified end-of-life journey for all.     SIGN UP FOR THE "GOOD DEATH" SEMINAR SERIES on February 12th at 7pm ET - Click here The Good Death Seminar Series will be hosted LIVE on Zoom! Space is limited! Save your seat now!         We dive into: (00:00) Good Death Seminar Series Introduction (06:22) The Importance of End-of-Life Planning (20:07) Family Advanced Directive Discussion Comfort Level (25:12) Advance Directive Importance and Preparation (31:06) Advanced Directive Benefits and Challenges (35:47) Advanced Directives and Legal Considerations (45:06) The Importance of the Pulse Form (57:04) Good Death Book Purchase Instructions (01:10:51) Good Death Book Bonuses and Certification (01:23:43) Initiating Conversations on End-of-Life Care (01:32:28) The Good Death Movement Conclusion       We want to hear from you!!! If you found this podcast helpful, Please Rate, Review, & Follow so we can reach more people.       Links mentioned in this episode: Doulagivers Institute The NEXT Free Level 1 End of Life Doula Training Registration LINK  The NEXT Free Doulagivers Discovery Webinar  Buy The Good Death Book   80-90% of a positive end of life depends on these two things: Knowing the basic skills on how to care for someone at the end of life and planning ahead - and BOTH Doulagivers Institute is giving you for FREE! Access them Below! Making your wishes known is one of the greatest gifts you can give to your loved ones. Download The Doulagivers 9 Choice Advance Directive now! It's FREE!     More about what we do at Doulagivers Institute - Click here!

Send us a textMany patients want to have a say in their medical care, especially when it comes to end-of-life decisions.Despite this, only a third of U.S. adults have completed any form of advance care directive.Even for those who do plan ahead, traditional paper-based advance directives often face challenges like misinterpretation or even being ignored altogether.Could video-recorded directives be the answer?In this episode of HealthBiz Briefs, MIDEO CEO Dr. Ferdinando Mirarchi sheds light on the limitations of standard advance care directives and explains why video-based solutions might deliver better results, offering greater clarity and ensuring patients' wishes are honored.This episode is brought to you by BetterHelp. Give online therapy a try at https://betterhelp.com/caretalk and get on your way to being your best self.As a BetterHelp affiliate, we may receive compensation from BetterHelp if you purchase products or services through the links provided.

What if you could transform the end-of-life experience into a holistic, human journey rather than a purely medical one? Join us as we explore the profound and often overlooked aspects of end-of-life care on this episode of "Ask a Death Doula." We're breaking down the three phases of end-of-life, from initial comfort measures to the body's natural decline, and highlighting the critical role of proactive planning. Discover how you can enrich these final moments for your loved ones and yourself by embracing new, progressive choices that celebrate life and honor the environment. Understanding legal preparations is crucial, and this episode sheds light on the importance of advanced directives and POLST forms. Learn why these documents are vital for ensuring your wishes are respected by medical professionals and how they can prevent common pitfalls. We share real-life stories to illustrate the necessity of awareness and education about these forms, empowering you to make informed decisions. This chapter is a must-listen for anyone looking to navigate end-of-life care with confidence and clarity. We also take a heartfelt look at sustainable end-of-life options that go beyond traditional practices. Imagine the intimacy of home wakes, the eco-friendliness of natural burials, or the innovative choices of water cremation and human composting. These alternatives not only honor the deceased but also tread lightly on the planet and are often more financially viable. Host Suzanne O'Brien expresses her gratitude for your participation and encourages you to explore the free resources available at doulagivers.com. Prepare to transform your perspective on end-of-life care and make it a deeply meaningful experience.       We dive into: (00:02) Navigating End of Life Care (06:49) End of Life Care Essentials (12:50) Understanding Advanced Directives and PULST Forms (17:48) Exploring Sustainable End-of-Life Options (27:02) Improving End of Life Care     We want to hear from you!!! If you found this podcast helpful, Please Rate, Review, & Follow so we can reach more people.       Links mentioned in this episode: Doulagivers Institute The NEXT Free Level 1 End of Life Doula Training Registration LINK  The NEXT Free Doulagivers Discovery Webinar    80-90% of a positive end of life depends on these two things: Knowing the basic skills on how to care for someone at the end of life and planning ahead - and BOTH Doulagivers Institute is giving you for FREE! Access them Below! Making your wishes known is one of the greatest gifts you can give to your loved ones. Download The Doulagivers 9 Choice Advance Directive now! It's FREE!     More about what we do at Doulagivers Institute - Click here!

In today's podcast we set the stage with the story of Dax Cowart, who in 1973 was a 25 year old man horribly burned in a freak accident. Two thirds of his body was burned, most of his fingers were amputated, and he lost vision in both eyes.  During his 14 month recovery Dax repeatedly demanded that he be allowed to die. The requests were ignored. After, he said he was both glad to be alive, and that the doctors should have respected his wish to be allowed to die. But that was 1973, you might say. We don't have such issues today, do we?  Louise Aronson's recent perspective about her mother in the NEJM, titled, “Beyond Code Status” suggests no, we still struggle with this issue. And Bill Andereck is still haunted by the decision he made to have the police break down the door to rescue his patient who attempted suicide in the 1980s, as detailed in this essay in the Cambridge Quarterly of HealthCare Ethics.  The issues that are raised by these situations are really hard, as they involve complex and sometimes competing ethical values, including: The duty to rescue, to save life, to be a “lifeguard” Judgements about quality of life, made on the part of patients about their future selves, and by clinicians (and surrogate decision makers) about patients Age realism vs agism  The ethics of rationale suicide, subject of a prior GeriPal episode Changes in medical practice and training, a disconnect between longitudinal care and acute care, and frequent handoffs The limitations of advance directives, POLST, and code status orders in the electronic health record The complexities of patient preferences, which extend far beyond code status The tension between list vs goals based approaches to documentation in the EHR And a great song request, “The Cape” by Guy Clark to start and end. Enjoy! -@AlexSmithMD  

In 1983, a 25 year old Nancy Cruzan was thrown from her car while driving home in Missouri, landing in a water filled ditch. She was resuscitated by EMS, but did not regain higher brain function, and was eventually diagnosed as being in a persistent vegetative state.  In 1988, Cruzan's parents requested that her feeding tube be removed, arguing that she would not want to continue in this state. The hospital refused without a court order, and the case eventually made its way to the Supreme Court. Arguing for the state of Missouri against the Cruzan's was Ken Starr, who would later be assigned the role of special prosecutor in the investigation of the Clintons (Whitewater, Lewensky, etc). In 1990 the Supreme Court ruled…for the state of Missouri.  On the one hand, this was unfortunate, as it meant Nancy Cruzan could not be disconnected from the feeding tube immediately. On the other hand, the ruling allowed states to set their own evidentiary standards to refuse or withdraw life sustaining interventions.  Missouri set a very high bar, explicit written documentation that applies to this specific circumstance, which the Cruzan's eventually cleared.  Other states set lower bars, including oral assignment of surrogate decision-makers. The Cruzan ruling led to a flood of interest in Advance Directives, and eventually to the Patient Self Determination Act, which mandates provision of information about advanced directives to all hospitalized patients. Today, we talk with Bernie Lo, prominent bioethicist and practicing primary care internist, and Laurie Dornbrand, geriatrician at the IOA On Lok PACE, about the legacy of Nancy Curzan.  We use Bernie's NEJM Perspective as a springboard for discussion.  We discuss, among other things: How and why in the 30 years since the Cruzan ruling the emphasis has shifted from advance directive forms to in-the-moment discussions And validating the importance of the advance directive forms in some circumstances, and in starting conversations The role of the clinician in engaging patients in advance care planning and in-the-moment serious illness conversation: what questions are important? What words to use? Is the POLST useful? How? Under what circumstances?  Should we abandon the term, “comfort measures?” In case you miss the introductions at the start of the podcast, Bernie and Laurie are married, and offer wonderful reminiscence of their clinical practice over the last several decades.  So when Bernie says, “I've heard you take these phone calls in the middle of the night, Laurie…” Now you know why! And great song choice: Both Sides Now by Joni Mitchell.  Joni suffered a stroke and had to completely re-learn how to play guitar.  Her comeback performances are inspirational, such as this one at the Newport Folk Festival, attended by another influential GeriPal couple, Sean Morrison and Diane Meier. You get to hear my stripped down Hawaiian slack key style version of Both Sides Now (easy to play with 2 fingers, still in rehab for broken hand, hoping to have full use again soon). Enjoy! -@AlexSmithMD  

In this podcast, Dr. Nick Schneeman, a geriatrican and the Chief Medical Officer for LifeSpark, brings his passion and expertise to discuss the state of care in geriatrics, along with how current delivery in care and payment models effect the geriatric population. Disclosure note: Dr. Nick Schneeman , speaker for this educational event, has no relevant financial relationship(s) with ineligible companies to disclose. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Describe what is meant by "value-based care". Describe current barriers to delivering high value care to a senior population. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.  All of the relevant financial relationships for the individuals listed above have been mitigated. Thank-you for listening to the podcast. SHOW NOTES:   *See the attachment for additional information.  PODCAST OVERVIEW- Geriatric care delivery and quality has not evolved significiantly. - Pockets of excellence exist in academic centers. - Social support systems is integral, but lacking in many parts of the country. - Fee for service (FFS) system is not a sustainable model per Dr. Schneeman for complex senior patients. - Training and exposure to the 'business platforms' in medicine is lacking with providers - FFS = paying for a specific service, procedure, treatment, etc. Value Based Care (VBC)- Value based care = outcomes/cost         - Clinical outcomes         - Experience outcomes of patient/family and caregiving team - How is VBC measured?         - Medical loss ratio (cost containment) - How does VBC work?         - Organization contracts with payor         - VBC organization takes on risk         - Money savings opportunity - Half of seniors in USA are already in a VBC model         - Medicare (CMS)         - ACO (group of doctors, health care organization, etc.)         - Medicare advantage (CMS product that insurance companies contract with federal government) - Cost Product (Medicare advantage product)         - Introduced in MN with assumption that this state will do such a good job with cost containment, but this wasn't how it worked out.         - For-profits don't participate in Medicare advantage products which keep the non-profits more accountable, although there are also disadvantages with for-profit programs. - How does the care delivery work in VBC organizations (Nick's viewpoint)?         - Step 1: Journey from simple problems into complexity         - Step 2: What is the current reality and quality of life?  (When people hear you restating their story, trust goes up immensily.)         - Step 3: What are you hoping for? (patient, family, etc.)         - Step 4: Acute care planning         - Step 5: Chronic care planning         - Outcomes:  POLST (physician orders for life-sustaining treatment) form that is comprehensive;            Chronic care plans that are clear and purposeful and match goals of care - Well done POLST forms require intential discussion with patient and advocates who have decision making capacity and understanding of the patient's reality and values Palliative Care- How it's integrated and its controversy - All practitioners should be able to make palliative decisions with and for their patients who they know intimately - Palliative care as a specialty exists largely due to a FFS model - Often this is a clinican the patient has never met before and is a one time consult - Private equity had created palliative care 'cold call' business models in recent years Value Based Care (VBC) - continued- How does a practitioner go about doing this? - Make sure the organization you join actually values the primacy of primary care - Clinicians need TIME with their complex patients and to be paid for this time - FFS can work well for simple problems - Who does this well? Small pockets, mostly senior care (i.e. clinic-based, homebased healthcare etc.) - Nurse, APP, physician - are assigned to each patient and continue to follow their care, avoid overprescribing, inappropriate abx - Private equity and Big insurance is getting into the game, but their approaches tend to be siloed and perhaps less humanistic - Recruiting quality providers to this care delivery model is imperative - Improved patient outcomes and costs exisst (i.e. geriatric assessment before cancer care) - Value Based Care really has to be an "all in" experience for a clinic or organization for it to work Training- Training typically happens in house, as opposed to a training program or course - Subspecialists will still be very much part of the care team, although decision making about proceeding with advanced therapies will be oriented around the VBC  medical home team - Pharmacy is a valuable team member as well, especially if part of the "goals of care" as opposed to merely looking up medications - Challenge: SNFs and long term care facilities often have significant staff turnover, care quality issues, and these can lead to unnecessary care, ED visits and hospitalizations Evidence Based Moment (EBM)  ResourcesMagill MK. Time to Do the Right Thing: End Fee-for-Service for Primary Care. Ann Fam Med. 2016 Sep;14(5):400-1. doi: 10.1370/afm.1977. PMID: 27621155; PMCID: PMC5394371. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394371/pdf/0140400.pdf Basu S, Phillips RS, Song Z, Landon BE, Bitton A. Effects of New Funding Models for Patient-Centered Medical Homes on Primary Care Practice Finances and Services: Results of a Microsimulation Model. Ann Fam Med. 2016 Sep;14(5):404-14. doi: 10.1370/afm.1960. PMID: 27621156; PMCID: PMC5394379. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.annfammed.org/content/annalsfm/14/5/404.full.pdf Thanks to Dr. Nick Schneeman for his expert knowledge and contribution to this podcast.

