You Only Die Once

By YODO

We are Dr. Bohn and Dr. Tartaglia, two osteopathic physicians specializing in Hospice and Palliative medicine. We started creating content to help families and patients approach the dying process with... more

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FAQs about You Only Die Once:

How many episodes does You Only Die Once have?

The podcast currently has 105 episodes available.

You Only Die Once episodes:

April 09, 2023 Hospital and Specialist in One Year
Prognostication is a complicated process. Physicians rely on many pieces of data to provide prognostic information and time frames for patients. Knowing the disease state, stage and how this will change over time as the disease advances is important for pts and families to know. Disease occurrence and progression many times is no ones fault and we need to resist to look for a place to place blame.
It is not about giving up but about patients making choices and having the ability and time to share thoughts with their Health Care Surrogate. Understanding the outcomes of offered procedures is crucial information for patients to have so they can consider what life and function might look like over time. Patients should have time to consider this information and accurate prognostication can provide this time.
One basic method that is not necessarily disease specific is the rules of threes. More than 3 hospital admissions in a year for the same organ system. More than 3 episodes of serious infections requiring a hospital admission. More than 3 specialists that a patient needs to see yearly because of serious medical issues. There are many disease specific prognostic data points but these are some broad areas that provide evidence of disease progression.
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19min
April 09, 2023 Occupational Therapy - Basics With Joanne Koechner
Our guest joining YODO today is Joanne Koechner, an Occupational Therapist. Joanne shares information OT and how it differs from other therapy specialties by improving function a patients ADL and IADL. Individual goals may vary but patients and the Health Care system are all motivated for Aging in Place with improved in home function.
OT works with patients across the full spectrum of settings (home to Nursing Home). OT evaluates pts and determines what needs to be performed, guided activities and exercises. They work with and educate: patients, family, and facility staff to optimize patients ability for independence and safe completion of daily tasks and to help them stay in their own home.
Changes in guidance and reimbursement by CMS , thus subsequently other insurances have resulted in limits on patient access to OT. Previously pts had access to extended periods of care in rehabilitation (what we refer to as Geriatric Boot Camp) after a medical event. Now, there are established goals for abilities and timed acceptable time to accomplish the improvements. Once patients have achieved the determined goals or if the time has run out for patients to demonstrate the required improvement, the patients are discharged to a different level of care. Patients and families are hopeful that they will be able to be safely discharged to home.
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33min
April 09, 2023 Not A Surgical Candidate
Being informed you are not a candidate to have a surgical procedure is very upsetting and for good reason. It eliminates a person from having an intervention thus concern for 'what next' and it implies the patient has an issue serious enough to prevent safe surgery. Preparing to have an operation is an involved process and requires the patient to be evaluated by multiple physicians. The physicians must consider the patients risks of the surgery as well as the benefits from the surgery. The tests and evaluations are to determine if the likely outcome is in the patients favor.
The evaluation may involve more than the Surgeon and the Anesthesiologist. There may be more tests needed than blood work, x-rays, and an ECG test. There can be side effects from the surgery and being put to sleep. People may be paralyzed for some surgical procedures: infection, pain, immobility, bleeding/clotting are potential risks.
Not all surgeries are major or open procedures, some are less invasive. There are now more and more minimally invasive surgeries available and these have lower risks. We have some suggestions for patients and families to aid patients that are being consider for surgery. Keep track of the details, names of the physicians, the tests and the results as well as dates. Ask questions and consider the implications of the surgery as well as if you are not a candidate.
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23min
April 09, 2023 Skin and Serious Illness
Skin is the largest organ of the body. In this episode, we discuss how this organ system can reveal a persons illness progression and may provide warning that a person has serious illness. The skin truly does provide significant protection for us. Skin takes a lot of abuse over our life, so age-related changes are anticipated. Skin can exhibit many findings to give physicians clues as to different disease processes, premature aging, medication effects, and nutrition abnormalities.
Supporting our skin with good care, prevention of injury, and protecting from dryness and the elements helps keep our best infection barrier intact. Prevention of infection by not allowing bacteria into the body for the immune system to fight off helps to keep us healthy. Providing care and limiting damage to the skin improves our overall health.
As disease states advance naturally over time, even with the best care, it may not be possible to prevent injury. Skin tears, shearing, bed sores, pressure wounds are all a high risk for patients with advanced illness. Families caring for a frail loved one worry about skin injury. Even with everyone working very hard to prevent injury to the skin, it can still occur. Families should not beat themselves up and certainly should not give up on their efforts to care for their loved one. Even before the end of life, wounds can occur, and some wounds actually indicate that the dying process may be starting. Continuing to care for people, providing support, showing compassion and protecting their dignity is a demonstration of the respect and love that the family shares for the person.
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23min
April 09, 2023 Capacity To Make Complex Medical Decisions
Capacity in healthcare refers to the patient's ability to make complex medical decisions. Capacity is not the same as competency. Surprisingly, it is not dependent on someone's orientation to person, place, or time.
Capacity is determined by the evaluation of a patient's:
1) Understanding
2) Appreciation
3) Reasoning
4) Communication regarding their medical situation.
