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WHOOOOA! This is a SERIOUSLY SERIOUS EPISODE with powerhouses! In this episode of the VeriGeri podcast, we dive into the framework and nuances of serious illness conversations. Dr. Paige Barker, Dr. Karen Bullock, and Dr. Carine Davila cover the bread and butter of essentials in serious illness conversations but also take us through how to center on the patient with their individual experiences. We apply their foundation through a case in the middle and listen to tips about working with interpreters at the end.

Show notes: https://verigeripodcast.com/show-notes/f/serious-illness-conversations-a-patient-centered-approach

Graphic Designer & Show Notes Editor: Jai Daniels, BA   Peer reviewers: Jason Lyou, MD, Shaina Fuller, MPH

Bios:

 Dr. Paige Barker, MD, is a clinician educator in general internal medicine with expertise in palliative care at the University of Florida. She's passionate about teaching palliative skills and improving serious illness communication.  She is the Palliative and End of Life Curriculum Director at University of Florida College of Medicine and leads the Goals of Care workgroup at UF Health. 

Dr. Karen Bullock, PhD, LICSW, FGSA, APHSW-C, is a Louise McMahon Ahearn Endowed Professor at Boston College School of Social Work and Global Public Health. She is a clinical social worker with expertise in health disparities, aging, serious illness care, and palliative care. She's led numerous federal grant funded research on equity, workforce development, and health sustainability. She is the John A. Hartford Faculty Scholar and has served on numerous national boards including SWHPN and the ACS Oncology Social Work Research Peer Review Committee. She is also the steering committee member for the Duke University REACH Equity Center and an affiliate faculty at the Center to Advance Palliative Care. She received the AAHPM Richard Payne Outstanding Achievement in Diversity, Equity, and Inclusion Award in 2024. 

Dr. Carine Davila, MD, MPH, is a palliative care physician at Massachusetts General Hospital dedicated to improving access to quality care for marginalized populations. She is the equity director for the Division of Palliative Care and Geriatric Care. Medicine and co created the Palliative Care Health Equity Curriculum. Dr. Davila co leads United Against Racism efforts and conducts research on improving serious illness communication for Spanish speaking patients, clinicians, and interpreters.

 

Timestamps:

00:00 – Introduction to the Episode

00:57 – Meet Our Guest Experts

04:03 – Defining Serious Illness Conversations

08:41 – Asking Permission

10:30 – Thoughtfulness with Historically Marginalized Patients

17:12 – Brief Summary of Serious Illness Conversations

18:23 – Case One: Willie Jenkins

25:33 – Providing Recommendations Based on Patient Values

31:11 – Closing Remarks  

• Just because people are aging doesn't mean they stop wanting or needing intimacy. In this episode, we dive into the often-overlooked topic of sexuality in older adults. Many healthcare providers hesitate to discuss sexual health with aging patients, often assuming they are no longer interested in sex. However, intimacy remains a crucial aspect of overall well-being. Our guests, Dr. Darlene Moyer and Dr. Travis Glenn, help us explore how to better support older patients in maintaining a fulfilling sex life.

 

• Show notes with summary and more detail: https://verigeripodcast.com/show-notes/f/sexuality-in-aging

 

• Episode timestamps

00:00 Introduction to Sexuality in Older Adults 01:01 Meet the Experts: Dr. Moyer and Dr. Glenn 02:40 Medieval Theme and Fun Facts 03:28 Defining Sex and Taking Sexual Histories 08:47 Addressing Sexual Health in Older Adults 09:45 Case One: Erectile dysfunction 15:18 Types of toys 18:37 Case Two: Pain during sex 21:30 Types of lubricants 24:11 Advice 25:36 Episode Recap and Closing Remarks    

• Dr. Darlene Moyer’s Bio:

Originally from Pennsylvania, Dr. Darlene Moyer completed medical school at the George Washington University School of Medicine followed by a Family Medicine Residency and Geriatric Fellowship at HonorHealth in Scottsdale, Arizona. Having worked in GME for over 14 years, she is currently an Associate Director at the HonorHealth Family Medicine Residency where she oversees Geriatric training. She practices in the inpatient, outpatient, and long term care settings, and even does home visits with her resident physicians. She is passionate about seeing each patient as an individual who deserves care unique to who they are. Outside of medicine her life is filled with being a mom to her two daughters, hiking, painting, and spending time with her husband, family, and dogs.    