Today we celebrate eight years, around 2 million listens, and 300 podcasts!    Eric and I take questions from you, our listeners, about: why we podcast, our most controversial podcast, which podcast changed our practice, favorite song request, should all nursing home residents complete the POLST, expanding access to durable medical equipment, palliative care in rural regions, do we have an advance directive, what we'd do to improve healthcare with 7 trillion dollars, treatment for poor appetite, and Eric on how to make a latte.  Thank you to Lynn Flint and Anne Kelly who serve as hosts for this episode, asking us the tough questions. We answer your questions hot ones style.  I borrowed some screaming hot sauces from my friends Jerome Kim and Tony Le, and added them to my small collection of extra mild sauces.  Every two questions we ate a chicken wing covered in hot sauce. The hot sauces progressed from mild to extreme (and I mean extreme) heat. Can I just say…it works?  Being asked a question with your mouth on fire, sweat streaming down your face, feeling the most awake and terrified you have ever been in your life, forces you to give an unadorned answer, straight from the heart. Don't take my word for it, listen for yourself! Or better yet, watch the video of this one on YouTube. Some of the funniest parts are caught on video, in the background. We will be re-watching this one for years to come. Thank you, dear listeners, for sending us your questions, for your enthusiasm, and for your support. Enjoy! -@AlexSmithMD    

In this episode, we emphasize the significance of being mindful about the conversations we have, the friendships we cultivate, and the music we listen to, as they can either nourish or deplete us.  Just as the food we consume can impact our physical well-being, the conversations we engage in can have a similar effect on our overall health.Investing time in nourishing conversations can be life-giving rather than promoting negativity. By dissolving fear and choosing where to focus our attention, we can engage in conversations that bring vitality and contribute to our overall well-being. Be mindful of our environment and relationships, as they can either invigorate us or drain our vital energy.  Let's not waste mental energy on things that do not nourish us. Our thoughts, feelings, and emotions have the power to shape our physical bodies and greatly influence our experiences.Quotes: "Once we live a conscious life, this moment of death can be enlightenment.""Holding space,  is  witnessing someone and the light that comes out of them without trying to fix.""Sometimes the opportunity to stop, pause, is the beginning of your healing."Topics Covered In This Episode:End-of-life issues.Home funerals and green burials.Embracing the fact that death is coming.Where do we go when we dream?Grief rituals and healing.Different approaches to death.The process of dying.Advanced Directives and Resources.Legacy planning and digital assets.Living life before we're dead.Declining health and caregiver transitions.Subtle bodies and energy healing.The gift of each moment.Get to know our guest speaker Gabi Dias:Insta: @goatgabi, @TheDeathTalkWebsite: www.goatgabi.comImportant Links:The 5 Wishes Document https://www.fivewishes.org/for-myself/POLST: https://polst.org/+++++++++++++++++++++SurvivingBreastCancer.org's  Mission: To empower those diagnosed with breast cancer and their families from day one and beyond. About SurvivingBreastCancer.org: SurvivingBreastCancer.org, Inc. (SBC) is a federally recognized 501(c)(3) non-profit virtual platform headquartered in Boston with a national and global reach. Through education, community, and resources, SurvivingBreastCancer.org supports women and men going through breast cancer. We provide a sanctuary of strength, compassion, and empowerment, where those diagnosed with cancer unite to share their stories, learn invaluable coping strategies to manage wellness and mental health, and find solace in the unbreakable bond that fuels hope, resilience, and the courage to conquer adversity.+++++++++++++++++++++Follow us on InstagramLaura and Will: https://www.instagram.com/laura_and_will/SurvivingBreastCancer.org: https://www.survivingbreastcancer.org/Support the show

This episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes Dr. Matthew Gonzales and Dr. Deborah Unger who are affiliated with a grant provided to the Providence Portland Medical Foundation. Grant funding supported Providence and the Oregon Physician Orders for Life Sustaining Treatment (POLST) Registry for a partnership to build a bi-directional interface which integrates Providence's Epic electronic health record with the Registry. Dr. Gonzales and Dr. Unger discuss about how POLST is designed to respect people's wishes around care/treatment inside and outside of health care settings. They also talk about how POLST is utilizing digital technology to inform others across different systems, the challenge of state-by-state legislation, and the insight gained through the project so far. Feedback or episode ideas email the show at wnlpodcast@copic.com Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The information contained in this podcast is not intended to be, nor is it, a substitute for medical diagnosis, treatment, advice, or judgment relative to a patient's specific condition.

Securing a Positive End-of-Life Experience through Planning Imagine having the power to dictate the quality and course of your end-of-life care, being able to define what 'quality of life' means for you. This episode explores just that, with expert insight from Suzanne O'Brien, a former hospice and oncology nurse with years of experience in guiding individuals through this deeply personal journey. Dive into the world of advanced directives and the surprisingly non-binding nature of these documents. Discover the power of the POLST form, a tool that can help ensure your wishes are respected when it matters most.  The conversation doesn't stop there. We navigate the significant role your healthcare proxy plays, shedding light on the importance of defining your personal benchmarks for quality of life and establishing clear communication lines with your loved ones. We'll delve into the nine choices advanced directive document, a comprehensive guide that covers everything from who should voice your desires, to the heartfelt messages you want your loved ones to hold onto. Drawing from a poignant tale of a hospice patient, we're reminded of the simple yet profound joys of life and the importance of maintaining that quality until the very end. Let's journey together into this solemn yet empowering topic of end-of-life care planning. You are also invited to join the upcoming Live Learning Lab Workshop to explore these topics further.   We dive into: (04:23 - 05:14) Seeking Legal Advice for Advanced Directives (08:26 - 10:39) Understanding Healthcare Proxies (12:43 - 14:39) Defining Quality of Life and Decision-Making (16:13 - 17:04) Importance of End-of-Life Care Communication (25:15 - 26:38) Choosing a Healthcare Proxy and Post Form (29:08 - 30:19) Creating Sacred End of Life Space (33:34 - 35:16) Redefining Relationship With End of Life   We want to hear from you!!! If you found this podcast helpful, Please Rate, Review, & Follow so we can reach more people.   Links mentioned in this episode: Doulagivers Institute The NEXT Free Level 1 End of lIfe Doula Training Registration LINK - January 18th at 7pm ET The NEXT Free Doulagivers Discovery Webinar - December 14th 80-90% of a positive end of life depends on these two things: Knowing the basic skills on how to care for someone at the end of life and planning ahead - and BOTH Doulagivers Institute is giving you for FREE! Access them Below! Making your wishes known is one of the greatest gifts you can give to your loved ones. Download The Doulagivers 9 Choice Advance Directive now! It's FREE! The Doulagivers Level 1 End of Life Family Caregiver Training AVAILABLE NOW ON DEMAND! Listen Now (edited)    More about what we do at Doulagivers Institute - Click here!  

Warum sind wir eigentlich nicht alle reich? Was glaubst du? Was GLAUBST du? Denn das ist der Schlüssel. Wir glauben alle an so großen Mist und dieser Mist hindert uns daran in jedwede Fülle zu kommen. Sandy Mercier ist für mich DIE Ansprechpartnerin, wenn es um Themen wie diese geht. Denn sie durfte lernen, wie sie in finanzielle kommt. Sie weiß, dass es nicht nur auf Trick 17 ankommt, sondern dass wir ganz viel und vor allem zuerst schauen dürfen, was uns ausbremst. Wir dürfen ein paar Staudämme auflösen, bevor der Geldfluss strömt. ======================== Links aus der Folge (Werbung - du unterstützt mich, wenn du auf die Amazon-Links klickst) Meine Schreibratgeber als eBooks, Hardcover und Hörbücher: https://adwbuecher.de/collections/fur-autoren Sandys Manifestationskurs findest du, wenn du ihr direkt schreibst. Am besten über Instagram: https://www.instagram.com/sandy_mercier_autorin/ Mein kostenloses Webinar für dich, wenn du möchtest, dass 2024 DEIN Jahr als Autorin wird // https://sba.seibestsellerautorin.de/webinarnotionplaner Bodo Schäfer // [https://shop.bodoschaefer-akademie.de](https://shop.bodoschaefer-akademie.de/) Joe Dispenza // https://drjoedispenza.info/s/Drjoedispenza Scheiß auf die Glücksfee von Claudia Engel // https://amzn.to/3QOEGwG Happy Money von Ken Honda // https://amzn.to/3SUTtbQ Mein Aufnahme-Setup (auch das sind Affiliate-Links): Kamera: Sony ZV-1 // https://amzn.to/3WynoFo Mikrofon: Røde VideoMic Pro // https://amzn.to/3G6lBSy Kopfhörer: AirPods 2 // https://amzn.to/3hGgoHW Computer: Mac studio M1 Max, 64 GB // https://tidd.ly/3RFXf6y Apple iPad Pro (2021) 12,9” bei Cyberport // https://tidd.ly/3HGtoHv ======================== Hashtags zur Folge: #geldblockaden #moneymindset #selfpublishing ======================== Hier findest du uns: ADW Website // [www.adwilk.de](http://www.adwilk.de/) ADW Instagram // [www.instagram.com/adwilk_autorin](http://www.instagram.com/adwilk_autorin) ADW Facebook // [www.facebook.com/adwilkautorin](http://www.facebook.com/adwilkautorin) SM Website // https://www.sandymercier.de SM Instagram // https://www.instagram.com/sandy_mercier_autorin/ SM TikTok // https://www.tiktok.com/@sandy_mercier_aut Hast du Fragen zu meinem Podcast? Wünschst du dir spezielle Inhalte? Dann schreib mir unter [andrea@adwilk.de](mailto:andrea@adwilk.de) oder auf Instagram unter @adwilk_autorin. Klick jetzt auf Abonnieren und verpasse keine neue Folge. Meine Bücher findest du hier: https://www.adwilk.de/shop/ Danke, dass du uns hörst und siehst! ======================== Eigenwerbung und unbeauftragte Werbung

What level of evidence do we need for POLST to use it ourselves, to advocate for wider usage, and for establishing POLST completion as a quality metric?  The answers to these questions will vary.  Reasonable people will disagree.  And today, on our podcast, our guests disagree.  Firmly.  AND we are delighted that our guests modeled respectful disagreement.  With no hard feelings.  Respectful disagreement is in short supply these days. Our guests today are Kelly Vranas, pulm crit care doc who published a systematic review in JAGS of the evidence for POLST (as well as other articles here, here,and here); Abby Dotson, who is Executive Director for National POLST and Director of the Oregon POLST registry; Karl Steinberg, geriatrician and palliative care doc and President of National POLST; and Scott Halpern, pulmonary critical care physician, bioethicists and palliative care researcher who was senior author of a Viewpoint in JAMA that was critical of the concept and evidence base for POLST (and argues little has changed).  We had a full podcast, and I wasn't able to give my take on the existing evidence for POLST, so I'll write it here. I'm in the middle between Scott and Karl, where I suspect Kelly is, though we didn't ask her explicitly.  On the one hand, I agree with Scott that observational studies finding those who complete a POLST stating a preference for comfort oriented care and DNR are not go to the ICU says little about the effectiveness of POLST.  Far more likely that those underlying preferences and values are what drove the findings than completion of the POLST form that codified the preferences into orders.  On the other hand, I agree with Karl that the POLST has face validity, and anecdotal evidence is overwhelming.  Certainly SOME of those avoided hospitalizations, CPR, and ICU stays were due to documentation of those orders in the POLST. The unanswered question is: HOW MUCH of the differences are due to the POLST?  It's not zero, as many of us have had cases in which we said, “Thank god we completed that POLST, it clearly stopped X from happening.” But is it a tiny, meaningless, fraction?  Or a substantial proportion?  My guess is a small but meaningful fraction of differences in observational studies is due to completion of the POLST, though the majority of differences are due to underlying preferences and values. Is that fraction due to POLST large enough that we should design quality metrics around completion of POLST? Absolutely not. Do we need better evidence, preferably from an RCT of POLST vs no POLST? Yes. Caveat as well that RCTs should not be placed on pedestal as the only answer-  often patients enrolled in RCTs do not represent real world patients - observational studies do.  For a trial to have value, it should not exclude patients over age 80, or those with dementia, or patients residing in nursing homes.  And it must be powered to detect a small but meaningful difference, not the same level of effect seen in observational studies. OK, I'll step off my soap box. Additional links mentioned in the podcast: Recent JGIM article on POLST in California nursing homes, hospitalization, and nursing home care Karl's GeriPal post on appropriate use of POLST  Enjoy! -@AlexSmithMD

