Barry Baines
Appearances
Health Chatter
100th Episode Special
Hi, yes. So I guess I'll go and say kind of one thing I think I really like about this podcast. Obviously, I enjoy working with everyone. I think it's really fun when we can all get together and talk and catch up.
Health Chatter
100th Episode Special
I think the main thing I really love about this podcast, though, is that we are in such a time right now where, you know, with social media and just everything, you know, debate shows and things like that are so popular. I think it's refreshing to have a podcast where these aren't debates.
Health Chatter
100th Episode Special
We're, you know, talking with professionals who are working in these topics that we're talking about, you know, starting these grassroots programs. And we're really getting, you know, like a feel for like what they're doing on a daily basis. And we're just kind of getting like that, information that people want without just back and forth and super heavy, maybe bias or opinions.
Health Chatter
100th Episode Special
And I think it's totally fine that people have bias and opinions and everyone should be heard, but it's kind of nice to just you know, listen to something that, you know, is really just information-based and just kind of, you know, these people are talking about their experiences, what they're doing and, you know, just like their personal and professional lives.
Health Chatter
100th Episode Special
So that's one thing I've come to really enjoy about working on this podcast.
Health Chatter
Tobacco Cessation
I think, you know, as a family physician, the way that played out is not so much certainly having the hammer of the information that this is all bad for you. But these are kind of things, just like with youth, that it's years, you know, it's years from now. And people are living in today, you know, mostly not, you know, what's going to happen 20 or 30 years. or 40 years from now.
Health Chatter
Tobacco Cessation
But for me, I think one of the biggest breakthroughs was actually more on the behavioral aspect of things is this whole idea of, yes, you give the information, but what's almost as important, if not more important, is to get an understanding of people's readiness to change their behavior. And there's a lot of public health work done for readiness to change.
Health Chatter
Tobacco Cessation
And every resident today, and certainly in primary care for sure, knows how to help assess their patient's readiness to change when they identify health behaviors, not just tobacco products usage, but other things as well. Because the threat of disease, that's a scare tactic, right? You want to scare people out of it.
Health Chatter
Tobacco Cessation
And when you're dealing with an addictive substance like nicotine, scare tactics don't necessarily work very well. But trying to work on people's motivation and realize that it's not going to be better quit today or, you know, or else. But really that it's a process and having that relationship over time and keep checking in, keep checking in. And over time, people sort of get the message.
Health Chatter
Tobacco Cessation
So there's that piece from a clinical perspective. What struck me, and again, I'll ask Dr. Patton about this. I remember seeing these graphs that was almost linear, that as taxing tobacco products, the level of taxes on tobacco products go up, usage goes down. I remember seeing these graphs, it was like,
Health Chatter
Tobacco Cessation
you know, taxes are going up and usage goes down, especially with youth, because they oftentimes don't have the financial resources to afford the escalating price. And that has been, you know, I mean, please correct me if I'm wrong, one of the biggest or most successful deterrents for tobacco product use in certainly in younger folks and probably other populations as well. So I hope
Health Chatter
Tobacco Cessation
Clarence and Stan, I kind of addressed the piece with how that information about health effects is just one piece of the puzzle. It's so complicated. You really need a combined strategy. And it's persistence. You have to keep coming back to it to get the message across.
Health Chatter
Tobacco Cessation
Well, you know, Stan, I'll just be really brief here. You hit the big three, okay? Yeah, right. Drugs or medications, all those, tobacco and alcohol. And some of that is inherent in the society that we live in and they become societal norms. And I think that's what makes it a real public health challenge to do that.
Health Chatter
Tobacco Cessation
And I was, my ears sort of perked up, Dr. Patton, when you talked about, you know, the request for the family-based interventions. I think that's going to be, you know, the key. And just a quick aside, I remember when secondhand smoke became big. And oftentimes that was a much better motivator for parents to either
Health Chatter
Tobacco Cessation
you know, could go to, you know, ideally to quit smoking, but as a second choice, don't smoke in the house, go outside, you know, if you want to, you know, smoke, okay. But, but don't make your kids sick because you're smoking in the house. And oftentimes that was a motivator, you know, for parents. So again, I guess the, you know, the glass is half full, at least you help the kid out.
Health Chatter
Tobacco Cessation
You know, and those cues of seeing their parents smoke all the time in the house, if they're not there, it's less reinforcement of the norm of, of, of smoking. So it's, I know that doesn't really clarify, you know, things, but it's sort of like we have all the tools and, you know, we have a big toolbox and how do we deploy what's in the toolbox that works for this particular person or this family.
Health Chatter
Tobacco Cessation
And a lot of times it's for me, it was, it was trial and error, but I had the advantage of relationship over years. And, you know, so that they, you know, I'd have patients come in and say, so when are you going to ask me about my smoking?
Health Chatter
Tobacco Cessation
Dr. B, you know, cause they knew, you know, but that was good because they knew to, you know, to expect that and they can prepare their excuses, what have you, or they say, you know, I think I'd like to, you know, then invest, look into that a little bit more. So it's, you have to take, like in public health, you have to take the longitudinal view.
Health Chatter
Tobacco Cessation
There are very few acute, you know, immediate things that you could do where you're going to see impacts. So I hope that informs the conversation a little.
Health Chatter
Tobacco Cessation
Barry? I think keep working with the goal of reduction of use. I think the goal of eradication in our capitalist society where a lot of other factors are at play. Eradication is not going to work just like prohibition didn't really help for alcohol. But I think long-term reduction and just incrementally and coming up with newer ideas.
Health Chatter
Tobacco Cessation
We're never at a loss for coming up with creative ideas to try out. And then researchers like Dr. Patton can tell us if we're on the right path or not. So thank you so much for sharing your information. It was really I really enjoyed it quite a bit. Thank you.
Health Chatter
Tobacco Cessation
Okay. Yeah. Barry. Yeah. Dr. Patton, can you just help us to differentiate between nicotine, which is the addictive substance that's in tobacco products, but obviously nicotine pouches and e-cigarettes, et cetera. But between that and tobacco, because it's the nicotine addiction that that gets people hooked and, you know, having them continue to use those products.
Health Chatter
Tobacco Cessation
Uh, but for tobacco, a lot of the, uh, really bad health effects, um, relate not to the necessarily the nicotine, but as you were just pointing out the burn, you know, the burn products and what that does to lung tissue and all those kinds of things. But aren't they, I mean, they're related obviously. Um, but can you differentiate between the two? In other words, are we
Health Chatter
Tobacco Cessation
dealing with two different issues that we need to attack to sort of improve health overall in our communities between, again, nicotine and tobacco products, of which it's more overlapped.
Health Chatter
Vaccinations Update
Well, number one, I certainly don't have all the answers. I do have some ideas and thoughts on that because actually it's very interesting. I was just going to try and, well, I guess pun intended, inject a little sunshine into this conversation. So not with my doctor hat on, but as, you know, like a human, just a person. Okay.
Health Chatter
Vaccinations Update
I'm amazed over the, and it's since COVID, how available and typically free you can get vaccines today. Right, right. I mean, everybody probably lives within a few blocks of someplace where they can go and get a vaccine, you know, certainly for again, you know, flu, COVID, you know, the big three are, you know, RSV and cost does not become an issue.
Health Chatter
Vaccinations Update
There has been an impact in doctor's offices as we have that really started with COVID with staffing issues. So like the clinic that I'm at, that I go to because, you know, I like to go to my clinic when I need to.
Health Chatter
Vaccinations Update
And as soon as you say the word vaccination, they say, well, just, you know, we're so backed up that it's going to be weeks and weeks till we can get you in to just get a vaccine from a nurse or nursing assistant, you know, whoever's going to administer it.
Health Chatter
Vaccinations Update
And they recommend, you know, go to, you know, Walgreens or CVS or the Hy-Vee or, I mean, because they say, because you can get in like tomorrow, you know, to get it. So the barrier isn't access, which as we know from a number of topics that we've talked about, access is a big problem. Now, just like there were food deserts in certain neighborhoods, I'm sure there are
Health Chatter
Vaccinations Update
CVS Walgreens deserts as well, so that certain communities don't necessarily have that same kind of access. But access, I think, is much, you know, much bigger. And, you know, certainly when I go in for, you know, just a regular exam, you know, my yearly, you know, my doc always covers all, you know, goes through my vaccination list and and goes through that.
Health Chatter
Vaccinations Update
And I think that continues to get, you know, to get done. But I think this is not as much a medical issue as some of the other things that we've talked about. And then mostly it's been politicization in our society and that where you stand on vaccines almost becomes like a code word or a code for what party what ideology you support.
Health Chatter
Vaccinations Update
And the other piece, and this is not what doctors can do, and then I'll kind of keep it short here. One of the things about, you know, everybody seems to think that if you change your mind about something, that you're a flip-flopper, you know, and that that's a bad thing. And the fundamental parts of science are you have a hypothesis and
Health Chatter
Vaccinations Update
And you expect people to disprove that if they can, so that we can develop something that's more true. So whether it be research on masks that comes out that says, well, we thought would be helpful, maybe it's not as helpful as it was, or certain vaccine effectiveness. Over time, we accumulate new information that helps us to get better with that. And what's happened is there's been this erosion
Health Chatter
Vaccinations Update
This is just my opinion, an erosion of trust in society about science and public health, because things change with it, even though, yes, it changes because we have new validated information that has us offer a different recommendation. But the population at large, I think there's the sense that if you're changing your mind, then you really don't know what you're talking about.
Health Chatter
Vaccinations Update
And so there's this notion of trust. And that to me is how do we get that back? You know, where I guess I remember I was just born after the polio vaccine came out. But I you know, you see the films that when the polio vaccine came out, I mean, it was sort of like. It was like, quote, a national holiday. They closed everything so that people could go and get the polio hits.
Health Chatter
Vaccinations Update
It was like your civic duty, which I think, you know, certainly, you know, Sheridan talked about that. You know, that's my civic responsibility to do that. And the population did that. And things have, you know, sadly changed so much that that's not the case. So I don't know.
Health Chatter
Vaccinations Update
You know, I guess in response to your question, I don't know what it is that physicians, you know, there's any more that we can do other than we keep bringing it up. We tell people how important it is. Reminders. And let them know that there's really good access and that it doesn't cost people anything. I mean, that's the other thing.
Health Chatter
Vaccinations Update
Barry. I'll keep this on more along the lines of what Clarence said. Even if you don't want to get the vaccine for yourself, get it for the people that you care about. Exactly.
Health Chatter
Vaccinations Update
Well, I guess when I went through our research, and Stan went through a very exhaustive list of vaccines that would have everybody really think that they're a pincushion if they got them all at once. But I guess how I like to break things down are the kind of vaccines that are sort of needed on what I'll call a seasonal basis.
Health Chatter
Vaccinations Update
In other words, we're getting into the flu season, and typically it follows a path where usually November to February, it just depends on, because all these viruses evolve. That's why, in fact, why we always need new vaccines because the viruses, even though they don't have a brain, it seems like they do because they evolve and they mutate and they change.
Health Chatter
Vaccinations Update
So what I always hear from my communities, and this is more friends as opposed to as patients, But this whole idea that because we have these phased-in illnesses that usually happen in the winter, there's a premium on several of them to get vaccinated against.