Occasionally the patient may have intermittent loss of Capacity. This could be due to any of the following: memory issues, cognitive impairment, an acute illness or possibly delirium, a medication effect, or lack of sleep.
Sometimes capacity returns, but for other patients, they have lost capacity for complex medical decisions. Physicians will assess for the patients to have the 4 components that indicate capacity.
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17min
April 09, 2023 Difficult Questions for your Physician
Dr Tartaglia and Dr Bohn advise an ongoing conversation with your physician regarding your disease state and stage. Physicians might be as unwilling to talk about these topics as you are to hear this information. Physicians have a responsibility to provide honest information to the patient. Caring for the patient is more than just ordering lab work, imaging tests, and writing scripts. Physicians must be cognizant to check their fears and hesitations so they do not lead patients unintentionllay to have false hope. Thus, most physicians will ask permission to provide information and if they are given the 'ok' by the patient, then they will proceed with the conversation.
Let your physician know if you need a better explanation. The physician should have excellent command of the patients language or use a translator to assist to provide information in a manner that the patient can easily understand. Dialogue between the physician and the patient is important. While it may be true that the physician may have a lot of information and may do a lot of talking, the physician should also listen and hear the patients questions and concerns.
Don't hold back; tell the physician if you need time to process or if you are overwhelmed. Don't hesitate to ask the physician several tough questions. Ask about side effects and outcomes. Ask what they would do. Ask about risks and benefits. Ask the 'what if' questions. Take a written list of questions with you. Take a family member or have one listen in on the phone.
You need the information so you can consider what is important for you and what fits your preferred quality of life. Patients must have information so they can provide guidance to their family and their physician about the care they want. We want to see patients and physicians regain control of healthcare. It has become big buisness and the patient and physician relationship is getting lost in all the money the big companies are making.
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23min
April 09, 2023 The Golden Hour : Things To Look For When Checking On Your Aging Loved One
This episode is part of the Serious Illness series. We review the ADL needed for Golden Hour, Travel Difficulties, Weight Loss, Rest Periods and Sleeping in a Recliner. Issues with these may indicate there is a serious illness that is causing these problems.
The Golden Hour is typically the first hour of a patient's waking day, during which they should be able to perform their ADL's without too much trouble or requiring assistance.
The Activities of Daily Living (ADL's) are the basic functions a person might complete in the first hour each morning (The Golden Hour). ADL’s include Hygiene and Grooming, Eating, Dressing, Transfers, Toileting and Ambulating. Different and more complicated are (Instrumental Activities of Daily Living (IADL's), these consist of: Shopping, Housework/ Housekeeping, Finances/Banking, Food Preparation, Telephone/ other Communication, and Transportation. Needing assistance w/ IADL are not as likely to prevent someone from living alone as ADL issues. Being unable to safely complete ADL, may indicate an underlying serious illness that is keeping them from being independent.
When a family member has difficulty traveling, whether it is just to the store or to meet friends for lunch or difficulty managing distant travel, there may be a serious illness causing it. Some patients have issues with coordinating travel because of the higher level executive function required to plan travel. For other people, it may be that there is an issue with the physical demands involved with travel. If there is a medical equipment issue that prevents patients from travel (wheel chair, oxygen, dialysis etc.) these types of things do indicate there may be a serious illness.
Noticing weight loss may be concerning. Possibly a health issue or also just as concerning, the person may not be able to shop or possibly not able to prepare the food. If the person cannot get to the store or manage to have groceries delivered, they may be losing weight as they are struggling to even get groceries. Checking on the pantry stores and the foods in the refrigerator intermittently is a great gift of kindness for your loved one. Taking them on a little outing to shop once a month will give tremendous insight to how they function outside the home. Short outings are much better than long ones.
If your loved one needs rest periods during the day, there may be a serious illness issue. If a person needs to rest more than they used to while performing routine tasks that they did not have issues with before, try to gently investigate what may be behind this. Look for increased need for sleep as well as needing to stop while performing an activity. Change in activity over time may indicate decline.
Sleeping in a Recliner may indicate serious illness. There are many reasons to sleep in a recliner and some are more worrisome than others. There are risks involved w/ Recliner Sleep: joint immobility, falls, breathing and GI symptoms, or pain. Look into why the person is no longer able to sleep in a bed.
Be mindful of feelings and be kind, don’t rush in and take over. Find ways keep them in their home and functional for as long as you can. Independence is important to people and many do not want to be a burden. Over time, you may need to provide more assistance and if you involve yourself early you will see how over time they need more assistance to remain safe.
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29min
April 09, 2023 Hospice Service Failures
Hospice service failures sadly do occur. Even just once is too often. Patients receiving hospice care and the loved ones that care for and support them are in a frightening place. Facing the end of life demands the highest and most reliable help. Fortunately, (most) insurances and CMS (Medicare) see the value of this care and cover the cost of hospice service. Patients deserve to have the promises of excellent care fulfilled by the competent and highly trained specialty staff that they employ.