Most people are very uncomfortable with the idea of death and dying and avoid the serious conversations and preparations involved in the process (one which we'll all experience eventually). On this episode of Renoites, we welcome one of the founders of the Doula Co-op, Emily Barney, to talk about what the death industry looks like today, and some of the better ways we can approach and talk about the end of our lives and the lives of our loved ones. Some of the questions we explored were about what the common practices look like today, how the death industry can take advantage of tragedy to exploit bereaved people, what natural death and home funerals look like, what a doula's role is for people who are nearing death (and for those who expect to still have a long life ahead of them), the challenge of burnout for people in highly emotionally demanding jobs, why you need to create a living will TODAY, and much more! If you have suggestions for future guests or topics, please let me know! Email conor@renoites.com Renoites is a fully LISTENER FUNDED project. This show simply can not exist without contributions from listeners just like you! Learn more and contribute a few dollar to help this show become financially sustainable at http://patreon.com/renoites I recently appeared on the Worst Little Podcast! Listen to that episode wherever you get podcasts or at https://www.worstlittlepodcast.com/   Additional Resources and Information: Contact: Emily's website: doulapurposes.com (currently under redesign)  Email: doulabarney@gmail.com   DOULA CO-OP Resources: Website: doulacoop.org Email: connect@doulacoop.org  Death Doula Resources: Melissa Chanselle-Hary, Death Doula sacredtransits.com NEDA (National End of Life Doula Association) - Tips on Choosing an EOLD Going with Grace - death doula training & community, end of life planning support & services organization   Funeral Consumer Alliance  Paying Final Respects: Your Rights When Buying Funeral Goods & Services National Home Funeral Alliance - community death care resources & providers directory Video - Sacred Crossings, home funeral FreeWill - create your own Will today, free! (does not include medical treatment planning) Filing an Advanced Directive with the NV Secretary of State NV Sec. of State - Forms & Resources (including POLST form)

We are off until October but are publishing re-runs of Season 9 episodes. We will be back with Season 10 in October 2023!---Join me, Savy and my guest Jeannette Koijane MPH the Executive Director of Kokua Mau as we talk about Advance Care Planning and Types of Hospice care. The Caring Caregiver Show, brought to you by Gimme A Break and sponsored by Givers Guides online magazine, your guide to Caregiving! We're here to bring back the joy of Caregiving, we're here for your support, to bring you resources that you need, because we know you're tired and frustrated and you DESERVE some "CARING"From this Episode:Kokua Mau - Hawaii's trusted resource for accurate information on Advance Care Planning including Advance Directives and POLST, palliative care and hospice careOur Resources:Gimme A Break - Non-profit for caregivers aiming to bring back joy to caregiving, free weekly support sessions offering caregivers a chance to relax, renew, resource and revive. Register or register a caregiver for a break.Givers Guides Magazine - The complete caregiver resource guide. Get your first issue today, as 100% of all profits are donated to support Gimme A Break.Your Host:Savy Makalena - founder of Gimme a Break and Givers Guides Connect with the Caring Caregiver Show:Facebook Page: Caring Caregiver ShowInstagram: caringcaregivershowWebsite: www.caringcaregivershow.comFacebook Group: Click here to join

VSED, or voluntary stopping of eating and drinking, is legal in all 50 states. It is not considered suicide. Why do people choose this option, and how can this manner of dying be more comfortable and peaceful? Suzanne O'Brien, RN, has thoughts that I will share. Judith Schwarz, RN, Ph.D., also has shared her thoughts on VSED. I have my thoughts, too, and included them for you in this episode.And what about life insurance? Does it cover VSED or MAID? If you want more information, check out https://vsedresources.com/https://www.compassionandchoices.org/our-issues/vsedListen and read my blog: https://whilewerestillhere.com and https://grimtea.comStarting with Episode 56, the episode music was added. It was composed, produced and provided by Kyle Bray specifically for this show.The logo artwork was provided by Maddie's Plush Pouch.

This week we will discuss Palliative vs Hospice with Dr. Karl Steinberg.  Palliative Care, Hospice Care, End-of-Life Care, Serious Illness Care, and Advance Care Planning/POLST all represent important elements of care for individuals dealing with serious illness, particularly those facing end-of-life situations. These are related but distinct concepts within the healthcare system. Palliative Care: This is a type of care that is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve the quality of life for both the patient and the family. Palliative care is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment. It's not limited to end-of-life scenarios and can help patients manage symptoms and side effects of disease or its treatment. Hospice Care: This is a specific type of palliative care for patients who are in the final stages of an incurable disease and have chosen to focus on comfort and quality of life rather than treatments aimed at cure. Generally, hospice care is considered when patients have a life expectancy of 6 months or less. It is often provided in the patient's home but can also be provided in hospice centers, hospitals, long-term care facilities, and nursing homes. End-of-Life Care: This refers to the support and medical care given during the time surrounding death. End-of-life care can include a broad range of possible treatments and support, depending on the patient's needs. It might include treating pain and other uncomfortable symptoms, providing emotional and spiritual support, and helping the patient and their family make decisions about care. Both palliative and hospice care can be part of end-of-life care. Serious Illness Care: This is a broad term that includes all types of care that someone with a serious, potentially life-limiting illness may receive. This can include everything from aggressive treatments aimed at curing or controlling the disease to palliative and hospice care aimed at managing symptoms and improving quality of life. Advance Care Planning/POLST (Physician Orders for Life-Sustaining Treatment): Advance Care Planning involves making decisions about the care you would want to receive if you become unable to speak for yourself. These decisions are often documented in an advance directive. A POLST form is a type of advance directive that becomes an actionable medical order when signed by a healthcare provider. The POLST form helps ensure that a patient's wishes regarding life-sustaining treatments are honored by emergency medical personnel, nursing home staff, and healthcare providers. ​All of these concepts share a common goal: to ensure the best possible quality of life for patients facing serious illnesses, while respecting their values, preferences, and goals for care. About Our Guest Dr. Karl Steinberg has been a nursing home, hospice, and home health agency medical director and chief medical officer in the San Diego area since 1995.  He received his bachelor's in biochemistry from Harvard and studied medicine at The Ohio State University College of Medicine, then completed his family medicine residency at University of California San Diego (UCSD) in 1990.  He has board certifications in family medicine and in hospice and palliative medicine, and is certified as a nursing home and hospice medical director in addition to having a certification as a healthcare ethics consultant.   Dr. Steinberg also serves as president of the National POLST Collaborative, and is a past president of AMDA and CALTCM and past chair of the San Diego and California Coalitions for Compassionate Care.  He serves on the National Advisory Board for the CSU Shiley Haynes Institute for Palliative Care and is the recipient of the 2022 Doris Howell Award for Excellence in Palliative Care.  Dr. Steinberg is on the Board of Directors of the San Diego County Medical Society and serves as a delegate to the AMA and California Medical Association's House of Delegates.  He is also an appointee to the California Insurance Commissioner's Long-Term Care Insurance Task Force.    ​Dr. Steinberg enjoys presenting at educational conferences to professional audiences and the public, and also serves as a consultant and testifying expert witness in civil lawsuits and regulatory matters.   He hosts two podcasts for AMDA, called JAMDA-on-the-Go and Caring-on-the-Go.  Dr. Steinberg is perhaps best known for taking his poodles on nursing home rounds with him.   

Join me, Savy and my guest Jeannette Koijane MPH the Executive Director of Kokua Mau as we talk about Advance Care Planning and Types of Hospice care. The Caring Caregiver Show, brought to you by Gimme A Break and sponsored by Givers Guides online magazine, your guide to Caregiving! We're here to bring back the joy of Caregiving, we're here for your support, to bring you resources that you need, because we know you're tired and frustrated and you DESERVE some "CARING"From this Episode:Kokua Mau - Hawaii's trusted resource for accurate information on Advance Care Planning including Advance Directives and POLST, palliative care and hospice careOur Resources:Gimme A Break - Non-profit for caregivers aiming to bring back joy to caregiving, free weekly support sessions offering caregivers a chance to relax, renew, resource and revive. Register or register a caregiver for a break.Givers Guides Magazine - The complete caregiver resource guide. Get your first issue today, as 100% of all profits are donated to support Gimme A Break.Your Host:Savy Makalena - founder of Gimme a Break and Givers Guides Connect with the Caring Caregiver Show:Facebook Page: Caring Caregiver ShowInstagram: caringcaregivershowWebsite: www.caringcaregivershow.comFacebook Group: Click here to join

Happy New Moon Beautiful Soul Sisters

Objectives: • Examine what is POLST and its use in Northeast Georgia Health System. • Review patient criteria for POLST qualification. • Understand POLST's role in assisting patients with expressing their medical wishes. • Recognize when POLST is appropriate for patient completion.