Health Chatter
Vaccinations Update
And, you know, COVID has followed a course where it still has its ups and downs, and it continues, and it's, you know, still here, even more than the way the flu has. virus stays with us from year to year. On the flip side, it seems like the new variants in COVID are a little less virulent, a little less lethal to the population.
Health Chatter
Vaccinations Update
That being said, the population ages, and if you have other conditions, even though the virus might not be as virulent for certain people with chronic conditions, that it could really knock them for a loop and they could die from COVID still. It's not like what we saw from three, four years ago for sure.
Health Chatter
Vaccinations Update
And so to me, the big three is COVID, flu, which we're not in the flu season yet, but we're getting there. And I see those as the top two. And then RSV is important for some populations is what I'm reading. And it seems like there's still a little bit of uncertainty about exactly who should be getting RSV and the effectiveness of the RSV vaccine.
Health Chatter
Vaccinations Update
So I see those three as the seasonal things that hit us every year, year after year. You should get ready for that. And then a lot of the other ones are either one time or two time, like in the Shingrix, the shingles vaccine. That's never... It's never an acute situation where, you know, shingles just comes up. It just is there all the time.
Health Chatter
Vaccinations Update
The hepatitis B vaccines, certainly the measles, mumps, rubella, you know, those kinds of things. I wouldn't say, I want to say that they were one and done, but because a lot of those diseases have left the population, this idea of herd immunity and people have antibodies to these things, which make it less likely that people are going to get those.
Health Chatter
Vaccinations Update
But those tend to be, you don't need them except on a multi-year basis. And some like shingles vaccine, hepatitis B, once you go through the series, you're done. Or at least as of now, as you know, one of the things with science and research is that we find out new things that always change our hypothesis or change our theories about what is the best practice. And so I think
Health Chatter
Vaccinations Update
it's sort of those two lumps, the, the, what do we have to get like now for this season and then other ones that are important. And, and that, so there's like two priority lists in my head. That's how I divide it out. Clarence, does that make sense? Wait, it does.
Health Chatter
Stereotypes & Labels
I hope my audio is working now. It's back. Yes. Okay. I think, you know, to that point, understanding what groups or labels that people identify with from a medical perspective, the $64 question is asking that person is not, I think, not just putting the onus on the, you know, on the person to bring that up, but as a medical provider,
Health Chatter
Stereotypes & Labels
to understand how their identification with the group, how does that in any way, shape or form, I'm talking about more broadly, how does that impact the healthcare that they see or what their healthcare needs are? And because that way you could say, oh, you know, oh, you're Jewish, but that doesn't really impact what, you know, what kind of healthcare I want, or I'm Muslim,
Health Chatter
Stereotypes & Labels
It doesn't, you know, impact that. Or I'm in the LGBTQ plus community. How does that impact that?
Health Chatter
Stereotypes & Labels
More often than not, you may, it will be very revealing because then they'll make you a better healthcare provider, whether you're a physician, nurse practitioner, nurse, et cetera, by understanding the impacts of that labeling or stereotyping or community that people belong to and their health beliefs. There's an intersection with that. And I go back to that idea of cultural humility.
Health Chatter
Stereotypes & Labels
I think it's much broader than that, is that the healthcare system would be much better served, as will our communities at large, by just bringing that information into the fore. And the fact is we're becoming more and more aware of our differences and how that might impact us, while at the same time to
Health Chatter
Stereotypes & Labels
to quote the famous Clarence Jones, you know, we are all human and we certainly share a lot more in common, but even with that, having that empathy and understanding and a more humble approach to things could help us all, you know, be better and do better.
Health Chatter
Stereotypes & Labels
Yeah, I have a lot of thoughts on this. I'll try and keep them under control. So just, you know, give me the, okay, that's, you know, that's good. So really wearing the medical hat, at a very high level, labeling and stereotyping, I would say that stereotyping is a subset of of labeling. And like most things, as in our research pointed out, it can be a double-edged sword.
Health Chatter
Stereotypes & Labels
There are things that can make it very helpful and things that make it not. And actually, Matthew, I think your story is the perfect example of the double-edged sword, not to say geographically that because you're in South Carolina, it was not so good. And then in Minneapolis, it was actually very helpful.
Health Chatter
Stereotypes & Labels
So I'd like to just break that down because this is something that goes back from a medical history perspective centuries. And at the very basis, this is labeling or stereotyping, depending where you go, men and women had always in medicine up to, actually it still happens, so I'm not going to say up until recently, are treated differently within the medical care system.
Health Chatter
Stereotypes & Labels
And all you have to do is look at a lot of the research that's done. Now, things have been changing, so there is a bit of self-correcting with mistakes, but almost all research has been done, you know, on men. And biologically, men and women are different. And so these broad generalizations of treatment go across the whole population when that's not the case.
Health Chatter
Stereotypes & Labels
And then when we had our pre-meeting to just talk about this topic a bit, some of us brought up this very idea that in research, labeling can be very helpful. Because you can identify groups that have specific health care needs depending on, you know, quote, their profile might be. So there is a positive for that.
Health Chatter
Stereotypes & Labels
But where I see this thing coming down as being, you know, more on the more negative side for stereotyping is that you make assumptions and you almost de-individualize a person by doing that. I remember reading articles when I was in medical school and in residency. I don't have the citations now, but, you know, you could find it where it looked to group ethnic groups by what they need medically.
Health Chatter
Stereotypes & Labels
So that one group, you know, literally one group, because they're educated, if you're treating them, you need to explain everything to them. so that they can make choices. And then if you're part of this other ethnic group, you don't really have to explain stuff, you just tell them what, you know, what you're going to do. And what it, you know, clearly, people are individuals.
Health Chatter
Stereotypes & Labels
And unless you decide to delve in to the individual goals of a person, what they know, what they don't know, what they'd want to know, If you don't have that approach that every patient you see is an individual, you're going to wind up going down a path that's totally inappropriate.
Health Chatter
Stereotypes & Labels
And as a result of that, when you go down those inappropriate paths, you're not going to be able to deliver individualized medical care. And necessarily, you know, how do you deliver good medical care if you don't you know, kind of wash away this lumping piece that we tend to do to make things more simple and more efficient.
Health Chatter
Stereotypes & Labels
So I, you know, and obviously that idea of ethnicity, maybe as a larger group, there might be some truths to it, but every individual in that group, it does not, they don't have the playbook for how they're supposed to be because they're part of an ethnic group. What does that even mean?
Health Chatter
Stereotypes & Labels
The answer is, yeah. I mean, the thing is, you know, yes, because number one, humans are not infallible. Okay. Quite the opposite. And you cannot take a person out of their environment and And the biases that all of us have.
Health Chatter
Stereotypes & Labels
And I think actually one, you know, a case in point was maybe it does, you know, depending where you go, the biases in a community in South Carolina are likely to be different than the biases in a community in Minneapolis. Yeah. And the people that are in that carry those biases with them. Oftentimes we tend to say, oh, I'm not, you know, I'm not that way.
Health Chatter
Stereotypes & Labels
But at a subconscious level, I think people treat people differently based on the biases that they have. And that carries over whether you're a physician, whether you're in law enforcement, whether you're a judge in court. And I mean, cases of this built-in bias in our society and the negative impacts it has, you know, we'll never run out of information that, that supports that.
Health Chatter
Stereotypes & Labels
Um, and one of the first steps has to be, if you can't be aware that this is how you're approaching things, how can you change if you don't know where you, where you're starting from?
Health Chatter
Burials, Funerals, & Health
Right. You know, it's, it's, you know, it goes on, I think, you know, longer than that, but certainly focusing in on, on that gradual reintroduction, I think is helpful. So that's the rituals that, that I kind of under, you know, understand and have been a part of. And for myself, they, they've always been very, very helpful. Maddie. How about for you?
Health Chatter
Burials, Funerals, & Health
Yeah, I'd like to say I'm an orphan in terms of my, both my, you know, once your parents are gone, and my parents died, you know, in a good number of years ago in 1990 and 1993, my dad first and then my mom, and my in-laws also now have passed with, so they're all gone. And one of the things that
Health Chatter
Burials, Funerals, & Health
to me that that always is important is understanding that even though your loved ones are gone it doesn't end the relationship that you have with them or that you had with them it's different you know because they're they're not there and I think one of the fears that
Health Chatter
Burials, Funerals, & Health
I kind of agree with Maddie. You know, there are some scripts about, you know, things to say. And I think the little story that you told, Stan, of just someone coming over and touching you, it's realizing the comfort of just a presence and being there and that you don't, people feel oftentimes compelled to say something. And then they're also worried.
Health Chatter
Burials, Funerals, & Health
They're not going to say the right, the right thing is how do you comfort? And oftentimes just going over and just looking at the person and touching them says, you know, says it all. Yeah. Um, and, and I, you know, I, I guess the thing, you know, something simple, I, you know, I'm sorry for your loss. Um,
Health Chatter
Burials, Funerals, & Health
Again, and then just, you know, hanging out or telling, you know, letting the griever sort of initiate, you know, where you go. And oftentimes I think what we bring when we go to a funeral is that we have within us a nugget, as it were, of the experience that we've had with their loved one. And it's the sharing of that that oftentimes...
Health Chatter
Burials, Funerals, & Health
brings the most comfort because oftentimes you hear things that you never heard before um you know about you know experiences and stuff like that and stuff like that so i you know i think simple is is best um and just being a presence and being there to listen and as maddie said and to support um i think the other the other piece is that uh realizing that initially
Health Chatter
Burials, Funerals, & Health
After the person, a loved one dies, there's lots of people visiting. Yes. And then as time goes on, all of a sudden, and that's a great support for the griever. And then what happens over time is that really disappears. And so thinking about maintaining a presence, not in the first weeks afterwards, but also to be checking in. that oftentimes can be the most helpful.
Health Chatter
Burials, Funerals, & Health
that I used to have, but I figured out a way to get around it is I worry that I'm, you know, that I'm going to forget about them and forget about that relationship. And so for me, when, when I lose a loved one, I want to ensure a way that I can remember them. And, you know, like I said, I've done, you know, a show on ethical wills where you kind of leave your values and things like that.
Health Chatter
Burials, Funerals, & Health
Because I think a lot of people, when they lose somebody and they grieve, they start to feel isolated. And then this is where we get into some of the medical things about why people get depressed. And it's normal to get depressed after you lose a loved one. I mean, that's a real health thing. However, when unresolved grief, which is grief
Health Chatter
Burials, Funerals, & Health
a very deep grief that goes on for a long period of time can create significant health issues for people that, you know, we obviously don't have, you know, we could spend many episodes, you know, focusing in, you know, on that piece. You know, they're shocking deaths.
Health Chatter
Burials, Funerals, & Health
So I always try and carry some legacy that, from loved ones. And that always rekindles the relationship and just makes it easier because the grief never totally goes away. It's always with you, this idea of get over it. It's more, how do you integrate yourself as a person with losses? Because all of us have losses
Health Chatter
Burials, Funerals, & Health
You know, through our lifetimes and some of it is, you know, losing, you know, losing loved ones. And that's what we're going to be focusing on. So my personal piece of that is how do you make it meaningful? Everybody grieves at their own rate and pace. And it just it doesn't go away. And the relationship doesn't go away either.