• Dr. Travis Glenn’s Bio:

Dr. Travis Glenn and his husband Dr. Bradley Glenn are the physician founders of Glenn Family Medicine on the island of Maui, HI. His training started at the Georgia Institute of Technology followed by medical school at Ross University School of Medicine. He then moved to Arizona to complete residency at HonorHealth in Scottsdale. He previously worked as a hospitalist at Banner University’s Phoenix campus, followed by a hybrid inpatient/ outpatient model in Hawaii before focusing on outpatient care and working with medical students from the University of Hawaii. When not in clinic he can usually be found exploring national parks or falling off his paddle board at the beach.    

• Guest Host Bio:

Megan Teramoto, BS, MS, is a first year medical student at the Pritzker School of Medicine. She received her Bachelor's and Master's degrees after studying Biochemistry at the University of Arizona. Outside of school, Megan enjoys volunteering and hiking.     

• Gurus:

 Darlene Moyer, MD, Travis Glenn, MD Guest Host: Megan Teramoto, BS, MS Hosts: Patty Lee, MD, Sam Ing, MD Graphic Designer: Jai Daniels, BA Primary editor: Sam Ing, MD Peer reviewer: Sindhura Vallabhaneni, MD    

In this special holiday episode, hosts Patty, Sam, and Megan, along with guest Tessa Garcia McEwen, discuss the challenges and strategies for caregivers and families of older adults with dementia during the holiday season. Tessa, a licensed clinical social worker with extensive experience in dementia care, shares valuable advice on modifications to holiday traditions, travel tips, and effective communication about dementia within families. This episode also covers coping techniques for grief and suggestions for engaging dementia patients in stimulating activities, emphasizing the importance of personalized care and support. We also learn about resources for grief counseling and practical tips for managing dementia symptoms in different environments.

Show Notes: https://verigeripodcast.com/show-notes/f/navigating-dementia-during-the-holidays

Please follow us on Instagram @verigeripodcast and follow us on Apple and Spotify! We are grateful to University of Chicago's BSD Office of Diversity and Inclusion for their support.

Guru: Tessa Garcia McEwen, AM, LCSW, DCCS, CDP Guest Host and Show Writer: Megan Teramoto, BS, MS Hosts: Patty Lee, MD, Sam Ing, MD Editor & Graphic Designer: Patty Lee, MD   Host Bio: Tessa has over 20 years of experience supporting diverse populations in the nonprofit and medical sectors, focusing on personalized care and intergenerational connection. Currently at UChicago Medicine, she primarily supports patients and families dealing with Alzheimer's disease and related dementias. Through the Memory Center and consults across outpatient neurology and neurosurgery clinics. She's also a global facilitator for Lorenzo's House, co-leading programs for youth and care partners impacted by dementia. Also a recipient of the Schweitzer Fellowship, Tessa emphasizes grief support, cultural humility, and compassionate care in her work. She co founded Dementia Friendly Hyde Park she holds a BA in sociology from Notre Dame and a master's in clinical social work from the University of Chicago. Tessa's full bio here   Guest Host Bio: Megan Teramoto, BS, MS, is a first year medical student at the Pritzker School of Medicine. She received her Bachelor's and Master's degrees after studying Biochemistry at the University of Arizona. Outside of school, Megan enjoys volunteering and hiking.     Timestamps: 00:28 Introducing Our Special Guest: Tessa Garcia McEwen 02:14 Warm-Up Questions and Holiday Traditions 03:28 Navigating the Holidays with Dementia 07:39 Celebrating in Nursing Homes 09:52 Communicating Dementia Diagnosis to Family 15:20 Traveling with Dementia 18:52 Coping with Grief During the Holidays 23:13 Final Thoughts 

In this episode, we're lucky to have Josh Sevier, an audiologist who delves into his personal journey from being a trauma medic to an audiologist and shares valuable insights on hearing loss, its diagnosis, treatment options, and its broader health impacts. He shares about the evaluation process, recommendations for hearing aids, cochlear implants, and tips for communication strategies. We're proud that this episode was written by Nihar Rama, a current medical student at University of Chicago, with show notes written by Kylie McElheran, a medical student from Oregon Health and Science University. Check out the show notes here!