Listen to ASCO's Journal of Clinical Oncology essay, “First Cousins Once Removed” by Dr. Matthew Farrell, a radiation oncology resident at UCLA. The essay is followed by an interview with Farrell and host Dr. Lidia Schapira. Farrell paints scenes of how different family dynamics can come into play when advocating for patients. TRANSCRIPT Narrator: First Cousin Once Removed, by Matthew J. Farrell, MD, MFA (10.1200/JCO.22.02611)  When I was a kid, long before I wanted to be a doctor or had even heard of oncology, I dreamed of becoming an actor. I grew up in Sacramento—not exactly the beating heart of the film industry—but my mother's mother lived in Santa Monica and we would stay with her for a month every summer. My father would unashamedly sneak me into movie premieres in famous theaters, and he bought us season passes to Universal Studios Hollywood. Despite having a serious job—as a psychologist in the emergency department—he was a kid at heart. Los Angeles was our promised land, and our shepherd was my father's cousin John, my first cousin once removed, who lived in West Hollywood and was a living, breathing actor.  John wasn't famous, not yet. He was in his late 20s, just starting out, doing mostly background work and some commercials while working as a waiter at the original Cheesecake Factory in Beverly Hills. All the staff loved him there, so much so that they would give us free pieces of cheesecake just for being related to him. John was generous, outgoing, expressive, and talented. Success seemed just around the corner.  One challenge for him was his voice. He had a thick Bronx accent, which would have been perfect if he had been auditioning for Raging Bull but which otherwise narrowed his prospects. He hired a voice coach to help him erase his accent. But that didn't mean he was trying to erase his New York roots. He was proud of his upbringing and family, coming from a long line of police officers, burly men with strong jaws and thick arms and outdoor voices who seemed to be the very genesis of their own stereotype. And as his Bronx accent faded, he was teaching it to me. He said he would take me to a baseball game at Yankee Stadium one day, and he imitated the beer hawkers who walked up and down the aisles, calling out to the crowd, “Get your beer here,” but pronounced, “Getcha bee-ah hee-ah!” John was the first person I distinctly remember being in perfect shape. He was a sight to behold—muscular and solid, yet graceful and light on his feet. In addition to being an actor, he was training as a dancer. Coming from generational athletic ineptitude myself, I was enthralled. He taught me how to moonwalk and do bicep curls. I would walk up to my mother and flex my tiny muscles, imagining a day when I would be as strong as John. One summer, John was much thinner—his face hollowed out, his previously bulky arms as lean as my own. What I only vaguely understood at the time was that he was gay, and he now had AIDS. This was the mid-1990s, and highly active antiretroviral therapy was on the horizon but just out of reach.1,2 His treatments failing him, he became desperate for a cure. He did twice daily coffee enemas, choked down repulsive herbal concoctions, and visited New Age visionary healers. For a long time, he remained optimistic. He was in constant contact with his agent, seeking out auditions even as his strength waned. He wasn't only a waiter at The Cheesecake Factory and he wasn't dying of AIDS; he was an actor who was going to be healthy again soon. Occasionally he would call my dad, buoyant with hope, “The virus is gone. I'm cured.”  Of course, he wasn't. My father never tried to talk John out of pursuing alternative therapies, though he considered doing so many times. The frantic search for a reprieve from death can take us many places, and it is not to be pitied. But how do you also protect your loved ones from harmful remedies and predatory scam artists? How do you provide the best treatment when there is no good treatment? In all my years, all 10 of them, I had thought that doctors knew everything, and if you went to them, you would get better. But John wasn't getting better. Together with his doctors, we embraced helplessness.  His CD4 count fell to zero. He developed skin lesions from Kaposi sarcoma. He was repeatedly hospitalized with Pneumocystis pneumonia. His organs began failing. Ultimately, he decided to leave the hospital on hospice. It was only then that he told his parents he was gay and had AIDS. At first, his parents couldn't believe he was gay. They told my father it was a phase, possibly brought on by his living in Los Angeles, a side effect of being an actor and dancer. Later, at his memorial service in New York, they would tell everyone he had died of a rare cancer. My father remembers someone asking John's mother what kind of cancer it was, and she said, “I don't know. It's very rare.”  During my winter break from school, my family visited John in his apartment. By that time, he had needed to quit his job at The Cheesecake Factory and stop taking auditions. His friends at the restaurant had thrown him a party and still came by his apartment most days. He lay in bed, drowsy and mildly delirious, too weak to stand. Even in this state, he kept trying to sit up to get us something to eat or drink. “I have cheesecake,” he said several times. “Let me get you some cheesecake.” Just a week later, on the day after Christmas, John lost consciousness. His kidneys weren't making urine, and he was uremic. My father urgently updated John's family in New York. His mother, father, and three sisters with their husbands flew in that day and crowded into John's small West Hollywood apartment.  For the first time, they met John's partner, Kevin, and five of their friends, gay men who had taken turns caring for John to make sure he was comfortable and never alone. Kevin was tall, elegant, and gentle. He was as introverted as John was extroverted, and he wouldn't have been caught dead on stage in front of an audience. He ran his own successful small business and had a quiet self possession. John, though he rarely showed it, was insecure about his slow progress in the acting world, and I think Kevin helped him feel more at ease. As a medical professional and the closest relative on the West Coast, my father had served as the point person for the hospice physician. He reported the latest news: John likely had just hours to live. John's New York family, previously shielded by distance, was caught off guard. And there was an uproar. The five stages of grief multiplied to 25, occurring in no discernible order—undulations of shouting and crying and jostling that rolled through the group like The Wave through a baseball crowd. At first, they wanted to take him off hospice. They looked ready to carry him out the door to the nearest hospital. They said his decline was too sudden. It just wasn't right. There must be something he hadn't tried. For every desperate hope they volleyed, my father sensitively explained what could and could not be done, and, more importantly, he described John's wishes. They gradually realized that saving him was impossible, and not what John needed anymore. At last, everyone seemed on the same page. Everyone but John. Day by day, he held on in his unconscious state, not crossing that final threshold, as if something were holding him back. John's family became increasingly exhausted, confused, and frustrated. They couldn't eat or sleep. On day four of John's marathon survival, we called in the hospice nurse. By this time, my grandfather—John's uncle— had also arrived. The nurse gathered everyone together and explained that it was often helpful to talk to your loved one, conscious or not, to say goodbye. People who are dying may feel obligated to cling to life for their family's sake. They may need our permission, even our encouragement, to let go.  And so, one by one, we all entered John's bedroom, knelt beside him, and said what we needed to say. And then, it was my grandfather's turn. By way of introduction, Grandpa Joe, my father's father, was raised in the Bronx by a stern mother and career soldier father. He was a businessman by profession and by religion. He rose in the ranks of multiple companies, eventually becoming the president of Hires Root Beer, a company that expanded during his tenure but was eventually bought by Orange Crush, which in turn crushed Hires Root Beer and made a lifelong enemy of my grandfather. (In my family, we do not drink Orange Crush.) Grandpa Joe never surrendered without a fight.  Accompanied by my father and me, Grandpa Joe marched up to John's bed and bent down beside him.  “You can fight this!” he said, shaking his fist. “I've had illnesses all my life and I came out on the other side. Did I let prostate cancer beat me? Hell no!” “Wait, Dad,” my father said. “Wrong plan.” “What?” Grandpa Joe said. “We had a whole conversation about this.” “When?” “Just now, with the hospice nurse. We need to let go, allow John to pass on.” “That's not what I heard.” “That's becoming clear to me.”  My father reviewed the plan, slowly, but no matter how well you explain yourself, sometimes people hear only what they're capable of hearing. Grandpa Joe couldn't surrender. He argued and fumed, eventually stormed out. So my father said goodbye for him. That night, John died.  I doubt the timing of his death was related to our collective send-off, but it sure felt like it was, and that will do. The next day, everyone assembled in John's apartment for the last time to decide what to do with his body. The family wanted to take him back to New York for a traditional burial.  But there had been talk that John's Los Angeles friends were planning to have him cremated. As if about to face off, two groups formed in opposing semicircles of folding chairs—the family seated on one side, and Kevin and his friends on the other. John's father, Hank, seemed ready to fight, his whole family there to back him up. Grandpa Joe kept saying we needed to put John on a plane and get him out of there.  In medical school, we learn that not all family members are created equal; when patients can't make decisions for themselves and there is no living will, you turn to the spouse first, adult children next, then parents, and so on. There is even a mnemonic (one of the clunkiest in existence) to help you remember the ranking: the Spouse ChiPS in For the patient—indicating Spouse, Child, Parent, Sibling, and Friend, in that order. Following this rule, Kevin would have come last. He and John weren't married, and gay marriage wasn't even legal then. My father, a child of the sixties, wasn't a fan of hierarchies. As a psychologist in the emergency department, he had always strived to foster a unanimous meeting of the minds and hearts. To make things a little easier on people like him, he says it is never too early to tell anyone and everyone what you want in life and in death. Then, importantly, write it down, in an advance directive, on a POLST form, and maybe even on a few napkins scattered throughout the house. Hank fired the opening salvo: he told Kevin that they were going to take John back to New York. Their community expected a traditional burial, needed it.  Kevin listened quietly until Hank finished. With a softspoken grace, he looked Hank in the eyes and told him he would never do anything against the family's wishes. If they wanted a burial in New York, he would help carry the casket. But, he said, John had told him many times that he wanted to be cremated and have his ashes scattered on Maui, at a certain overlook they had visited together. There was a long silence. Hank looked around, at his wife and family, at Grandpa Joe, all of whom seemed to be waiting for him to deliver their counterpunch. But then he lowered his head. He started crying into his hands.  A minute passed, and then he sat upright, sniffed, and nodded. In a clear, firm voice, he said, “That's it. That's what I want for John. I want you to take him to Maui.” In perhaps the only true miracle I have ever personally witnessed, Kevin and his friends lifted from their chairs in perfect unison, crossed the small living room, and flooded the family with hugs. Everybody cried, and the many headed beast of our congregation dissolved into a sea of affection. Kevin did go to Maui to scatter John's ashes. Afterward, John's family celebrated his life with a memorial service at their church in New York. My father gave the eulogy and Kevin sat with the family. All of this was a long time ago now. John would be in his fifties. He would have mastered a Hollywood accent. His big break would have come. He would have taken me to the Oscars. I moved away from California to go to graduate school and medical school, but eventually, I found my way back to Los Angeles. I still go to iconic theaters. I finally bought season passes to Universal Studios Hollywood. And like everyone else in this town, I'm trying to write a screenplay. But I'm not an actor. I'm not remotely famous. I'm a radiation oncology resident.  I've learned a few things since the 1990s, and so has the rest of the world. It still devastates me that John just missed the major advances in care. I think about him regularly during my training. In oncology, life-prolonging breakthroughs are frequent, which inevitably means that some people will be among the last to miss out. Some people, and their families, will look to me for hope when there is none. In their entreaties, I see shades of my own loved ones—my father's diplomacy, Grandpa Joe's doggedness, Kevin's advocacy, Hank's compromise. Most of all, I see glimmers— brief resurrections—of John, whose disease stripped away so much, but left in clear relief his kindness and humanity.  Dr. Lidia Schapira: Hello, and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I'm your host, Dr. Lydia Schapira, Associate Editor for Art of Oncology and a professor of medicine at Stanford University. Today we're joined by Dr. Matthew Farrell, a radiation oncology resident at UCLA. In this episode, we will be discussing his Art of Oncology article ‘First Cousin Once Removed'. At the time of this recording, our guest has no disclosures.   Matt, welcome to our podcast, and thank you for joining us. Dr. Matthew Farrell: Thank you so much for having me. Great to be here. Dr. Lidia Schapira: It's our pleasure. I'd like to start this conversation just asking a little bit about your reading preferences. Are there any books that are on your figurative night table right now that you'd like to recommend to our listeners?  Dr. Matthew Farrell: Yeah, a lot of times that night table is very figurative in that I am listening to audiobooks. Living in LA, I spend a lot of time in the car, so I listen to a lot of books. But I do like to physically read certain books, and one of those recently was George Saunders' new collection of short stories, Liberation Day. He is a wonderfully creative, funny, warm-hearted writer of short stories, which is one of my favorite forms. It's what I've written the most and what I studied the most back when I was in school, taking classes, undergraduate and graduate in creative writing.  Dr. Lidia Schapira: Tell us a little bit about your passion for writing and how you have integrated that into your professional life now as a medical oncologist?  Dr. Matthew Farrell: Yeah, I studied writing and was interested in writing before I transitioned to medicine. So, I minored in creative writing in college, and then I went to graduate school to get a Master of Fine Arts in creative writing and fiction writing. And it was partially that process that eventually led me into medicine. I realized that a lot of what I was writing about actually had to do with medicine. And as I was rereading some of my own work, I was drawn to stories of illness and family and recovery and processing grief, and I decided that those stories were really compelling to me and decided to transition to medicine. It was also helpful that my wife - girlfriend at the time - was applying to med school, so I had that idea in my head, and she was inspiring to me. So, I transitioned to medicine.I love to keep writing. I still love writing, and a lot of what drew me into oncology specifically is the brilliant, captivating, moving stories of interacting with people. And so it's one of my outlets and things I do for fun, as well as a way of helping me process what I see.  Dr. Lidia Schapira: Before we talk about this story, let's talk a little bit about your ideas of the language that we use, because I know you've written about that as well. So, as a writer and as a person who loves to reflect and find story, tell us a little bit about how you negotiate the words you use and the language you hear your colleagues and your peers using with patients.  Dr. Matthew Farrell: Coming from a writing background, where in workshop, we would go through our own stories, my writing professors would go through each word with a fine-toothed comb and sometimes in very elaborately, critical ways would say that this is a terrible word, this destroys the whole sentence, the whole story. And it just had me paying attention to the written language as well as the spoken language. And one of my creative writing mentors, my thesis advisor Ahud, he had leukemia and eventually died of leukemia, and he talked a lot about the experience of having cancer and the way that cancer is often talked about in this kind of heroic way in which the treatments are weapons and cancer is waged on a battlefield and people with cancer are heroes of that and how that can be very empowering in certain circumstances and also very draining in others. Dr. Lidia Schapira: Those are such fine points, and it's obvious that you're very careful about the language that you use in your writing. So, let's talk a little bit about this piece that we've just published in JCO that is a little different than most of the pieces because it describes scenes. Tell us about how you put these scenes together, what it meant to you, and what the overarching message is for your readers.  Dr. Matthew Farrell: Yeah, I think I'm used to writing scenes. I'm used to writing both fiction and nonfiction stories like this, and when I was approaching this, I just wanted to try to capture the experiences as I had understood them. And I also talked a lot with my family about them to try to remember what it was like and how our thoughts have changed on it over time. And so I tried to capture who John was and my memories of him as best as I could. I think that the best way to get across people's personalities, their vibrancy, is by writing scenes about them, because I can never describe someone as well as they can illustrate themselves through their own actions and dialogue. Dr. Lidia Schapira: So John was this figure that you had admired as a child and was so interesting, and then you bring us to a very debilitated John and some scenes in his apartment. Tell us a little bit about the time, the context, and the illness.  Dr. Matthew Farrell: Sure. This was the mid-1990s, and there were a lot of changes going on in the care of HIV and AIDS, a lot of rapid changes in our understanding of the illness as well as the treatments available for it. And it was really hard and devastating that John was able to see a lot of promising treatments on the horizon, but they weren't readily available to him when he needed them. And so it's tragic to think about, if all of this had happened just a year later with the rollout of HAART, or Highly Active Antiretroviral Therapy, his story might have been completely different, and he could easily still be here today, but he just missed it. And so that was very hard to see him go from being just about as vibrant and healthy and active a person as can be imagined, someone who I just envied and admired in terms of his physical ability; for him, if he could go from where he was to where he ended up, it was just completely devastating. Dr. Lidia Schapira: And then there was the stigma of the disease and the scene that you so beautifully share in your piece about different family members coming in to talk with him and say their goodbyes. And I think it was your grandfather who just couldn't let go of the ‘you must fight, you're going to get well' narrative. And I think your father, who is a psychologist, was sort of saying, "Hey, wait, we're having the wrong conversation here. This isn't what we agreed to." Can you tell us a little bit about what that felt like to you, observing it, perhaps your younger self and how you've thought about that now as a professional who's probably having these difficult conversations with patients?  Dr. Lidia Schapira: This was my first experience with these sorts of conversations, and I think about them a lot now, is I do have these talks with people, and I just can picture my Grandpa Joe charging in there and saying, "You can fight this," completely out of tune with what the goal was. And he and my father are similar in some ways, but very different in others. My father is very relaxed, easy-going. He could come to a cordial agreement with a grizzly bear, and my grandfather was that grizzly bear in some respects, and he was stubborn and not always the best listener. But what was striking about it to me is that I know that my grandfather's actions in that moment, even though they weren't in line with what we were trying to do or what my father and the hospice folks were trying to have us do, they still came out of love and out of devotion to John. Grandpa Joe, how he expressed his love for his family was through fighting for them, and so he was doing that for John in the only way that he knew.  And so when I am involved in conversations toward the end of life with goals of care now and I see situations in which people don't always reach the same page or come to the same understanding, I'm reminded of the fact that that can be surprising and frustrating, but it's okay because people process grief in their own ways and express love in their own ways.  Dr. Lidia Schapira: I can just imagine you're thinking about that when you're in a room and you're sort of casting people, "Oh, this is a Grandpa Joe. He means well, he loves a lot, but we just need to help him to understand what's happening." And there's another character in your story that I want you to talk a little bit about, and that's Kevin, the loving partner and caregiver, who's first sort of marginalized by the large group descending upon them and claiming John. And then there's a scene where there's peace between all factions. Tell us a little bit about how that felt to you, witnessing it as a child and how you thought about it in the years that came later.  Dr. Matthew Farrell: Yeah, I was still very young at the time, but these scenes completely seared themselves into my memory. And the piece that ended up coming out of this scene was due to Kevin and Kevin alone and his love for John, which he communicated so well, as well as the knowledge he had of John's wishes that other people didn't have. That is what allowed people to come together and to begin healing. And it has reminded me that it is never too early to share your wishes with people you love who can then be advocates for you when you can no longer advocate for yourself. I tend to think about it this way: when you communicate your wishes to other people, you are allowing yourself to get the type of care you want and not get the type of care that you don't want. But you're also giving a gift to your loved ones because by Kevin communicating what John wanted to our family, to John's father, it gave everyone the confidence that they knew that they were giving John what he wanted. And that provided a lot of comfort. So if you share that with someone and then they have certainty that they're helping you achieve what you would want. And that's the gift that Kevin gave to our family that none of us will ever forget.  Dr. Lidia Schapira: I think the use of the word ‘gift' is wonderful, totally appreciated. And I understand you're very deliberate with your choice of words, so I appreciate that. I think that we don't quite know how to value sometimes some of the gifts that our patients give us in the exam room, at the bedside, in terms of how they help us, help them by being clear, by expressing their gratitude often. And you bring that out so beautifully.  So as a gifted and trained writer who's now embarking on a career in radiation oncology, how are you going to continue to combine these talents? Are you writing a play or what are your plans?  Dr. Matthew Farrell: I still just write a lot in whatever comes to me. And I do write a lot about medicine and also a lot not about medicine. And it's fun for me. I did study writing formally, but I still have tons to learn all the time and I'm still learning from other people. And I try to be as open as I can to feedback in my own writing. I am, among other things, trying to write a screenplay, like many people in LA. I also worked briefly in the film industry for a summer at a film management company, and there was this joke about how everyone in LA is writing a screenplay, but almost no one has written a screenplay. And so I'm unfortunately still in the former category, but working on it. Dr. Lidia Schapira: Is there something you've learned working in the film industry that you want to share with your colleagues working in oncology that could help us be better doctors?  Dr. Matthew Farrell: One is just, I think, movies, shows, writing, a lot of it is focused on people and humanity and the human condition. And I find those stories very moving. And those sorts of stories are also very present and central in medicine. I think that obviously, by getting to know people, you can help them achieve what they want. I know that, again, this whole story was my first encounter with the limitations of medicine and when there aren't very many treatment options available to help people therapeutically. But still, there were many good outcomes for us to work toward in this situation, and in oncology, too. Whether that's helping to provide understanding, helping people come together, helping provide comfort. I know hospice and palliative care was incredibly helpful to John, and that's one of the things that I like about radiation oncology, among many other things, is its role in palliative care, and palliation in terms of reducing pain, reducing bleeding, reducing suffering, enabling functional gain and quality of life. And yeah, I think that the stories that I encountered in movies, which I got a great appreciation for, among other things from John, and the stories that I read about in my study and writing, I still am learning and experiencing those stories in medicine. And it's been each kind of phase that I was in have been incredibly moving to me and have helped me grow as a person.  Dr. Lidia Schapira: So before we end, I have to ask you this question. Do you have a favorite illness memoir or story that has been published or has been used to inform a play?  Dr. Matthew Farrell: One of the writers that I've studied the most who wrote about medicine as well as illness was Anton Chekhov. I took a whole course on him when I was in graduate school and he was a physician, one of the great physician writers of all time. And he wrote about, in contrast to what a lot of other writers were writing about at the time, he wrote about doctors, people, peasants, everyday humanity in really moving ways. And he just has so many stories about illness and pain and loss that are all worth reading.  Dr. Lidia Schapira: Well, thank you. It's been a lovely conversation. We enjoyed reading your story and learning about the family. Thank you for sharing that with us.  Until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all of the ASCO's Shows at asco.org/podcasts.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  Like, share and subscribe so you never miss an episode and leave a rating or review. Guest Bio:   Dr. Matthew Farrell is a radiation oncology resident at UCLA.