Health Chatter
Burials, Funerals, & Health
I want to just quickly tie together a couple of things. One is the great research that Sheridan had done. And that is that funerals are expensive. And most people don't know about it. Oftentimes, and this actually is a plea for doing some pre-planning, as Clarence mentioned, and as all of us know, taxes and one other thing in life and death, we are all going to die.
Health Chatter
Burials, Funerals, & Health
And one of the greatest gifts that you can leave for your family is to do some pre-planning about your funeral. because then you have that say beforehand. And I don't mean just about how the service is going to be, because that's also very important. But understanding the options that are available from a cost perspective, that's extremely important.
Health Chatter
Burials, Funerals, & Health
And being aware of those kind of things and having those conversations is very helpful. Again, obviously, if you're in hospice, Those things are addressed up front. And so, you know, expected, those things are expected. But there are, you know, most people don't go into hospice, so they don't have, you know, that, you know, that ability to have those conversations.
Health Chatter
Burials, Funerals, & Health
So it's a lasting relationship as long as you're alive to remember a person that you love that's gone. it helps to kind of get through the days sometime. I have one really quick humorous story and then I'll kind of be quiet here.
Health Chatter
Burials, Funerals, & Health
So it's kind of thinking about the pre-planning aspect. And also in the whole area of funerals, there's, you know, not surprisingly, green funerals. And I think Sheridan was taught, I forget if it was Sheridan or Maddie about the service, I think it was Sheridan, the service with the tree and the ashes and things like that.
Health Chatter
Burials, Funerals, & Health
And more and more people are opting for green funerals that, again, you know, for further, you know, reading and research. But these other options have come up. And the fact that cremation has become much more common than regular, you know, what I call standard burials. And most of that is because of the cost.
Health Chatter
Burials, Funerals, & Health
And the other last piece is that I know the whole funeral industry has started to pivot around the importance of pre-funeral planning to really help the family to meet the needs so that it's not under pressure where, you know, I lost my loved one, I need to bury them.
Health Chatter
Burials, Funerals, & Health
And then you're, you know, the pressure to make all these decisions and you're already not making your best judgments because you're grieving. And so the idea of you can get sort of get over the denial part that we are, that we all are going to die at some point. And to be thinking more about how to make that process a little bit more helpful and less stressful for everybody.
Health Chatter
Burials, Funerals, & Health
That's the other thing is when you do that pre-planning, it takes a big load off the survivors. And so that's my plea is to be thinking about having those conversations. Yeah.
Health Chatter
Burials, Funerals, & Health
But I always remember my mom and my dad, when they had tough decisions that, you know, even though like my grandmother, my Bubby, even though she was gone, both my dad and my mom would, you know, kind of, you know, talk to her, they wouldn't go to a medium to contact her, but it was sort of like, you know, what would Bubby do in an, you know, in this kind of situation.
Health Chatter
Burials, Funerals, & Health
So, so they're also, you can call them up to consult, you know, with you in your mind's eye, in your mind's eye. And that's, that's very, you know, that's very important too. So I say, obviously as a hospice medical director, I've, I, deal, you know, deal a lot with people who go through that.
Health Chatter
Burials, Funerals, & Health
And it has really sensitized me to, you know, some of the before conversation, you know, Clarence, that everybody does it in their own way. That's not one size fits all. Correct. I said too much already. I'm going to be quiet now.
Health Chatter
Burials, Funerals, & Health
I think the, you know, ritual traditions, how they relate to religion, being Jewish, what I appreciate is the ability to actually stretch out the grieving process. A lot of times, you know, when a person dies, it's sort of like the pressure to get over it. And, and that actually creates a lot of health issues for people.
Health Chatter
Burials, Funerals, & Health
Um, and you know, in, in Judaism with death, you get this gathering of community to really help. And it's just how it stages that grief where that, that first week, uh, in Judaism is called the Shiva period. Um, where, you know, basically you, uh, it's, it's supposed to be seven, seven days long Shiva means seven in, uh, in Hebrew. Um,
Health Chatter
Burials, Funerals, & Health
Most people these days or a lot of people shorten it a bit to not just be sitting and you cover your mirrors in your house and you sit on hard stools when guests come. But most of that Shiva period is spent talking about the person who's gone and remembering stories. And everybody who knew that person has a story. And so you get this treasure trove of stories, which provides a lot of comfort.
Health Chatter
Burials, Funerals, & Health
So there's that first week. And then the second week, the next phase is a month long period. And that's called Shloshim. And again, it's you sort of stay away from celebrations and stay with your morning and then gradually reintegrate into your community. And usually the morning period lasts a year where you would say a special prayer for those who are observant. called the Kaddish.
Health Chatter
Burials, Funerals, & Health
It's a prayer of remembrance in a way. And then at the end of that time, the grieving period formally ends, although everybody appreciates that it never ends. And there's on the anniversary of that person's death, that's sort of when people are remembered. Interestingly, the anniversary of my mother's death starts tonight. So I'll be...
Health Chatter
Burials, Funerals, & Health
you know, saying this prayer and lighting a candle, you know, so again, it comes on. So I sort of like that more gradual reintegration back into your community rather than trying to compress your grieving and, you know, kind of just, you know, get over it kind of thing because I think we've already acknowledged that everybody goes at their own pace and you know, even a year may not be enough.
Health Chatter
Preventive Services Task Force Community Guide
Barry. Thanks. Yeah, I want to try and create just a little bridge here between some things that Clarence was talking about and the information that Allison was presenting and Tom, you as well. A lot of these recommendations, to me, they're sort of like the gold standard and they have a great... you know, research base behind it, great evidence base behind it.
Health Chatter
Preventive Services Task Force Community Guide
And oftentimes, I've always had a conundrum between, well, what's going to be, again, from the time and money piece that, you know, I think of that in terms of operationally how you do it, and then, and I How much does it cost to do that? In the recommendations and in the community guide and even back to the Community Preventive Service Task Force work, is there ever a prioritization
Health Chatter
Preventive Services Task Force Community Guide
about sort of like, you know, the likelihood of success of operationalizing something that from a financial perspective, from a money perspective, it just could never be done. In other words, we have the answer, you know, if we could buy, you know, Vaxavans and send them around to every community knocking on every door, we can get a lot more people, you know, immunized.
Health Chatter
Preventive Services Task Force Community Guide
But that's not going to be practical because of, workforce issues and financial issues. So I'm just trying to reflect that from a community hat perspective and even a clinician in an office. Are there some of these recommendations, do they get ranked in any way in terms of likelihood of success or ease of implementation so that you can sort of make that impact
Health Chatter
Preventive Services Task Force Community Guide
but in a more efficient way, recognizing limitations on our time and money. I hope that makes sense.
Health Chatter
Preventive Services Task Force Community Guide
Yeah, a little medical insight. This is just such the community guide in particular is such an excellent resource to have in a community and a clinician's toolbox. What I like about it is that it's pretty comprehensive. It doesn't tell you what to do because oftentimes community interests
Health Chatter
Preventive Services Task Force Community Guide
lean in one direction or another, but I think it really points you in the right direction so that you're not totally wandering in the wilderness to try and figure out what to do. I was also glad to hear that review process because that's one of the things is that in medicine and science, we know that things oftentimes don't stay the same, they're always changing.
Health Chatter
Preventive Services Task Force Community Guide
And, and with, you don't want to drive people crazy every two weeks by, you know, changing things around, but on a periodic and systematic way of doing it, it could be very helpful because you always want to be up. You do want to be up to date. That's for sure. So thank you all for just this really very interesting show as many of our shows are to me.
Health Chatter
Preventive Services Task Force Community Guide
So thanks for being here and enlightening me a bit more on the community guide and, the Community Preventive Service Task Force.
Health Chatter
Arthritis and Rheumatology
Sorry to interrupt you, Barry. Yeah, go ahead, Barry. Now, so I'm going to stick my neck out a little bit here. because of what you were talking about with that other study. Um, one of the things over the past, you know, decades is that, uh, we spend more and more time sitting in front of the screen, the computer.
Health Chatter
Arthritis and Rheumatology
Um, and so I'm just when I know that, you know, hand things as well from, you know, keyboarding and stuff like that. So I'm just wondering, you know, how, uh, what, what we do in our daily activities, how that has, uh, brought up or impacted the prevalence of some of these things.
Health Chatter
Arthritis and Rheumatology
And then my sort of a second part of the question that goes beyond that, but that is there are things that we can do that don't have to be medication. There are a lot of lifestyle things that really can make a big difference in its impact on arthritis, certainly osteoarthritis, and I would imagine as well. rheumatoid arthritis.
Health Chatter
Arthritis and Rheumatology
But I was just wondering if you could touch on how this has really changed what some of the arthritis conditions that we're seeing as an impact from our daily activities.
Health Chatter
Arthritis and Rheumatology
Barry. You know, my biggest takeaway, and this is for our listeners out there, oftentimes we have like my knee hurts and you go in to see the doctor for that. But also, you know, my wrist hurts and my ankle hurts sometimes, things like that. What I'm coming away with is that earlier recognition can have a tremendous impact on long-term disability, all those kinds of things.
Health Chatter
Arthritis and Rheumatology
And so my takeaway is if you have, you go to the doctor and you have a joint that aches, be proactive and say, also, by the way, you know, you need to know that my, you know, I have other joints that hurt, but not as much as my knee.
Health Chatter
Arthritis and Rheumatology
Because that's going to automatically raise yellow flags so that this is more than just, oh, it's just arthritis and you need to take some ibuprofen, things like that. So that's a big takeaway for me. I think people tend to focus, and doctors as well, and nurse practitioners, on presenting symptoms.
Health Chatter
Arthritis and Rheumatology
And we need to make sure that even as patients, that when we come in, try and expand the view a little bit, because that could have a great impact on... you know, on results over long term. Yeah, absolutely. Yeah. Yeah.
Health Chatter
Arthritis and Rheumatology
Barry, Dr. Barry. Yeah. So, you know, trying to go down this path, I'm pretty sure we're going to go down a few paths here and talking about arthritis and and rheumatology and all those kind of things. Paul, as you were talking about this, it seems like the treatments that have been available have markedly changed over, you know, the past 20 to 30 years. I mean, really, you know, very remarkably.
Health Chatter
Arthritis and Rheumatology
And with most arthritis conditions, usually pain and swelling, you know, seem to be very common symptoms. And so, you know, people go to, you know, to treat the pain so they can, you know, then do things. But at a higher level, can you just give us an overview of what you've seen in rheumatology in the treatment of these diseases over the past 20 years?
Health Chatter
Arthritis and Rheumatology
It seems like every time I watch the commercials on, you know, every time I watch TV, There are all these commercials about all these new immunologic agents that are very hard to pronounce, so they have to come up with catchy names from a brand perspective.
Health Chatter
Arthritis and Rheumatology
I wonder if you could just talk about that from the perch of a rheumatologist and changes that you've seen and how that relates to us as consumers or just as people.
Health Chatter
Traveling & Health
and uh having that checklist um makes it very very easy and you can always add to it usually you can't take things off of those checklists because our lives tend to get more complicated over over time uh but having that checklist is just a great way to know like i say that you pack your you know you also want to pack your toothbrush and toothpaste yeah exactly as well as uh is everything.