Admission nurses set the tone for the Hospice vendor. If communication is not accurate from the hospice as well as the family at the time of admission, issues are bound to occur. Expectations of the patient and family must be heard and the hospice must explain accurately what can be provided. The staff that provides the care must be competent, highly trained and skilled in their assessments as well as capable of providing compassionate care. Staff that misses their appointments with the patients and do not call to reschedule are another source of service failure. Staffing shortages are all too common. Sadly, staff turnover has been higher than is optimal for most hospice agencies. Training new staff is expensive and time consuming. Hospice work is not for everyone either. It takes special people to provide this care.
The responsibility of hospice is across all disciplines, starts with the patient accepting the service and does not end at the passing of the patient but continues for one more year. Insurance and CMS require the team of hospice disciplines to meet every two weeks to discuss each patient on service. They are to review recent changes and discuss anticipated needs of the patient. The Bereavement staff is to follow the family for one year after the passing of the patient to assist and provide a resource for grief-related issues.
Leadership from Non-Medical Administration can be more crucial for the performance of the various disciplines that provide the service than the physician leadership. If the employee work environment for the field staff (aids, nurses, social workers, chaplains, APRN and physicians) is unfavorable, the effect on the staff will show with no shows, staff turnover and burnout. All this results in service failures by the hospice vendor.
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30min
April 09, 2023 From Hospital Discharge to Hospice Admission
Admission to a Hospice while at a hospital can be seamless and provide the high level of care a patient requires as well as the needed support for the family. Hospitalization for critical illness is a very stressful and difficult time. Having smooth transition to Hospice care can reassure patients and families and remove some of the anxiety that occurs.
For patients on Hospice at home already that have had some acute event occur that prompted return to the hospital is not common but does occur. The Hospice vendor will send a nurse to meet with the patient and family in the Emergency department or the next day at the hospital for the patient to 'revoke' hospice service if that is what the patient elects to do, and receive more aggressive care. Then at time of discharge, if the patient and family want to resume with hospice care, they can sign up for that service once again.
New referrals to hospice may occur while at a hospital as a disease state has reached an advanced stage and now patients want to accept that service. The hospice vendor will come to the hospital to meet with the patient and family and discuss their services. The patient has the option to talk with more than one hospice agency and select the one that can best meet their needs. The hospice will certify the patient and papers can be signed at the hospital.
Unless you are very familiar with the various hospice agencies in your area, consider more than one. The hospital as well as the hospice agency will want a safe discharge, so any equipment, supplies, or oxygen that might be needed will be delivered prior to the patient being discharged.
If a patient is too critically ill to survive transportation to a different location, it is advised the patient accept hospice there at the hospital for the few remaining hours of life. The hospice team will visit the patient there and support the family while the patient is cared for at the hospital with hospice level care.
Representing the patient's choices is such an important responsibility. Sometimes the patient can no longer communicate what they want. The hospital physicians have responsibility to inform patients and families as changes occur in their health so if patients want to change their decisions they can do so with the most current information. Circumstances change, trajectory of an illness or disease state may change, thus the patients hopes may change.
Patients may have instructed their families that they did not want to wind up on machines but circumstances were such that these machines are now in use. The family may wish to designate a time when the machines can be removed compassionately with support provided and symptoms managed to alleviate suffering. If the course of the illness has become clear and cure is not available, care and compassion are always to be provided, and comfort focused hospice care can be provided during those times.
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21min
April 09, 2023 Healthcare Surrogate Part Two
We have another episode similar to this regarding the Health Care Surrogate, and discuss some different points in that video. We truly want to encourage you to designate your HCS early and communicate with them regarding your choices of these difficult decisions.
Your primary and alternate HCS should: know they have been selected, be someone you trust to follow your instruction, be able to make difficult decisions, respect your views on Quality of Life, be your voice rather than what they want for you, and be someone you communicate with over time as your preferences may change.
For some people, the preference is to accept all available treatments and interventions. The focus is more for preservation of life with less concern for outomes. The acceptance of all procedures and interventions matters more to extend life than predicted quality of life.
For others, the choices they accept may focus on the anticipated functional level that the physicians expect. The quality of life may impact the decisions as 'being alive' may not equate to 'living'. This is a very personal choice.
Neither is a wrong choice. The HCS needs to respect the choice of the patient, just as the patient must provide information to guide the HCS. Your HCS should be someone that knows how you lived your life and what your belief system is to guide them. The HCS needs to be accessible to you and to your physicians.
Being chosen as a Health Care Surrogate is a burden and an honor. The burden is to be the voice of the patient when they can not state for themselves what they would chose because they no longer have the capacity to interpret their surroundings and cannot make their needs known. The HCS needs to separate what they want for the patient from what the patient would say if they could understand their health situation and what the next moments, hours, and days ahead may look like for them. The HCS position is one of honor as they have been selected because they respect the patients' choices and have the strength to be that person's voice.
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20min

FAQs about You Only Die Once:

How many episodes does You Only Die Once have?

The podcast currently has 105 episodes available.

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