& check out cool graphic design by medical student Jai Daniels from University of Chicago on our instagram! Suscribe, like and follow - you know what to do!

Host Bio: Dr. Josh Sevier is an audiologist and clinical program manager of the cochlear implant program at UChicago Medicine. His clinical interests are research, objective measures, cognition, and training in cochlear implants, which he teaches about at multiple universities and publishes in numerous peer-reviewed journals. He’s been involved with advocacy and legislation on a state and national level, including the Government Relations Committee for the American Academy of Audiology, Executive Board for the Illinois Deaf and Hard of Hearing Commission. He is the current President of the Illinois Academy of Audiology. 

Guest Host Bio: Nihar is a third-year medical student at the University of Chicago Pritzker School of Medicine and a Cincinnati native. He is interested in pursuing a career in otolaryngology-head and neck surgery. Outside of medicine, Nihar loves staying active, playing and discovering music, and working on his comedic timing.

Writer: Nihar Rama, BS

Co-Producers: Nihar Rama, BS, Patty Lee, MD, Samantha Ing, MD

Primary editor: Patty Lee, MD

Graphic designer: Jai Daniels, BA

 

Timestamps:

1:20 Introductions

2:38 Josh’s journey to becoming an audiologist

4:32 Signs that someone might have hearing loss

7:15 Social impacts of hearing loss in geriatric patients

8:41 Referrals to audiology and types of hearing loss

10:52 Audiology evaluation details

13:50 ENT vs. Audiology

15:07 Case of Liz Senning, communication strategies/tips for families

16:47 Hearing Aids (commitment, costs, insurance coverage)

21:22 OTC Hearing Aids

24:28 Cochlear implants

27:42 Case 2 (90 y/o patient with severe vascular dementia and hearing loss)

29:34 Recommendations for patients adjusting to hearing aids

 

We are grateful to the University of Chicago Biological Sciences Division Office of Diversity and Inclusion for support. 

WELCOME TO SEASON 2!!!! This episode we're going a little bit back and going over the diagnosis and prognosis of dementia (see episode 7 for management of dementia). Does it take just a test score? A hunch? Probably not, but we'll go through the details. Our superstar guest is Dr. Sing Palat, MD (bio below), and our guest host is Andrew Dang, MD, a primary care physician. Don't forget to follow up on Instagram at @verigeripodcast! 

Show notes

Guest bio:

Sing Palat MD, from Golden Colorado, completed her geriatrics fellowship at the University of Colorado after medical school and an internal medicine residency at the University of Pittsburgh.  She is currently a medical director with Optum Senior Community Care, supporting clinicians practicing in long-term care communities.  On weekends, she plays the piano, volunteers at The Well free clinic, and goes sightseeing with her husband and teenage son.

 

Time stamps:

02:55: what's the difference between normal aging and pathologic cognitive impairment?

05:45: what are some misconceptions about dementia?

07:15: what are some common questions about dementia, including family history?

08:45: how do you diagnose dementia?

10:13: Summary

11:27: Staging dementia

14:50: how often do you assess for progression?

16:05: how can families support their loved ones in diagnosis of dementia?

16:44: what can we counsel families about?

18:27: what about Andrew's experience in residency clinic?

19:22: how do you navigate assisted living services? 

20:32: when should we start considering assisted living?

24:43: how do you help families try to preserve the patient's identity in dementia?

 

This episode was in part funded by the Small Grants Program at University of Chicago BSD Office of Diversity & Inclusion. We are truly grateful for the support.

Guru: Sing Palat, MD Peer Reviewer: Elizabeth Zavala, MD Guest Host: Andrew Dang, MD Hosts: Patty Lee, MD, Sam Ing, MD Graphics designer: Jai Daniels Show notes writer: Patty Lee, MD  

Elder abuse...who you gonna call???????? ADULT PROTECTIVE SERVICES IN YOUR STATE! Think you know what to do, how to report, and when to report? Think again! For no specific reason, we have tea time with Annie Vernon-Cwik, LCSW, ASW-G, to discuss. 