Health Chatter
Traveling & Health
Yeah, I think the biggest pro for this is that being in a new setting really helps you to see things in a different way. And it's very stimulating for the brain from a creative perspective, you know, seeing new scenery. And, you know, certainly I'll talk about traveling domestically here. There are parts of our country and our state.
Health Chatter
Traveling & Health
It's not like, you know, travel has to be always going on a plane. But very often, in particular, when we connect with nature, And we have lots of natural, stupendous, awesome things, you know, in our parks and rivers and mountains and, you know, in this country. And it really is very stimulating to the brain and helps you think about, you know, things differently. It's very restorative.
Health Chatter
Traveling & Health
So like, you know, if you're stressed out, sometimes that break helps. I think to build on Clarence's piece, it helps expand your worldview as you get out of your neighborhood. And that to me always ranks at the top of the list because oftentimes when you travel, you have new experiences, even experiences that are challenging, sort of being able to solve problems in a new setting
Health Chatter
Traveling & Health
just expands your brain's ability. And so for me, that's always been the number one thing is how it really gets your brain going, which ultimately results in more energy to do things and more productivity in general.
Health Chatter
Traveling & Health
Yeah, I think that top of mind for me is sort of the first division in the tree is are you traveling domestic or are you traveling overseas? Some things are common to both. I think the biggest issue when you're traveling overseas from really a purely health perspective is are you going someplace where you need immunizations before you travel? And I know that certainly the Twin Cities area.
Health Chatter
Traveling & Health
No, because once you're in a different environment, okay, it changes things. And my experience has been when I travel to a new environment, you sort of need to compromise more
Health Chatter
Traveling & Health
You become more tolerable, you know, tolerance increases, patience increases, hopefully, and acceptance of things so that, you know, the idea that, you know, you negotiate, it's perfectly okay for someone to go shopping on Fifth Avenue and someone to go to the, you know, Museum of Modern Art and, hey, you know, I'll meet you here in an hour and a half.
Health Chatter
Traveling & Health
We have international travel clinics because it's sort of hard to keep up on all the vaccines that you might be needing if you're going overseas. And so that's extremely important because the one thing you don't want to do is be getting on a plane, getting off the plane, and then being asked for your immunization status on this, that, or the next thing. And and then they don't let you in.
Health Chatter
Traveling & Health
And so sort of negotiating time and space and things like that, I think it helps you to see the people you're traveling with in a more appreciative way, but also understanding that we all have our limitations and we do all need our space. And somehow I've always found that being in a different environment
Health Chatter
Traveling & Health
breaks, you know, all of us get into, you know, this pretty inflexible way that we act and behave, you know, usually when we're at home in comfortable surroundings that we know. And then when you're in a place that you don't know, I think it helps you to loosen up and even have conversations about things like that and be able to do those kind of things.
Health Chatter
Traveling & Health
of you know of traveling is again it puts you in a a different environment and and you're able to uh you know to do things a little differently and and understanding that sometimes they work and sometimes they don't we're right we're all human and uh you know we might go down one path and you know maybe i have to backtrack so that was i realized that when i when i travel um
Health Chatter
Traveling & Health
Although realistically, what's more of an issue is really to protect yourself when you're traveling, particularly with third world countries, and depending where you're actually going to be going. So I think the vaccination thing is an important thing. And I just encourage people,
Health Chatter
Traveling & Health
Yeah, I just want to say one quick thing about CPAP machines because my sister-in-law just was in town, came in and as you know, you have to empty out all the water bottles, right, before you get on the plane and stuff. And the CPAP machines, she says, I need to get distilled water when I get there to use that. You could actually just use filtered water For a few days.
Health Chatter
Traveling & Health
But if you're going to be gone, need to, again, put that on the checklist. Right, Clarence? Yeah, you know, am I going to be able to am I going to be able to get distilled water? Usually that's an easy thing to to find. But again, it's just one more of those things where, you know, she wasn't thinking about it until she got here. And then it was like. Where can we go?
Health Chatter
Traveling & Health
Just that when you add up all the pros and cons, and I think we covered a lot of those kind of things. The bottom line, I think, is that the positives still outweigh the negatives. when you travel, for many of the things that we talked about.
Health Chatter
Traveling & Health
And also, as we had our conversation, a lot of the negatives, the cons, the stressors and things like that, that we can do something beforehand to lessen those, which ultimately will make any travel experience you have more positive, right? You could either all right, add positives or take away negatives. And that, you know, the net result is a better experience.
Health Chatter
Traveling & Health
to talk to their doctor or call the international travel clinics that are, you know, that are in town to find out about that. And maybe we could just get some resources for folks so they can save them some investigatory work to try and find out.
Health Chatter
Traveling & Health
So I'd say do, you know, do the planning and you'll enjoy your trip more. And there's just lots of rewarding activities and things that you can do with travel. It has lots of benefits. And I hope to Be able to take advantage of some of those. I know my limitations as I get older. I can't do what I did, you know, 40 years ago.
Health Chatter
Traveling & Health
And so I can go on a hike that's more flat rather than, you know, climbing a mountain. But again, it's that planning piece that can really, really help. You do need to be more deliberate with planning.
Health Chatter
Traveling & Health
Yeah. There are some apps. Actually, my daughter, who works for the health department, put me on to one thing. It's called Docket. Yeah. And it keeps track of all the immunizations that you get because they're all reported. You know, your immunizations are, you know, reported in. And so that's one easy way to to do that. So that was just the one thing that that just. you know, more of an aside.
Health Chatter
Traveling & Health
We're not going to be getting into that, you know, I don't think. But I think from a purely health perspective, the other piece that affects regardless of where you travel is if you're taking medications, which, you know, certainly get to my age and probably, you know, speak for some of the hosts that are here. And it's very important to make sure
Health Chatter
Traveling & Health
Number one, that you have all the medications that you need for the time you're going to be away. Also, I read these tips like everybody else. Don't just pack it in your luggage that's going to go on the plane because you might be going one place and your luggage might be going to another place.
Health Chatter
Traveling & Health
The importance of keeping medications that are really close to you and your personal belongings that are going to be with you all the time. And then I just divide out things. And this is regardless of whether you're traveling internationally or domestically. Its impact on health is both, you know, good and bad, and it's physical and mental.
Health Chatter
Traveling & Health
And those, I think, are when I look at the research that we have, it sort of breaks it down, you know, into those kind of things. So, you know, on the On the physical side, we have impacts of how many time zones that you're going through.
Health Chatter
Traveling & Health
And it really, even though we all think we might be great travel warriors, when it comes down to it is every time zone that you travel through has an impact on your sleep pattern and our circadian rhythms or bio rhythms, as it were. And it could make you feel like you're dragging
Health Chatter
Traveling & Health
for days and that's and that's true um and so sort of having a handle on how many time zones you're going to go through and how you might be able to mitigate um you know that whole thing because you go to a place and you're going to be staying for a week you don't want to be spending you know five of those seven days like with your eyes half closed right as you as you go through and then the other piece is again i'm just kind of you know putting these out there high level
Health Chatter
Traveling & Health
hopefully high level enough, and then we can pick up the conversation threads on those. Traveling is stressful. It's very stressful because a lot of what we're doing is out of our control, particularly transportation, airports. We know how that's changed. How many things do I have to take off to get through security? Make sure that I have my ID correctly.
Health Chatter
Traveling & Health
Overseas, in addition to immunizations, it's your passport, things like that. And there are lots of things you could just Google for travel tips that oftentimes give you a list of things that are very, very important, which can come in handy. I know I went overseas. One of the tips was if you're traveling overseas and you have a passport, make a copy of your passport.
Health Chatter
Traveling & Health
Oh, and by the way, you know, like the Xerox copy. And by the way, don't keep it with your passport. And I was I was overseas. This is about 13, 14 years ago on a vacation to Portugal. And a couple of days before we left, I lost my passport. And I had to go to the embassy. But fortunately, I did make a copy of my I had a copy and I wasn't keeping it with my passport.
Health Chatter
Traveling & Health
And so it, it, it relieved, it was very stressful losing your passport, but it was a relief that I had everything that was needed so that I could get a temporary one.
Health Chatter
Traveling & Health
Yeah. And I'll be honest, I don't exactly know what the current, you know, what's the most up-to-date, you know, advice on that kind of thing from a common sense perspective. Because you're going to be traveling somewhere, a lot of time zones away, but you're going to be coming back
Health Chatter
Traveling & Health
I think I tend to just weigh in, again, just as a health chatter, you know, co-host and advisor here, is just keeping to that regular schedule is the best thing. That being said, though, you know, when your days are all sudden or nights and vice versa, that can be difficult. So if you have complicated medication management schedules and stuff,
Health Chatter
Traveling & Health
I think it's certainly worth having a conversation with your provider.
Health Chatter
Traveling & Health
Or physician to sort of map out a plan. But again, the thing is, one way to relieve the stress is to have a plan of what you're going to do. And typically, if you're a little off for a few days on a medication, most of the time that's not going to be You know, the end, you know, the end of the world overall.
Health Chatter
Traveling & Health
And it's still but again, to relieve that stress of, oh, my gosh, what am I going to do now? It's I'm supposed to take this morning. Now it's night. Having a plan for that is one way to relieve that stress. Yeah.
Health Chatter
Traveling & Health
Yeah, and the thing is, there's the idea of having a travel checklist. There's a book that was written called The Checklist Manifesto. Okay. And actually, it was written by Atul Gawande, who wrote Being Mortal. I think many of you, you know, hopefully our listeners have heard that's a fantastic book to be reading as well. But the point is having a checklist is just to help you not forget anything.
Health Chatter
Traveling & Health
And you know, the reality is, The airline pilots that fly our planes, they know how to fly the planes, but before they could do anything, they have to go through this exhaustive checklist. Surgeons in operating rooms have to go through a checklist before they operate so that, oh, it was the left leg, not the right leg. It's just one of those things, just so that you don't forget,
Health Chatter
Organ Donation with LifeSource
And porcine or pig heart valves have been used in medicine for valve replacement for you know, for a while, certainly before the technology of, you know, pretty artificial valves. Yeah.
Health Chatter
Organ Donation with LifeSource
Yeah. Barry. Yeah. Kind of building on this with the donations, this focus is mostly on agreeing to be an organ donor. And then typically you say you have to be on a ventilator and it's an in-hospital death. Could, What is your interface with live donation? Obviously, this would have to be with a paired organ, like a kidney. You're not going to donate your heart if you only have one of them.
Health Chatter
Organ Donation with LifeSource
How does Lifeforce interface with people who are interested in being live donors?
Health Chatter
Organ Donation with LifeSource
Last thoughts, Barry? I think Susan and Nicole just really covered
Health Chatter
Organ Donation with LifeSource
the basis on it and you know shared and also you know that sharing is so helpful that you know it really brings a human face to the experience and and oftentimes because that that emotional feeling is what oftentimes makes this so meaningful as opposed to just a you know a check mark you know on your driver's license when you hear the actual story
Health Chatter
Organ Donation with LifeSource
And then on the back end, obviously, is, you know, her aunt did a lot to extend people's lives and improve their quality of life. And so it's just like a blessing that you can, you know, pass on to paying it forward, passing it on to others. So Susan and Nicole, thank you so much.