If you spent time over the holidays with your aging family members-parents or grandparents-you may have noticed that they need a little more help with self-care, hygiene, or simply getting around. Women over 40 generally become the caretakers in this situation and they may not know that options are available to help keep our relatives safely at home as long as possible or know when it's time to consider independent or assisted living. Alicia Harmon talks with Kim about these options, including respite care that can help keep everyone safe and happy as they age in place. She offers ways to start those tough but necessary conversations that most of us don't really want to have. These are the links to the resources that Alicia mentions during this conversation. Please share with anyone who may need this information. POLST - https://polst.org/form-patients/ Five Wishes - https://www.fivewishes.org/ FB - https://www.facebook.com/SHCWestCentralWI Alicia Harmon is the owner of SYNERGY HomeCare for three years and she has a passion for connecting generations and combating loneliness in our communities. She lives in Arden Hills, MN but was raised in Prescott, WI. She and her husband of 13 years, Nick, have 2 boys Leo (11) and Reese (9) and a 6 month old puppy Winnie. If you would like to connect with Alicia you can email her at aliciaharmon@synergyhomecare.com **************************************** Kim Benoy is a retired RN, wife and mother who has found a passion for inspiring other women using essential oils, blog, and podcast called Midlife with Courage. She is following her journey to be a light and lead others who are feeling stuck and even bored doing what is expected. She helps women over 40 find their courage, confidence and calm so they can live every moment! Website: www.midlifewithcourage.com Instagram: @midlife_with_courage Facebook: https://www.facebook.com/Midlifewithcourage LinkedIn profile: linkedin.com/in/kim-benoy-250754111

#chiropractor #mentalhealth #neurofeedback #mentalhealth #chiropractor #neurofeedback #neurofeedbackpodcast Dr. Mike Pierce joins Jay Gunkelman the man who has read over 500,000 brain scans on the NeuroNoodle Neurofeedback Podcast. Dr. Pierce discusses Celiac Disease, WGA, Insulin Resistance How Do you Describe Neurofeedback to Parents in simple Terms? What happens when you bring someone out of a coma? POLST, Chiropracting and Mental Health, Gluten and Anxiety, How food can affect your mental health, Chiropractic Neurology, Kessler Hospital in New Jersey Michael Pierce has directed the medical program of a large destination wellness spa with a commercial kitchen and dormitories that cared for mental and physical illness using physical medicine, food, lifestyle modifications and humanistic psychology. He has a doctorate in chiropractic, a post doctorate in neurology with specialty national board certification, a Bachelor of Science degree, has completed culinary school and attended graduate business school. He teaches internationally in health care, business and in peaceful unarmed police aikido weapons control tactics (PACT). Dr. Pierce is faculty instructor for neurophysiology for the Vollmer Polygraph and Forensic Institute. He has consulted for over 100 medical businesses in the US and Europe and designed several natural supplement products while lecturing for the industry. Michael was raised in an environment of active diet modification and saw firsthand the changes in families, nursing mothers, infants, children, pets and livestock on modified diets and supplement regimens. Dr. Pierce has been a coma recovery team leader with interns from Northwestern Health Sciences University and has led the intentional recovery of coma/persistent vegetative state using chiropractic neurology. He has been faculty including associate professor of neurology for the Carrick Institute, colleges, and associations in fields of health care including neurochemistry, clinical neuro-diagnosis, neurological rehab, lab-based nutrition, healthcare business and business ethics, massage therapy, acupuncture, mental health, genetics, laboratory science, occupational therapy, culinary science, and law enforcement. He is the neurophysiology, statistics, and psychophysiology instructor for the Vollmer Institute for Polygraph Examiners. His work has ranged from animal populations to pediatric neurology cases where the placebo effect cannot confound alternative methods. He has collaborated intensely with biological dentists, holistic veterinarians, behavioral optometrists, psychologists, and biological psychiatrists. He has consulted for over 80 practices in the US and Europe. He has formally studied music, eastern and western philosophy, and medical anthropology. Dr. Pierce has worked closely with high‐net‐worth families, performers, celebrities and professional athletes on chronic health issues and peak performance. He was a health care freedom lobby advisor in Minnesota and a health food industry consultant for both retail stores and for nutritional supplement manufacture and sales. Michael has experience in business development, operations management, product design and education for small and large clinics, nutritional supplement companies and retail stores. He is currently completing the diplomate in quantitative electro-encephalography brain mapping analysis and mentorship. --- Send in a voice message: https://anchor.fm/neuronoodle/message Support this podcast: https://anchor.fm/neuronoodle/support

In this podcast series, Joseph Guarisco, MD FAAEM, a past chair of the AAEM Operations Management Committee, is joined by guests to discuss operations management issues for the emergency physician. Join him as he discusses issues of importance to emergency physicians.