State specific reporting contacts

Show Notes: https://verigeripodcast.com/show-notes 

Reference to episode 2 on dispo, safety, and independence in the older adult:

Apple EP2

Spotify EP2

Timestamps 1:30 Annie’s background in Adult Protective Services 2:44 What is Adult Protective Services and who do they serve? 3:38 How to report (in Illinois) 4:27 9 types of abuse 4:43 Physical abuse 5:00 Emotional abuse 5:26 Financial exploitation 5:57 Sexual abuse 7:38 Confinement 8:04 Passive neglect and willful deprivation 9:28 Abandonment 10:18 Self neglect 11:30 We are mandated reporters 12:43 How to report and what happens after a report is filed 14:10 What does reporting look like in a nursing home? 17:35 Cases 17:46 Case of a man with moderate dementia with significant weight loss and weakness and refusal of help 21:55 Case of a woman with dependence on daughter for medication 23:21 Case of a woman with anxiety and threat of being placed in a nursing home 26:18 Case of a woman who is worried about fraudulent credit card charges

Gurus: Erin Zahradnik, MD, Carrie Jackson

Hosts: Patty Lee, MD, Sam Ing, MD

Guest Host: Marissa Korte, MD

A patient and family member come in stressed because of wandering/paranoia at home, and they need help! Time is ticking. What do you say? What are nonpharmacological interventions anyway? Does it live up to its character count? When and how do you use antipsychotics? What about THC? Also, some other things to add to the potpourri - what about THC and benzos? AHHHH!!!! In this episode, we talk with Dr. Zahradnik, a geriatric psychiatrist, for her advice, and with Carrie Jackson, who is a writer and was a caregiver for her father in her 20s as her mother was diagnosed with Parkinson's around the same time. 

Erin K. Zahradnik is an associate professor and director of geriatric psychiatry in the Department of Psychiatry at the University of Chicago Medical Center. She received her medical degree from University of Kansas School of Medicine, completed psychiatry residency at Yale-New Haven Hospital, and finished fellowship training in Geriatric Psychiatry and in Hospice and Palliative Medicine, both through the Icahn School of Medicine at Mount Sinai in NYC.

Carrie Jackson is an Evanston-based freelance writer and communications specialist, with a focus on holistic health and fostering sustainable communities. Music and art fill her up, and she enjoys exploring Chicago's rich cultural offerings while also curating her own events. A year-round biker, you can find Carrie trekking around the world or getting lost in the great outdoors here at home. Connect at CarrieJacksonWrites.com.

Show notes for summary and bonus tips!: https://verigeripodcast.com/show-notes/f/yes-and---management-of-behavioral-symptoms-in-dementia

Timestamps

2:01 About Dr. Erin Zahradnik and Geriatric Psychiatry

2:57 What are behavioral symptoms anyway?

4:12: Introduction to Carrie Jackson, who was a caregiver for her dad with dementia

05:27 Comorbid mood disorders

07:09: How do you screen for comorbid mood disorder in people with dementia?

08:12: A case of dementia and agitation

10:15 Nonpharm treatment – what are the options & the clinician perspective

12:19 Nonpharm treatment – the caregiver perspective

17:25 When to use pharmacological treatment

17:50 SSRIs in mild dementia with comorbid anxiety and depression

19:17 Black box warning of antipsychotics

20:38 Antipsychotics: type, dosing, schedule

25:46 THC

28:52: Two bonus rounds

29:30 Case of delusions

34:29 Case of benzos

 

What is hospice? What is inpatient hospice? What happens when you press "discharge to hospice"? What are some pearls and pitfalls of communicating about hospice? Find out in this episode as Dr. Khan addresses misconceptions, myths, pearls and pitfalls, settings, a case of anoxic brain injury, and concepts on end of life management.

1:39 Introduction to the Guru

4:23 Origins of hospice

7:19 Taboos of hospice

8:39 What does comfort mean to you?

10:44 A Case of anoxic brain injury

15:22 Guiding communication 

18:04 Pearls and Pitfalls

23:07 Where can the service of hospice be provided?