Health Chatter
Organ Donation with LifeSource
Barry? Yeah, so on this same list, we have Minnesota, North and South Dakota. I had a friend who actually was a recipient of a kidney transplant. He lived in New York. And Could you just tell us a little bit if you know, is it a state registry where priorities are concerned?
Health Chatter
Organ Donation with LifeSource
Because I sort of recall that the waiting list in New York was like two years and that he was sort of shopping around for other states where he might be able to get on a list that was a bit shorter. Can you just talk a little bit about how that priority piece of things work and state registries?
Health Chatter
Childhood Diabetes
Yeah, I just wanted to build on that and actually ask more questions because it seems that one of the issues is with the designated food deserts. In a lot of these communities, There are no grocery stores. And the only grocery store is, I would say, 7-Eleven. You know, it's Speedway. It's, you know, Holiday. It's the gas stations and fast foods. You have lots of those, but not grocery stores.
Health Chatter
Childhood Diabetes
And then in addition, another area is that school lunches and breakfasts, too,
Health Chatter
Childhood Diabetes
be an opportunity that oftentimes um you know a lot of students in schools are eligible for reduced or free lunches and they also get breakfast and so i'm just you know you know wondering how how significant and i think it does play a significant role but i haven't looked at the research and so i'd be curious to hear from you know teresa both you and julie about that issue if you don't have access julie talked about access to food if you don't have access
Health Chatter
Childhood Diabetes
to healthy foods you know you have to eat and unfortunately you get lots of calories then you know there might be empty calories but people do need we need calories to carry on and function um and oftentimes these uh low nutrition calories tend to be the most affordable which kind of gets you in this downward spiral and a trap of you know i gotta feed my family i don't have access to
Health Chatter
Childhood Diabetes
healthy food. So I just wonder if we could just talk a little bit about that. I know we're not going to solve the world's problems on that, but understanding that, that always has been something that pops into my head as being, you know, a significant issue if we're going to make headway and do education.
Health Chatter
Childhood Diabetes
Barry. in addition to the thank yous, I think this is a more of a beginning conversation. And I think getting the word out and getting people talking about this as an issue can also, I hope, create some momentum toward understanding and action. And this is just wonderful to certainly Teresa to reconnect with you and Julie to meet you and
Health Chatter
Childhood Diabetes
a topic that just is of such importance to all communities, but certainly in the Minnesota community. So thank you so much.
Health Chatter
Childhood Diabetes
Only that I agree with you 100%. And it's very complex and multifactorial. And things, you know, begin even before children are born in terms of that environment that might predispose them to both obesity, and certainly to diabetes as well. So it's one of these things that's with us.
Health Chatter
Childhood Diabetes
It's also very genetic because I know as Teresa and Julie probably can talk about, there are certain populations that have a very high prevalence of diabetes that probably has a significant genetic link as well.
Health Chatter
Childhood Diabetes
you know, in the late 70s and 80s. And a lot of it is from the nutritional perspective, I sort of remember, you know, the 70s and 80s, where the fast food boom, took off. And again, that wouldn't win any healthy food awards, mostly with offerings and a lot more fried foods coming in, more processed foods. So I actually have questions about that.
Health Chatter
Childhood Diabetes
Even though things are multifactorial for how this happened, it's sort of Can we sort out what are the big play? You know, I'd like to hear what are the priority ones where then we could, you know, all sort of, you know, think about and work together to start making an impact. It's so complicated. We can't do it all. But if we could do something, then Clarence will, you know, will be more calm.
Health Chatter
Childhood Diabetes
I'll be more calm and Stan will be more calm. But that's one of the things is how can we also help to get the word out? But I wonder if you could just, you know, help us to understand sort of what that priority piece, what are the big players, you know, in this?
Health Chatter
Caregiver Burnout
Yeah. Barry. Yeah. So I sort of have a two part question or question and comment. So when I was as a family physician, when I was in practice, I don't.
Health Chatter
Caregiver Burnout
I don't remember very often when the issue where, you know, I was seeing a patient, let's say during a health maintenance exam, and I may have known about their family, but, you know, it was rare that I would ask, so, you know, are you involved in caregiving for your elderly parents? And, you know, how's that going? You know, it just, it was not on the radar screen.
Health Chatter
Caregiver Burnout
And so my first, this is more of a, informational plea for our listeners is that I was always ready to be helpful if I knew, but if you don't know what you don't know, it's difficult to move that forward. And so oftentimes waiting for the physician or nurse practitioner or the professional medical provider that you're seeing to sort of
Health Chatter
Caregiver Burnout
you know, make the opening, you know, put up the ante and make the opening bet, you know, on, well, how are things going in this? I think it will be very important for people who are involved in caregiving to just put that on the table, just as part of, and to say, well, how are you doing?
Health Chatter
Caregiver Burnout
And just, you know, like matter of factly, even though people feel it's an obligation, oftentimes, if you're a family member to do this, it does have consequences, you know, clearly down the road. So my first plea for people listening, like I say, I wish I knew then what I know now, but, you know, let's just move ahead.
Health Chatter
Caregiver Burnout
But to really encourage people, if they're involved in being a part of care of a parent, a cousin, a relative, a friend, whatever, to put that on the table. So that's, okay, but now here's the question, okay? is so what's the path for a caregiver to get help, you know, moving ahead? And it might not even be because they're burned out, because obviously I always like, you know, prevention.
Health Chatter
Caregiver Burnout
I think everybody benefits if we could prevent that from happening. So can you share some of your wisdom and insight as to how a caregiver can can kind of be more, you know, proactive about how to deal with this, because you already, you know, pointed out on the medical side, the quicker and sicker, so they're home.
Health Chatter
Caregiver Burnout
And then there's all the activities of daily living that oftentimes, you know, family caregivers get, you know, dressing, bathing, toilet, I mean, just the whole you know, a bunch of things and are not really prepared. And so you'd be, you're very reactive to what happens. And it's always the phone call. Oh no. But I have a job where I have my kids as well.
Health Chatter
Caregiver Burnout
So I'll, I'll kind of be quiet and listen because, uh, um, see what, you know, what I missed.
Health Chatter
Caregiver Burnout
Yeah, yeah. Barry. Yeah, so this is a question that I believe encompasses both professional caregivers and family caregivers. And it builds on Clarence's question that he had for, again, how do you kind of recover from caregiver burnout?
Health Chatter
Caregiver Burnout
But before you have to recover from it, are there a handful of what I would call red flag signs that you are dealing with caregiver burnout, whether it be professional or family, and they're I mean, it's somewhat different because of settings typically, but can you share your expertise on that?
Health Chatter
Caregiver Burnout
What are those red flags that, boy, if you're experiencing this, you are showing signs of caregiver burnout very obviously, and it's time to then, I guess, raise the- Raise the red flag. The white flag that I need help. I can't just put this myself.
Health Chatter
Health & Safety
But it's, you know, you don't think of it quite in the same terms. of people falling off buildings and dying as a result of that. Exactly.
Health Chatter
Health & Safety
Yeah, Barry. Yeah, well, I think one of the things that's happened over time, and this does get into the health care system, as it were, and why it really is important for these, you know, when people have their checkups for kids,
Health Chatter
Health & Safety
In particular, I mean, one of the things that I used to do when I was in a more active full range family medicine practice, one of the most important things that we did was having the conversation with parents about the list of safety things to do. And, you know, quite honestly, we didn't, you know, it's like what you don't, you know, you don't know what you don't know. Yeah.
Health Chatter
Health & Safety
And and that's actually that, you know, who knew about, you know, Clarence or me sticking a fork into an outlet? You know, the kids are curious. OK. And so it really there's a lot of weight on educating the public about this, whether it be, you know, through nurses. Physicians, when you're seeing patients to make sure that safety is
Health Chatter
Health & Safety
you know, is put on the table and, you know, as well to really have that conversation and also having some excellent handouts that fortunately now are made up in different languages for, you know, for people whose, you know, English might not be their primary language. And many of these things are relatively easy to mitigate if you know what they are. But if you don't know, then that's a problem.
Health Chatter
Health & Safety
And, you know, again, in my practice over the years, you do wind up with seeing some of these, you know, avoidable tragedies, you know, that have happened. And so I think trying to be proactive, again, putting on my public health hat, Um, you know, this is something that's, that's very important to, to address.
Health Chatter
Health & Safety
Uh, of course you can't get away from the impact of, you know, substandard housing and issues that make it, you know, even more dangerous, like, like in the home and things. So it's not something that's necessarily in isolation, but it is a piece of that mosaic. It's a piece of that puzzle. And it's something that I think needs to be, uh, needs to be addressed.
Health Chatter
Health & Safety
Second Amendment rights and the political part of it. But the reality is, is that we have an epidemic of lots of people owning guns just in general. And one of the kids, the leading cause of death in kids, at least, is from firearms. And and there are things that really can be done to mitigate that quite a bit.
Health Chatter
Health & Safety
I'm not talking about gun violence in the streets where they're relatively random acts, but in the home, there are so many gun accidents that happen as a result of kids getting a hold of guns that are loaded. And these generally tend to be pretty accidental. And again, it's making a plea again for using gun locks
Health Chatter
Health & Safety
So they can't be fired, not having ammunition, you know, not having bullets in the gun, having it in a separate place and having your gun locked up somewhere. Of course, you know, this gets away from, you know, why people have guns. A lot of times they say, well, I have a gun to protect myself. And, you know, I can't protect myself if my gun is locked or if it's, you know, somewhere else.
Health Chatter
Health & Safety
But the reality is kids are very curious and they get into that and you wind up with a tragedy as a result of that. And I know that there have been a lot of efforts to make sure that firearms are safely locked up and certainly for sportsmen and hunters, et cetera. They're, generally speaking, I think have a lot more and take a lot more care
Health Chatter
Health & Safety
of equipment to keep, you know, their guns in a separate place and keep it locked up. But it's hard to imagine that firearm deaths are the leading cause of death in kids, young people. You know, I always, you know, thought it was cars, you know, which we also, you know, get into. And the basic rules of gun safety as detailed in our
Health Chatter
Health & Safety
excellent research is it's not complicated things you know that you that you need to do to kind of keep your family safe just internally within within your house um and and those are things that uh just you know really i think should be you know should be highlighted because kids kids can't distinguish the difference between real guns and play guns yeah yeah yeah yeah
Health Chatter
Health & Safety
Well, basically that's one of the areas of health and safety where there is a structure in place. There are departments within governmental perspectives that really address those kinds of things. And certainly things like mine, when I kind of think of the biggies, certainly mine safety, construction, Safety is another one.
Health Chatter
Health & Safety
And I think part of it is, you know, is, is understanding the environment, right? You're in a shower. Oftentimes bathtubs can be even worse versus a standup shower. But if you take a shower and you know, you have the bathtub. So, you know, just think about it. Soap plus water. Slippery. Exactly. Slippery. I don't know any, any bathtubs or wall pots in the bathroom that are soft. It really is a,
Health Chatter
Health & Safety
you know, almost like an accident waiting to happen. But that's why even without grab bars, at least maybe have one of those suction mats or something that provide, you know, a little bit more stability when you're, you know, when you're standing.