#mentalhealth #chiropractor #neurofeedback #neurofeedbackpodcast Dr. Mike Pierce joins Jay Gunkelman the man who has read over 500,000 brain scans on the NeuroNoodle Neurofeedback Podcast. Dr. Pierce discusses Celiac Disease, WGA, Insulin Resistance How Do you Describe Neurofeedback to Parents in simple Terms? What happens when you bring someone out of a coma? POLST, Chiropracting and Mental Health, Gluten and Anxiety, How food can affect your mental health, Chiropractic Neurology, Kessler Hospital in New Jersey Michael Pierce has directed the medical program of a large destination wellness spa with a commercial kitchen and dormitories that cared for mental and physical illness using physical medicine, food, lifestyle modifications and humanistic psychology. He has a doctorate in chiropractic, a post doctorate in neurology with specialty national board certification, a Bachelor of Science degree, has completed culinary school and attended graduate business school. He teaches internationally in health care, business and in peaceful unarmed police aikido weapons control tactics (PACT). Dr. Pierce is faculty instructor for neurophysiology for the Vollmer Polygraph and Forensic Institute. He has consulted for over 100 medical businesses in the US and Europe and designed several natural supplement products while lecturing for the industry. Michael was raised in an environment of active diet modification and saw firsthand the changes in families, nursing mothers, infants, children, pets and livestock on modified diets and supplement regimens. Dr. Pierce has been a coma recovery team leader with interns from Northwestern Health Sciences University and has led the intentional recovery of coma/persistent vegetative state using chiropractic neurology. He has been faculty including associate professor of neurology for the Carrick Institute, colleges, and associations in fields of health care including neurochemistry, clinical neuro-diagnosis, neurological rehab, lab-based nutrition, healthcare business and business ethics, massage therapy, acupuncture, mental health, genetics, laboratory science, occupational therapy, culinary science, and law enforcement. He is the neurophysiology, statistics, and psychophysiology instructor for the Vollmer Institute for Polygraph Examiners. His work has ranged from animal populations to pediatric neurology cases where the placebo effect cannot confound alternative methods. He has collaborated intensely with biological dentists, holistic veterinarians, behavioral optometrists, psychologists, and biological psychiatrists. He has consulted for over 80 practices in the US and Europe. He has formally studied music, eastern and western philosophy, and medical anthropology. Dr. Pierce has worked closely with high‐net‐worth families, performers, celebrities and professional athletes on chronic health issues and peak performance. He was a health care freedom lobby advisor in Minnesota and a health food industry consultant for both retail stores and for nutritional supplement manufacture and sales. Michael has experience in business development, operations management, product design and education for small and large clinics, nutritional supplement companies and retail stores. He is currently completing the diplomate in quantitative electro-encephalography brain mapping analysis and mentorship. --- Send in a voice message: https://anchor.fm/neuronoodle/message Support this podcast: https://anchor.fm/neuronoodle/support

Join special guest, Leonard R. Hock Jr., DO, MACOI, CMD, and our host, Diane Sanders-Cepeda, DO, CMD, for this episode of FMDA's Journal Club, Resident Wishes: DNR, POLST, Advanced Care Planning, and More. Our learning objectives for this session were: Discuss current approaches to advance care planning. Revisit the value and limitations of do-not-resituate (DNR) orders. Describe the opportunities and challenges for Physician Orders for Life-Sustaining Treatment (POLST) in Florida. Discuss the future state of advance care planning, palliative, and hospice care delivery. Recorded: August 31, 2022 Special Guest: Leonard R. Hock Jr., DO, MACOI, CMD Hosted by: Diane Sanders-Cepeda, DO, CMD Available Credit: The American Board of Post-Acute and Long-Term Care Medicine (ABPLM) issues CMD credits for AMDA On-The-Go and affiliate podcast episodes as follows: Claim CMD Credit

If you were ever in an emergency, who would answer medical questions on your behalf? If you don't have an advanced directive, you might not be able to control what happens next. Listen in to Hope Young from Kokua Mau as she explains the importance of this critical piece of information, and why we all need one!

Dr. Jim deMaine is with us to talk with us about advocacy in serious illness and his book Facing Death: Finding Dignity Hope and Healing at the End.  Dr. deMaine is a retired Pulmonary and Critical Care physician, an accomplished public speaker, and an outspoken advocate for end-of-life decisions. In his book Facing Death: Finding Dignity, Hope and Healing at the End, Jim shares numerous stories that serve as cautionary tales about completing advance care planning discussions prior to a serious illness or health crisis. The book illuminates the weakness of the healthcare system, managing to also highlight the lessons Jim learned about end-of-life planning during his career.  With honesty, compassion, and respect for the legacies of his patients, Dr. deMaine shares why advocacy for our health needs is so crucial to ensuring meaning in our own deaths and the deaths of our loved ones.   Purchase your copy of Dr. deMaine's book by clicking here or here.  Connect with Jim deMaine's blog at endoflifeblog.com.   To purchase your copy of The Day I Die: The Untold Story of Assisted Dying in America on Amazon, click here. To read more about Ms. Hannig's book, visit anitahannig.com. To purchase the book through IndiaBound Books, click here.       Connect with The Love Always Project by clicking here and access their Resource page for more support. Find more information about hospice philosophy, end-of-life care, and self-care for both personal and professional caregivers here.  Find more podcast episodes from The Heart of Hospice here: https://theheartofhospice.libsyn.com/ Connect with podcast host Jerry Fenter at jerry@theheartofhospice.com. Connect with podcast host Helen Bauer at helen@theheartofhospice.com.  

Medical Ethicist Abbott, MD walks us through her perspectives on myriad ethical quandaries including:  How to approach discordance between a patient's written wishes and a family member who says do the opposite, the ethics of operating on demented patients who have an acute life threatening critical illness, a case of a young man with an unsurvivable brain bleed and whether or not to extubate him before the family enters the resus room, strategies to skillfully guide families through withdrawal of life support, and the real consequences of restrictive hospital visitation policies.   Interested in one-on-one coaching? Learn more at roborman.com Support our work on Patreon For full shownotes visit our podcast page   Guest Bio: Dr. Jean Abbott is a medical ethicist and faculty at the Center for Bioethics and Humanities and Core Faculty, Master of Science in Palliative Care, University of Colorado Health Sciences Center. She is also Professor Emerita University of Colorado School of Medicine, and 30 year veteran of the emergency department.  Not part of her CV but germane to this show...she was my attending when I was a resident in the 1990s and had a profound impact on who I became as a physician. Irreverent, quick witted, and a tireless patient advocate, she is one of the finest physicians I have ever known.    We discuss: Visitor policy– one of the enduring tragedies of the COVID-19 pandemic; A case of a 45 year old with an unsurvivable brain bleed – Do you remove the endotracheal tube before the family enters the room to say goodbye or do you await their permission to extubate?; The struggle that society has with brain death; Withdrawing and withholding care in the emergency department; One way to approach death disclosure; Accommodating requests to delay death so family members can arrive to say their goodbyes; The case of a minimally communicative, demented (but happy) patient with a subdural hemorrhage who was unable to provide consent to surgery and has no POLST; Reasons why we tend to over treat in the ED; The scenario where the patient's POLST form (eg. comfort measures only) and the desires of the power of attorney (do everything) do not align; Priming families in the ED; The ethical thing to do when you can't get informed consent from a patient; Navigating the “Daughter from California”; When does the medical Power of Attorney kick in?;

Medical Ethicist Abbott, MD walks us through her perspectives on myriad ethical quandaries including:  How to approach discordance between a patient's written wishes and a family member who says do the opposite, the ethics of operating on demented patients who have an acute life threatening critical illness, a case of a young man with an unsurvivable brain bleed and whether or not to extubate him before the family enters the resus room, strategies to skillfully guide families through withdrawal of life support, and the real consequences of restrictive hospital visitation policies.   Interested in one-on-one coaching? Learn more at roborman.com Support our work on Patreon For full shownotes visit our podcast page   Guest Bio: Dr. Jean Abbott is a medical ethicist and faculty at the Center for Bioethics and Humanities and Core Faculty, Master of Science in Palliative Care, University of Colorado Health Sciences Center. She is also Professor Emerita University of Colorado School of Medicine, and 30 year veteran of the emergency department.  Not part of her CV but germane to this show...she was my attending when I was a resident in the 1990s and had a profound impact on who I became as a physician. Irreverent, quick witted, and a tireless patient advocate, she is one of the finest physicians I have ever known.    We discuss: Visitor policy– one of the enduring tragedies of the COVID-19 pandemic; A case of a 45 year old with an unsurvivable brain bleed – Do you remove the endotracheal tube before the family enters the room to say goodbye or do you await their permission to extubate?; The struggle that society has with brain death; Withdrawing and withholding care in the emergency department; One way to approach death disclosure; Accommodating requests to delay death so family members can arrive to say their goodbyes; The case of a minimally communicative, demented (but happy) patient with a subdural hemorrhage who was unable to provide consent to surgery and has no POLST; Reasons why we tend to over treat in the ED; The scenario where the patient's POLST form (eg. comfort measures only) and the desires of the power of attorney (do everything) do not align; Priming families in the ED; The ethical thing to do when you can't get informed consent from a patient; Navigating the “Daughter from California”; When does the medical Power of Attorney kick in?;

This week, we talk about the POLST form; your Provider Orders for Life-Sustaining Treatment. Join us as we walk you through this important form, step-by-step, giving you the confidence to get it done for yourself or with your aging loved one! Show Notes: Julie's Uplifting Story of the Week: https://www.guideposts.org/caregiving/resource-center/5-ways-to-plan-for-the-final-years Inga's Uplifting Story of the Week: https://wdc.org/ More Information: POLST Directory: https://polst.org/state-programs/ Montana POLST: https://boards.bsd.dli.mt.gov/medical-examiners/provider-orders-life-sustaining-treatment/ Follow Inga & Julie! Connect with Inga on LinkedIn: https://www.linkedin.com/in/inga-lake-4857301b8/ Connect with Julie on LinkedIn: https://www.linkedin.com/in/julie-brubaker-3a89b2114/ Follow Caregiven on Instagram: https://www.instagram.com/thecaregivenpodcast/ Follow Caregiven on TikTok: https://www.tiktok.com/@thecaregivenpodcast?lang=en Subscribe to the Caregiven YouTube Channel: https://www.youtube.com/channel/UChtq-gS4yCWGE5UFnrU8OAA Follow EPAGA Home Care on Facebook: https://www.facebook.com/EPAGAHomeCare Join the Care and Share Facebook Group: https://www.facebook.com/groups/715609402176814 Follow EPAGA Home Care on Instagram: https://www.instagram.com/epagahomecare/ Follow EPAGA Home Care on LinkedIn: https://www.linkedin.com/company/epaga-home-care Visit EPAGA's Website for more articles about home care: https://www.epagahomecare.com/articles Interested in going into business for yourself, but not by yourself? Learn about our home care franchise opportunities at www.epagahomecarefranchise.com!

So many times healthcare workers are focused on life-saving interventions for their patients. But what happens when the goals of care shift to providing comfort care only? What does that really mean? Do you clearly understand the difference between palliative care and hospice care? Do you know what a POLST is? This is a topic we don't talk enough about until we're in those situations. In this episode Nurse Alice speaks with Beth Cavenaugh, RN, BSN, CHPN who knows all too well what nurses are up against, not only during this overwhelming era but always. With over twenty-five years in internal medicine, short stay surgery, and hospice care, she understands firsthand that compassion in health care can sometimes be elusive. She shares her expertise in palliative care and hospice, as well as her new book, The Power and Pain of Nursing, which aims to arm both new and seasoned nurses with the tools necessary to care for themselves in the face of one of the most demanding professions in the world. 

World-renown posek Rav Asher Weiss gives Halachik and ethical guidance on the role of a Frum physician in end-of-life care to the Jewish Physicians Network. Topics covered - Approaching discussions with families regarding removing ventilator support. - How to proceed when terminal extubation is requested - MOLST or POLST forms not congruent with Jewish values -How do we look at Physician-assisted suicide? - A Jewish patient's right to deny care and a physician's responsibility to intervene This talk was CME accredited by New York Medical College and hosted by the Beis Medresh for Medical Halacha. To learn more about the Jewish Physicians Network or to join please visit https://www.jewishphysiciansnetwork.com/ to learn more about the Beis Medresh for Medical Halacha and to join their excellent chabura program please visit. https://medicalhalacha.org/ A special thank you to Dr. Edward C. Halperin, the chancellor, and CEO of New York Medical College for working to get this event accredited.

What is a MOLST? POLST? Advance Directive? Living will? We'll straighten out the confusion and discuss how you can best help your patients to make complicated medical decisions and communicate them effectively.Come join our community! Sign up at www.tiipm.orgWhen your patient is crying do you know just what to do? Can you confidently help patients manage anxiety or pain without controlled medications? Come learn with Dr. Chiaramonte and improve your integrative symptom management skills!- evidence supported patient care skills- self care for you- patient resources for your office- group case-based discussionswww.integrativepalliative.com/training

Enduring CME will expire on 4/1/2024 Objectives: • Examine what is POLST and its use in Northeast Georgia Health System. • Review patient criteria for POLST qualification. • Understand POLST's role in assisting patients express their medical wishes. • Recognize when POLST is appropriate for patient completion. No disclosures Accreditation and Designation: The Northeast Georgia Medical Center & Health System, Inc. is accredited by the Medical Association of Georgia to provide continuing medical education for physicians. The Northeast Georgia Medical Center & Health System, Inc. designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s) TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Enduring CME will expire on 3/31/2024 Objectives: • Identify how narratives influence medical decision-making • Describe an overview of Henrietta Lacks' immortal role in medicine • Understand the importance of patient-centered communication • Recognize when POLST is appropriate for patient completion. No disclosures Accreditation and Designation: The Northeast Georgia Medical Center & Health System, Inc. is accredited by the Medical Association of Georgia to provide continuing medical education for physicians. The Northeast Georgia Medical Center & Health System, Inc. designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s) TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

You ever want to intubate someone, but they tell you no? Chris swears a little less (barely) in today's episode that examines DNR's, POLST forms, and inaccurate SaO2 probes. We also get another rant from Chris!