26:43 A little about payment

30:29 End of Life symptoms

Guru: Mohammed Ilyas Ahmed Khan, MD 

Hosts: Patty Lee, MD, Sam Ing, MD

Guest Host: James Fan, MD

Editor: Sam Ing, MD

Show Notes Editor: Marissa Korte, MD

Peer Reviewer: Vasyl Hereha, MD

Infographic Peer Reviewers: Vasyl Hereha, MD, and Jigar Joshi, MD

Ever toss and turn after a goals of care meeting? Wondered when to consult ethics and palliative care? Had moral distress before, during, or after a family meeting in the dead of night after missing a meal and back-to-back pages? Have we got an episode for you! Join us as Dr. Mark Watson, a palliative care, hospice, and ethics expert, goes through the differences between a surrogate and a healthcare power of attorney (POA), and then we throw him into the deep end of increasingly difficult situations with more and more heat! How will he fare? Will us fellows continue to deeply breathe in the second stall of the bathroom with silent tears rolling after reliving the trauma of situations, mistakes, and disagreements in residency (this is not personal I swear)? Will Marissa, M4 now MD, be able to take the heat? FIND OUT!

Show notes edited by Caroline Montag, BA: https://verigeripodcast.com/show-notes/f/spicy-difficult-situations-with-dr-mark-watson

0:40 Intro to our guru

0:57 Outline

1:53 Intro by Dr. Watson

3:04 Bread & Butter of surrogate versus healthcare power of attorney 

3:36 Healthcare Power of Attorney (HCPOA)

5:51 Surrogate 

8:25 What about the capacity of a surrogate or HCPOA?

11:08 Introduction of the challenges for Dr. Watson

11:45 Case 1: A patient with frailty, severe dementia, and full code 

18:36: Case 2: Advance Care Planning says one thing about a feeding tube, but family wants another

25:02: Case 3: Asking about code status to a patient in distress 

32:36: Case 4: An unbefriended patient

35:24: Case 5: Surrogate wants to reverse code status 

39:31: BONUS: Hospice with Full Code 

42:06: A brief summary and short motivational comments by Dr. Watson

 

Guru: Dr. Mark Watson

Hosts: Patty Lee, MD, Samantha Ing, MD, Marissa Korte, MD

Editor: Patty Lee, MD

Our Very Excellent Peer Reviewers: Melissa Marinelli, MD, Jason Lyou, MD

Show Notes Editor: Caroline Montag, BA

Theme Song: Samantha Ing and Patty Lee, mixed by Tak Ikuma

Piano transitions: Patty Lee 

In this episode, we delve into the complexities of managing feeding difficulties in patients with advanced dementia. Dr. Kostas, a seasoned clinician in geriatric medicine, shares insights and strategies for counseling patients and families facing these challenging situations. Then, we’ll turn to Dr. Kochar, a gastroenterologist with extensive experience in procedural medicine with a unique geriatric lens. She shares insights into the complexities of assessing patients for percutaneous endoscopic gastrostomy (PEG) tubes. Drawing from a case involving a 70-year-old patient with multiple comorbidities, Dr. Kochar, explores the nuanced considerations involved in deciding whether a PEG tube is appropriate in cases where it’s not severe dementia.

Check out the show notes for more nuggets of wisdom and quick links & references: https://verigeripodcast.com/show-notes/f/goals-before-holes 

Inspiration for episode: a question from Nicole Lum, MD

Inspiration for episode title: Coined by Dr. Mark Watson and adopted by the Regional Palliative Fellows of Chicago 2023-2024 

Gurus: Tia Kostas, MD, and Bharati Kochar, MD, MS Hosts and Co-Producers: Patty Lee, MD & Samantha Ing, MD Guest Host: Marissa Korte, MS Editor: Patty Lee, MD Peer reviewer: Katherine Thompson, MD  Show notes creator: Marissa Korte, BS Faculty Mentor: Christopher Chiu, MD, FAAP, FACP Music:  - Theme Song: Samantha Ing and Patty Lee, mixed by Takakuni Ikuma - Piano transitions and background: Patty Lee 

Diarrhea. Abdominal pain. Weight loss. Patient might not be able to tolerate colonoscopy. What do you do?! Join us and Dr. Kochar as we go through the bread and butter of diarrhea and IBD and the "beyond" of an intersection between Geriatrics and GI. 