Health Chatter
Health & Safety
I'd like to weigh in quickly on that, only because I know that when I started to drive, Actually, my dad had a 1963 car, which they didn't have seatbelts yet. But in 1963, the government mandated that you had to have the mounts in the car for a seatbelt. You didn't have to have a seat, but they had the mounts.
Health Chatter
Health & Safety
And when I started to drive in 66, one of the first things I did, my dad kind of looked at me. I said, we got mounts. Let's buy some seatbelts. Right. I was ahead of the, you know, ahead of the curve there. I think, you know, with seatbelts in particular, um, the seatbelts that are not used, uh, it's like, you don't, you don't have them now.
Health Chatter
Health & Safety
Uh, fortunately as you go flying at 40 miles an hour, uh, you know, into your, uh, steering wheel, which, uh, uh, it used to serve as a spear, uh, the way they weren't collapsible or putting your head through the windshield. But what's very interesting is how other countries have really ramped up their seatbelt use.
Health Chatter
Health & Safety
And one of them is actually providing, in particular, Great Britain and Australia, that actually in their public service announcements and trying to get people to wear seatbelts, use rather graphic advertisements that actually show what happened to people who didn't wear their seatbelts. It's quite gruesome if you have seen those. And it's real. I mean, this is what happens.
Health Chatter
Health & Safety
And most people don't have a clue of what these things are about. Oh, wear a seatbelt. Oh, what is it like? And one of the things that's interesting is that in the United States, they tend to downplay what actually happens to people in those situations. And that actually runs over also to firearms.
Health Chatter
Health & Safety
And when you look at where a lot of the accidents and mortality comes from, it's in these, you know, fairly dangerous occupations. And, you know, from a health and safety perspective, though, you do have government regulation, you have government intervention, and that Obviously, you can't get away from the political aspects of that, which I'm not going to delve into.
Health Chatter
Health & Safety
That, you know, other than the tragedies of firearms and, you know, say, oh, you know, you're in my thoughts and prayers now. Maybe, you know, sort of being more realistic about what happens when things go awry and might get people to think twice about it. I know that the seatbelt usage in other countries that have used this method has really made a difference where people think twice.
Health Chatter
Health & Safety
The flip side of that is that cars are getting safer and safer, certainly with airbags. But again, you need to be wearing your seatbelt to do that. People come out of crashes that you know, not even that many years ago, you'd be dead. I mean, or if you survived, you'd, you know, go on again into quality of life things. But if you survived, you're so injured that it's just a long road back.
Health Chatter
Health & Safety
Let me put it that way. So you really do need to wear your seatbelt to stay safe. And that certainly carries over again to the car seat use and having kids in the backseat until they're actually a certain size or shape to be able to sit in front. That's my little mini sermon there on car safety and stuff. And Stan, I took that course, I did a re-up on that senior citizens driving course.
Health Chatter
Health & Safety
And so- You know about it. It's always very revealing and very, very interesting. And so you have some thoughts.
Health Chatter
Health & Safety
Again, I just echo, Stan, what you said. And to build on that, people should understand that there are so many things that you could do. You can't spend the rest of your life just making your home safe. I mean, from a realistic perspective. But number one is understand what the biggest risks are and do something. You know, take some action. If you can't do it all, that's okay, but get a start.
Health Chatter
Health & Safety
And so at the very least, for health and safety concerns within the workplace, there is a process and there is a navigational path. And the responsibility gets to be a little bit different. than when we get into some of the more personal health and safety issues that we'll get into where the onus really falls on individuals and families and things like that.
Health Chatter
Health & Safety
And also there are resources within the community, I believe, for getting some of the safety measures, certainly in home for kids. You know, parents can get free car seats for their kids. Correct.
Health Chatter
Health & Safety
As one example, I think there's a lot of community resources getting the plugs for your outlets, you know, the safety plugs on that, so that there are resources, and I'm assuming that we might have some linkages in our on the website that might help people to get that, or to ask their health provider or within their community what resources are available.
Health Chatter
Health & Safety
Because in this case, really, an ounce of prevention is truly worth a pound of cure when it comes to safety. Absolutely.
Health Chatter
Health & Safety
The other thing I just wanna say, stepping out to the side here just for a second, is that the research that was done for this is amazing. I mean, the facts that are there in the areas for exploration, Um, I'm so glad that this is going to be a resource for people who listen to the podcast, um, because it could really could make your head spin on the one hand.
Health Chatter
Health & Safety
On the other hand, these are all things, whether it be in minds in, you know, in occupational issues or at home or in the office. Um, there are things that we can do, uh, to mitigate, uh, against, uh, unexpected bad things happening to people.
Health Chatter
Health & Safety
Yeah, and I also, I just want to asterisk the falls piece Because certainly within the occupational sphere, I think our research showed over 36% of all deaths recur from falls. And the idea of falls certainly is very, very high for a cause of death for elderly. It's also very common. And also for kids, which we can get into, kids can't fly.
Health Chatter
Health & Safety
initiative with kids falling out of windows from, you know, in tenement, in tenement buildings. So something like falls is one of those things that really go across the whole spectrum, I think, of all the air, you know, just about all the areas that we're going to be covering. So I just wanted to, you know, point that out. That's a good connection.
Health Chatter
Health & Safety
So I think that Stan, if I could also just weigh in a little bit, kind of building on what you said, the workplace has changed a lot over the years. And we tend to focus when we think of work safety about all the disastrous things that can happen, you know, falling off buildings, getting electrocuted, you know, being struck by a fallen hammer, you know, things like that.
Health Chatter
Health & Safety
But I think the ergonomic thing, we're seeing this more and more, you know, not only from the standpoint people are using computers more. So we have a lot of issues with, you know, certainly, you know, carpal tunnel and, things from keyboarding. But the other thing is just the amount of sitting that people do.
Health Chatter
Health & Safety
I don't have the statistics offhand, but I think they equate the amount of sitting that people do in a day to the equivalent of smoking a pack of cigarettes per day as mortality. If you don't get up every hour and walk around, they're just sitting and sitting
Health Chatter
Health & Safety
It really is a health issue and work today is sitting in front of a computer and, you know, you get hand strain and neck strain, stuff like that. But you also wind up sitting way too, you know, way too much. And those have impacts. Those are more of like what I would call the micro health issues, even though for an individual, it's very, can be very significant.
Health Chatter
Hospice Care
And then they volunteer, they work with, you know, with patients, they don't deliver medical care because they're just like, I would say normal people, you know, they're just normal people. And so let's say that I'm, I'm home and my wife is sort of taking, you know, care of me. But, you know, she needs to go out and go shopping as an example. So,
Health Chatter
Hospice Care
When a volunteer comes to stay for an hour or so, that would give, you know, my spouse some respite to go out, do some shopping, maybe go for a coffee with, you know, with a friend outside. So they kind of, you know, do that. They could, you know, we have volunteers that will play music, would read, you know, read to them.
Health Chatter
Hospice Care
Hospice, a number of hospices, these aren't required, but additional services, music therapy, pet therapy. So imagine that they, I don't know if Murphy or Riker would meet the criteria for that, but a lot of people, you know, they really connect with animals. And there's a lot of hospice programs have, you know, what's called pet therapy, you know, for hospice.
Health Chatter
Hospice Care
you know sort of get a twofer and and cover you know not only the the music that they bring and that's very important because you know really it's soothing for the soul you know you have absolutely music that you like you know have a dog who hops up on your bed and just sits there and you could you know pet them and that make that does make you feel feel better better so the
Health Chatter
Hospice Care
array of services that you can get from hospice. There are quite a few of them.
Health Chatter
Hospice Care
Yeah, typically what happens, the vast majority of people who become hospice volunteers, not surprisingly, are people who had a loved one who was in hospice and the care that they received. Hospice requires that if you did have a loved one in hospice, you had to wait a year before you could apply to be a hospice volunteer. Interesting. Okay. But the vast majority have that experience.
Health Chatter
Hospice Care
Yeah. So the way the benefit works, again, it's designed for people who have a life expectancy of six months or less. The reality is we don't, you know, we really don't have a crystal ball on that, okay? And it's not like, oh, your six months is up, so you can't be in hospice anymore. The way it's set up, is for under Medicare, there's a benefit periods that they call.
Health Chatter
Hospice Care
So the first benefit period is three months. So the person gets enrolled in hospice and three months, you know, goes by. And then if they still at that time after three months, if everyone agrees that given the likely course of their disease, their prognosis is six months or less, they, can be recertified. And then there's a second benefit period of three months. Okay.
Health Chatter
Hospice Care
So that gets you the six months. Here's where the math gets just a little bit, changes a little bit. At the end of six months, once again, the patient comes up for recertification. Okay. They've been in hospice for six months. Has their disease been progressing while they've been in hospice? Have they been deteriorating or sort of going downhill basically.
Health Chatter
Hospice Care
But yeah, they've been alive for six months, but reasonably you would expect that their prognosis is still six months or less. And so they could be recertified, then the benefit period shorten up to two months at a time. And those require the medical director making a visit to the patients wherever they are,
Health Chatter
Hospice Care
and agree because the medical director is the one who has the magic of signing the paper that says I recertify, you know, John Doe as being appropriate for hospice for another two months. And then, and so literally every two months, a patient can come up with recertification. And all of us have heard stories, certainly in, you know, in medicine of people who have like cancer, which
Health Chatter
Hospice Care
is a high frequency reason why people are in hospital. Though these days we also see a lot of Alzheimer's disease in the end stages, end stage Parkinson's disease, some of the neurologic diseases like ALS, what people know as Lou Gehrig's disease.
Health Chatter
Hospice Care
Heart failure is another big reason why people go into hospice as their, their heart function declines and different lung diseases, COPD, chronic obstructive pulmonary disease, those kinds of things. In addition to you know, to different, to different cancers.
Health Chatter
Hospice Care
Yeah. Well, if That's a very difficult question, so I'm going to put that out there. Because the vast majority of people do have access to hospice care. In addition, I can tell you that certainly within the Twin Cities, there are many hospices that will take patients and enroll patients in their hospice if they don't have insurance. Okay. And so they provide the care.
Health Chatter
Hospice Care
The focus, again, for hospice, the compassion level is very, very high. And to think that someone who has a very short life expectancy is effectively dying and having symptoms that are creating a lot of pain, oftentimes not only physical, but... you know, psychological, spiritual, and those services.
Health Chatter
Hospice Care
I mean, you know, part of humanity is to be compassionate and to try and accompany people on this last journey that they take. And so very often in those cases, people will, you know, find a way to deliver you know, hospice care. But in general, like I say, the vast majority of people have access to it.
Health Chatter
Hospice Care
That being said, one of the biggest issues we see, right, we talked about the other side, oh, well, six months, and I told you what happens after six months. And the big reality is that for this benefit that's designed for six months, the median length of stay in hospice. So that's 50% of people who are enrolled in hospice die in two weeks or less.
Health Chatter
Hospice Care
Wow. Okay. Yeah. Okay. So what winds up happening is that people are refer to hospice very late in the course of their illness. Why does that happen? We alluded to some of that. It's about some miscommunication about the kind of care or treatments they were receiving, right? If someone thinks, well, I'm going to get cured, I'm not going to go into hospice.