One of my favorite Piece of My Mind essays in JAMA is by Rebecca Sudore, titled, “Can We Agree to Disagree?”  And today our guests agree to disagree.   And yet, and yet… They also agree across a whole range of issues, some of which surprised us. This is the latest in our series of podcasts on concerns about, and potential of advance care planning.  If you're new to this discussion, don't start with this podcast!  Start by reading this article by Sean Morrison, Diane Meier, and Bob Arnold in JAMA, and this response from Rebecca Sudore, Susan Hickman, and Anne Walling. Then listen to these prior podcasts with Sean Morrison and Rebecca Sudore about this issue, and we recently discussed differences between Advance Care Planning and Serious Illness Communication with Juliet Jacobsen and Rachelle Bernacki.   On today's podcast we ask our guests about areas in which there might be agreement or disagreement, including: The Best New York style bagels are made in California. Assigning a surrogate decision maker is important for everyone, including those who don't have serious illness. Where does POLST fit in with this debate? All decisions are made in advance, the question that we are debating is how far in advance and what to call it Completion of advance directives and billing codes for advance care planning as quality metrics Among other topics.  I'm heartened that we could have this discussion as a field, as it shows that we've grown to the point where we can agree to disagree respectfully with each other.   We can work it out! Links to a few couple items mentioned on the podcast: Objectives for Advance Care Planning 2018 Systematic Review of Systematic Reviews on ACP -@AlexSmithMD

Living Will. DNR. Advance Directive. POLST.  You know these forms are important. But are they the same? Do you need all of them? What are they for? And when would you need them?   Forms are location specific. Do an online search for "[where you live] and [name of form]" or ask your lawyer to get the right version for you.   Recap of summary:  Everyone over the age of 18 should specify their wishes and designate a health care proxy, ideally with an Advance Directive or Living Will and Medical Power of Attorney If you're close to the end of life or frail and the risk of complications from resuscitation would not be worth it, that's when you want a Do Not Resuscitate (DNR) order If you're close to the end of life and don't want to artificially extend your life and you want to be sure that your wishes are honored (and it's available in your area), get a Physician Orders for Life Sustaining Treatment (POLST)

If you develop dementia, odds are you will spend the last months to years of your life in a nursing home or assisted living facility.   While we like to think about how our goals and preferences will influence what that life looks like, including whether you will get potentially burdensome interventions, your fate is probably influenced more by factors like where you live and what nursing home you happen to end up in.  On today's podcast we dive into drivers of invasive procedures and hospitalizations in advanced dementia by talking to some pretty brilliant nursing and nurse practitioner researchers focused on dementia, geriatrics, and palliative care in nursing homes: Ruth Palan Lopez, Caroline Stephens, Joan Carpenter, and Lauren Hunt. We start off discussing the findings of Ruth Palan Lopez's publication in JAMA IM on the ADVANCE study.  This study explored nursing home organizational factors and staff perceptions that are associated with the variation in care for residents with advanced dementia.  Now when I say variation, I'm not talking about small little clinically questionable variations.  I'm talking about some nursing homes with no residents with advanced dementia being tube fed, and some with nearly half of their residents with advanced dementia being tube fed.   We go on to talk about other findings of this study including that staff in all nursing homes expressed assumptions that proxies for Black residents were reluctant to engage in ACP and preferred more aggressive care, issues with the skilled nursing facility benefit (“rehabbing to death”), the palliative care needs of nursing home residents, and so much more. For a deeper dive, check out some of these other studies and resources we talked about in the podcast: The Influence of Nursing Home Culture on the Use of Feeding Tubes.  Archives of Internal Medicine 2010 The Lived Experience of Providing Feeding Assistance to a Family Member with Dementia Rehabbed to Death. NEJM Palliative Care in Nursing Homes: Discussion of a Multinational Trial with Lieve Van den Block A Podcast with Caroline Stephens about her publication in JAGS where she studied palliative care-eligibility and POLST completion  

Who needs advanced directives? Well, all of us do, and tonight we will learn why. It's not just about wanting CPR or not, there is so much more to this essential conversation that needs to take place with your loved ones. Hope Young from Kokua Mau is in the studio to explain the difference between directives, living wills, and why we should all start thinking about this now.

Hola, somos el equipo de cuidados paliativos!نحن مجموعة من الأطباء والممرضات والأخصائيين الاجتماعيين والقساوسة ، هنا لتقديم ......wait, how do you say "extra layer of support" in Arabic? And can I scan this POLST form into Google Translate?Welcome to Episode 5, in which Sarah and Dan interview two medical interpreters about the challenges and joys of interpreting in the pediatric palliative care setting. Daniela Obregón (@GetConnCare) is an independent Spanish language interpreter, translator, and cultural consultant, and Amani Zaki is an Arabic interpreter at Children's Hospital Los Angeles. What habits of clinicians drive interpreters crazy? What's it like to be the conduit for so much emotionally-charged language in family meetings? Listen and find out!