Check out the show notes for more nuggets of wisdom and quick links & references: https://verigeripodcast.com/show-notes/f/diarrhea-and-inflammatory-bowel-disease-in-the-older-adult

02:08 Introduction of Dr. Bharati Kochar

05:57 The Case

06:46 The Questions

09:05 IBS vs IBD

10:07 Microscopic colitis

10:38 Review 

11:34 Scratching the surface on PPIs

13:30 Ddx 

14:20 Workup

16:18 Flex sig?

17:45 What's a really red flag?

18:26 Coordinate care with GI

19:27 What if dx'd with IBD?

20:36 UC vs Crohn's 

20:51 Treatments 

21:57 What Geriatricians should know about IBD treatments 

22:22 The 'Roids 

Guru: Bharati Kochar, MD, MS Hosts and Co-Producers: Patty Lee, MD & Samantha Ing, MD Editor: Patty Lee, MD Peer reviewers: Christopher Chiu, MD, FAAP, FACP, Antoinette Pusateri, MD Show notes creator: Marissa Korte, BS; edited by Antoinette Pusateri, MD Faculty Mentor: Christopher Chiu, MD, FAAP, FACP Music:  - Theme Song: Samantha Ing and Patricia Lee, mixed by Takakuni Ikuma - Piano transitions and background: Piano by Patricia Lee 

"They can't live alone at home." "What's the discharge plan???" Ever meet the conundrum of providing the "right" support of an older adult at home trying to balance independence and safety? We speak with one of our star social workers, Annie Cwik-Vernon, LCSW, Advanced Social Worker in Gerontology (ASW-G), as she walks us through a difficult clinical situation, navigates different levels of care, and clarifies the selection of a decision maker. 

Check out the show notes for more info or the too-long-didn't-listen:

https://verigeripodcast.com/show-notes/f/balancing-independence-and-safety-in-an-older-adult

Timestamps:

01:29: Introduction of our guest

04:29: The case

06:50 Evaluating support in the house

08:10 Medication support

11:49 Finances and logistics for a caregiver

16:35 Different discharge locations

17:00 Assisted vs supportive living

20:04 Memory Care

23:54 Senior and independent living

28:23 How to assess for a decision maker

30:00 Illinois surrogacy act

35:46 We attempt to trap Annie in a legal guardianship scenario

 

Edited by: Samantha Ing, MD

Co-produced by: Patty Lee, MD, Samantha Ing, MD

Show notes by: Marissa Korte, BS

Music:

- Theme Song: Samantha Ing and Patricia Lee, mixed by Takakuni Ikuma - Piano transitions and background: Piano by Patricia Lee 

Which medications should I stop to prevent my patient' falls? What's the deal with Vitamin D and falls? And what matters most to Geriatricians? On this, the FIRST episode of VeriGeri, we speak with Dr. Lisa Miura, Geriatrician, Associate Professor of Medicine, and fall expert at Oregon Health and Science University to answer these questions and more. Hear Dr. Miura carefully walk us through a new patient fall assessment- including what physical exam maneuvers, labs, and imaging she utilizes to understand the story behind the fall. She teaches us all about identifying and reducing patients' modifiable risk factors for falls, as well as simple interventions that go a long way in fall prevention.

Show notes: Falls with Dr. Miura (verigeripodcast.com)

0:00 Intro

1:53 This episode’s Guru, Dr. Lisa Miura

3:22 The Case!

3:48 Questions to ask

4:46 Conditions of the fall

5:17 Definition of a fall

7:16 Chart review approach

8:50 How to maximize time in a visit

9:09 Relationship between falls and cognitive decline, mood

10:24 The interesting medication list

11:11 The rest of the patient encounter, including social history and physical exam

12:00 Dr. Miura’s approach

12:12 Addressing polypharmacy

13:42 Gabapentin

14:59 Styles in making medication changes

16:59 Cognitive workup

17:24 Sensory impairments

17:45 Urinary symptoms

18:05 Blood tests for neuropathy

18:32 Social history clarification

19:06 Things to care about in the home environment

19:34 Footwear

19:55 Exercise

21:00 Physical Exam

25:40 Labs & imaging

27:12 Vitamin D

29:06 Assessment and Plan

33:50 Outro

 

Hosts: Patty Lee, Sam Ing, Marissa Korte

Guru: Dr. Lisa Miura

Case writers: Patty Lee, Sam Ing with edits from Dr. Lisa Miura