Health Chatter
Hospice Care
Because typically when you go into hospice, the focus is just for symptomatic kind of medications and treatments and things that oftentimes, if it's not comfort focused, if it's designed to slow the disease down, usually that's not something that's covered.
Health Chatter
Hospice Care
Yeah. Well, Clarence, that is such a great question because many people think that if you're getting hospice care, that you're going to have hospice care providers in your home 24 hours a day. And that's not the case at all. In fact, for home hospice, to deliver hospice in your home, you need to have the family support that's going to provide the majority of the care, basically.
Health Chatter
Hospice Care
In terms of making sure they admit it. In other words, you get skilled nursing visits usually once a week or once every two weeks. More frequently, certainly as the disease is progressing more, you get social work visits every month or so. You'll get chaplaincy visits every week or two, just depending. But most of what's done is educating the family for how to care for this person that is dying.
Health Chatter
Hospice Care
And again, home health aides will come in a couple of times a week to help like with bathing and things like that. But it's the family that's providing the majority of the care, again, under the guidance of the hospice team. And the hospice team, they're always available if issues come up for managing those kinds of things. And that's pretty much how the care is delivered. It's not
Health Chatter
Hospice Care
like a nurse from hospice who's sort of in your house eight or 10 hours a day, it's called intermittent nursing care. You get a couple of visits, always available by phone.
Health Chatter
Hospice Care
And the focus is always, especially let's say if there's pain issues, then there'll be more intense visits to make sure that the pain could be well-managed to the extent that the person wants their pain controlled or other symptoms, breathlessness, let's say if they're having you know, heart failure or lung problems. And so hospice will provide oxygen.
Health Chatter
Hospice Care
They provide all the medications they pay, you know, so you don't have to pay for any of the hospice medications. That's all included, um, equipment. If you need a hospital bed, for example, to cause people, you know, can't get up, you know, easily anymore. So a lot of the, what's called durable medical equipment, that's the term for that. Um,
Health Chatter
Hospice Care
So it provides all of those ancillary services plus the medical services. And the hospices that I work with, the primary doctor for that patient, the programs I've worked with, we've always kept those doctors as being still the primary care. That's another reason why people don't want to go into hospice because they're worried that they're going to lose their doctors.
Health Chatter
Hospice Care
And oftentimes, you know, who knows the pain? You know, it's the doctor who's been taking care of the patient for years and years and years. They know them and hopefully the family as well. So that trust piece is there. And that is so very, you know, so very important.
Health Chatter
Hospice Care
Well, they're actually hired by hospice. There are chaplains that are required.
Health Chatter
Hospice Care
To be, and I mean, chaplains are clearly, however you want to turn that. They are part of the integral hospice team. You can't be a Medicare certified hospice if you don't have chaplaincy services as part of your hospice program.
Health Chatter
Hospice Care
Most of the chaplaincy that are in hospice have special training that focuses on die you know dying on people who are dying and dealing with their you know with their issues um and you know even though they may be from a particular denomination it it's they take people where they're at and you know we certainly try if someone um let's say real you know let's say his muslim needs an imam um
Health Chatter
Hospice Care
chaplains, they have their network in the community. Or if it's a Jewish patient who wants a rabbi or a Catholic person wants a priest or a Protestant wants a minister, they reach out to help. The other reality, again, is that people are connected to their church in a generic sense. They're a house of worship. They're connected to that.
Health Chatter
Hospice Care
And hospice, again, reaches out if you've been in a religious, you know, setting with, you know, whether it be minister, you know, priest, rabbi, imam. Yeah. You know, you sort of want to continue with that. And hospice, you know, makes the connections to let that happen because oftentimes those people, again, they know the patients, they know the families.
Health Chatter
Hospice Care
And so we try and keep everybody in the loop. as much as either the patients and their families and those providers would want to be doing that. Does that make sense?
Health Chatter
Hospice Care
No, because for, I don't think so, because the majority of people, there is no cost to them to enroll in hospice.
Health Chatter
Hospice Care
Yeah, yeah. I don't think it's not cost, okay? However, you make a good point. If someone is not aware of that... then they may think that there's a cost and that would keep them away. Generally speaking, hospice programs need to do evaluations from families after they deliver services. And for years again, I've been in the business for 25 years. The number one thing that families report
Health Chatter
Hospice Care
is I wish I had gotten my loved one into hospice sooner. That's the number one thing. Every doctor and nurse knows about hospice. Every long-term care facility, they know about hospice. Every hospital knows you know, knows about hospice and they certainly do talk about it. Okay. You know, when people are, you know, are in there, have you, you know, thought about that? Can I push you a little bit?
Health Chatter
Hospice Care
Yeah, and this- This is something that comes on, I'm speaking now as a physician. Okay. That's our fault. Okay. And there have been a number of studies to give you, this will explain why is it two weeks or less for 50%. Okay. Yeah. Studies have shown that in general, physicians overestimate prognosis by 500%. Wow. Wow. Okay. Wow. So, so if, if your prognosis is two months, okay.
Health Chatter
Hospice Care
That, that realistically you're, you're going to live for 60 days. Okay. Most physicians will think that you're going to probably live about a year. And since hospice is six months or less. Okay. Well, you're not ready for, for a hospice because you know, and part of it, it's not, Like I say, it's on the physicians, but there's a dynamic.
Health Chatter
Hospice Care
It's the doctor and the patient to get together for this because people want to live. So it's a hard conversation to have, but that's one of the things. So in fact, one of the things that has been done for hospice is to get doctors to to think if they have any patients, like if you say, do you have anybody that you know is going to die in six months or less?
Health Chatter
Hospice Care
Well, if you overestimate by so much, you almost have nobody who meets that criteria. But we changed the question. We call it the surprise question. Doctor, do you have any patients where you would not be surprised if you open the paper in the next year and saw their name in the obituary that they had passed. Wow.
Health Chatter
Hospice Care
And once you, that's a very different, because six months or less, well, I'm just a doctor, you know, I'm not God. I don't, you know, I don't know. I don't know the end. But generally speaking, do you know what I mean? You say, would you be surprised if, you know, if Mr. Mrs. McGillicuddy, you know, died in the next year. And then you think, well,
Health Chatter
Hospice Care
boy you know probably not you know she has like pretty bad heart failure um you know and i know i wouldn't be surprised because then and then that's that's the patient that it you can be referred to hospice and hospice will have that conversation with you you don't have to choose to go to enroll in hospice but then you know if you get the referral at least those conversations
Health Chatter
Hospice Care
could happen more with people who this is what they do all the time. And they can lay things out.
Health Chatter
Hospice Care
Right. And, and to be, and to be clear, this is not, you know, This is not meant to be a blame game because the dynamic here, you know, it takes two to tango, right? And when, you know, for most people, as they go through their illness, their goals change over time. Okay. And many people's goals are, I want to live as long as I can. Okay.
Health Chatter
Hospice Care
And as you know, in medicine, we continue to have treatments that may or may not help that goal. And so it's one of these things where everybody is hoping... For, you know, for the best here. And so it's easy. Again, this idea of six months or less, that's a hard thing to, you know, to get your head around. And then you also have patients and their families and you have families that are not sick.
Health Chatter
Hospice Care
Have you ever heard of families that are not on the same page on things? Never. I don't know what you're talking about. So then there's all these, these, all these family dynamics, you know, as well that, that happens. So it's, it's very, it's very complicated.
Health Chatter
Hospice Care
And again, one of the things that sort of helps is the idea of reframing this, even though yes, six months or less, but if we think in terms of a,
Health Chatter
Hospice Care
larger time frame we know that it's going to be less than that most likely okay because we tend to overestimate prognosis so if we you know so that to me is the key that's sort of the the key and that was why i wanted you to answer that question okay i i hope i answered it no no you did you did you did yeah but you answered it in a sense of this that it's a struggle for everybody
Health Chatter
Hospice Care
Oh, that sounds good. So when people think about hospice care, To give it that context is that typically when we have illnesses and different diseases, there are different treatments for it. And as you pointed out from my notes, there's three types of care. Curative care, it's sort of self-explanatory, but that's care that you get to cure the disease.
Health Chatter
Hospice Care
No, I think it's, I think it's great. And the other thing to realize that a lot of people probably don't don't, they don't know this. When I was just doing my regular family practice stuff, not my, you know, my family practice stuff, with seeing patients and things like that. I, you know, used to do what I call womb to tomb, you know? Okay. I had very few patients in the course of a year who died.
Health Chatter
Hospice Care
Do you know what I mean? I had maybe a, maybe a handful. And so if you just run into that every few months or so, unlike treating diabetes or high blood pressure or strep throat, where you see a lot of that, you know the drill, you know what to do.
Health Chatter
Hospice Care
With end-of-life care, and it doesn't, for again, the general primary care physician, an internist, a family physician, as opposed to, let's say, geriatricians or oncologists, cancer specialists, you know, even cardiologists who tend to see the more difficult heart failure things.
Health Chatter
Hospice Care
If you don't see lots of patients, you don't, you don't learn the drill for how to have, you know, how do you have those conversations, which as you can imagine are very sensitive conversations. They're very difficult conversations to have.
Health Chatter
Hospice Care
That's another great question. That's why I love being on Health Chatter. Our conversations are just so good. Actually, everybody is aware of cultural competency. Or at least they should be. The hospice team is very sensitive to the cultures that they're working in, which are a diverse set of cultures.
Health Chatter
Hospice Care
And you could be part, as we all know, you could be part of a culture, but you still need to know individually, what does that mean to that person? Okay. You can't say everybody, you know, who's part of this culture acts in this way and has these wishes. No, it's not the case. So it's, it's recognizing and asking the question directly. So how do you, you know, what is,
Health Chatter
Hospice Care
You know, how do you and your family approach end of life? And then when they tell you then and that that informs the treatment plan moving forward, because then you know. So it's being being humble enough to know that it's OK to not know.
Health Chatter
Hospice Care
And be culturally sensitive and ask. I don't know. So I would ask Clarence, what has been your experience with people in your family who have passed? How did that go? And how do you see this for yourself? And so you ask, you listen. And that's the other thing is that hospice care in general doesn't have, we don't have our agenda yet. Like our agenda is sort of, what are your goals?
Health Chatter
Hospice Care
And so to give an example, let's say you have a strep throat, okay? And you go to see a doctor or nurse practitioner, you know, whatever. And oh, yes, you have a strep throat and you're given an antibiotic and you're cured of your strep throat. That is curative. That is curative care. Remissive care is kind of a big word. And what does that actually mean?
Health Chatter
Hospice Care
And how can we help you to meet your goals? That might not be what I would want to do, okay? But it's not about me, right? It's about you.
Health Chatter
Hospice Care
your attending physician, your doctor. or the nursing staff, they may have had the conversation with you a little bit like, Stan, there really is not anything more that we can do at this point to slow down the way your disease is going. And realistically, you have a few months left to live. Let me tell you about OK, the doctor will say, let me tell you that we have this other
Health Chatter
Hospice Care
you know, kind of care called hospice care that focuses on keeping you comfortable and improving the quality of your life as best as can be done in the remaining time you have. Is that something you'd be interested in? And you would say, of course, you know, yes, I think I've been on this road.