I know a lot of you guys are probably already taking trips, have taken trips for the summer. I know if you guys are like, I'm getting pretty antsy here, um, to get out and go travel and to go do things, especially after class steer and just not having as many opportunities and options moving around.   So I wanted to help give you guys some tips and tricks when it comes to traveling, when it comes to eating healthy and staying on track, because this is a huge deal.    it is amazing how much information is available to travelers today. When you are traveling with a special diet, it's important to use these resources and really just plan ahead.   Trip advisor.com is a fabulous resource to check out restaurants where you are traveling to before you arrive. And this gives you the opportunity to review restaurants and menus before you leave. If you stay at your location more than a day or two, you guys can look on Google maps to also see where grocery stores are in, in your vicinity and take the time to pick up some healthy snacks or breakfast options.   Download Dining Out Guide, click here.  . . . SHOW NOTES   Interested in joining the Hansen Method?! From 16 weeks to a year-long coaching program, there's an option for you. To learn more about the Hansen Method, click here.    Create a thriving thyroid following our PROVEN system for improving thyroid and hormone function! Join hundreds of women who have improved their symptoms by 80% and lose on average 30lbs in the 4 months. Learn more here.     If you have questions about the Hansen Method and want to discuss your specific situation and make sure this is the right program for you you can schedule a complimentary thyroid breakthrough call with one of our team members. schedule here. Hurry, my schedule fills up quickly and we only work with limited amount of women at any given time.   Thinking about using nutrition and holistic health for restoring thyroid function? Learn EVERYTHING you need to know by joining our Free Facebook Group. Adrenal and Thyroid Balance Community.   Confused at what steps you steps you need to do first, download our Freedom From Fatigue Guide without top 5 recommendations to improving your thyroid function.   Confused about what thyroid test to have done? Download our Thyroid Panel Guide.   Facebook Community Instagram   Xo, Shannon Hansen   AUDIO TRANSCRIPTION   (00:00): This is episode 40 healthy traveling tips. Welcome back to this thriving diverts podcast, where we choose to become empowered patients and take our health into our own hands. Hi, I'm Shannon Hanson, a Christian entrepreneur, a mom of three. And after dealing with my own health mystery, I made it my mission to learn everything I could about the thyroid. I soon became certified as a holistic wellness practitioner, a functional nutrition practitioner and a functional diagnostic practitioner. And so much more. After that, I founded the revolutionary thyroid program, the Hanson method as a health professional and a mom, I fully understand the importance of having a fun, simple, and sustainable plan for achieving a responsive site. So I share actionable and practical strategies for developing a responsive site so that the ambitious moms and women can gain freedom from fatigue and lose a thyroid weight once. And for all each week, I will be here for you along with my guest experts, we will be sharing simple and tangible tips that work for not only your hormones, your family, and your mindset, so that you can get back to living the life that you envisioned for yourself. (01:22): Welcome to the thriving thyroid podcast. Okay, welcome back. You guys. I know a lot of you guys are probably already taking trips, have taken trips for the summer. I know if you guys are like, I'm getting pretty antsy here to get out and go travel and to go do things, especially after class steer and just not having as many opportunities and options moving around. So I wanted to help give you guys some tips and tricks when it comes to traveling, when it comes to eating healthy and staying on track, because this is a huge deal. It is amazing how much information is available to travelers today. When you are traveling with a special diet, it's important to use these resources and really just plan ahead. Trip advisor.com is a fabulous resource to check out restaurants where you are traveling to before you arrive. (02:20): And this gives you the opportunity to review restaurants and menus before you leave. If you stay at your location more than a day or two, you guys can look on Google maps to also see where grocery stores are in, in your vicinity and take the time to pick up some healthy snacks or breakfast options. That really can be a huge life saver. So with us and our family, we do a lot of road trips where usually within four to eight hours of a lot of really great places to go hang out with. The biggest thing that I have learned with kids and for myself is number one to pack healthy snacks. You guys, because planes get delayed trains get missed. Traffic becomes unbearable. We get the munchies. There's a long distances between this city and that city. So don't forget that we don't want to be caught when we're hungry when we're traveling, because this makes it a lot more likely that we will have more of those non friendly options. (03:30): And that can really derail a lot of your trip, especially if you're like me and you have digestive issues and I eat something I can be very uncomfortable for days, and that's not what we want. Especially when we're on trips. We want to be able to sleep all. We want to have energy feel good. We want to, you know, be able to have the energy to go out. We don't want to be, you know, bloated or heavy or constipated or, you know, having to quickly through us, all of those uncomfortable things. So snacks are a great way to keep them in the car, to have a, you know, a small cooler where you can just kind of restock as you go. Now again, everybody's going to be a little bit different and like different things and different trips are going to require different things. But here we go. (04:21): I will just give you some simple options that are friendly and they travel well. So number one, nuts and seeds. Number two, you guys can make a homemade trail mix and really have the opportunity to customize this trail mix for you and your family. I love to always sprinkle in some m&ms. I like the mini m&ms when I'm making and at home that trail mix. Now I know some of you are going to be like, oh my gosh, Shannon, you eat M and Ms. It's not an everyday thing. You know, we really try to stay away from the guys, but you know, with non trip, you want to have a little bit of fun. And I have found that that is just a really great option for my family, especially since we love the nuts and seeds. One of the other things that I love to do is I make a homemade granola and this is a really, really good for breakfast. (05:13): And it's also really good for snacks. It's also, you know, it's good, right? I'm going to, it's just kind of like an all around. I make it in a way that's a little more sticky. And so it's very snacky. It's not too crunchy anyways. That's just the way that Shannon likes it. The next option for packing snacks, do you guys have bars kind bars, Lara bars, Luna bars. My husband likes these protein bars that I think are disgusting, but you know, have different options or your family and different flavors. And just look for some of those more, obviously clean the options. We love the Lara bars. Half of my family loves the peanut butter ones. The other half loves the chocolate chip ones. I've tried the cherry ones. Those ones are also super good when it comes to the Lara bars. (06:04): So really just kind of look at what works well for you and your family, fruit, you guys, the crew is always a really great option. Apples, oranges, bananas, my husband and my kids love bananas. Great. berries, blueberries, raspberries, things like that can also travel really well. Just make sure you can put it on the top of your ice chest and okay. So other things like jerky, beef, jerky, Turkey, jerky, elk jerky. If you guys have access to that veggies with premise, you know, those little hummus cups, we get the organic ones from Costco or my kids really, really love the guacamole packs from Costco as well. So you guys can kind of mix it up and mix and match those types of things, those peanut butter packages. They have some that are in like those squeezable tube. So that's an option. (07:02): I'm trying to remember, Justin's I believe is the brand where you guys can squeeze that on your apples. You can put it on celery, you can bring raisins and do ants on a lug. There's really a ton of options. Some other things that I like to do, especially when I have maybe a little bit more time to plan and prepare ahead of time. I love to make protein balls for my kids, for myself. I love having the kale chips. I like salty things, kale chips, again from Costco. They have like these cheesy ones that are pretty good applesauce pouches. Again, cost is a great place dates. If you bring those almond butter packages with some dates, that is a fantastic treat when you guys are on the road, because you get a little bit of sweetness and snacky food, and it's just, it's so delicious. (07:57): So delicious. The next tip that I have for you guys, number two is stay well hydrated. I know for me, this is an issue, especially when we're on the road. I don't want to have to pull over and go to the bathroom, but when we're traveling, we always want to have a refillable water bottle with us. This can be great because sometimes when we go traveling or hiking or camping, where, you know, maybe in situations that we don't always have access to water, so water bottles are great. Some of them even have built in water filtration systems. Those can also be good, but if you are traveling, you can fill your water bottle. After you go through security to avoid any of those delays, you can buy water bottles, things like that. It's also especially important to drink more water when you are flying because the air on the airplane is very low humidity, which can cause dehydration. (08:59): So some symptoms of becoming dehydrated include headache, fatigue, reduced concentration, muscle cramps. Now I was on a airplane, oh man. A couple years ago. And there was a lady. We were, I was traveling from Phoenix to somewhere else. I don't remember what or where, but I do remember this lady. She walked past me and I could tell, oh, she doesn't look so good. She went to the bathroom. She came out, she was walking down the aisle and guess what? She collapsed right there in the middle of the aisle. Obviously a lot of people went to her side and they were able to assist her in aid her. Well, it came out that she had gone hiking earlier that day in Phoenix, it was summer, it was hot and she hadn't drank, drank any water. She was drinking sodas and juices and things like that. (09:53): So she was massively dehydrated and will adding the triple or the double whammy, triple whammy, whatever have you, when it comes to the low humidity on the low humidity, on the airplane, exasperated the issue and caused her to think and go down which was know very scary for a lot of people because we were really over nowhere. So if it really was an emergency, it would have had to rate and nobody wants to be caught in a situation like that. So if you are susceptible to motion sickness like you you guys can bring along some herbal tea bags, such as ginger or peppermint or camomile. Those things can be really, really beneficial. You can also look into some homeopathic remedies that is typically what I use in combination. And I've also found that sitting up front, having a little bit of air in my face with AC or either depending on the time of year, that always helps me a little bit as well. (11:01): And then being hydrated, making sure that I'm looking at the road that I'm not looking down. One of the things that I did discover a couple years ago that worked really well for me, at least this is the only combination that I could have found. So at the time I was really struggling with anxiety and I was using CBD patches and I, that specific trip we were traveling and I think it was about six hours to California where you're going to Anaheim. My husband had a business trip there and it just so happened that it was in Anaheim. So we decided, yes, we are going to go and took the kids to Disney and just do some fun things. When he wasn't on his trip. So I took the kids, we did a few things and then he did his thing. And then at the end of it, we, we did business. (11:52): Well, I also had a lot of business work to do, and that meant that I needed to be on my computer. So normally I would not touch my computer or a book or anything while I'm driving down the road, because I am susceptible to that motion sickness. And this 10, I was like, I don't really have another option. I'm going to just kind of do what I put. I was able to work on my computer for close to two hours with one of those CBD patches. And I just thought that that was so amazing. So that may or may not work for you guys, but I use a lot of peppermint when I'm in the car, smelling it. I put it on peppermint, essential oils. Put it on my wrist, on my POLST points around my neck, making sure that I'm smelling it. (12:37): And then we also use some homeopathy or motion sickness, which you guys can Google search and figure out, you know, which one is going to be a good option for you. All right. Number three is aware of hotel breakfast. Free hotel breakfast may save you money, but they're not often vibrated friendlies. So much of what is offered is filled with gluten it's filled with sugar. So really just keep it simple. If you do go use that eggs, right eggs, a lot of them have hard-boiled eggs or they have apples and fruit. And if there is no real healthy option for breakfast, you know, then you can use the snacks that you packed and they come in really handy. Or I know in my area, they have some still pet packages that don't have a lot of sugar in them. So again, planning ahead. (13:38): I can bring some of those if I don't have an option at the restaurant some of the restaurants that we go to are not restaurants, excuse me. Some of the hotels we go to have a little bit better quality of breakfast. I mean, we have a few options, like some potato hashes in the morning, or just different things like that. And we can make pretty good decisions when it comes to eating a hotel breakfast. But a lot of them it's just cereal, maybe oatmeal, maybe, you know, something along those lines. So definitely look into that and you can always look online to see what options they have at those hotel restaurants or hotel restaurants, those hotels have for your breakfast options. Number four, if you guys are going to places that maybe you're staying in an Airbnb, or you have an extended stay, we stayed in a few hotel rooms where we have a kitchenette and two bedrooms. (14:36): So like having a suite where you have maybe some of those options to cook, or maybe you guys, if you're like us and maybe I'm the little bit more advanced stages of your journey. You know, we sometimes bring our instant pot or our slow cooker. I don't have a slow cooker anymore. I just use my instant pot because it's one in the same, pretty much I will bring those or I'll bring like a toaster oven or something like that, so that we can do more cooking at the location that we are staying in, and this can reduce our how often we eat out what we eat out, those types of things. So if you have that option, you know, really planning ahead and being able to go to the grocery store again, especially if you're staying there for two, three, four days. (15:27): I know sometimes with my husband's business trips, we will be there for seven to 10 days. And so it does make a lot of sense for us to go to a grocery store, to cook plan, prepare meals in the hotel room, at least as much as possible. Obviously we're kind of out of our routine. So we do eat out a little bit more, but some of the other things that you can do when you're staying in a hotel, you guys can ask for a mini fridge, a microwave, some of them already have them in the room. That way you guys can just plan, prepare, make sure that you are eating nutrient dense foods that help support your body and help support the function of your body. You can also, if you want to bring a whole bunch of things or just really prioritize the I want to say electronics, the kitchen appliances that you bring, you can bring a smoothie maker and your instant pot, or, you know, or maybe if you have a friends or have a oven in your place, maybe you just want to bring, you know, your blender and that way you can do smoothies, right? (16:34): Bring some protein powder, maybe have it already portioned out for, you know, five days, seven days, and then buy some frozen berries when you get there with some greens or, or, or, or right. We have so many options. And I know her myself, when I first started this journey, I remember thinking, oh my gosh, what am I going to do? How am I going to do this? And it was almost paralyzing. I felt like, I don't know how to go out. I don't know how to do this. And little by little, I got more and more resourceful and it started kind of figuring out, Hey, I have more options. I don't need to push myself back into a corner or, you know, not travel or do some of those things because, you know, I want to live life. I want to enjoy life. And oftentimes that's the biggest thing that holds people up is we really forget that we have options. (17:27): So I hope this episode was very inspiring for you guys, as you travel and give you guys some ideas and at least gave you some opportunities to get those creative juices flowing through you so that you can make better decisions when you travel it and just be more prepared so that you come back from feeling vacation, from feeling energized and full of energy, instead of feeling like, oh my gosh, now I need to detox from my vacation. Nobody wants to do that. We all want to take vacations that when we come home, we feel energized. We feel ready to go with you guys. Thank you so much for being here. And I will see you in the next, (18:12): The number one question I get asked as a practitioner is what should I be eating for my thyroid? Then it is followed up. Do I have to go gluten free? What about dairy? Can I have dairy? Should I cut out grains? And the tension seems to rise with each question. So I have decided to put together a super affordable pirated recipe book for you guys. The thyroid recipe bundle breaks down the actual recipes that I use with my clients, and they are seeing massive results. One of my clients recently, actually, she's not a client. She's just part of our Facebook community. She purchased this guide, followed it, and within a month lost over seven pounds. This bundle includes well, the easy smoothie recipes for breakfast in the morning. It also includes our massive thyroid recipe book that has over 60 recipes, including things for breakfast, lunch, dinner, snacks, desserts, all of that. In addition to that, we are offering guys two hours of training, video training that goes over meal planning and meal prep as an additional bonus to all of those things on the weekend, we are offering you one done for you meal plan. That includes the grocery shopping lists, the prep guide and everything you need to be super successful. You guys, all of this for a super low cost of $37, I have literally taken out all of the guests work in inside (19:42): This bundle so that you know what foods you should be eating. What kind of foods, how to pair them, how to put them together. All of it, the link is in the show notes, head over, check it (19:53): Out because this offer will not last very long. Wait, (20:04): Please subscribe. If you found value in today's episode, he listening to you and Sharon Instagram and please tag.  

This is a short interview with Hailey CNA. Hailey discusses her concerns about the need to decide if they want CPR before they might need it, when the end of life is approaching. POLST.org https://linktr.ee/HospiceExplained

EMS A to Z: The DNR Order Show Notes: From your hosts, Dr. Josh Gaither, Dr. Amber Rice, and Dr. Rachel Munn What is a DNR? A Do Not Resuscitate order is exactly that – a prehospital medical order directing EMS providers to withhold resuscitative measures, like CPR and intubation, if the patient is in cardiac arrest. To be valid a DNR must be: Signed by the patient, a physician, and a witness (or notarized). Have a photo or description of the patient. It is typically on orange paper, but photocopies are accepted if otherwise valid. What other forms might we see? POLST and MOLST forms are more detailed and communicate the patient's wishes as far as resuscitation as well as long-term care (dialysis, medical nutrition, etc.). While these are not necessarily specifically intended for prehospital providers; they do communicate the patient's wishes and we strive to respect those. Advanced Directives or a Living Will are legal documents prepared, often far in advance of an illness, that detail the patient's wishes for end-of-life care (among other things). They can be lengthy but are valid if present and available. If in doubt (for example: no paperwork present, but family says “they're DNR!”); begin BLS resuscitation and call medical direction for assistance!

This episode discusses advanced directives and the choices available on the POLST form. https://linktr.ee/HospiceExplained

"Advance care planning is not enough. It's critically important that we develop highly reliable systems." Dr. Stephanie Anderson Respecting Choices® Advance care planning - clarifying your wishes in advance about the kind of care you want to receive - improves outcomes for patients, families and healthcare providers. The data is so conclusive that legislation was passed in the 1990's to increase the number of Americans having an advance directive. The legislation failed, but it's a great start. In this conversation with Emily Lauri and Dr. Stephaie Anderson, we explore the problem and possible solutions. Meet Dr. Stephanie Anderson Dr. Stephanie Anderson is the executive director of Respecting Choices, a division of C-TAC Innovations. She is responsible for designing and leading strategy and operations including the delivery of this internationally recognized program. She has over 25 years of experience in palliative care, hospice, home care, case management, and emergency medicine. Dr. Anderson earned her doctor of nursing practice degree from the University of Iowa specializing in health systems administration. Dr. Anderson has served in a variety of leadership roles. In these roles, her palliative care program was awarded Joint Commission Certification and the system received the Circle of Life award from the American Hospital Association. She co-chaired the Iowa Physician Orders for Scope of Treatment (IPOST) movement, resulting in new legislation and statewide implementation. Dr. Anderson joined Respecting Choices in 2013 as a senior faculty consultant and evolved into the director of consultation and education services prior to her current role. Dr. Anderson currently chairs the National POLST central region leaders group, co-chairs the POLST program assistance committee and a member of the program standards committee. She is vice president of Advance Care Planning - international. Dr. Anderson believes person-centered decision making based on an individual's goals and values truly transforms care and should be the top priority to delivering exceptional whole-person healthcare. Person-Centered Decision Making Respecting Choices' goal is to design a system of person-centered care that is guided by the best scientific evidence and is aligned with an individual's goals and values. This system requires a shared decision-making process that involves respectful interaction among providers, individuals, and families, and keeps the focus of planning on what matters most to each and every person for any healthcare decision. Episode Credits Pat Cupples provided original music for this episode. Additional music is from the band Hotels & Highways. Photo credit: Gundersen Health System Join us to learn more: "Medicare 2021: What Changed?"

Dr Heather Bell and Dr Kurt DeVine deviate from addiction to address the COVID19 pandemic. Today features an update from the U of Mn discussing the COVID studies people are able to participate in- special emphasis on health-care workers.  Then we were joined by Drs. Sandler and Welsh discussing POLST and end-of-life symptom management. To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct and Facebook: @theaddictionconnectionhk

A Physician Orders for Life-Sustaining Treatment, or “POLST” makes sure that decisions about care at the end of life are written as medical orders that health care providers must follow. The POLST should list the medical care people do or do not want, given their current health condition. Without a POLST, emergency care providers generally must provide such medical treatment to keep people alive. Learn why this is so important to you on this episode of the Bottled Business Sense Show. View show at: http://wfblegalconsulting.com/bbss/ WFB Legal Consulting--LAWYER FOR BUSINESS--A BEST ASSET PROTECTION Services Group