Health Chatter
Hospice Care
I've been back in and out of the hospital, you know, every, every month for the past, you know, five months, whatever. And they say, great, we're going to have, we'll ask a hospice program, you know, person to come in. Oftentimes hospitals have palliative care teams. Okay. In hospital services who can come in, they're not hospice. Right. Palliative care, but they can come in. They're well-trained.
Health Chatter
Hospice Care
Basically, it's care that's designed to slow down the progress of a disease. In other words, people have diseases that can't be cured. but they can be well managed. So one example is diabetes. Okay. Once you have diabetes with rare exceptions, I know there are things like pancreas transplants and stuff like that, more esoteric.
Health Chatter
Hospice Care
They will have those conversations with you. And together you'd say, you know, I think I'd like to go with hospice. Got it.
Health Chatter
Hospice Care
Yes, yes. These are family conversations. And then while you're still in the hospital, either they can get hospice to come in to see you, but hospice really can't enroll you until you're home. Okay, so it might be, Stan, we're going to send you home tomorrow morning, and tomorrow afternoon, there's a hospice program that's going to come out and talk with you.
Health Chatter
Hospice Care
Hopefully they could come in and say hi to you while you're in the hospital and say, Stan, we'll, you know, we'll see you tomorrow after you get out and we'll get everything together. Talk about your, you know, your symptoms, making you, you know, comfortable, et cetera.
Health Chatter
Hospice Care
Oftentimes. Yeah. Yeah. Yeah. Yeah. But it could also be, you know, friends, friends and family, people who have had experience with that. The information can come from anywhere. This is one interesting point. People with very advanced lung cancer, they just looked at people who just received the regular treatment of chemotherapy, all that stuff, and people who had all that same treatment.
Health Chatter
Hospice Care
In addition, they also got palliative care, not hospice, but palliative care, which again is designed to focus on symptom control, et cetera. People with the same prognosis for cancer If they also received palliative care, they lived a month or two longer than people who just received remissive care.
Health Chatter
Hospice Care
Well, the symptom management. It's more because then your mindset is there, your mental stuff. is really the mind can do really big things for us and so so that's just another thing why trying to get people involved early and that's why you see you know people asking for support in the obituary and they talk about how great hospice was and and my family say i i wish
Health Chatter
Hospice Care
we have this for for longer it's still a gift though you know even if it's a short time okay there's a lot of things that can get reconciled that can get done to put everybody at peace and so even two even two weeks could be a gift you know what i mean i always say we want we want more
Health Chatter
Hospice Care
But in general, if you have diabetes, you receive remissive care, which basically helps to control the disease and slow down its progress. So in the diabetes case, it might be different medications that you take or insulin. People are familiar with hearing that insulin could be something like that. And so it's to slow things down.
Health Chatter
Hospice Care
And in fact, a lot of cancer care, okay, is focused on remissive care to really control the progress of the disease, hopefully so that people are able to, you know, have a quality of life and be around for a while as they move ahead. Then the third type of care is called palliative care. And people may be familiar with that as care that focuses on comfort and treating symptoms.
Health Chatter
Hospice Care
It's a kind of care that doesn't cure anybody of a disease. It doesn't slow down the progress, but the focus is on comfort so that people are comfortable as their disease progresses. Within that umbrella, if you think of palliative care as a little umbrella, under palliative care is hospice care. And that's, you know, that's exactly where it fits in.
Health Chatter
Hospice Care
And hospice care is a type of palliative care for those people who have a prognosis or a life expectancy of six months or less. And we'll get into this more. It's not an exact kind of thing where you have to, you know, circle a date on your calendar and, well, gee, if I, you know, if it's the wrong date, I can't get it, you If that's what's chosen. So we'll talk about that in detail.
Health Chatter
Hospice Care
We'll let that spill out and spin out a little bit as we go ahead. But those are the different types of care. And quite honestly, a lot of people are not clear on the types of care that they're getting, especially when it comes to cancer care. Part of that is that we want to be hopeful, we want to be optimistic, and we hear things differently.
Health Chatter
Hospice Care
I know there have been a number of studies where people who had very advanced illnesses, very advanced cancers, colon cancer and lung cancer, that they were receiving treatment that was clearly remissive. They weren't going to be cured of their disease.
Health Chatter
Hospice Care
And they thought that the treatments that they were getting 70 and 80% thought that the care they were getting was going to be curing them of their cancer. And it wasn't. So it's again, you know, you know, at the bottom line is always communication is very important. And so that people understand just to bring in a piece from the serious illness and talking with your doctor,
Health Chatter
Hospice Care
that communication becomes very important. The other piece as well is what are people's goals of the care that they receive? And that's, again, is another conversation. And we did cover a bit of that last time.
Health Chatter
Hospice Care
So that lays out the four different, well, really three different categories of care that people receive with the subset under palliative care being hospice care, which is what we're gonna focus on today.
Health Chatter
Hospice Care
Okay. Okay. And I'm going to do a little background painting as well, because even the term hospice has four different meanings. Wow. Okay. So I think we're going to focus on hospice care, which is a philosophy of care. That's the type of palliative care. We already covered that. But hospice also has the meaning it's a benefit that Medicare provides. It's a Medicare hospice benefit.
Health Chatter
Hospice Care
And in fact, not only is that a medical insurance benefit, it's also present in a lot of public health insurance programs and many, many private insurance programs, whether it be Blue Cross Blue Shield, whatever. Almost all of those types of programs, the majority try and mirror what's considered the gold standard of a hospice benefit from what Medicare does. does.
Health Chatter
Hospice Care
So even people who are not of Medicare age, if they have a terminal illness or a life limiting illness, most of the time they would be eligible to go into a hospice setting or not hospice setting. Well, let's stop and repeat that. Most of the time they'd be eligible to receive hospice care, even if they're not of Medicare age. The other definition, when we talk about hospice,
Health Chatter
Hospice Care
is like a hospice program. So most people who receive hospice care, it's usually through a hospice program that's related to home health. It's all of the care systems, certainly within Minnesota, have hospice programs within their services that they provide. And then the last thing is that hospice, sometimes people think of hospice as a place that you go to.
Health Chatter
Hospice Care
And in fact, there are some freestanding hospice homes that people can go into. These tend to be private pay, but some people might be familiar within our community. We have Weedham Residential Hospice, J.A. Weedham. We have the Pillars Hospice Home. Out in Oakdale, we have NC Little in Edina. And then there's also Our Lady of Peace, which is also in St.
Health Chatter
Hospice Care
Paul that offers a place for people to actually go and spend their last days.
Health Chatter
Hospice Care
Yeah, I mean, every state can have their thing going, but those are the, you know, the standard things. The reality is probably less than 1% of people actually avail themselves of services within a hospice home, as it were. Number one, because they tend to be private pay and they could be expensive.
Health Chatter
Hospice Care
Typically they're reserved for people who are really at the end, like days to weeks, generally speaking. And the vast majority of care and hospice is given in the person's home or the place where they're living that they call home. So it'll be either
Health Chatter
Hospice Care
you know, in their home, their, you know, a house, their apartment, you know, what have you, or if they're living in assisted living, or if they're living in a, they needing long-term care in a nursing facility, nursing home, they can, they receive care there. Hospice goes, hospice programs go wherever the people are. And that, and that's where they deliver the care
Health Chatter
Hospice Care
Um, and most people would prefer to be in a comfortable place. They're, you know, their home is surrounded by their loved ones. And that's, so that's sort of where the care gets delivered in the vast majority of cases. But when you talk about hospice, sometimes people think, oh, that's a place, right? You know, well, but hospice care, you receive wherever you are.
Health Chatter
Hospice Care
And in fact, if you start off in your home, And you're receiving hospice and then you need a higher level of care. So you go into an extended care facility or long-term care facility. Hospice follows you wherever you go.
Health Chatter
Hospice Care
So there actually are a group of people. Hospice is very much... When I was very involved with that, it's really a team type of care. I always say hospice is a team sport, but that's the lighter kind of thinking that only a hospice medical director might say.
Health Chatter
Hospice Care
But it's very important because within that Medicare hospice benefit, when people receive hospice, that benefit requires that a hospice provide
Health Chatter
Hospice Care
nursing care skilled nurse a skilled nurse social work a chaplain to deal with spiritual issues usually they have home health aides to provide some help at home with bathing things like that a medical director that sort of oversees things then in addition they also have to have volunteers 5% of the hours of care that hospice provides under Medicare have to be, you know, involving volunteers.
Health Chatter
Hospice Care
Right, exactly. So let's say, let's say I was in hospice, okay. As a, as a patient and and I have, and I elect to have, I mean, a person could refuse that, but hospice volunteers are trained. Actually, I usually, in my hospice medical director days, I usually am part of their orientation.
Health Chatter
Long-Term Care, Longevity, Loneliness, & Aging
Yeah, Barry. Yeah, one of the things that I wanted to just pick up on is what Clarence had mentioned, and actually all of us have talked about the complexity of this issue. And oftentimes it seems to me that there is a significant knowledge gap, and especially for families, in that they really, they don't know what they don't know. And so they don't know what questions to ask.
Health Chatter
Long-Term Care, Longevity, Loneliness, & Aging
And as a result of that, my question is really more what resources might be available for either a checklist of things to cover, a script that they can have the conversation, just a sidebar. My wife and I were involved in having our well, Sandy's mom, but my mother-in-law who had dementia to move into a long-term care facility. And of course she said she never wanted to do that.
Health Chatter
Long-Term Care, Longevity, Loneliness, & Aging
And soon after we did that, my wife and I had had the conversation that sort of like what Clarence was talking about as well, is that when it came to be that time, even if I might not like it, I know that in the bigger picture, that might be the best thing to do. And oftentimes, once you broach the subject and have the conversation, it's easier to talk about.
Health Chatter
Long-Term Care, Longevity, Loneliness, & Aging
But many people don't know where to start. They don't know what they don't know, so they don't know what to ask. So I'm wondering what light you might be able to shed on that aspect of it from our resources.
Health Chatter
Long-Term Care, Longevity, Loneliness, & Aging
Well, I think the balance here is between quality of life and quantity of life with a lot of these things and kind of deciding. And that's where it gets very individual that each person has their priorities and they'll move ahead. So calorie restriction for me, 1100 calories. I don't know if that. the juice is worth a squeeze.
Health Chatter
Long-Term Care, Longevity, Loneliness, & Aging
You know, live another year, you know, longer, but I'll be, you know, going through the cupboards all the time that, you know, that that's not necessarily a positive.
Health Chatter
Long-Term Care, Longevity, Loneliness, & Aging
But I think also some of the other things, there are some, there are some basic things that people can do that I've been reading about, especially related to dementia is getting enough sleep and getting good quality sleep that there's been, quite a bit of research there.
Health Chatter
Long-Term Care, Longevity, Loneliness, & Aging
And also, I just come down that it's this idea, I think if you have some friends, and you stay connected with them, you know, humans are, you know, sort of hardwired to be interacting with other people. And And it serves purposes, not only social, but checking in every day, making sure people are doing okay from day to day. And it's that everyday interaction that I think helps.
Health Chatter
Long-Term Care, Longevity, Loneliness, & Aging
And one other question, just a real brief one, is that when you do have a loved one, let's say with dementia that goes into long-term care, it would seem to me that frequency of visits, though short, is probably qualitatively better than feeling like you have to be there for eight hours.